Antepartum predictors of fetal distress in postterm pregnancy

The purpose of this study was to determine the efficacy of combining nonstress testing with ultrasound assessment of amniotic fluid volume for the antenatal evaluation of the postterm fetus. Postterm patients (884) were managed with amniotic fluid assessments and nonstress tests (including evaluation for variable and late decelerations) twice a week. There were no perinatal deaths or major neonatal morbidity. However, the antenatal testing sensitivity, specificity, negative, or positive predictive values were not improved by combining the two tests. Individually, amniotic fluid assessment was just as accurate a predictor of fetal well-being and was a significantly more sensitive test than the nonstress test. In addition, antenatal predictors of fetal distress and intrapartum signs of fetal distress were almost exclusively those reflective of umbilical cord compromise. These findings stress the importance of antenatal screening for signs of umbilical cord compromise as an early indication of potential fetal compromise. Although the results also suggest that amniotic fluid assessment is superior to the nonstress test, they do not conclusively support the use of amniotic fluid assessment as the sole parameter for postterm antenatal surveillance.     

The impact of maternal age,body mass index and maternal weight gain on the glucose challenge test in pregnancy

Objective. The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results.

Methods. A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24–28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Student's t-test, receiver–operator characteristic curve and multivariate logistic regression.

Results. Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p < 0.05). A direct correlation was found between these parameters and GCT results (R² = 0.08, R² = 0.102 and R² = 0.116, respectively; p < 0.05). Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are the optimal predictors of abnormal GCT results.

Conclusions. Mid-trimester maternal BMI of ≥30 kg/m² and maternal age ≥32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.     

Amniotic fluid volume as a predictor of fetal distress in postterm pregnancy

OBJECTIVE: To determine the efficacy of amniotic fluid volume (AFV) assessment in predicting intrapartum fetal distress in post-term pregnancy compared with the conventional nonstress test (NST). METHOD: A prospective study of 252 postterm patients who underwent antepartum assessment of AFV and NST with intrapartum continuous FHR monitoring was conducted and subjected to analysis. RESULT: AFV was significantly more accurate in predicting intrapartum fetal distress than the NST with sensitivity, specificity, positive and negative predictive values of 72.73%, 90.87%, 26.67% and 98.65%, respectively. CONCLUSION: AFV assessment was an effective method in predicting fetal distress in postterm pregnancy.     

The impact of maternal age, body mass index and maternal weight gain on the glucose challenge test in pregnancy.

OBJECTIVE: The aim of this study was to determine whether maternal age, prepregnancy and mid-trimester body mass index (BMI), or excessive mid-pregnancy weight gain predict abnormal glucose challenge test (GCT) results. METHODS: A retrospective chart review of 75 consecutive singleton pregnancies was performed. Patients were screened at 24-28 weeks of gestation with a 50-g oral GCT. Prepregnancy BMI and pregnancy weight gain up to the time of GCT testing, as well as other demographic data, were recorded. Statistical analysis included regression analysis and Student's t-test, receiver-operator characteristic curve and multivariate logistic regression. RESULTS: Maternal age and prepregnancy and mid-trimester BMI were significantly higher in women with an abnormal GCT (p<0.05). A direct correlation was found between these parameters and GCT results (R(2)=0.08, R(2)=0.102 and R(2)=0.116, respectively; p<0.05). Mid-trimester maternal BMI of >or=30 kg/m(2) and maternal age >or=32 years are the optimal predictors of abnormal GCT results. CONCLUSIONS: Mid-trimester maternal BMI of >or=30 kg/m(2) and maternal age >or=32 years are useful predictors of abnormal GCT results. We suggest that these factors should also be considered when selective screening for gestational diabetes mellitus is practiced.     

子痫前期合并胎儿生长受限的母儿妊娠结局分析

目的:探讨子痫前期(PE)合并胎儿宫内生长受限(FGR)的母儿结局。方法:选取591例PE孕妇,按新生儿出生体重分为小于胎龄儿组(SGA组,95例)和适于胎龄儿组(AGA组,496)。随访母体妊娠结局和新生儿结局。结果:与AGA组孕妇相比,SGA组孕妇的胎盘早剥发生率增加,因胎儿窘迫行剖宫产的比率增加(P0.05),新生儿病房收治率增加,住院时间延长,差异均有统计学意义(P0.05);其他孕妇严重并发症包括重度高血压、肺水肿、肾功能异常和HELLP综合征发生率,以及孕期和产后降压药和硫酸镁使用比率均无显著变化,差异无统计学意义。结论:PE合并FGR未导致除胎盘早剥之外母体严重不良妊娠结局的增加,但新生儿不良预后增加。     

The impact of maternal depression in pregnancy on early child development

Objective  Postpartum depression in mothers is associated with developmental problems in their children. Many women who are depressed following childbirth are also depressed during pregnancy. The aim of this study was to examine the associations between maternal depressive symptoms during pregnancy and child development at 18 months of age.
Design  A prospective cohort study, Avon Longitudinal Study of Parents and Children.
Setting  The former county of Avon, southwest England.
Population  All pregnant women in the defined area with delivery dates between April 1991 and December 1992, 9244 women and their children.
Methods  Data were collected antenatally, at 18 and 32 weeks of gestation and at 8 weeks and 8 months postnatally, through postal questionnaires, including a self-report measure of depression (Edinburgh Postnatal Depression Scale [EPDS]). By the time their child was 18 months old, women completed five further questionnaires about their children's health and development.
Main outcome measure  Child development at 18 months using a modified Denver Developmental Screening Test (modified DDST).
Results  Applying the standard 12/13 cutoff, 1565 (14%) women were depressed antenatally but not at either time-points postnatally. Employing the modified DDST, 893 (9%) children were developmentally delayed at 18 months of age. Persistent depression (EPDS ≥ 10 at both time-points) is associated with developmental delay (adjusted OR 1.34, 95% CI 1.11–1.62). Applying the 12/13 and 14/15 cutoffs gave similar results. After further adjustment for postnatal depression, the effect sizes were slightly attenuated.
Conclusions  These findings highlight the importance of depression in pregnancy. Some effects on child development attributed to postpartum depression are caused in part by depressive symptoms during pregnancy.     

Survey of the management of postterm pregnancy

A survey of the management of postterm pregnancy was conducted among the 80 institutions with approved maternal-fetal medicine programs. Seventy-two (90%) completed questionnaires were received. After 42 weeks' gestation, when the cervix is unfavorable for induction, the nonstress test is the most commonly used test to assess fetal well-being (84.7%). In 50% of the institutions, pregnancy is terminated at some point beyond the 42nd week, in spite of an unripe cervix and lack of evidence of fetal compromise. In the other half, intervention does not take place under such conditions. The need for more consistent guidelines for the management of postterm pregnancy is emphasized.     

The importance of clinically detectable ketonuria in patients with post-term pregnancy

The aim of this study was to ascertain whether the notable ketonuria in patients with postterm pregnancy can be associated with abnormal fetal assessment tests. The 207 pregnant patients with postterm pregnancy after 41 gestation week have been included in the medical survey after testing their urine: including ketons, glucose, pH, albumen and individual weight. 24 patients in this study have been diagnosed with maternal ketonuria (11.59%). The ketonuria in patients with postterm pregnancy directly correlates to abnormal results of fetal heart rate tests, Nonstress test, amniotic fluid index, placenta grading III. The importance of clinically notable ketonuria in patients with postterm pregnancy is discussed.     

The impact of maternal age on pregnancy and its outcome.

There were 28,600 deliveries of 500 g or more to women at the Rotunda Hospital between January 1st 1985 and December 1st 1989. Of these, 595 were to women aged 40 years and over. Thirty-five variables of clinical significance were analyzed, comparing those of 40 years of age and more with those under 40. The older group had significant increases in gestational diabetes, ante-partum hemorrhage, fetal distress, prematurity, low birth weight and perinatal mortality. Chromosome congenital abnormalities were significantly higher, particularly Down syndrome. There were significantly increased rates of induction and cesarean section in the older women. Some evidence of interaction of age with other factors was found, however these were difficult to separate out in the clinical setting. We therefore recommend it wiser to manage all elderly gravidas in a high risk manner dealing with cases individually within this framework. Intervention should, however, need to be justified in the older as in the younger woman.     

An overview of maternal and fetal short and long-term impact of physical activity during pregnancy

Purpose

To explore information available in the literature about the possible benefits resulting from physical activity (PA) in non-risky pregnant women, repercussion on maternal organism, fetal development, and on long-term offspring health.

Methods

Critical narrative review using online databases.

Results

Through critical discussion of studies focused on PA practiced during pregnancy, it was observed that some of the outcomes investigated on both mother and offspring showed conflicting findings. Considering the impact of maternal PA in certain offspring characteristics, due to the fact that their findings come from studies with small samples, they do not allow the stablishment of scientific evidence. However, a feature that shows broad consensus among studies is the view of PA during pregnancy as a safe intervention for mother and fetus. In situations where studies employing PA of moderate-intensity have not enough power to ensure a positive influence on certain clinical outcomes, what is observed is the lack of their influence, not negative impacts. Regarding epigenetic modulations measured late in the offspring, it has been attributed to PA a positive modulatory role on metabolic, hemodynamic and even on behavioral characteristics. However, possible mechanisms involved in these epigenetic changes have not been sufficiently explored.

Conclusion

Maternal PA appears to be safe for both mother and fetus, and additional studies are needed to confirm the real influence of this practice in the offspring, as well as the perpetuation and transfer of these features between generations.

     

Induction of labor or serial antenatal fetal monitoring in postterm pregnancy: a randomized controlled trial

OBJECTIVE: To compare induction of labor at gestational age 41 weeks with expectant management in regard to neonatal morbidity. Secondary aims were to assess the effect of these managements on mode of delivery and maternal complications. METHODS: Between September 2002 and July 2004, postterm women with singleton cephalic presentation and no prelabor rupture of membranes were randomly assigned to induction of labor at 289 days or antenatal fetal surveillance every third day until spontaneous labor. Main outcome measures were neonatal morbidity, operative delivery rates, and maternal complications. RESULTS: Five hundred eight women were randomly assigned, 254 in each group. No differences of clinical importance were observed in women in whom labor was induced compared with women who were expectantly managed with regard to the following outcomes: neonates whose 5-minute Apgar score was less than 7 (three neonates in the induction group compared with four in the monitoring group, P=.72); neonates whose umbilical cord pH was less than 7 (three compared with two, P=.69); prevalence of cesarean delivery (28 compared with 33, P=.50); or prevalence of operative vaginal delivery (32 compared with 27, P=.49). In the induction group more women had precipitate labors (33 compared with 12, P<.01; number needed to treat was 13), and the duration of second stage of labor was more often less than 15 minutes (94 compared with 56, P<.01; number needed to treat was 7). CONCLUSION: No differences were found between the induced and monitored groups regarding neonatal morbidity or mode of delivery, and the outcomes were generally good. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00385229. LEVEL OF EVIDENCE: I.