The obstetric and neonatal outcome of pregnancy in women with a previous history of infertility: a prospective study.

OBJECTIVE--To compare the frequency of common antenatal problems, the amount of antenatal surveillance and the obstetric and neonatal outcome in women with and without a history of infertility. DESIGN--A prospective cohort study with age and parity matched controls. SETTING--A single consultant unit at the Jessop Hospital for Women, Sheffield, over a 22-month period. SUBJECTS--114 women with a history of infertility who reached 16 weeks gestation with a singleton live fetus and 114 control women matched for age and parity. MAIN OUTCOME MEASURES--Frequency of antepartum complications, amount of antepartum surveillance, obstetric and neonatal outcome. RESULTS--Common antenatal complications were not increased. In the infertility compared with the control group, the relative risk of requiring an emergency caesarean section was 2.43 (95% CI 1.05-5.63). There was no difference in birthweight. CONCLUSION--Many of the previously observed differences in outcome of pregnancy in women after infertility compared with those without are associated with age and parity but these characteristics do not explain the increased frequency of emergency caesarean section.     

Adverse obstetric outcome in women with a history of infertility: a retrospective study.

Women with a history of infertility are associated with a higher incidence of adverse pregnancy outcome. This retrospective study reviewed 105 women with a known history of infertility; of these 105 women, 77 (73%) conceived spontaneously and 28 (27%) had assisted conception. Our finding confirms higher perinatal complications; relative ratios (RR) for pre-eclampsia was 4.6 (95% CI=2.1-9.9), intrauterine growth restriction 4.8 (95% CI=1.9-12.0), gestational diabetes 1.8 (95% CI=0.5-5.8), pre-term premature rupture of membrane 2.3 (95% CI=0.6-8.8) and pre-term labour 2.6 (95% CI=1.1-5.9). We postulate that women with a history of infertility are at high risk of such obstetric complications and may benefit from intensified antenatal care.     

The effect of low-dose ovarian stimulation with HMG plus progesterone on pregnancy outcome in women with history of recurrent pregnancy loss and secondary infertility: a retrospective cohort study

We assessed the outcome of pregnancy in women with a history of recurrent pregnancy loss (RPL) following treatment with low-dose human menopausal gonadotropin (HMG)+progesterone or progesterone alone. This single-center retrospective cohort study included data from women diagnosed with RPL and treated between February 2005 and December 2012 with one cycle of HMG?+?progesterone or progesterone alone. Primary endpoint was the rate of ongoing pregnancies and losses by treatment, age (<38 vs.?≥38?years) and in the subgroup with unexplained RPL. Of 169 RPL patients, 35.5% (n?=?60) received HMG?+?progesterone and 64.5% (n?=?109) progesterone alone. Compared to progesterone alone, HMG?+?progesterone led to a lower, although not significant, frequency of losses (3.3% vs. 11.9%, p?=?.09) and a twofold higher rate of ongoing pregnancies (41.7% vs. 19.3%, p?=?.002). Similar results were obtained in the subgroup of patients with unexplained RPL (ongoing pregnancies: 48.1% upon HMG?+?progesterone vs. 21.3% upon progesterone, p?=?.03; losses: 0% vs. 8.5%, respectively, p?=?.29) and in those?<38?years (ongoing pregnancies: 47.4% vs. 18.8%, respectively, p?=?.003; losses: 5.3% vs. 10.9% respectively, p?=?.47). These findings suggest that HMG in women with RPL may reduce the rate of miscarriages and increase that of live births regardless of RPL cause and in women aged?<38?years.     

The obstetric prognosis and neonatal outcome of pregnant women with psychiatric disorders

Obstetric prognosis and neonatal outcome of pregnant women with psychiatric disorders were retrospectively investigated. 1. Out of 1.472 deliveries at Saga Medical School from April 1983 to July 1988, there were fourteen cases (0.95%) involving psychiatric disorders-six of epilepsy, one of anxiety neurosis and seven of schizophrenias. 2. Total blood loss was relatively great in four epileptic patients. However, the general prognosis for each was good and the neonatal outcome was uneventful. 3. As for schizophrenic patients, six out of seven cases grew worse during the pregnancy and four in the postpartum period. Three cases underwent cesarean section due to their mental illness. 4. We made inquiries about the postpartum life of schizophrenic mothers and children, and received five answers (70.1%). It was found that schizophrenic mothers could not bring up the baby by themselves; they needed the help of their husbands and their own mothers. It is concluded that consistent management by both psychiatrist and obstetrician from the antepartum period to postpartum life are required for psychotic mothers and their children to obtain a favorable prognosis, and a follow-up system is desirable for the physical as well as the mental growth of the infants.     

IVF twins have similar obstetric and neonatal outcome as spontaneously conceived twins: a prospective follow-up study

Studies comparing the outcome of spontaneous versus IVF twin pregnancies report heterogeneous results. This may depend on differences in the studied populations and/or in the management approach to twin pregnancy. The aim of the present study was to compare both maternal and perinatal outcomes in dichorionic diamniotic twin pregnancies who where spontaneously conceived or originated by successful homologous IVF. In order to get homogeneous observations, monochorionic twin pregnancies and triplet pregnancies were excluded. Moreover, to avoid any possible bias deriving from differences in the obstetric management, all pregnancies were managed by the same team applying fixed obstetric protocols. The study included 223 twin pregnancies, 84 conceived by IVF and 139 spontaneously conceived. Overall, maternal and perinatal outcomes were similar in the two groups: no significant differences were observed as far as gestational age at delivery, birthweight, perinatal morbidity and mortality, and rate of malformations were concerned. The rate of Caesarean section was slightly, but not significantly, higher in IVF pregnancies. In conclusion, the outcome of IVF twin pregnancies is comparable to that of spontaneously conceived twin pregnancies, provided that the same management criteria are applied.     

Pregnancy outcome of women exposed to bupropion during pregnancy: a prospective comparative study

OBJECTIVE: Bupropion was developed for the treatment of depression, but subsequently was found to be effective for smoking cessation. To date, there are no prospective comparative studies examining its safety in pregnancy. The primary objective was to determine whether bupropion increases the risks for major malformations above baseline. The secondary objective was to examine the rates of live births, stillbirths, spontaneous and therapeutic abortions, mean birth weight, and gestational age at birth. STUDY DESIGN: Women who were pregnant or planning a pregnancy and taking bupropion were enrolled in the study. Follow-up of pregnancy outcome was carried out between 4 months and 1 year after delivery. Three comparisons were carried out: 1) women exposed to bupropion vs a nonteratogen group; 2) those taking for depression vs other antidepressants, vs a nonteratogen group; 3) spontaneous abortions were compared between those taking for depression, vs another antidepressant group vs a nonteratogen group. RESULTS: We completed follow-up on 136 women exposed to bupropion during the first trimester of pregnancy. There were (105) live births, no major malformations, the mean birth weight was (3450g), the mean gestational age at delivery was (40 weeks), the number of spontaneous abortions was 20, there were 10 therapeutic abortions, there was 1 stillbirth, and 1 neonatal death. There were no statistically significant differences between any of the end points we examined between the exposed and comparison groups, with the exception of significantly more spontaneous abortions in the bupropion group (P = .009). CONCLUSION: These results suggest that bupropion does not increase the rates of major malformation above baseline. The higher rates of spontaneous abortions are similar to other studies examining the safety of antidepressants during pregnancy.     

Determinants of pregnancy rate and obstetric outcome after laparoscopic myomectomy for infertility

OBJECTIVE: To determine the effect of myomectomy on infertility and to assess the factors influencing reproductive outcome. DESIGN: Retrospective study. SETTING: Tertiary care center. PATIENT(S): One hundred and three infertile women with uterine leiomyoma who had had infertility >2 years and a follow-up time >12 months were enrolled. Follow-up was complete for 88 patients, including 28 (31.8%) with primary infertility and 44 (50%) with unexplained infertility. The mean (+/-SD) age of the patients was 36.1 +/- 2.1 years. INTERVENTION(S): Laparoscopic myomectomy. MAIN OUTCOME MEASURE(S): Pregnancy rate according to patient and fibroid characteristics. RESULT(S): Forty-two patients became pregnant (40.7%). The mean (+/-SD) delay in conception was 7.5 +/- 2.6 months. Nearly 80% of the women conceived spontaneously. Of 44 pregnancies in 42 women, 36 live newborns were delivered. No dehiscence of uterine scar occurred. The pregnancy rate was significantly higher in women <35 years of age or <3 years of infertility. Women with unexplained infertility had higher pregnancy rate than did women with multifactorial infertility (P<.001). No difference was noted in pregnancy rates according to fibroid characteristics. CONCLUSION(S): Fertility and pregnancy after laparoscopic myomectomy depend primarily on patient age, duration of infertility before myomectomy, and existence of associated infertility factors.     

A comparative study of pregnant women attending a tertiary obstetric unit and a district general hospital with a previous history of postnatal depression.

The aim of this study was to compare pregnant women with a previous history of postnatal depression, attending a Tertiary Obstetric Unit in Belfast and a District General Hospital in Newry. Women with a previous history of postnatal depression recorded at booking for their most current pregnancy were studied between January 2001 and May 2002. A total of 443 women (6.6%) in Belfast had a history of postnatal depression, compared with 113 women (6%) in Newry. The most common age range was 31 - 35 years in both centres. Some 69% of women in Belfast compared with 81% of women in Newry were given treatment. Fluoxetine was the commonly prescribed drug for each centre. During this subsequent pregnancy, 19 women (4.3%) in Belfast and five women (4.4%) in Newry remained on antidepressants. There was one woman in each centre who took an overdose during this pregnancy. More women in Newry were given treatment. During the subsequent pregnancy, the percentages of women from each unit requiring antidepressant therapy were similar.     

Pregnancy outcome among obese women: a prospective study

We investigated pregnancy outcome among obese women using a prospective cohort study comparing consecutive deliveries of obese and nonobese patients. Stratified analysis, using the Mantel-Haenszel technique, was done to assess the association between obesity and the risk for cesarean delivery (CD) while controlling for confounding variables. Complete data were abstracted for 376 women, of whom 21% ( N = 79) were obese. CD rate was significantly higher among obese women (32.9% versus 18.9%; P = 0.006). Maternal obesity was associated with multiparity (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.27 to 6.97; P = 0.012), fertility treatments (OR 11.3, 95% CI 2.84 to 44.89; P = 0.001), insulin-treated gestational diabetes (OR 24.55, 95% CI 2.28 to 264.08; P = 0.008), and hydramnios (OR 20.46, 95% CI 2.17 to 192.89; P = 0.008). When controlling for possible confounders, the association between maternal obesity and CD remained significant (weighted OR 2.2, 95% CI 1.2 to 4.1; P = 0.018). No significant differences were noted between the groups regarding neonatal complications. Both first and second stages of labor were longer in obese women. Obesity is a risk factor for developing gestational hypertension, insulin-treated gestational diabetes, and hydramnios. Moreover, maternal obesity is an independent risk factor for CD. Additional independent risk factors for CD were fertility treatments, insulin-treated gestational diabetes, and hydramnios. However, neonatal outcome of obese women is comparable to women with normal prepregnancy body mass index.     

A prospective study on buprenorphine use during pregnancy: effects on maternal and neonatal outcome

BACKGROUND: Exposure to illicit drugs in utero is associated with low birth weight and premature birth. Therefore, maintenance therapy for opioid dependence during pregnancy has been recommended to help withdrawal from street drugs, in order to improve maternal health and decrease risks to the fetus. METHODS: In 2002-2005, 67 pregnancies of 66 buprenorphine users were followed prospectively in an outpatient multidisciplinary antenatal setting by an obstetrician, a midwife, a psychiatric nurse and a social worker. Decreasing doses or even abstinence from buprenorphine was encouraged. Outcome measures were daily buprenorphine dose, fetal growth, gestational age at birth, mode of delivery, birth weight, Apgar scores, umbilical pH values, and occurrence of neonatal abstinence syndrome [NAS]. National statistics were used as reference values. RESULTS: The daily dose of buprenorphine decreased by 2.3 mg (median, range increase of 8 mg to decrease of 24 mg). There were no more incidences of premature birth, cesarean section, low Apgar scores (< or = 6) or umbilical artery pH <7.05 at birth than in the national register, despite the lower birth weight. A total of 91% of the infants needed treatment in a neonatal care unit, 76% had NAS, and 57% needed morphine replacement therapy. Seven infants were taken into care directly from the maternity hospital. Two sudden infant deaths occurred later. CONCLUSIONS: The pregnancies and deliveries of buprenorphine-using women were uneventful, but severe NAS and need for morphine replacement therapy was seen in 57% of the buprenorphine-exposed newborns. A high number of sudden infant deaths occurred.     

Low concentration Ropivacaine in labor epidural analgesia. A prospective study on obstetric and neonatal outcome]

BACKGROUND: Epidural analgesia effectively alleviates labor pain. However controversy exists about the effect of epidural analgesia on labor outcome. The aim of this study is to assess the effect of a low concentration local anesthetic (ropivacaine 0.08%) in labor epidural analgesia (LEA) on labor pain relief, on the incidence of cesarean sections and instrumental vaginal deliveries, and on neonatal outcome. METHODS: In the period April 1998 - July 2000, 323 women in active labor with live, singleton and in vertex presentation fetuses at term of gestation were included in this prospective study. Women with pre-gestational and/or obstetric diseases or previous caesarean deliveries were excluded. One-hundred and five patients requiring - by written informed consent - LEA were allocated to receive standardised protocol of a low concentration local anesthetic (ropivacaine 0.08%) coadministered with opioid (sufentanil): ropivacaine group. The remaining 239 parturients who didn't require LEA were included in the control group. RESULTS: The demographic characteristics of the two groups were similar; 12 (10.4%) patients receiving LEA delivered by cesarean section, 17 (14.8%) by vacuum extractor whereas 86 (74.8%) had a spontaneous delivery. The risk of cesarean section (adjusted for age, BMI, parity, neonatal weight and gynecologist) resulted lower, even if not significantly, in the ropivacaine group (OR 0.9; 95% IC: 0.6-1.3), while a significant increased instrumental vaginal delivery rate has been reported, although little numbers reduce statistical significance. Neonatal outcome was unaffected by the use of LEA. CONCLUSIONS: The conclusion is drawn that a lower concentration of ropivacaine (0.08%) in LEA produces good labor pain relief with no detectable adverse effects on mother and neonate, and without significantly increasing cesarean section rate.     

The association between previous single first trimester abortion and pregnancy outcome in nulliparous women

Objective: To determine the association between single previous abortion and pregnancy outcome in nulliparous women.

Methods: A retrospective cohort study of all nulliparous women who delivered in a university-affiliated tertiary hospital (2009–2014). Pregnancy outcome of women with single previous first trimester abortion (study group) was compared to those of primigravida (control group).

Results: Of the 44?371 deliveries during the study period, 14?498 (32.6%) were of nulliparous women, of them 1501 (10.3%) had single previous abortion (<13 weeks). Except for a higher rate of diabetes mellitus in the study group (6.1 versus 4.4%, p?=?0.003), no differences were found between the groups regarding pregnancy complications. In multivariate analysis, previous single abortion was independently associated with induction of labor (OR?=?1.31, 95%C.I 1.04–1.63, p?=?0.01), cesarean section (OR?=?1.38, 95%C.I 1.18–1.60, p?<?0.001) and retained placenta (OR?=?1.29, 95%C.I 1.03–1.61, p?=?0.02). Among nulliparous women with previous single abortion no difference in pregnancy outcome was observed between those with previous induced termination of pregnancy and spontaneous abortion, except for increased risk for retained placenta in those with previous spontaneous abortion.

Conclusion: Single early previous abortion in nulliparous women was associated with higher rate of induction of labor, cesarean section and retained placenta compared to primigravida women.     

The midwife factor in obstetric procedures and neonatal outcome

AIMS: In the face of major tendency towards midwifery-led-care it was our purpose to investigate the extent of the influence of the midwife on the rates of obstetric procedures and perinatal outcome. METHODS: 5384 consecutive deliveries at the Department of Obstetrics and Gynecology, University of Graz, were enrolled in the study. The following data were collected: mode of delivery, pH of umbilical artery, Apgar score. Firstly, data were investigated for interindividual differences and, secondly, for relationship with age of the midwife as a measure of experience. RESULTS: Interindividual differences were significant for episiotomy rates (minimum: 31.6%; maximum 76.9%; p < 0.001), forceps rates (minimum: 1.7%; maximum 11.1%; p = 0.002) and pH of umbilical arteries (minimum: 7.21; maximum: 7.28; p = 0.001) but not for cesarean section rates and Apgar scores. Linear regression analysis was significant between age of midwives and pH of umbilical arteries (p < 0.001; r = 0.055) and for one-minute Apgar score (p = 0.009; r = 0.050) but not for episiotomy rates, cesarean section rates, forceps rates and five-minutes Apgar score. CONCLUSIONS: There are large interindividual differences in obstetric intervention rates which cannot be explained by the midwives' age. Provision of health care should be primarily determined by need and not by the personal characteristics of the health care provider, thus interindividual differences should be reduced and more often taken into account when analyzing any kind of data.     

Elevated risk for neonatal outcome following denial of pregnancy: results of a one-year prospective study compared with control groups

AIMS: Newborns following denied pregnancies are delivered after either late onset or total absence of antenatal care, with a presumed subsequently increased risk for neonatal outcome. For this specific group, several characteristic outcome parameters are investigated. METHODS: During the period July 1, 1995 to June 30, 1996, a prospective case sampling was performed for denied pregnancies in Berlin. Besides determination of the parameters' frequency, comparison with two control groups is performed: a normal group (BBR, all Berlin deliveries in 1995) and a high risk group (VIR, all deliveries at a perinatal center in 1996). RESULTS: Altogether 69 neonates occurred. For gestational age < 37 weeks, birth weight < 2500 g, small for gestational age, transferal rate of newborns to neonatal unit and surgical delivery, a statistically significant worse outcome is demonstrated for denied pregnancies versus BBR and VIR (p-level < 0.05). Neonatal mortality is 5.8% in all cases, the corrected rate is 1.5% (excluding three non-viable cases of 21st and 23rd week of gestation). CONCLUSIONS: The data underline the elevated fetal outcome risk for newborns after denial of pregnancy. In this group, total absence or late onset of antenatal care results in a manifestation of pregnancy dependent risks. Preterm births and small for gestational age newborns, together with deaths, may be classified as at least potentially avoidable.     

Thromboprophylaxis throughout pregnancy in women with previous history of recurrent miscarriages of unknown aetiology

The purpose of this prospective preliminary clinical study was to assess the efficacy of thromboprophylaxis throughout pregnancy in women with a history of unexplained first trimester recurrent miscarriages. From the 53 patients originally assigned to the study 15 were excluded. The remaining 38 were treated with low molecular weight heparin (LMWH-natroparine calcium 0.3 ml twice daily) and low dose aspirin from the day the fetal heart motion was detected until the 37th week or earlier at the onset of premature labor. Among the patients treated (n = 38) thrombophilia screening was positive in 16 patients and in the remaining 22 no causative factor was detected. The overall success rate (viable pregnancy > or = 24 weeks) was 92.2% with no significant difference between patients with positive or negative thrombophilia screening. The most significant complications were: preeclampsia (21%), IUGR (26%), placenta abruptio (5.2%), injection site haematoma (44%) and skin reaction (15.7%). No abnormal bleeding was observed during vaginal or caesarean section. The results of this study suggest that thromboprophylaxis during pregnancy, which has already been successfully tried in patients with recurrent miscarriages with a causative factor, may be similarly effective in patients with such a pregnancy complication but of unknown aetiology.     

The international study of pregnancy outcome in women with maternal phenylketonuria: report of a 12-year study

OBJECTIVE: The purpose of this report was to update the results of the Maternal Phenylketonuria Collaborative Study, which was established to assess the efficacy of a phenylalanine-restricted diet in preventing morbidity among the offspring of women with hyperphenylalaninemia. STUDY DESIGN: During a 12-year period 576 women with hyperphenylalaninemia were enrolled in this study. Outcome measures were stratified according to classification of maternal hyperphenylalaninemia and the time at which dietary control of phenylalanine level was achieved. RESULTS: Optimal physical and cognitive fetal outcomes occurred when maternal blood phenylalanine level <600 micromol/L was achieved by 8 to 10 weeks' gestation and maintained throughout pregnancy (trimester average, 相似文献   

Pregnancy outcome in elderly primigravidae with and without a history of infertility

Summary. The pregnancy outcome of 196 primigravidae aged 35 years or over, with no history of involuntary infertility, was compared with that of 196 matched primigravidae aged 20–25 years, and also with 72'elderly' primigravidae (35 years) whose pregnancies had followed a period of involuntary infertility of at least 1 year. The older primigravidae with no history of infertility had a four-fold risk of preterm (<37 weeks) delivery, a five-fold risk of caesarean section and significantly increased rates of vaginal operative delivery, chronic hypertension and fibroids, when compared with the primigravidae between 20 and 25 years of age. They also showed a greater tendency to severe preeclampsia and perinatal death, but these differences were not statistically significant. Elective caesarean section was twice as common in the older women with a history of infertility than in those without such a history (20.8% compared with 10.7%) although this difference was not statistically significant. No other differences in pregnancy outcome were found between the two'elderly' groups.