Perinatal outcome and amniotic fluid index in the antepartum and intrapartum periods: A meta-analysis

OBJECTIVE: Our purpose was to perform a meta-analysis of studies on the risks of cesarean delivery for fetal distress, 5-minute Apgar score <7, and umbilical arterial pH <7.00 in patients with antepartum or intrapartum amniotic fluid index >5.0 or <5.0 cm. STUDY DESIGN: Using a MEDLINE search, we reviewed all studies published between 1987 and 1997 that correlated antepartum or intrapartum amniotic fluid index with adverse peripartum outcomes. The inclusion criteria were studies in English that associated at least one of the selected adverse outcomes with an amniotic fluid index of 5.0 cm. Contingency tables were constructed for each study, and relative risks and standard errors of their logs were calculated. Fixed-effects pooled relative risks were calculated for groups of studies that were homogeneous, whereas random-effects pooled relative risks were calculated for significantly heterogeneous groups of studies. RESULTS: Eighteen reports describing 10,551 patients met our inclusion criteria. An antepartum amniotic fluid index of 5.0 cm, is associated with an increased risk of cesarean delivery for fetal distress (pooled relative risk, 2.2; 95% confidence interval, 1.5-3.4) and an Apgar score of <7 at 5 minutes (pooled relative risk, 5.2; 95% confidence interval, 2.4-11.3). An intrapartum amniotic fluid index of 相似文献   

Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid

The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37–42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g. , severe fetal acidemia, Apgar score ≤3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7–14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuos fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome. Received: 15 November 1999 / Accepted: 12 April 2000     

妊娠合并哮喘与围产儿预后

目的 探讨妊娠合并哮喘及其病情控制程度与围产儿预后的关系。方法 对1990年1月至1999年12月间我院住院分娩的妊娠合并哮喘患者16例的临床资料进行回顾性分析。按病情控制程度分为发作组(9例)及缓解组(7例),并随机选取同期住院分娩的孕妇32例作为对照组,对3组新生儿出生体重、出生1分钟Apgar评分、羊水状况、早产及胎儿宫内发育迟缓(IUGR)等围产儿预后指标进行比较分析。结果 发作组新生儿出生体重低于缓解组及对照组(P<0.05),后两组差异无显著性(P>0.05);发作组剖宫产分娩、新生儿Ⅰ度窒息、IUGR及羊水异常的发生比例高于对照组(P<0.05);发作组早产的发生比例与后两组相比,差异无显著性(P>0.05);结论 妊娠合并哮喘时,病情反复控制不良者可导致多种围产儿并发症,需积极治疗减轻病情.改善围产儿预后。     

Perinatal outcome in Berlin (Germany) among immigrants from Turkey

Purpose Are there differences regarding important perinatal outcome-parameters in Berlin relating to ethnicity? Patients and methods A database was available covering 152,193 single deliveries in all hospitals in Berlin/Germany in the period 1993–1999, including 132,555 German women and 19,638 women of other ethnicities. Comparisons were made between a total of four pairs of sub-groups matched in terms of parity and social status (significance level P < 0.01). Results Pregnant migrants come for their first antenatal check-up significantly later, thus delaying the initiation of necessary diagnostic or therapeutic measures. Migrants show higher rates of prepartal and also postpartal anemia than the German women. In all sub-groups the German women had a significantly higher frequency of planned cesarean sections. Migrants were significantly less likely to receive an epidural anesthesia during delivery. It is also noticeable that the rate of congenital malformations of neonates is significantly higher in the migrant collectives. Conclusions Important perinatal quality parameters such as infant and maternal mortality and rates of premature delivery have largely converged between German and Turkish migrant mothers. The differences found (e.g., rates of planned cesarean section, epidural anesthesia, or anemia) could be interpreted as indications of persistent differences in quality of care for migrants.     

The association of triple-marker test results with adverse pregnancy outcomes in low-risk pregnancies with healthy newborns

Objective This study was designed to investigate the relationship between the second trimester maternal serum markers and adverse pregnancy outcomes in healthy newborns. Materials and methods A total of 749 women who delivered in our institution with complete follow up and second-trimester triple marker test data available were included in the study. Women with multiple pregnancies, chronic diseases, diabetes mellitus, obesity, smokers and infants with chromosomal and congenital abnormalities were excluded. Maternal serum alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) and unconjugated estriol (uE₃) values were investigated in our cohort who developed preeclampsia (n = 28), gestational diabetes (GM) (n = 69), preterm labor-birth (n = 100), oligohydramnios (n = 37) and macrosomia (n = 59) by using receiver operating characteristic (ROC) curve analysis, with chi-square and Pearson’s correlation tests. Results Women with uE₃ ≤ 1.26 MoM (P = 0.001, AUC = 0.666), HCG > 1.04 MoM (P = 0.032, AUC = 0.599) or AFP ≤ 0.69 MoM (P = 0.049, AUC = 0.600) values significantly developed oligohydramnios. Also, macrosomic infants were observed in women who had HCG values > 0.86 MoM (P = 0.047, AUC = 0.578). Patients with HCG > 1.04 MoM (P = 0.04, AUC = 0.565) and uE₃ ≤0.88 MoM (P = 0.049, AUC = 0.571) developed GDM. HCG levels ≥2.5 or ≥3 MoM were significantly associated with the development of oligohydramnios [P = 0.005; OR = 4 (95% CI: 1.7–9.7)], [P = 0.008; OR = 4.9 (95% CI: 1.7–13.7)], respectively. When women with adverse (n = 237) and normal (n = 512) outcomes were compared there were significant differences in maternal serum AFP (1.40 ± 0.84 vs. 1.23 ± 0.75 MoM, P = 0.006) and uE₃ values (1.38 ± 1.42 vs. 1.45 ± 0.98 MoM, P = 0.001). Conclusions Serum estriol, AFP or HCG values in triple test results may be associated with development of oligohydramnios, gestational diabetes and macrosomia in women with healthy and normal appearing fetuses. Presented in part at the VI. Congress of the Turkish-German Gynecological Association, Antalya, May 18–22, 2005. Abstract, S12, Arch Gynecol Obstet 2005; 271 (Suppl 1-Abstract Book): Poster-MFM&P-32.     

Antepartum management and neonatal outcome of triplet pregnancies

Materials and methods The maternal and neonatal outcome of 27 triplet and 1 quadruplet gestations was studied at the University Hospital of Verona.Results Mean maternal age was 31.7±3.7 years; 24 women (85.7%) were nulliparous. Six (21.4%) patients had conceived spontaneously. Common maternal complications were: preterm labor (78.6%), anemia (57.1%), preeclampsia (25.0%). Thirteen patients (46.4%) had cervical cerclage, 21(75%) received tocolysis, 20 (71.4%) corticosteroid prophylaxis, 4 (14.3%) unfractionated heparin. All patients underwent Caesarean section with mean gestational age of 32±2.5 weeks and mean postoperative stay was 9 days. Three patients were treated in ICU after delivery, 1 was hysterectomized and 6 received blood transfusions. The live newborns were 80, the stillborns 5. Mean birth weight was 1,520±516 g (range 650–2,665), 95.0% being LBW. The following neonatal complications were observed: RDS (28.7%), cerebral hemorrhage (26.2% of II° and 1.2% of III°), anemia (20%), PDA (12.5%), ROP (6.5%), polyglobulia (3.75%), NEC (2.5%). Mean hospitalization time was 30.6 days (range 2–132).Discussion Iatrogenic multiple births are increasing as the use of assisted conception techniques expands. Gynecologists should be aware of maternal complications and neonatal outcome of triplet pregnancies and infertility management strategies should try to avoid iatrogenic multiple gestations.     

The outcome of macrosomic fetuses in a low risk primigravid population.

OBJECTIVES: To ascertain whether fetal macrosomia is associated with increased maternal and neonatal morbidity in uncomplicated, singleton, vertex deliveries at term in primigravid women. METHODS: This was a retrospective population based survey of 8617 deliveries over an 11-year period. These were stratified into three birthweight categories: 2500-3999 g (n=7854), 4000-4499 g (n=666) and > or =4500 g (n=97). Outcome variables included maternal characteristics, delivery details, maternal and perinatal morbidity data. RESULTS: Increased BMI and incidence of Caucasian ethnicity and non-smoking were significantly greater in macrosomic compared with non-macrosomic infants (P<0.001). Increasing birthweight (especially > or =4.5 kg) was associated with significantly (P<0.001) lower rates of spontaneous onset of labor, spontaneous vertex deliveries and significantly higher rates (P<0.001) of maternal and neonatal morbidity. CONCLUSIONS: This study supports the notion of expectant management in suspected fetal macrosomia in low risk primigravid women until 40 weeks gestation. Thereafter, the safest mode of delivery is controversial, with some evidence pointing to elective cesarean section as a viable alternative in these women. A prospective RCT is needed to evaluate the best management option in terms of fetal and maternal outcome in cases of suspected macrosomia after 40 weeks' gestation.     

HPV infection among women in a representative rural and suburban population of the USA

Objective

To study the prevalence of low-risk and high-risk HPV genotypes in a largely suburban, non-Hispanic, white female population of the USA, and to determine the positive predictive value of one-occasion HPV detection and genotyping using high-grade squamous intraepithelial lesion (HSIL) cytology as the endpoint for clinical evaluation.

Methods

HPV DNA present in liquid-based cytology specimens collected by gynecologists in private practice was amplified using nested polymerase chain reaction. HPV DNA was validated by signature DNA sequencing for accurate genotyping.

Results

Of 2633 specimens, 278 were positive for HPV DNA of any genotype. Among 255 single HPV infections, the most prevalent genotype was HPV-16 (n = 50; 19.6%), followed by HPV-52 (n = 24; 9.4%). Only 10 specimens, all positive for a high-risk HPV, were associated with an HSIL cytology result. Among them were 6 of the 50 specimens (12%) tested positive for HPV-16. One novel HPV-39 variant was detected in repeat testing in a patient with persistent HPV infection.

Conclusion

DNA sequencing is a useful method for increasing the specificity of HPV genotyping as an aid to follow persistent high-risk HPV infections to reduce excessive colposcopies in populations with low cancer prevalence.     

Perinatal outcome in singletons after modified natural cycle IVF and standard IVF with ovarian stimulation

Objective

Singletons born after IVF treatment are at risk for adverse pregnancy outcome, the cause of which is unknown. The aim of the present study was to investigate the influence of ovarian stimulation on perinatal outcome.

Study design

In this single-centre retrospective study, perinatal outcome of singleton pregnancies resulting from IVF treatment with (n = 106) and without ovarian stimulation (n = 84) were compared. For IVF without ovarian stimulation, a modified natural cycle protocol was used.

Results

No differences were found in pregnancy duration, proportion of prematurity and proportion of low birth weight. Mean birth weight of modified natural cycle vs standard IVF singletons was 3485 (±527) vs 3218 (±670) g; P = 0.003. After adjustment for prognostic factors by linear regression analysis, the difference in birth weight remaining was 134 g; P = 0.045.

Conclusions

Birth weights of modified natural cycle IVF singletons found in this study are higher than standard IVF singletons, suggesting that ovarian stimulation may be a causative factor in the occurrence of low birth weight in standard IVF.     

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births

Objective  To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.
Design  A nationwide cohort study.
Setting  The entire Netherlands.
Population  A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods  Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures  Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results  No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions  This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.     

Perinatal outcome of induced and spontaneous pregnancies of primiparous women aged 35 or over.

OBJECTIVES: To compare the neonatal and maternal morbidity data associated with induced or naturally conceived pregnancies of primiparous women aged 35 years and older. METHODS: We recruited primiparous women aged 35 years and older, who delivered between January 1995 and December 2000. The outcomes of the induced (n=62) and naturally conceived (n=132) pregnancies were compared. The Fisher exact test was used for univariate analysis in order to compare the delivery and pregnancy characteristics in the two groups. RESULTS: Cesarean section featured with a 0.76 times lower prevalence among the induced pregnant women, than among the spontaneous ones, but the difference was not significant statistically. The induced pregnancies were not associated with a significantly higher rate of perinatal complications. CONCLUSIONS: Induced pregnancy does not involve a higher risk of maternal complications. The incidence of premature newborns and intrauterine growth retardation was high in both subgroups, but without a statistically significant difference.     

Perinatal cytogenetic discrepancy in a fetus with low-level mosaicism for trisomy 21 and a favorable outcome

ObjectiveWe present perinatal cytogenetic discrepancy in a fetus with low-level mosaicism for trisomy 21 and a favorable outcome.Case reportA 40-year-old woman underwent amniocentesis at 19 weeks of gestation because of advanced maternal age. Amniocentesis revealed a karyotype of 47,XY,+21[7]/46,XY[14]. She underwent cordocentesis 21 weeks of gestation, and the karyotype of cord blood was 47,XY,+21[13]/46,XY[38]. The prenatal ultrasound findings were unremarkable. After genetic counseling of a favorable outcome of low-level mosaic trisomy 21 at amniocentesis, the parents decided to continue the pregnancy, and a 3128-g phenotypically normal male baby was delivered at 38 weeks of gestation without phenotypic features of Down syndrome. Postnatal cytogenetic analysis of cord blood revealed a karyotype of 47,XY,+21[3]/46,XY[47]. The placenta had a karyotype of 47,XY,+21[8]/46,XY[32], and the umbilical cord had a karyotype of 47,XY,+21[5]/46,XY[35]. Array comparative genomic hybridization analysis on the DNA extracted from cord blood revealed no genomic imbalance. Polymorphic DNA marker analysis excluded uniparental disomy 21. Interphase fluorescence in situ hybridization analysis on urinary cells revealed trisomy 21 signals in 2/102 (1.96%) cells compared with 2/103 (1.94%) cells in normal control.ConclusionThe cells of abnormal cell line in prenatally detected mosaic trisomy 21 may decrease in number or disappear in various tissues as the fetus grows, and there exists perinatal cytogenetic discrepancy in mosaic trisomy 21 detected at prenatal diagnosis.     

Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses

OBJECTIVE: Uncontrolled studies suggest that in vitro fertilization twins have increased rates of preterm birth and low birth weight and would warrant increased antenatal monitoring. The objective of this meta-analysis was to determine whether the incidence of poor obstetric outcomes is higher for in vitro fertilization twins than for spontaneously conceived twins who were matched for maternal age. STUDY DESIGN: Medline and EMBASE were searched with comprehensive search strategies. Case-control and cohort studies of twins who were conceived by in vitro fertilization or in vitro fertilization/intracytoplasmic sperm injection, with the transfer of fresh embryos or cryopreserved (frozen) in women with infertility, and/or whose partners were subfertile or infertile, compared with naturally (spontaneously) conceived twins who were matched for maternal age (case-control studies) or which were controlled for it (cohort studies). Two reviewers independently assessed titles, abstracts, and study quality and extracted the data. Statistical analysis was performed with commercial statistical software. Dichotomous data were meta-analyzed with odds ratios as measures of effect size, and continuous data was meta-analyzed with mean differences. Interstudy variation was incorporated with the assumption of a random effects model for the treatment effect. RESULTS: Compared with spontaneously conceived twins who were matched for maternal age, in vitro fertilization twins have an increased risk of preterm birth between 32 and 36 weeks of gestation (odds ratio, 1.48; 95% CI, 1.05-2.10), and an elevated risk of preterm birth at <37 weeks of gestation when parity is also matched for an odds ratio of 1.57 (95% CI, 1.01-2.44). There was an increased rate of cesarean delivery among in vitro fertilization twins (odds ratio, 1.33; 95% CI, 1.06-1.67). There were no significant differences in incidences of perinatal death, low birth weight infants, or congenital malformations. CONCLUSION: In vitro fertilization twins have increased rates of preterm birth compared with spontaneously conceived twins who were matched for maternal age, despite the fact that their outcomes would be expected to be better because of the decreased proportion of monochorionic twins.     

妊娠合并心脏病伴肺动脉高压患者的妊娠结局

目的 探讨妊娠合并心脏病伴肺动脉高压患者的妊娠结局。方法 收集1996年1月至2004年8月间,我院产科收治的61例妊娠合并心脏病伴肺动脉高压患者的临床资料（其中先天性心脏病36例,风湿性心脏病21例,心律失常1例,原发性肺动脉高压性心脏病2例,系统性红斑狼疮性心脏病1例）,根据肺动脉压力情况分为轻度组32例[30-49mmHg（1mmHg=0．133kPa）],中度组23例（50～79mmHg）,重度组6例（t〉80mmHg）,分析各组心脏病种类、心功能级别、终止妊娠孕周和方式以及母儿结局。结果 （1）轻度组心功能Ⅰ-Ⅱ级者23例,中度组心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级的发病例数分别为9、5、5、4例,重度组心功能Ⅲ-Ⅳ级者5例。（2）风湿性心脏病患者中,中、重度肺动脉高压者11例,占52％（11／21）;发生严重心功能衰竭者9例,占43％（9／21）,先天性心脏病患者中,以轻、中度肺动脉高压者为主（97％,35／36）,且以心功能Ⅰ-Ⅱ级者为主（81％,29／36）。（3）轻度组足月妊娠24例,新生儿平均体重为2744g;中度组足月分娩11例,早产8例,医源性流产4例;重度组足月分娩1例,早产3例,医源性流产2例。各组围产儿疾病发生率比较,差异无统计学意义（P〉0．05）。（4）妊娠合并心脏病伴肺动脉高压者的分娩方式以刮宫产分娩为主,占79％（48／61）。（5）孕产妇死亡率为2％（1／61）,医源性胎儿丢失率为13％（8／61例）。结论 随着肺动脉压力的升高,孕妇心功能衰竭的发生率随之增加,围产儿疾病发生率和胎儿丢失率也明显增加;妊娠合并风湿性心脏病患者中、重度肺动脉高压的发生率高于先天性心脏病患者;手术终止妊娠是比较安全的分娩方式。     

Advanced maternal age and adverse perinatal outcomes in an Asian population

Objective

To investigate (1) whether there is an increasing trend in the mean maternal age at the birth of the first child and in the group of women giving birth at age 35 or older, and (2) the association between advanced maternal age and adverse perinatal outcomes in an Asian population.

Study design

We conducted a retrospective cohort study involving 39,763 Taiwanese women who delivered after 24 weeks of gestation between July 1990 and December 2003. Multivariable logistic regression was used to adjust for potential confounding variables.

Results

During the study period, the mean maternal age at the birth of the first child increased from 28.0 to 29.7 years, and the proportion of women giving birth at age 35 or older increased from 11.4% to 19.1%. Compared to women aged 20–34 years, women giving birth at age 35 or older carried a nearly 1.5-fold increased risk for pregnancy complications and a 1.6–2.6-fold increased risk for adverse perinatal outcomes. After adjusting for the confounding effects of maternal characteristics and coexisting pregnancy complications, women aged 35–39 years were at increased risk for operative vaginal delivery (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–1.7) and cesarean delivery (adjusted OR 1.6, 95% CI 1.5–1.7), while women aged 40 years and older were at increased risk for preterm delivery (before 37 weeks of gestation) (adjusted OR 1.7, 95% CI 1.3–2.2), operative vaginal delivery (adjusted OR 3.1, 95% CI 2.0–4.6), and cesarean delivery (adjusted OR 2.6, 95% CI 2.2–3.1). In those women who had a completely uncomplicated pregnancy and a normal vaginal delivery, advanced maternal age was still significantly associated with early preterm delivery (before 34 weeks of gestation), a birth weight <1500 g, low Apgar scores, fetal demise, and neonatal death.

Conclusion

In this population of Taiwanese women, there is an increasing trend in the mean maternal age at the birth of the first child. Furthermore, advanced maternal age is independently associated with specific adverse perinatal outcomes.     

Trauma in pregnancy,obstetrical outcome in a tertiary centre in the Netherlands

Purpose: To determine obstetrical outcome and predictive value of obstetrical symptoms and diagnostic examinations on adverse outcome after maternal trauma in pregnancy.

Materials and methods: Retrospective study in a Dutch tertiary medical center, including women admitted for trauma in pregnancy between 1995 and 2005 and infants born from these pregnancies. Characteristics at trauma (type of trauma, severity) and obstetrical outcome were recorded, as well as prevalence and severity of trauma; prevalence of obstetrical symptoms and abnormal diagnostic examinations. Composite adverse obstetrical outcome was defined as fetal death, placental abruption, birth?<37 weeks and/or birth weight <10th percentile. The predictive value of obstetrical symptoms or abnormal diagnostic tests on an adverse pregnancy outcome was analyzed (logistic regression analysis).

Results: Trauma admissions occurred in 10 per 1000 deliveries. Injuries were non-severe in 147/159 (92%). Obstetrical symptoms and/or abnormal diagnostic tests were present in 64/159 (40%) and 12/159 (8%) respectively. Adverse pregnancy outcome was encountered in 17/80 cases, mainly preterm births (13/80 (16%)). Severe injuries were predictive for an adverse pregnancy outcome.

Conclusions: We found a considerable rate of trauma during pregnancy. There was an increased risk for preterm birth and severity of injuries was predictive for adverse outcome.     

Maternal and perinatal outcome in varying degrees of anemia.

OBJECTIVES: To analyze the maternal and perinatal outcome in varying degrees of anemia. METHODS: A total of 447 pregnant women were divided into group I (Hb>11 g%, n=123 women), group II (Hb 9-10.9 g%, n=214 women), group III (Hb 7-8.9 g%, n=79 women) group IV (Hb<7 g%, n=31 women). Their maternal and perinatal outcome, mode of delivery, duration of labor and postpartum complications were noted and analyzed using multiple logistic regression to calculate odds ratios (95% CI) for duration of labor, mode of delivery and low birth babies. Chi square or Fisher's exact test was employed for difference in proportions and Student's t-test for testing difference between means. RESULTS: Mean age (27+/-4.25 years) and number of women with parity >3 were highest in group IV. The patients with Hb<8.9 g% had a 4-6-fold higher risk of prolonged labor compared to Hb>11 g%. The odds ratios for abnormal delivery (cesarean and operative vaginal deliveries) showed a 4.8-fold higher risk (95% CI 1.82, 12.7) in patients with Hb 相似文献   

Surveillance of pregnant diabetics — comparison between outpatient and inpatient management

From 1982 to 1993 67 diabetic women attended the University Women's Hospital obstetric clinic at Würzburg. These women were separated into two groups: group 1 (inpatient group) delivered between 1/82 and 7/87, group 2 (outpatient group) delivered between 8/87 and 4/93. Between 1982 and 1987 we used extensive inpatient care. But did not so after 1987. The fetus was monitored by ultrasound scans, cardiotocography, oxytocin stress test and doppler measurements. Nearly all patients used home blood glucose monitoring. We compared blood glucose levels, mode of delivery and fetal outcome for the two groups. There was no significant difference in the average blood glucose levels between the two groups. Cesarean section rates (37%) and gestational age at delivery (37 weeks) were similar in both groups. Fetal macrosomia (birth weight > 4000 g) occured more frequently in the outpatient group (group l: 4%, group 2: 25%,P<0.01). This fact did not effect perinatal morbidity. Postnatal metabolic disorders did not increase. Fetal anomalies occured less frequently in the outpatient group (group 1: 7%, group 2:2%.P<0.05). Correspondence to: B. Seelbach-Göbel     

Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation

OBJECTIVE: This study was undertaken to determine maternal and perinatal outcomes after expectant management of severe preeclampsia between 24 and 33 weeks' gestation. STUDY DESIGN: A prospective observational study of 239 women with severe preeclamptic and undelivered after antenatal steroid prophylaxis was performed. Pregnancy prolongation and maternal and perinatal morbidities were analyzed according to the gestational age at time of expectant management: 24 to 28, 29 to 31, and 32 to 33 weeks. Statistical analysis was performed by Student t test and chi(2) test. RESULTS: The days of pregnancy prolongation were significantly higher among those managed at less than 29 weeks (6) compared with the other groups (4). There were 13 perinatal deaths: 12 in those managed at less than 29 weeks and 1 in those managed at 29 to 31 weeks. Neonatal morbidities were significantly higher among those managed at less than 29 weeks compared with the other groups. There were no instances of maternal death or eclampsia. Maternal morbidities were similar among the groups. CONCLUSION: Expectant management of severe preeclampsia at 24 to 33 weeks in a tertiary care center is associated with good perinatal outcome with a minimal risk for the mother.