Dilemma of increased obstetric risk in pregnancies following IVF-ET

Purpose : To determine the rates of pregnancy complications following in vitro fertilization in comparison with those in a matched control group. Methods : A total of 13,543 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, between January 1, 1995 and February 28, 2002 were subjected to retrospective analysis. The 230 (1.7%) pregnancies following IVF-ET were evaluated and matched with spontaneous pregnancies concerning age, parity, gravidity, and previous obstetric outcome. Demographic and selected maternal characteristics, pregnancy and labor complications, and neonatal outcome were compared in the two groups. Results : The pregnancy complication rate was partly significantly higher among the singleton IVF-ET pregnancies. The obstetric risk was elevated, though not significantly concerning twin pregnancies. Conclusions : IVF-ET presents an additional obstetric risk. The neonatal outcome displays a significant difference only concerning an increased premature birth rate of singleton pregnancies. Triplet IVF-ET pregnancies involve a much higher risk of both pregnancy complications and neonatal outcome.     

Maternal hemodynamic changes and predictors of poor obstetric outcome in women with rheumatic heart disease: a five-year observational study

Objective: To assess prospectively the maternal cardiovascular hemodynamic changes and obstetric outcome in women with rheumatic heart disease (RHD) and to detect predictors of poor outcome.

Methods: This prospective observational study included 204 pregnant patients with RHD who were divided into two groups; successful pregnancy group with living fetus (n?=?126) and poor obstetric outcome group with fetal or neonatal loss (n?=?78). Hemodynamic changes, maternal and fetal outcome were assessed and recorded.

Results: There was a highly significant difference between the two groups regarding disease criteria with more women suffering from stenotic lesions (mitral and aortic), pulmonary hypertension, previous heart failure, receiving cardiac medications and higher NYHA class (III and IV) in the poor obstetric outcome group (p?p?Conclusions: Increased maternal age and body mass index together with NYHA class III–IV, significant pulmonary hypertension, reduced ejection fraction and development of heart failure during pregnancy are strong predictors of poor maternal and fetal outcome.     

Domestic Violence During Pregnancy: Evaluating the Impact on Maternal and Perinatal Health—A Pilot Study in Uttar Pradesh

IntroductionDomestic Violence [DV] is a global health problem of pandemic proportions. WHO identifies it as psychological, physical or sexual violence or threats of the same, in the premises of one’s home. The perpetrator can be husband, intimate partner, friend or a family member. DV during pregnancy has widespread implications on adverse obstetric maternal and foetal outcomes.Aim of the StudyTo find out the prevalence of domestic violence in antenatal women and observe the association between DV and maternal and perinatal outcome.MethodologyIt is a cohort study carried out at ELMCH, over a period of 10 months. Data were collected from pregnant women reporting to the outpatient department of obstetrics and gynaecology in their third trimester of pregnancy. The pregnancies were followed up till delivery and one week postpartum to study the obstetric and perinatal outcome. Appropriate statistical methods were applied to determine significance of the observations, and odds ratio was calculated for the risk factors.ResultsThe prevalence of DV during pregnancy was 22.2%, with psychological violence being the most common form observed. Increased relative risk was found for hypertensive disorders of pregnancy, antepartum haemorrhage, recurrent urinary tract infection and preterm labour. Apgar scores of babies in affected mothers was lower, and there were significantly greater NICU admissions. This was independent of period of gestation at delivery.ConclusionDV affects at least 1/4th of antenatal women. Majority of them do not realise the extent and forms of DV and accept the violence as a routine norm of marital life. DV during pregnancy has a significant association with adverse obstetric and perinatal outcomes.     

Índice de riesgo gestacional,vía de parto y resultados perinatales

IntroductionThe degree of complexity of an obstetric population is directly related to delivery type and its perinatal results. Thus, greater gestational risk is associated with a higher rate of cesarean sections and worse perinatal outcome.ObjectiveThe aim of this study was to analyze gestational risk in our obstetric population by relating it to delivery type and perinatal outcome.ResultsWe analyzed 36,300 deliveries over a 5-year period (1995 to 2000). Of these, 4,325 were cesarean sections, representing a mean cesarean rate of 11.9% (11 to 13.3). Using the gestational risk index of the Perinatal Medicine Section of the Spanish Society of Obstetrics and Gynecology, 14.6% of the pregnancies analyzed were high risk, corresponding to a high a cesarean rate, 26.6% (22-31) (odds ratio [OR]: 3.1) and perinatal mortality of 6.5 per thousand births (5.8-7.2).The complexity factors that most increased the risk of abdominal delivery were breech presentation (OR: 5.9) and twin pregnancy (OR: 5.1), followed, in order of importance, by diabetes (OR: 3.1), hypertension during pregnancy (OR: 3.0) and small for gestational age neonates (OR: 2.7).ConclusionsThe highest rates of cesarean sections in the Hospital Universitario Materno Infantil de Canarias were observed in the most complex population. The population variables that increased the risk of cesarean section in our service, expressed in decreasing order of importance, were: breech presentation, multiple pregnancy, gestational a pregestational diabetes, hypertension during pregnancy, small for gestational age neonate, prior cesarean section, a history of infertility, poor previous obstetric outcome and being an elderly primigravida.     

Obstetric and neonatal outcomes of IVF versus spontaneously conceived dichorionic twins

ObjectiveTo evaluate the obstetric and neonatal outcomes of dichorionic twin (DD) pregnancies after IVF in comparison to spontaneous conception (SC).DesignRetrospective cohort study.SettingWomen Hospital – Hamad Medical Corporation, Doha, Qatar.Material and methodsAll cases of DD twin pregnancies during the period from January 2002 to December 2011 were included. Demographic and clinical data, obstetric and neonatal outcomes of DD twin pregnancies after IVF and SC were compared.Main outcome measuresMaternal and neonatal outcome.Results145 (80%) and 175 (79.6%) DD twins after IVF and SC were included respectively. IVF was not associated with more obstetric complications than SC group. Six neonatal deaths occurred in both groups. The rate of CS was slightly but not significantly higher in IVF pregnancies (78% versus 68%). In IVF and SC there were 15 malformed fetuses in each group.ConclusionsThe present study reported comparable obstetric and neonatal outcomes of DD twin pregnancies after IVF in comparison to SC provided that the same management criteria are applied to both types of twin pregnancy.     

Macroscopic and microscopic morphology of first trimester miscarriage and subsequent pregnancy outcome - An exploratory study

IntroductionReduced chorionic villous vascularization is associated with first trimester miscarriage and second trimester fetal loss. Differences in villous vascularization have been observed in combination with complications in the third trimester of pregnancy. The aim of this study was to investigate whether abnormal morphology and reduced chorionic villous vascularization in first trimester miscarriages are associated with an increased risk on adverse outcome and/or pregnancy complications in subsequent pregnancy. Secondly, to assess the influence of these parameters on the length of the interpregnancy interval and infertility.MethodsIn a retrospective cohort study 134 consecutive women who underwent dilatation and curettage for a miscarriage were included. The degree of chorionic villous vascularization in miscarriage tissue was determined by a pathologist. Ultrasound details of these miscarriages and clinical data on the subsequent pregnancy of these women were obtained.ResultsNeither reduced vascularization nor early embryonic arrest in first trimester miscarriages are associated with an increased risk of a subsequent miscarriage or adverse obstetric and perinatal outcome of subsequent pregnancy. Abnormal morphology of the first trimester miscarriage did not influence the time to subsequent pregnancy. A shorter mean interpregnancy interval between miscarriages was observed after miscarriages with reduced chorionic villous vascularization (5.5 vs. 10.7 months; p = 0.051), showing a trend towards an association.DiscussionChorionic villous vascularization and morphology have no influence on subsequent pregnancy outcome. Therefore it remains unknown what aspects of miscarriage are causing the increased risk on subsequent miscarriage and complications in the third trimester of the subsequent pregnancy.     

Concomitant Adenomyosis among Patients with Asherman Syndrome

Study ObjectiveTo characterize obstetric outcomes for concomitant Asherman syndrome and adenomyosis.DesignA retrospective cohort study.SettingA community teaching hospital affiliated with a large academic medical center.PatientsA total of 227 patients with Asherman syndrome with available hysteroscopy and pelvic ultrasound reports.InterventionsTelephone survey to assess and compare the obstetric outcomes of patients with Asherman syndrome with concomitant adenomyosis (Group A) vs patients with Asherman syndrome without concomitant adenomyosis (Group B).Measurements and Main ResultsA telephone survey and confirmatory chart review were conducted to obtain information on patients’ demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman syndrome management. Adenomyosis was a common sonographic finding, detected in 39 patients with Asherman syndrome (17.2%). In this cohort, 77 patients attempted pregnancy and produced 87 pregnancies. Age (odds ratio [OR] 0.67; 95% confidence intervals [CI], 0.52–0.86) was negatively associated with a pregnancy outcome. Age (OR 0.83; 95% CI, 0.73–0.95) and severe Asherman disease (OR 0.06; 95% CI, <0.01–0.99) were negatively associated with a live birth outcome. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among patients with Asherman syndrome.ConclusionAdenomyosis is relatively common in patients with Asherman syndrome. Adenomyosis does not seem to add any distinct detriment to fertility among patients with Asherman syndrome.     

Studying the impact of the psychosocial work environment on pregnancy outcome: A review of methodological issues

Abstract

This paper reviews methodological considerations pertinent to our understanding of the impact of work-related stress on a range of pregnancy outcomes. Despite the importance of this issue to working women, the existing research is relatively scant, results are somewhat contradictory, and reasons for this may lie in the methodological challenges associated with this area. The paper considers the definitional problems inherent in pregnancy outcome as well as work stress research; the nature of possible mechanisms for any effect, and of the direct and indirect evidence available; the nature of evidence available on the impact of psychosocial stress in arenas other than work; the difficulties of simply comparing working and non-working women; and some methodological issues in recent research into work stress and pregnancy.     

Pregnancy outcome in patients with Takayasu’s arteritis: cohort study and review of the literature

Objective: The objective of this study is to investigate the clinical features of pregnancy in women with Takayasu’s arteritis managed in a tertiary medical center and review the literature in order to establish the course and recommended follow up and treatment for these pregnancies.

Materials and methods: Retrospective analysis of 20 pregnancies in 6 women with Takayasu’s arteritis. Patients were recruited from the high risk pregnancy clinics at Sheba Medical Center, where follow up included strict control of blood pressure and treatment of obstetric and disease-related complications.

Results: Mean maternal age was 29.3?±?3 years. Thirty-six patients had both supra and infradiaphragmatic arterial disease, of them two had an abdominal aorta involvement and three out of six patients had an isolated supradiaphragmatic disease. Of 20 pregnancies, six pregnancies (30%) resulted in early spontaneous miscarriages, and one pregnancy was terminated at 17 weeks due to fetal anomalies. The remaining 13 pregnancies (65%) resulted in live births. Three out of 13 (23%) neonates were small-for-gestational-age. The most common complication was maternal hypertension affecting 8/13 (61.5%) pregnancies. Preeclampsia occurred in one pregnancy. Four out of 13 (30.7%) pregnancies necessitated preterm induction of labor due to obstetric indications or uncontrolled disease.

Conclusions: Although Takayasu’s arteritis is associated with pregnancy complications, tight preconception disease control, strict follow up, and targeted treatment of high blood pressure can result in positive pregnancy outcome.     

First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome

ObjectiveTo determine the pregnancy outcome as a function of the first-trimester serum 25-hydroxyvitamin D₃ [25(OH)D] status and to compare the 25(OH)D levels in the first and third trimesters.MethodsPregnant women (n = 466) tested for serum 25(OH)D levels during the first trimester were followed up until the end of pregnancy, and the obstetric and neonatal outcomes were compared in reference to the baseline 25(OH)D status. The third-trimester 25(OH)D levels were additionally measured in a subset of women (n = 148).ResultsThe obstetric and neonatal outcomes did not vary as a function of the first-trimester 25(OH)D status. Neither did the 25(OH)D levels vary as a function of pregnancy outcomes. Overall, the 25(OH)D levels significantly decreased from the first to the third trimester. The first- and third-trimester 25(OH)D levels of samples initially taken during autumn/winter were significantly lower than those that were initially taken during spring/summer. Interestingly, the decrease in 25(OH)D levels during the third trimester was independent of the season of sampling.ConclusionThe pregnancy outcome was independent of the first-trimester 25(OH)D status. Overall, the 25(OH)D levels significantly decreased in the third trimester. More research in this area is warranted.     

The effect of prenatal smoke exposure on child neuropsychological function: a prospective mother–child cohort study

ABSTRACT

Objective: To study prospectively the effect of prenatal smoke exposure (PSE) on child neuropsychological function and intelligence quotient (IQ).

Background: PSE has been associated with adverse effects on child neurodevelopment. However, some studies reported that these associations disappear after adjustment for potential confounders.

Methods: A cohortof 248 mothers-child dyad was followed from the first trimester of pregnancy until children were 7.5 years old. PSE was recorded during pregnancy by questionnaire and plasma cotinine. The Wechsler Intelligence Scale for Children, the Neuropsychological Assessment of Executive Functions for Children (ENFEN) and the School Neuropsychological Maturity Questionnaire were administered at 7.5 years of age. The effect of PSE on child IQ and neuropsychological function was assessed with ANCOVA, adjusting for obstetric, neonatal and sociodemographic factors.

Results: Children whose mothers smoked throughout pregnancy scored lower in interference (ENFEN) compared to unexposed children (F = 4.1; p = .008). The results showed no differences in other executive functions, verbal and visual memory and IQ between the PSE groups.

Conclusion: PSE had little effect on child neuropsychological outcome and was limited to mental flexibility. Nevertheless, these findings support further efforts aimed at encouraging mothers to quit smoking in pregnancy.     

Maternal and fetal outcome in women with antiphospholipid syndrome: a three-year observational study

Objectives: To assess prospectively the maternal and fetal outcome in women with primary antiphospholipid syndrome (APS) and to find out predictors of poor obstetric outcome.

Methods: A prospective observational study included 162 patients with primary APS who were divided into two groups, group 1 with previous thrombosis (n?=?74) and group 2 without previous thrombosis (n?=?88). Patients were followed from the start of pregnancy till delivery under standard treatment to detect maternal and fetal outcome.

Results: There was a significant difference between the two groups with higher rate of miscarriage (p?<?0.05), maternal venous thromboembolism (p?<?0.001), intrauterine fetal demise and neonatal death (p?<?0.05) in group 1. No significant difference between the two groups regarding the rate of preeclampsia, eclampsia, postpartum hemorrhage, prematurity and admission to neonatal intensive care unit (p?>?0.05). By univariate and multivariate analyzes in the whole study participants, previous thrombosis, triple positivity of APS antibodies, previous delivery before 34 weeks, the presence of antiβ2GP1 antibodies and maternal age above 30 years were independent predictors of pregnancy loss.

Conclusion: Poor obstetric outcome is higher in patients with previous thrombosis. The search for optimal prognostic markers and new therapeutic measures to prevent complications in APS patients is warranted.     

An antenatal prediction model for adverse birth outcomes in an urban population: The contribution of medical and non-medical risks

Objectivesin the Netherlands the perinatal mortality rate is high compared to other European countries. Around eighty percent of perinatal mortality cases is preceded by being small for gestational age (SGA), preterm birth and/or having a low Apgar-score at 5 minutes after birth. Current risk detection in pregnancy focusses primarily on medical risks. However, non-medical risk factors may be relevant too. Both non-medical and medical risk factors are incorporated in the Rotterdam Reproductive Risk Reduction (R4U) scorecard.We investigated the associations between R4U risk factors and preterm birth, SGA and a low Apgar score.Designa prospective cohort study under routine practice conditions.Settingsix midwifery practices and two hospitals in Rotterdam, the Netherlands.Participants836 pregnant women.Interventionsthe R4U scorecard was filled out at the booking visit.Measurementsafter birth, the follow-up data on pregnancy outcomes were collected. Multivariate logistic regression was used to fit models for the prediction of any adverse outcome (preterm birth, SGA and/or a low Apgar score), stratified for ethnicity and socio-economic status (SES).Findingsfactors predicting any adverse outcome for Western women were smoking during the first trimester and over-the-counter medication. For non-Western women risk factors were teenage pregnancy, advanced maternal age and an obstetric history of SGA. Risk factors for high SES women were low family income, no daily intake of vegetables and a history of preterm birth. For low SES women risk factors appeared to be low family income, non-Western ethnicity, smoking during the first trimester and a history of SGA.Key conclusionsthe presence of both medical and non-medical risk factors early in pregnancy predict the occurrence of adverse outcomes at birth. Furthermore the risk profiles for adverse outcomes differed according to SES and ethnicity.Implications for practiceto optimise effective risk selection, both medical and non-medical risk factors should be taken into account in midwifery and obstetric care at the booking visit.     

Female Sexual Function during Pregnancy and after Childbirth

IntroductionHealthy sexual function during pregnancy and after childbirth is one of the cornerstones for couples to evolve from partners to parents.AimThe aim of our review is to evaluate the available evidence and define present knowledge about female sexual function during pregnancy and after childbirth.MethodsPubMed was searched for articles on sexual function during pregnancy and after childbirth, published from 1960 up to date. The most relevant articles have been reviewed and included.Main Outcome MeasuresThe main outcome is the review of the effect of pregnancy, delivery, and postpartum on female sexuality.ResultsA total of 48 articles which specifically addressed this topic were included. Sexual function was found to have a significant global decline during pregnancy, particularly in the third trimester and this persisted for 3–6 months following delivery. The lack of adequate information about sex in pregnancy and concerns about the possible adverse obstetric outcomes are the most relevant factors responsible for the avoidance of sexual activity during pregnancy. Breast-feeding, dyspareunia, and postpartum pelvic floor dysfunction were reported as possible causes for the delay in resuming sexual intercourses after childbirth.ConclusionsCouples should be informed about the decline of libido, desire and orgasm, commonly encountered during pregnancy, particularly in the last trimester, and puerperium which may lead to reduction in sexual intercourse frequency. Serati M, Salvatore S, Siesto G, Cattoni E, Zanirato M, Khullar V, Cromi A, Ghezzi F, and Bolis P. Female sexual function during pregnancy and after childbirth.     

Incidence and Perinatal Outcome of Multiple Pregnancies After Intracytoplasmic Sperm Injection Compared to Standard In Vitro Fertilization

Purpose: Our purpose was to assess the incidence of multiple pregnancies and their obstetric outcome after intracytoplasmic sperm injection. Methods: The study group comprised women who delivered twins or triplets after intracytoplasmic sperm injection and standard in vitro fertilization. The incidence and main perinatal outcome of 140 multiple pregnancies resulting from intracytoplasmic sperm injection or standard in vitro fertilization treatment were analyzed. Results: A total of 60 multiple pregnancies was obtained after intracytoplasmic sperm injection (3.4 ± 1.1 embryos/cycle) and 80 after standard in vitro fertilization (3.3 ± 2.0 embryos/cycle). The incidence of multiple pregnancy, i.e., 22.6 compared to 20.7%, respectively, was calculated. The obstetric outcome of 47 multiple pregnancies after intracytoplasmic sperm injection was 39 twin deliveries at between 27 and 37 weeks of gestation (mean, 36 ± 3.3) and 8 successful triplet deliveries between 26 and 36 weeks of gestation (mean 32.6 ± 2.4). The outcome after regular in vitro fertilization was similar. No major malformations were observed. Conclusions: The results of this study showed that the incidence of multiple pregnancies after intracytoplasmic sperm injection was similar to that after standard, conventional in vitro fertilization. The perinatal outcome did not differ between both groups.     

Treatment of twenty-two patients with complete uterine and vaginal septum

Study ObjectiveTo assess the fertility and obstetric outcome after surgical treatment of complete uterine and vaginal septum.DesignRetrospective study (Canadian Task Force Classification II-2).SettingTeaching hospital in France.PatientsTwenty-two women who have experienced infertility, pregnancy losses, dyspareunia, or dysmenorrhea.InterventionHysteroscopic section of complete uterine septum and resection of longitudinal vaginal septum.Measurements and Main ResultsImprovement of dyspareunia or dysmenorrhea and obstetric outcome, focusing on the miscarriage rate, obstetric complications, and the gestational age at delivery were assessed. Overall, 20 women had conceived a total of 37 pregnancies, with 10 and 8 deliveries before and after metroplasty, respectively. Median gestational age at delivery was not significantly different in both groups (36.5 [33–39.5] vs 38.0 weeks’ gestation [35–40], respectively). Preterm delivery occurred in 4 cases (25%) before the surgery and in 3 cases (14%) after (p = .44). The live birth rate was also not significantly different before and after surgery (62.5% and 38%, respectively) (p = .19). There was a decrease of caesarean section and significantly fewer breech deliveries after metroplasty (p = .01). A decrease in the prevalence of dyspareunia or dysmenorrhea was observed after metroplasty in the 19 patients originally displaying these symptoms. No perioperative complications were observed in this series.ConclusionResection of vaginal septum and hysteroscopic metroplasty for complete uterine septum with resection of the cervical septum is a safe procedure that may improve dyspareunia and dysmenorrhea when present. Reproductive and obstetric outcomes after this procedure do not appear to be compromised, even though a relatively high miscarriage rate remains after metroplasty, questioning its systematic practice in symptom-free women without any previous obstetric history.     

Database Autopsy: An Efficient and Effective Confidential Enquiry into Maternal Deaths in Canada

BackgroundMaternal death surveillance in Canada relies on hospitalization data, which lacks information on the underlying cause of death. We developed a method for identifying underlying causes of maternal death, and quantified the frequency of maternal death by cause.MethodsWe used data from the Discharge Abstract Database for fiscal years 2013 to 2017 to identify women who died in Canadian hospitals (excluding Quebec) while pregnant or within 1 year of the end of pregnancy. A sequential narrative based on hospital admission(s) during and after pregnancy was constituted and reviewed to assign the underlying cause of death (based on the World Health Organization's framework). Maternal deaths (i.e., while pregnant or within 42 days after the end of pregnancy) and late maternal deaths (i.e., more than 42 days to a year after the end of pregnancy) were examined separately.ResultsWe identified 85 maternal deaths. Direct obstetric causes included 8 deaths (9%) related to complications of spontaneous or induced abortion; 9 (11%), to hypertensive disorders of pregnancy; 15 (18%), to obstetric hemorrhage; 11 (13%), to pregnancy-related infection; 16 (19%), to other obstetric complications; and <5 (<6%), to complications of management. There were 21 (25%) maternal deaths with indirect obstetric causes, and <5 (<6%) with undetermined causes. Of 120 late maternal deaths, 16 (13%) had direct obstetric causes, among them, 9 deaths by suicide (56%). One hundred late maternal deaths (83%) had indirect obstetric causes; and <5 (<4%) had undetermined causes.ConclusionsThe majority of maternal deaths in Canada have direct obstetric causes, whereas most late maternal deaths have indirect obstetric causes. Suicide is an important direct cause of late maternal death.     

Obstetric Risks and Outcomes of Refugee Women at a Single Centre in Toronto

ObjectivesWomen who are refugees during pregnancy may be exposed to homelessness, poor nutrition, and limited access to health care, yet the pregnancy outcomes of this vulnerable population have not been systematically evaluated. We undertook a study to determine the risk of adverse obstetric and perinatal outcomes among refugee women in Toronto.MethodsUsing a retrospective cohort design, we examined pregnancy outcomes for refugee and non-refugee women delivering at St. Michael’s Hospital in Toronto, between January 1, 2008, and December 31, 2010. The primary outcome measures were preterm delivery (< 37 weeks’ gestational age), low birth weight (< 2500 g), and delivery by Caesarean section.ResultsMultiparous refugee women had a significantly higher rate of delivery by Caesarean section (36.4%), and a 1.5-fold increase in rate of low birth weight infants when compared with non-refugee women. In subgroup analysis by region of origin, women from Sub-Saharan Africa had significantly higher rates of low birth weight infants and Caesarean section than non-refugee control subjects. Further, compared with non-refugee control subjects, refugee women had significantly increased rates of prior Caesarean section, HIV-positive status, homelessness, social isolation, and delays in accessing prenatal care.ConclusionsRefugee women constitute a higher-risk population with increased rates of adverse obstetric and perinatal outcomes. These findings provide preliminary data to guide targeted public health interventions towards meeting the needs for obstetric care of this vulnerable population. Recent changes to the Interim Federal Health Program have highlighted the importance of identifying and diminishing disparities in health outcomes between refugee and non-refugee populations.     

Teenage pregnancy and ethnicity in the Netherlands: frequency and obstetric outcome

Objectives To study differences in frequency and obstetric outcome of teenage pregnancy (not ending in induced abortion) between the main ethnic groups in the Netherlands. Design A retrospective cohort study based on the 1990–93 birth cohort in the National Obstetric Registry.

Subjects A total of 10 583 teenagers and 54 501 20–24-year-old women who had a singleton pregnancy and were primiparous.

Main obstetric outcome measures These were perinatal death occurring between the 16th week of pregnancy and 24 h after birth, preterm birth and operative delivery (vaginal extraction and Cesarean section).

Method Comparison of the frequency of teenage pregnancy between ethnic groups and by bivariate and multivariate analysis of the three outcome measures between the teenage groups, the teenage groups and ethnically related 20–24-year-old women, and the teenage groups and Dutch 22–24-year-old women.

Results A total of 55.2% of pregnant teenagers had non-Dutch ethnicity compared to 13.8% of all pregnant women. Islamic-Mediterranean teenagers constituted the largest group, one in four of all primiparous Mediterranean women being younger than 20 years of age, followed by black teenagers.

Except for Hindustani teenagers, perinatal death occurred in all non-Dutch teenage groups more frequently than in Dutch teenagers, but the differences were only significant for black teenagers (odds ratios of black compared to Dutch teenagers were 2.89 (95% confidence interval (CI) 1.89–4.4) and 1.53 (95% CI 1.19–1.98), respectively). Rates for preterm birth were higher in black and Asian than in Dutch teenagers, but the difference was only significant for black teenagers (odds ratio 1.53, 95% CI 1.19–1.98). Compared to ethnically related 20–24-year-old women, rates of perinatal death and preterm birth were significantly higher in Dutch, black and Asian teenagers and, for preterm birth only, in Mediterranean teenagers. Correction for preterm birth showed that only part of these differences in perinatal death could be explained by preterm birth.

Vaginal extraction and Cesarean section occurred less frequently in teenagers than in ethnically related (and in Dutch) 20–24-year-old women. Mediterranean teenagers had the lowest Cesarean section rate and Blacks the lowest vaginal extraction rate.

Conclusion Teenage pregnancy in the Netherlands is much more common in minority ethnic groups than in the indigenous population, particularly among Islamic-Mediterraneans and Blacks. Obstetric outcomes vary considerably, these being best in Hindustani and poorest in black teenagers, and being worse in teenagers than in 20–24-year-old women. However, teenagers less often had assisted delivery.

The results of this study were first reported in the Nederlands Tijdschrift voor Geneeskunde 1999;143:465-71     

Improved pregnancy outcome following earlier splenectomy in women with immune thrombocytopenia: a 5-year observational study

Objective: To assess prospectively the maternal and fetal outcome in women with immune thrombocytopenic purpura (ITP) who undergone earlier splenectomy compared to women on medical therapy.

Methods: A 5-year observational study included pregnant women in the first trimester previously diagnosed with primary ITP with 74 patients underwent splenectomy before pregnancy and 86 patients on medical therapy. Patients were followed throughout pregnancy and labour to record their obstetric outcome. Data were collected and tabulated.

Results: There was a higher platelet count in the splenectomy group at enrollment (p?p?p?p?p?p?p?p?p?Conclusion: Earlier splenectomy in patients with ITP may have a beneficial impact on obstetric outcome and should be explained to patients wishing to get pregnant. Further larger multicenter studies are warranted to confirm or refute our findings.