Pregnancy outcome after third trimester amniocentesis: a single center experience

Objective: To evaluate pregnancy outcome following late amniocentesis (>24 weeks of gestation). Study design: A retrospective cohort of all women with singleton pregnancy that underwent late amniocentesis in one tertiary center. Results: Pregnancy outcome was validated in 168 women who underwent late amniocentesis. Overall, for the all study group the mean gestational age for amniocentesis was 31.6?±?2.3 weeks and the mean gestational age at delivery was 38.1?±?2. Indications for late amniocentesis included abnormal ultrasonographic findings (n?=?120), suspected intrauterine infection (n?=?23), advanced maternal age (n?=?13), abnormal first or second trimester biochemical markers (n?=?8) and others. The overall rate of spontaneous preterm delivery (<37 weeks) was 8% (13/168) with mean gestational age at delivery of 34.7?±?1.3. In only five cases (3%), delivery occurred ≤ 34 weeks of gestation. In one case (0.60%) of amniocentesis performed at 32 weeks of gestation, delivery occurred within 48 hours and in other four cases (2.40%) delivery occurred within 10 days. When amniocentesis was performed due to ultrasonographic findings to rule out chromosomal abnormalities (n?=?117/182), abnormal karyotype was found only in three cases. Conclusions: The risk of significant prematurity following late amniocentesis is low. This information is important when counseling patients considering performing one.     

Brachial plexus injury: a 23-year experience from a tertiary center

OBJECTIVE: The purpose of this study was to analyze the data on brachial plexus injury and its relationship with shoulder dystocia from a tertiary center for a 23-year period. STUDY DESIGN: A review of the logbooks on labor and delivery and the nursery and the International Classification of Diseases codes identified all newborn infants with brachial plexus injury who were delivered at our center. RESULTS: During the 23 years (1980-2002), there were 89,978 deliveries, of which there were 85 cases of brachial plexus injury (1/1000 births) with vaginal delivery. The injury was permanent (> or =1 year) in 12% of the cases, and only 2 cases have been litigated. Newborn infants that weighed > or =4 kg were significantly more common among those infants who had shoulder dystocia and brachial plexus injury than those infants without injury (odds ratio, 6.55; 95% CI, 2.30, 18.63). The rate of permanent brachial plexus injury was similar between the 2 groups. CONCLUSION: A case of brachial plexus injury occurs 1 time in every 1000 births, is permanent in 1 of every 10,000 deliveries, and is litigated 1 time for every 45,000 deliveries. The infrequent nature of injury may preclude prevention.     

Clinical manifestations of pregnancy in patients with Takayasu arteritis: experience from a single tertiary center

Objectives  

Takayasu arteritis predominantly affects young women of reproductive age; therefore, the management of pregnancies with this disease is of great importance in clinical obstetrics. However, only a limited number of such cases have been reported in the English literature. Our aim in this study was to investigate the clinical features of pregnant women with Takayasu arteritis managed at a tertiary center in Japan.     

Fetal abnormalities leading to termination of singleton pregnancy: the 7-year experience of a single medical center

OBJECTIVE: To assess the distribution of fetal indications leading to termination of pregnancy (TOP) in our institute. METHODS: All pregnant women with singleton pregnancies who underwent TOP due to fetal abnormalities in our institute between January, 1998 and December, 2004 were divided between early TOP (<23 weeks' gestation) and late TOP (> or =23 weeks' gestation). RESULTS: There were 328 (71%) and 134 (29%) early and late TOPs, respectively. The TOPs were performed at a mean gestational age of 20.1 +/- 4.8 weeks. The groups varied significantly in the indications for TOP (p = 0.04), which were primarily structural abnormalities (mostly CNS) followed by chromosomal/genetic defects. Fetal structural abnormalities were more common in the late TOP group (62.7% vs 54.2%) while chromosomal-genetic defects were more common in the early TOP group (40% vs 29.1%, respectively). Fetal infection (mostly cytomegalovirus) was similar ( approximately 4%) for both groups. The early TOP group had significantly more hydrops, gastrointestinal, face and neck abnormalities, while the late TOP group had significantly more cardiovascular abnormalities (p < 0.01). CONCLUSIONS: The impact of early chromosomal/genetic screening contributes to early TOPs, while midgestation anomaly and cardiac scanning significantly contribute to late TOPs. Fetal infection contributes equally to both categories of TOPs.     

Fetal abnormalities leading to termination of twin pregnancies: the 17-year experience of a single medical center

Objective: To assess fetal abnormalities leading to termination of pregnancy (TOP) performed in twin pregnancies.

Method: The current study consisted of all women with dichorionic twin pregnancies (study group) who underwent TOP due to fetal abnormalities in our institute from 1999 to 2015. The data were compared to our registry of all parturient women with a singleton pregnancy (control group) that underwent TOP due to fetal anomalies at the same period.

Results: There were 2495 cases of TOP because of fetal indications during the study period. Of them, 86 (3.4%) and 2409 (96.6%) were from the study and control group, respectively. Structural anomalies were the leading indication for TOP in twins compared with singleton pregnancies (81.4% versus 50.9%, respectively, p?p?p?Conclusions: We found a different distribution for fetal anomalies leading to TOP in twins versus singleton pregnancies. The main indication for TOP in the study group was structural malformations, with a predominance of CNS abnormalities.     

Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey

Objective: The aim of present study was to evaluate the indications and the complications associated with neonatal exchange transfusion (ET) performed for hyperbilirubinemia.

Methods: This study included overall 306 neonates who underwent ET between 2005 and 2012. The demographic characteristics of patients, causes of jaundice and adverse events occurred during or within 1 week after ET were recorded from their medical files. Those newborns that underwent ET were classified as either “otherwise healthy” or “sick” group.

Results: Of the 306 patients who underwent ET, 244 were otherwise healthy and had no medical problems other than jaundice. The remaining 62 patients were classified as sick that had medical problems other than jaundice ranging from mild to severe. The mean gestational age was 37.6?±?2.5 weeks and the mean peak total bilirubin levels was 25.8?±?6.6?mg/dl. The mean age at presentation was 5.4?±?3.8?d for all infants. The most common cause of hyperbilirubinemia was ABO isoimmunization (27.8%). None of newborns died secondary to ET. Three infants had had necrotizing enterocolitis, and also three infants had had acute renal failure. The most common encountered complications of ET procedure were hyperglycemia (56.5%), hypocalcaemia (22.5%) and thrombocytopenia (16%).

Conclusions: Our data showed that ABO isoimmunization was the most common cause of hyperbilirubinemia. Even mortality was not seen, very rare but major gastrointestinal and renal complications were associated with ET. The majority of adverse events associated with ET were laboratory abnormalities mainly hyperglycemia, hypocalcaemia and thrombocytopenia which were asymptomatic and treatable.     

Outcomes and complications of severe acute postpartum hemorrhage treated with or without transarterial embolization in a single tertiary referral center: A 20-year experience

ObjectivePPH is usually unpredictable; and such fast, urgent and sudden massive life-threating hemorrhage. This study is to assess the efficacy of transarterial embolization (TAE) in treating severe PPH in a single institution over a period of 20 years.Materials and methodsFrom January 2000 to October 2019, all women with acute PPH more than 1500 cc and/or DIC were enrolled in this retrospective study. These women were divided into two groups according to whether they have received TAE as the second-line treatment. Group 1 (n = 27) included women without receiving TAE from January 1, 2000 to October 31, 2009, and group 2 (n = 30) included those who receiving TAE from November 1, 2009 to October 31, 2019.ResultsThe overall success rate of TAE in control the PPH and preserved the uterus is 80%. The hemoglobin 12 h after PPH in group 2 is significantly lower than in group 1 (7.64 ± 1.6 vs. 8.58 ± 1.9, respectively. P = 0.05). Total unit of packed red blood cell (pRBC) transfusion is significantly higher in the group 2 than group 1 (9.8 ± 5.7 vs. 6.8 ± 3.9; p = 0.03). The rate of hysterectomy is significantly higher in group 1 than group 2 (46.7 vs. 20%; p < 0.001).ConclusionIn conclusion, TAE is safe and effective in control bleeding in PPH with a high success rate to preserve uterus and prevent DIC. TAE should be routinely used as a secondary line of treatment during PPH in all hospitals.     

Revisiting the fetal loss rate after second-trimester genetic amniocentesis: a single center's 16-year experience

OBJECTIVE: To estimate an institution's specific fetal loss rate after a second-trimester genetic amniocentesis. METHODS: This is a retrospective cohort study using our prenatal diagnosis database for all pregnant women presenting for care between 1990 and 2006. We compared the fetal loss rate in women who underwent amniocentesis between 15 and 22 weeks of gestation with those women who did not have any invasive procedure and had a live fetus documented on ultrasound examination between 15 and 22 weeks. Only singleton gestations were included. Logistic regression analysis was used to adjust for potential confounders between the groups. RESULTS: Among 58,436 women meeting the inclusion criteria, complete outcome data were available for 51,557 (88%), 11,746 (91%) in the amniocentesis group and 39,811 (87%) in the group that did not have amniocentesis. The fetal loss (miscarriages and intrauterine fetal death) rate in the amniocentesis group was 0.4% compared with 0.26% in those without amniocentesis (relative risk 1.6, 95% confidence interval [CI] 1.1-2.2). Fetal loss less than 24 weeks (including induction for ruptured membranes and oligohydramnios) occurred in 0.97% of the amniocentesis group and 0.84% of the group with no procedure (P=.33). The fetal loss rate less than 24 weeks attributable to amniocentesis was 0.13% (95% CI -0.07 to 0.20%) or 1 in 769. The only subgroup that had a significantly higher amniocentesis attributable fetal loss rate was women with a normal serum screen (0.17%, P=.03). CONCLUSION: The institutional fetal loss rate attributable to amniocentesis is 0.13%, or 1 in 769 at Washington University School of Medicine. The total fetal loss rate was not significantly different from that observed in patients who had no procedure.     

High frequency oscillatory ventilation in children: experience of a medical center in Taiwan.

BACKGROUND/PURPOSE: Data about the effectiveness of high frequency oscillatory ventilation (HFOV) in children with respiratory failure are limited. This study investigated the efficacy and prognostic factors of this treatment. METHODS: Children between 2 months and 18 years of age who received HFOV between January 2000 and September 2006 in a tertiary care center were enrolled in this retrospective study. RESULTS: Thirty-six HFOV treatments were given to 33 patients (twice in one patient and three times in another patient) at a mean age of 5.4 +/- 5.0 years. HFOV was used as a rescue after conventional mechanical ventilation (CMV) for 4.4 +/- 4.2 days. The mean duration of HFOV was 7.6 +/- 7.9 days. The most common indication for HFOV was oxygenation failure, which was due to pneumonia with acute respiratory distress syndrome in 15 (45.5%), severe lobar pneumonia in nine (27.3%), pulmonary hemorrhage in eight (24.2%) and pneumothorax in one (3%). PaCO2 was significantly improved 4 hours after HFOV and the PaO2/FiO2 ratio increased significantly 12 hours later. The oxygenation index and alveolar-arterial oxygen difference P(A-a)O2, however, did not change markedly. Four (12%) patients needed further extracorporeal life support and two of these survived. The overall survival rate was 45.5%. Patients with heavier body weight (p less than 0.05) and of the male gender (p less than 0.05) had a higher risk of mortality. CONCLUSION: As a relatively late rescue therapy after failure of CMV, HFOV may improve PaCO2 and PaO2/FiO2 in children with respiratory failure. However, it carries an increased mortality rate in patients with heavier body weight and male gender.     

Treatment outcome of pulmonary tuberculosis in eastern Taiwan - experience at a medical center.

BACKGROUND/PURPOSE: The World Health Organization (WHO) has proposed that treatment outcome is an important indicator of tuberculosis control. This study investigated the outcome of tuberculosis treatment at a medical center in eastern Taiwan. METHODS: A total of 166 pulmonary tuberculosis patients notified by Tzu Chi Hospital in 2002 were included in this study. Treatment outcome data were collected at the local level and categorized according to WHO recommendations as cured, treatment completed, failed, died, defaulted, or transferred. Outcomes of the 166 patients, as reported by the National Tuberculosis Program were obtained from the Taiwan Center for Disease Control (Taiwan CDC) for comparison. RESULTS: Of the 166 patients, outcome was classified as cured in 46 (27.7%), treatment completed in 73 (44.0%), died in 27 (16.3%), treatment failed in five (3.0%), and defaulted in 15 (9.0%). Males were more likely to die or to default than females, and the elderly were more likely to die than younger patients. Patients with comorbidities were significantly more likely to die than patients without (p = 0.025). Patients with a history of tuberculosis were more likely to default (p = 0.050). Smear-positive patients were more likely to fail, and patients without cavitation on chest radiograph were more likely to have successful treatment. Outcomes of 26 (15.7%) cases in this cohort were unavailable (18 cases) or inaccurate (8 cases) on the Taiwan CDC website. CONCLUSION: The unsatisfactory outcome of pulmonary tuberculosis treatment in this medical center in eastern Taiwan highlights the importance of implementing directly observed treatment short course strategy. Improvement in the quality of data reported by the National Tuberculosis Program is urgently needed.     

Laparoscopic management of complications in gynecologic laparoscopic surgery: a 5-year experience in a single center

Study ObjectiveTo evaluate the feasibility and efficacy of laparoscopic management of complications without conversion to laparotomy in gynecologic laparoscopic surgery.DesignRetrospective clinical study (Canadian Task Force classification III).SettingUniversity teaching hospital.PatientsA total of 2668 women who underwent gynecologic laparoscopic surgeries from March 2003 through February 2008.InterventionsGynecologic laparoscopic surgeries.Measurements and Main ResultsWe investigated major complications during gynecologic laparoscopic surgery. Based on patients’ medical records, we reported types of laparoscopic surgery, types of complication, early recognition of complications, and treatment method of complications. Overall, 33 (1.24%) complications occurred in this study. There were 18 (0.67%) bladder injuries, 6 (0.22%) major vessel injuries, 3 (0.11%) bowel injuries, 3 (0.11%) ureteral injuries, 2 (0.07%) diaphragmatic injuries, and 1 (0.04%) intravesical foreign body. In all, 32 of 33 complications were successfully repaired laparoscopically. In 1 case, rectal perforation occurred on the third day after surgery; Hartmann operation followed by colostomy reversal was performed.ConclusionLaparoscopic management of complications in gynecologic laparoscopic surgery is feasible and efficient.     

Central nervous system lupus and pregnancy: 11-year experience at a single center

Objective: To describe the pregnancy outcomes in women with central nervous system (CNS) manifestations of lupus. Methods: Between 1991 and 2002, the outcome of five pregnancies in four patients with CNS lupus were retrospectively reviewed. All patients had an established history of systemic lupus erythematosus (SLE), and either a history of CNS lupus or active CNS lupus. Pregnancy outcomes assessed included term and preterm birth, intrauterine growth restriction, abnormal antepartum testing, perinatal mortality, pre-eclampsia and other maternal morbidities. Results: Evidence of active CNS lupus symptoms developed in three of the five pregnancies. Two pregnancies were complicated by early onset pre-eclampsia, abnormal antepartum testing and extreme prematurity, with one subsequent neonatal death. The remaining three pregnancies had good neonatal outcomes, but were complicated by severe maternal post-pregnancy exacerbations, and the eventual death of one patient. Conclusions: CNS lupus in pregnancy represents an especially severe manifestation of SLE, and may involve great maternal and fetal risks.     

Survival prospects of extremely preterm infants: a 10-year experience in a single perinatal center.

During a 10-year period, 1977 to 1986, 233 (53%) of 442 inborn live births between 23 and 28 weeks' gestation survived; their 1-year survival rate was 7% at 23 weeks, 30% at 24 weeks, 31% at 25 weeks, 55% at 26 weeks, 67% at 27 weeks, and 71% at 28 weeks. No significant change in survival rate was observed over the years. Twelve percent of pregnancies and 20% of infants were multiple gestations. Singleton births had significantly higher survival rates compared with multiple births (58% versus 41%). The obstetric intervention rate, as measured by the frequency of cesarean section, increased significantly over the years: from 15% in 1977-1978 to 33% in 1985-1986. The neonatal intervention rate, as measured by the frequency of live births offered neonatal intensive care, remained unchanged. Ten percent were not treated: 4% had major malformations and 6% were considered "nonviable." Active perinatal management, which assumed fetal-neonatal viability, accounted for better survival rates compared with centers with a more passive management policy. Information on survival based on gestational cohorts plays an important role in helping obstetricians, neonatologists, and parents make appropriate management decisions.     

Surgical treatment of congenital cystic adenomatoid malformation: a retrospective study of single tertiary center experience

Objective: To summarize the experience drawn from treatment of fetus with congenital cystic adenomatoid malformation (CCAM).

Methods: This retrospective report has reviewed a clinical history of 115 patients with CCAM from September 2012 to June 2014. All cases were divided into two groups according to symptomatology: group A (n?=?96, asymptomatic group) and group B (n?=?19, symptomatic group). Major factors were compared between two groups. Numerical data were presented as the median (range). The difference between median was performed with ANOVA.

Results: The mean gestational age of prenatal diagnosis was 24.3 weeks (range, 17–36). 49 cases with CCAM volume ratio (CVR) were retrospectively analyzed, with a median max CVR of 0.95 (range, 0.19–3.2), In the 115 cases, mean operation age was (3.7?±?0.32) months old. Symptom is significantly associated with lesion size and chest radiographs (CXR) (p < 0.05). Compared with symptomatic CCAM patients, asymptomatic patients were associated with better clinical outcome.

Conclusions: The value of CVR to evaluate prognosis showed no statistical significance. Although CXR are not reliable indicators to assess the lesion, it can predict the emergency situation. Due to potential trend of symptomatic and poor postoperative symptoms group, early postnatal CT scan and early surgical treatment are suggested.