A comparison of maternal and neonatal outcomes of pregnancy with mental disorders: results of an analysis using propensity score-based weighting

Purpose

To assess and compare maternal and neonatal outcomes of pregnancy with or without mental disorders.

Methods

We performed a retrospective cohort study of births at our institution from January 2009 to December 2011, which included all live singleton births during these 3 years. Women emergently transferred to our institution in the middle of their pregnancies were excluded. Associations between mental disorders and perinatal outcomes were estimated using statistical analysis, and multivariable analysis was performed using propensity score-based weighting.

Results

A total of 1,166 women were included, 152 (13.0 %) of whom had mental disorders. Comparison of maternal characteristics showed that women with mental disorders were significantly more likely to be multiparous, smokers, recipients of public assistance, unmarried, and to have inadequate perinatal care. Comparison of perinatal outcomes showed that preterm births (PTB) before 37 weeks were significantly increased in women with mental disorders (10.5 vs. 6.0 %, P = 0.037). There were no significant differences in low birth weight (LBW), pregnancy-induced hypertension, and gestational diabetes mellitus. Multivariable analysis using propensity score weighting showed that after adjusting for other factors, women with mental disorders were more likely than women without mental disorders to have PTB before 34 weeks [adjusted odds ratio (OR) 4.79, 95 % confidence interval (CI) 1.49–15.4; P = 0.009], PTB before 37 weeks (adjusted OR 2.46, 95 % CI 1.62–3.69; P < 0.001), or LBW (adjusted OR 1.83; 95 % CI 1.32–2.55; P < 0.001).

Conclusion

Maternal mental disorders were associated with adverse birth outcomes and socioeconomic disadvantage.     

Value of follicular fluid vitamin D in predicting the pregnancy rate in an IVF program

Purpose

This study investigated whether there is a correlation between levels of 25OH-D in the follicular fluid and the serum of infertile women and the results of IVF and rates of pregnancy. The association between the levels of 25OH-D in the follicular fluid and the vitamin D repletion status was also assessed.

Methods

Two hundred and twenty-one infertile women participated in an IVF cycle from 2010 to 2011 in a prospective observational study. Serum and follicular fluid were collected for vitamin D analysis. Deficient, insufficient, and sufficient levels of vitamin D were defined as 10, 10–29, and 30–100 ng/ml, respectively. IVF cycle parameters and clinical pregnancy rates were also compared with the vitamin D level.

Results

The levels of vitamin D deficiency, insufficiency, and sufficiency were 22.6, 70.1, and 7.2 %, respectively. The fertilization rates associated with these three levels of vitamin D were 43.17, 53.37, and 58.77 %, respectively, (P = 0.054), and the implantation rates were 17.33, 15.26, and 18.75 %, respectively, (P = 0.579). No significant correlation was seen between the pregnancy rate and the serum vitamin D level (P = 0.094) or the follicular vitamin D level (P = 0.170). The serum and follicular fluid vitamin D levels showed a significant correlation (P = 0.000).

Conclusion

Although vitamin D is an important hormone in the human body, no correlation was found between the serum and follicular vitamin D level and the pregnancy rate in the IVF cycle.     

Intra-operative hydrotubation improves fertility of women with distal tubal occlusion after reproductive surgery

Purpose

Hydrotubation has been considered to be a complimentary procedure to reproductive surgery, usually being conducted after surgery. The objective of this work was to assess the potential value of intra-operative hydrotubation in improving fertility of tubal infertile women.

Methods

180 tubal infertile women were randomly assigned to one of the three groups: intra-operative hydrotubation (IH), post-operative hydrotubation (PH) or control group. In IH group, the hydrotubation was performed immediately after adhesiolysis during the surgery process, while in PH group it was performed within 3–7 days after the first post-operative menstruation. The incidence of post-operative pelvic infection and average hospitalization length were recorded. The post-operative pregnancy outcomes, including intrauterine pregnancy (IUP) rate and incidence of ectopic pregnancy, were recorded at 2 years follow-up.

Results

No significant difference was found among the three groups, either in the incidence of pelvic infection (P = 0.877) or in the average hospitalization length (P = 0.596). At 2 years of follow-up, the rate of IUP in IH group was significantly higher than that in either PH or control group (P = 0.017 and 0.039, respectively), but no difference was observed between PH and control group (P = 0.752). No significant difference in the incidence of ectopic pregnancy was showed among three groups (P = 0.947).

Conclusions

The appropriate use of intra-operative hydrotubation can improve the post-operative IUP rate, serving as a complementary procedure for the surgical treatment of fertility reversal.     

Impact of vaginal ascorbic acid on abnormal vaginal microflora

Background

In recent years, it has become evident that ovarian stimulation, although a central component of in vitro fertilization (IVF), may itself has detrimental effects on oogenesis, embryo quality, endometrial receptivity, and perhaps also perinatal outcomes.

Objective

To evaluate the effect of higher gonadotrophin dose on clinical pregnancy rate in normo-responder ICSI cycles with long protocol.

Methods

A retrospective study was planned in the Department of Reproductive Endocrinology of Zekai Tahir Burak Women’s Health Education and Research Hospital. 362 normo-responders undergoing ICSI cycles with long protocol were included in the study. Group 1 (n = 260): Total gonadotrophin dose <2198 IU and Group 2 (n = 102): Total gonadotrophin dose >2198 IU. Laboratory IVF outcome, clinical pregnancy rate were evaluated.

Result(s)

There was no statistically significant difference between peak estradiol levels, endometrial thickness, fertilization rates among the Group 1 versus Group 2 (p > 0.05). But there was a statistically significant difference in age, baseline FSH, oocyte number, 2PN, and clinical pregnancy among the Group 1 versus Group 2. Clinical pregnancy rate were significantly higher in Group 1 compared with Group 2 (p < 0.001). Lower gonadotrophin dose, 2PN was an independent positive predictor of clinical pregnancy (OR 2.65 for gonadotrophin dose, OR 1.1 for 2PN)

Conclusion(s)

Higher total gonadotrophin dose adversely affect clinical pregnancy in normo-responder patients undergoing ICSI cycles with long protocol.     

Risk of childhood overweight or obesity associated with excessive weight gain during pregnancy: a meta-analysis

Purpose

Several investigations have shown that the risk of childhood overweight and obesity may be associated with excessive gestational weight gain (GWG), but the study samples were limited and results were mixed; hence we conducted this meta-analysis to assess the explicit association between them and present evidence.

Methods

We searched PubMed, EMbase, Ovid, Web of knowledge and Cochrane library for relevant studies. Bibliographies from retrieved articles were also manually searched. Cohort studies that presented results by OR or RR with 95 % CI for the association of maternal excessive GWG and child overweight/obesity were included. The pooled estimates were calculated by fixed-effect model or random-effect model according to the heterogeneity.

Results

Twelve cohort studies were identified, and the combined OR of excessive GWG and childhood overweight/obesity was 1.33 (95 % CI 1.18–1.50) with evidence of heterogeneity (P = 0.000, I ² = 71.1 %). Adjustment of maternal BMI, investigation area, age of children, research type, and omission of any single study had little effect on the pooled estimate. After eliminating the effect of publication bias by trim and fill analyses, the result still remained statistically significant (OR 1.21, 95 % CI 1.05–1.40).

Conclusions

This meta-analysis suggests that the risk of childhood overweight/obesity is significantly associated with excessive gestational weight gain.     

The diagnostic and prognostic value of serum YKL-40 in endometrial cancer

Purpose

To evaluate the diagnostic and prognostic value of serum YKL-40 in endometrial cancer (EC).

Methods

Serum YKL-40 levels were detected and compared in 34 of the 50 cases with EC before surgery, in 22 of the 34 with EC after surgery, in 30 cases with uterine myoma, and in 30 healthy women as normal controls. Receiver operating characteristics (ROC) curves were adopted for diagnosis and calculation of area under each ROC curve in EC. The progression-free survival (PFS) and overall survival (OS) between YKL-40 positive and negative patients were compared in the follow-up.

Results

The mean pre-operative serum YKL-40 values were significantly higher than that in the uterine myoma cases and in the healthy women (P = 0.000). The mean post-operative serum YKL-40 in the 22 EC cases was significantly lower than pre-operative serum YKL-40 levels in these cases (P = 0.000). There were critical differences between the area under ROC curve for YKL-40 and CA125 (P = 0.053). The PFS and OS for the YKL-40-positive patients were significantly shorter than those for the YKL-40-negative patients.

Conclusion

Preliminary investigations have shown that serum YKL-40 level may have a definite clinical value in the diagnosis and prognosis of EC.     

Membrane stripping to prevent post-term pregnancy in Enugu, Nigeria: a randomized controlled trial

Objectives

This study aimed at evaluating the effectiveness and safety of membrane stripping at 40–41 weeks of gestation as a means of preventing post-term pregnancy and the need for formal induction of labor in Enugu, Nigeria.

Methodology

A randomized controlled trial of 134 post-date pregnant women at the University of Nigeria Teaching Hospital, Enugu, Nigeria, from February to November 2012. The intervention group received membrane stripping while the control group did not receive membrane stripping.

Results

The incidence of post-term pregnancy in the membrane stripping group was 16.1 % (10/62) versus 39.3 % (24/61) in the control group (RR 0.41; 95 % CI 0.22–0.78; P = 0.004; NNT = 4). Membrane stripping reduced the duration of pregnancy by 3 days (P < 0.001). The procedure also significantly reduced the need for ‘formal’ labor induction [7/62 (11.3 %) vs. 23/61 (37.7 %); RR 0.30; 95 CI 0.14–0.65; P = 0.002]. However, maternal and neonatal complications were similar between the two groups.

Conclusion

Membrane stripping reduces the incidence of post-term pregnancy and need for formal induction of labor in post-date pregnant women, without increased maternal or neonatal complications.     

Magnesium supplementation to prevent high blood pressure in pregnancy: a randomised placebo control trial

Purpose

To assess if hypertension during the last part of pregnancy could be prevented by magnesium supplementation.

Methods

Pregnant primagravida women from a local antenatal care unit were given an oral supply of 300 mg magnesium as citrate or placebo from pregnancy week 25 in a randomised double-blind setup. Blood pressure was recorded during pregnancy as well as pregnancy outcome.

Results

In the magnesium-supplemented group, the average diastolic blood pressure at week 37 was significantly lower than in the placebo group (72/1.4 mean/SEM vs 77/1.4, p = 0.031). The number of women with an increase in diastolic blood pressure of ≥15 mmHg was significantly lower in the magnesium group compared with the women who received placebo (p = 0.011). There was an inverse relation between the urinary excretion of magnesium during pregnancy and the diastolic blood pressure (p = 0.005).

Conclusions

Magnesium supplementation prevented an increase in diastolic blood pressure during the last weeks of pregnancy. The relation between diastolic blood pressure and urinary excretion of magnesium suggests that magnesium is involved in the regulation of blood pressure and that the increase in diastolic blood pressure in pregnancy could be due to a lack of magnesium.     

Association of the Glutathione S-transferases M1 and T1 polymorphism with male infertility: a meta-analysis

Background

Genes of different pathways regulate spermatogenesis, and the complexity of the spermatogenic process indicates that polymorphisms or mutations in these genes could cause male infertility. Published data on the association between the GSTM1 and GSTT1 polymorphism and male infertility risk are inconclusive. To derive a more precise estimation of the relationship, a meta-analysis was performed.

Methods

A total of 11 studies regarding GSTM1 and 9 studies regarding GSTT1 between 1999 and 2012 were identified through researching MEDLINE, EMBASE and the Chinese Biomedical Database. It was performed to obtain summary estimated odd ratios and 95 % confidence intervals of GSTM1 and GSTT1 for male infertility, with attention to study quality and publication bias.

Results

Overall, a significant association was seen between GSTM1 (OR?=?1.20, 95 % CI?=?1.02–1.40, P_{heterogeneity}?=?0.000, P?=?0.027) genotypes and male infertility. Significant associations were also observed in subgroups of Caucasian populations (OR?=?1.65, 95 %CI?=?1.16–2.34, P_{heterogeneity}?=?0.006, P?=?0.005), but were not observed in Asian populations (OR?=?1.09, 95 % CI?=?0.72–1.65, P_{heterogeneity}?=?0.054, P?=?0.697) when stratified by ethnicity. While there was no significant association was seen between GSTT1 (OR?=?1.00, 95 % CI?=?0.74–1.35, P_{heterogeneity}?=?0.000, P?=?0.980) null genotypes and male infertility. Simultaneously, significant associations were not observed in subgroups of Caucasian populations (OR?=?0.94, 95 %CI?=?0.44–2.00, P_{heterogeneity}?=?0.000, P?=?0.867) and Asian populations (OR?=?0.93, 95 % CI?=?0.46–1.87, P_{heterogeneity}?=?0.002, P?=?0.838) when stratified by ethnicity.

Conclusion

Our results suggest the GSTM1 null genotype contributes to male infertility susceptibility, while GSTT1 gene polymorphisms are not associated with male infertility in our study.     

Nifedipine Versus Ritodrine for Suppression of Preterm Labor and Analysis of Side Effects

Objectives

To compare the tocolytic efficacy of Nifedipine and Ritodrine, their adverse effects and neonatal outcome.

Design

Prospective randomized trial.

Methods

One hundred twenty women with clinical features of preterm labor fulfilling designated inclusion and exclusion criteria were enrolled in the study. They were allocated to either nifedipine group or Ritodrine group by using simple randomization technique. Tocolytic efficacy, maternal side effects and neonatal outcomes were evaluated. Tools of statistical analysis used were Epi Info software and Chi square test.

Results

Tocolysis was successful i.e., prolongation of pregnancy for 48 h in 54 (90%) women in Nifedipine group as compared to 41 (68.3%) women in Ritodrine group (P value = 0.003 and χ² = 8.54). The prolongation of pregnancy up to 37 weeks was observed in 28 women (46.6%) in Nifedipine group compared to 16 women (26.6%) in Ritodrine group (P value = 0.033). 18 women (30%) in Nifedipine group had side effects compared to 48 women (80%) in Ritodrine group (P value < 0.001). Neonatal outcome was similar in both the groups.

Conclusion

Oral Nifedipine is cheaper and effective alternative which has fewer and less serious side effects as compared to I.V. Ritodrine for suppression of the preterm labor.     

Haplotype analysis of single nucleotide polymorphisms in anti-Müllerian hormone gene in Chinese PCOS women

Purpose

Anti-Müllerian hormone (AMH) inhibits FSH-stimulated follicle growth and aromatase activity. The three fold higher serum AMH in PCOS patients may account for the increased number of small follicles and androgen level. We attempted to determine whether polymorphisms in AMH gene were associated with PCOS in Chinese han population.

Methods

A case–control study involving 475 PCOS patients and 512 normoovulatory women was conducted. Rs10407022 and rs8112524 were two tagging SNPs selected according to the HapMap database. Taqman assay was used for rs8112524 genotyping, and PCR–RFLP method for rs10407022.

Results

No significant difference was found in genotypic or allelic distributions of both of the two SNPs, rs10407022 and rs8112524, between PCOS women and controls. LH level and progesterone level were significantly higher in rs8112524 AA genotype in PCOS group (P = 0.012, 0.014 respectively). TA haplotype might enhance susceptibility to PCOS (P = 0.013, OR = 4.996, 95 % CI = 2.001–5.251), and GA haplotype might be protective (P = 0.000, OR = 0.117, 95 % CI = 0.049–0.417).

Conclusions

Although individual TagSNPs in AMH gene do not affect susceptibility to PCOS, haplotypes of the two SNPs were associated with PCOS risk, as TA haplotype might enhance susceptibility to PCOS and GA inversely.     

Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study

Objective

The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with uterine malformations.

Study design

This was a retrospective population-based cohort study including women with a diagnosis of uterine malformation arised from workup for infertility or recurrent pregnancy loss, was accidental during pregnancy, or was noticed at the time of cesarean delivery.

Results

A total of 280,721 pregnancies met the inclusion criteria and were divided into two study groups: (1) pregnancies in women with uterine malformations (n = 1099); and (2) controls (n = 279,662). The rate of women presenting uterine malformations was 0.39%. The prevalence of cervical os insufficiency was significantly higher in women with a uterine malformation than in the control group (3.6 vs. 0.4%, p < 0.001). A multivariate analysis, performed to evaluate risk factors for cervical insufficiency in women with uterine malformations. Mullerian anomalies (OR 6.19, 95% CI 4.41–8.70, p < 0.001), maternal age (OR 1.05, 95% CI 1.04–1.06, p < 0.001), recurrent abortions (OR 12.93, 95% CI 11.43–14.62, p < 0.001), and ethnicity (OR 2.86, 95% CI 2.454–3.34, p < 0.001) were found to be independently associated with the development of cervical insufficiency.

Conclusion

Uterine anomalies have a strong association with cervical insufficiency. Women with uterine anomalies have an increased risk to develop pregnancy complications that arise from a loss in cervical function during the midtrimester or early third trimester.

     

Bevacizumab in the treatment of ovarian cancer: a meta-analysis from four phase III randomized controlled trials

Background

The aim of this meta-analysis was to summarize the efficacy and safety of bevacizumab in the treatment of ovarian cancer.

Methods

We sought to identify randomised controlled trials (RCTs) by searching PubMed and Web of Science. Outcomes were objective response rate (ORR), progression-free survival (PFS), overall survival (OS), and adverse events.

Results

Four studies with 4,246 patients were included. Combination of bevacizumab and chemotherapy resulted in a statistically significant improvement in ORR (OR 2.165, 95 % CI 1.511–3.103) and in PFS (HR 0.691, 95 % CI 0.517–0.865), compared with chemotherapy alone. There was no evidence of a significant improvement in OS (HR 0.934, 95 % CI 0.826–1.041). It also had significantly increased risk of gastrointestinal events (OR 2.743, 95 % CI 1.580–4.763; P < 0.001), hypertension (OR 4.630, 95 % CI 3.737 to 5.737; P < 0.001), proteinuria (OR 4.872, 95 % CI 2.617–9.069; P < 0.001), and arterial thromboembolism (OR 1.994, 95 % CI 1.210–3.286; P = 0.007).

Conclusion

This meta-analysis suggests that the addition of bevacizumab to chemotherapy offers meaningful improvement in objective response rate and progression-free survival in ovarian cancer treatment, but does not benefit overall survival. It also significantly increased the occurrence of gastrointestinal events, hypertension, proteinuria, and arterial thromboembolism.     

Is serum placental growth factor more effective as a biomarker in predicting early onset preeclampsia in early second trimester than in first trimester of pregnancy?

Purpose

To determine whether maternal serum placental growth factor (PlGF) is more effective as a biomarker in predicting the occurrence of early onset preeclampsia in first trimester or early second trimester of pregnancy.

Methods

A prospective cohort study was conducted on women with singleton pregnancies, screened from the antenatal clinic. Serum PlGF estimation was done at 11–14 weeks of gestation on 1,244 women and at 22–24 weeks of gestation on 1,206 women from the initial study population. A cut-off value of <228 pg/ml for serum PlGF at 11–14 weeks of gestation and <144 pg/ml for serum PlGF at 22–24 weeks of gestation were determined by receiver operating characteristic (ROC) curve analysis for identifying pregnant women at risk of developing early onset preeclampsia (<32 weeks of gestation). Univariate logistic regression analysis was used to analyze the association between serum PlGF < 228 pg/ml at 11–14 weeks of gestation and <144 pg/ml at 22–24 weeks of gestation with the occurrence of early onset preeclampsia and odds ratio (OR) was computed. P value < 0.05 was considered statistically significant in this study.

Results

Maternal serum PlGF <144 pg/ml at 22–24 weeks of gestation had a stronger association (OR 18.83; 95 % CI 12.08–22.24; p = 0.000) than serum PlGF <228 pg/ml at 11–14 weeks of gestation (OR 2.76; 95 % CI 1.29–3.94; p = 0.007) with the occurrence of early onset preeclampsia. The sensitivity and specificity of serum PlGF <144 pg/ml at 22–24 weeks of gestation (84 and 78, respectively) were much higher than those of serum PlGF <228 pg/ml at 11–14 weeks of gestation (58 and 66, respectively) in predicting early onset preeclampsia.

Conclusion

Maternal serum PlGF may be more effective as a biomarker in early second trimester than in first trimester of pregnancy, in predicting the occurrence of early onset preeclampsia.     

Outcome of Gestational Diabetes Mellitus from a Tertiary Referral Center in South India: A Case–Control Study

Background

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational diabetes mellitus (GDM) poses numerous problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women.

Study Design

A case–control study with 286 cases and 292 age-matched controls was conducted for a period of 11 months (August 2007–June 2008) in Sree Avittom Thirunal Hospital, Thiruvananthapuram, India.

Materials and Methods

Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed.

Statistical Analysis

Univariate analysis was done by means of t test, Odd’s ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant.

Results

The frequency of induction of labor was significantly higher than spontaneous labor (OR = 1.84, P = 0.001). 40.1 % GDM mothers and 35.8 % of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor (OR = 1.66, P = 0.04). Babies of diabetic mothers had a positive trend toward prematurity (OR = 2.3, P = 0.007). Hypoglycemia was the most common neonatal complication (OR = 11.97, P < 0.001) and nine babies of diabetic mothers were macrosomic (OR = 5.2, P = 0.02).

Conclusions

Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.     

Fertility,pregnancy outcomes and deliveries following myomectomy: experience of a French Caribbean University Hospital

Background

Myoma is the most common benign tumor in women of childbearing age, with a high frequency in Afro-Caribbean than in other women. Depending on their number, size and location, myomas are suspected to be a cause of infertility. Conservative treatment by myomectomy is possible for symptomatic patients wishing to preserve their fertility.

Purpose

The aim of this study was to evaluate the fertility of patients undergoing myomectomy in the University Hospital of Pointe-à-Pitre, Guadeloupe.

Methods

We conducted a retrospective study including all patients under age 42 who had conservative surgery from January 1st, 2005 to December 31st, 2009. The main judgment criteria were the occurrence of postoperative pregnancy and its outcome.

Results

Of 297 operated patients, 220 were interviewed by phone (74.1 %), 124 (56.3 %) had tried to obtain a pregnancy and 54 patients (43.5 %) had 66 pregnancies (59.1 % being live births and 25.8 % miscarriages). For fertility after surgery, univariate analysis identified the number (more than 6, P = 0.0027) and an intramural location (P = 0.027) of myomas as negative factors and multivariate analysis identified age (over 35 years, RR = 2.45) and the association of other causes of infertility (RR = 2.21) as negative factors for pregnancy.

Conclusion

The modest conception rate (43.5 %) after myomectomy among those women trying to obtain a pregnancy may be linked to the specificities of our population, and in particular its relatively high age and the frequent association of multiple causes of infertility.     

Late Pregnancy Outcomes in Women with Vaginal Bleeding in Their First Trimester

Purpose

First trimester vaginal bleeding (FTVB) does not usually terminate the pregnancy. However, its outcome is a matter of debate. This study sought to assess the outcomes of pregnancies, complicated by FTVB.

Methods

In this cohort study, 236 gravida 1 and 2 FTVB patients with delivery after 28 weeks of gestational age, admitted to Imam Hossein Hospital during 2009–2010, were evaluated. The control group consisted of 944 gravida 1 and 2 women without any history of vaginal bleeding. Late pregnancy outcomes such as gestational hypertension, preeclampsia, placental abruption, preterm delivery, and premature rupture of membranes in the mothers and low birth weight (LBW), intrauterine growth restriction(IUGR), Apgar score at 5 min <7, and NICU admission in the infants were evaluated. Logistic regression was used for estimation of odds ratios (OR) and 95 % confidence interval.

Results

Compared to controls, the FTVB cases had more premature rupture of membranes (OR = 10), gestational hypertension (OR = 5.3), and placental abruption (OR = 4.7), while their infants had higher odds of LBW, IUGR, Apgar score at 5 min <7, and admission to NICU too. The incidence of premature rupture of membranes was 3.6 % in the controls and 27.1 % in the cases (RR = 10, P < 0.001). The incidence of gestational hypertension and LBW was 1.5 and 7.2 % (P < 0.001) in the controls and 6.6 and 12.3 % (P < 0.001) in the cases. The other outcomes were similar in both groups.

Conclusion

FTVB may play a role in the development of late pregnancy outcomes in mothers and infants. Thus, it is recommended to evaluate some interventions on FTVB cases to prevent complications.     

Prediction of Pre-Eclampsia by a Combination of Maternal History, Uterine Artery Doppler, and Mean Arterial Pressure (A Prospective Study of 200 Cases)

Objective

To determine the clinical value of uterine artery Doppler Pulsatility index (PI) at 22–24 + 6 weeks scan and importance of maternal history and mean arterial pressure (MAP) in the prediction of pre-eclampsia.

Materials and Methods

This was a prospective screening study of 200 women with singleton pregnancy. Maternal history and blood pressure were recorded, and MAP was calculated. Transabdominal Doppler ultrasound of uterine artery was performed. Mean PI was calculated, and the presence or the absence of bilateral early diastolic notch was noted. Women were then followed up through pregnancy and delivery for the development of pre-eclampsia, gestational hypertension, and SGA.

Results

The mean ± SD PI value for subjects who had an adverse pregnancy outcome was significantly higher (0.84 ± 0.28) than mean ± SD PI value for subjects who had normal pregnancy outcome (0.71 ± 0.16) with P value <0.000.

Conclusion

Second trimester uterine artery Doppler is a useful screening method for identification of high risk pregnancy in women who can be kept under close surveillance for better maternal and neonatal outcome. This test works better when combined with previous history of pre-eclampsia and MAP.     

Perinatal outcomes of pregnant women with cervical intraepithelial neoplasia

Objective

To investigate the perinatal outcomes of pregnant women with cervical intraepithelial neoplasia (CIN).

Method

The women in this retrospective case–control study were recruited from Beijing Obstetrics and Gynecology Hospital from August 1, 2007 to February 28, 2010. All the cases were 13–32 gestational weeks, who were diagnosed by colposcopy conducted cervical biopsy. A total of 108 cases were followed-up to the day of delivery.

Results

(1) Complications of colposcopy conducted cervical biopsy: there were two cases of pregnant women, who suffered cervical local compression after undergoing colposcopy conducted cervical biopsy, as the bleeding could not be stopped, the wound was treated by local suture. The incidence of such event was 1.8 % (2/108), without any colposcopy and biopsy-related adverse event. (2) Cesarean section rate was 63.6 % (56/88) in CIN, which was higher than 30.0 % (6/20) in cervicitis, and the cesarean section rate increased as CIN grades elevated, and gestational weeks of delivery advanced.(P < 0.05). (3) We did not detect significant difference for the incidence of polyhydramnios, premature rupture of fetal membranes, placental abruption, cervical laceration and postpartum hemorrhage, low birth weight infants, amniotic fluid II–III degree, neonatal deformity and neonatal asphyxia between pregnant women with CIN and cervicitis (P > 0.05); however, the incidence of oligohydramnios and premature infants in pregnant women with CIN group were higher than that in cervicitis group (P = 0.007; P = 0.020). (4) Vaginal delivery and HR–HPV infection did not increase the incidence of perinatal complication; the volume of postpartum hemorrhage within 2 h after birth in vaginal delivery was less than in cesearean section for pregnancies with CIN (P = 0.000).

Conclusion

Pregnant women with CIN can be diagnosed by colposcopy conducted cervical biopsy, and they should be carefully monitored oligohydramnios and preterm during pregnancy. Pregnant women with CIN during pregnancy, excluding other obstetric operation indications may choose vaginal delivery first.     

Pregnancy outcomes in women with mitral valve prolapse and mitral valve regurgitation

Purpose

To examine pregnancy and perinatal outcomes in patients with mitral valve disorders [mitral valve prolapse and/or mitral regurgitation; mitral valve disorders (MVD)].

Methods

A retrospective comparative study was conducted comparing all singleton deliveries, during the years 1988–2010, of women with and without known MVD. Women lacking prenatal care were excluded. Stratified analysis using logistic regression was performed to control for confounds.

Results

Out of 233,194 singleton deliveries that occurred during the study period, 390 deliveries occurred in women with MVD. Using a multivariate analysis, advanced maternal age (OR = 1.06; 95 % CI 1.05–1.08; P < 0.001), recurrent abortions (OR = 1.62; 95 % CI 1.15–2.28; P = 0.005), hypertensive disorders (OR = 1.62; 95 % CI 1.17–2.26; P = 0.004) and Jewish ethnicity (OR = 2.21; 95 % CI 1.76–2.79; P < 0.001) were found to be significantly associated with MVD. Since cesarean sections (CS) were significantly higher in deliveries of patients with MVD (17.9 vs. 14 %; P = 0.025), another multivariate analysis was constructed, with CS as the outcome variable. MVD was not found to be an independent risk factor for CS (OR = 1.05; 95 % CI 0.79–1.37; P = 0.74).

Conclusions

MVD associated with advanced maternal age, recurrent abortions, Jewish ethnicity and hypertensive disorders were not found to be an independent risk factor for CS.