67例早发型重度子痫前期患者围产儿预后分析

目的目的探讨67例早发型重度子痫前期患者围产儿预后及相关影响因素。方法回顾性分析2003年12月-2010年3月在北京友谊医院妇产科妊娠28～33＋6周分娩的67例早发型重度子痫前期患者的临床资料,探讨围产儿预后及相关影响因素。结果 71例（双胎4例）围产儿中胎死宫内13例,治疗性引产过程中死产5例,新生儿重度窒息死亡8例,1例出生后4d因ARDS死亡,围产儿总死亡率380‰（27/71）;新生儿出生缺陷发生率70%（5/71）。45例存活的新生儿中失访11例,34例新生儿随访1个月～6年,1例产后10d死亡,1例产后1＋个月发现脑瘫,31例新生儿后期发育未见明显异常。影响围产儿死亡的相关因素：新生儿出生体重（P=0.000）、分娩孕周（P=0.001）、规律产检（P=0.03）、期待治疗的天数（P=0.04）;与胎死宫内明显相关的因素为胎盘早剥（P=0.037）、严重FGR（P=0.001）。与围产儿死亡不相关的因素：孕妇年龄、产次、体重指数、平均动脉压、24h尿蛋白。结论早发型重度子痫前期孕妇围产儿死亡率较高,母体严重并发症和孕周是影响围产儿死亡的主要因素,加强围产期保健、积极防治并发症、适时终止妊娠可改善围产儿预后。     

A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups

Objective: To determine the risk factors of adolescent pregnancies and to ascertain the effects of this condition on the maternal and infant outcomes. Methods: The study was carried out on 100 adolescent mothers less than 20 years of age and on a same number of adult mothers between 22 and 32 years of age and their infants. A socio-demographic attributes questionnaire form, a pregnancy follow-up and birth history form, and a mother and infant follow-up form were used. Results: The mean age of the adolescent mothers was 17.8?±?0.7 years and that of the adult mothers was 26?±?0.3 years. Income level of 83% of the families of adolescent mothers and 69% of the families of adult mothers was below the poverty line (p < 0.05). Dropout rate (i.e. rate of those not attending any school) was 36% in the adolescent group and 21% in the adult group. Rate of exclusively breastfeeding during the first 2 months was 40% in adolescents and 62% in adults (p < 0.01). Higher rates of adolescent mothers felt themselves inadequate infant care and with 7% of them experiencing problems in accessing a healthcare institution. Conclusions: Properly following up adolescent pregnancies during prenatal and postnatal periods may be helpful for preventing the negative impacts on mother and infant health.     

Maternal and neonatal outcomes among pregnant women with fibromyalgia: a population-based study of 12 million births

Purpose: Fibromyalgia (FM) is a rheumatologic disorder marked by chronic, widespread pain and associated comorbid conditions. The purpose of our study was to evaluate the effect of FM on maternal and neonatal outcomes.

Methods: Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1999 to 2013, we conducted a population-based retrospective cohort study consisting of women who delivered during that period. Logistic regression was used to compare maternal and neonatal outcomes among pregnancies in women with and without FM.

Results: Of 12 584 918 births during the 15-year study period, 7758 (0.06%) were to women with FM with rates increasing over the study period. Women with FM were more commonly older in age, overweight or obese, and users of alcohol, tobacco, and illicit drugs. They were more likely to experience anxiety, depression, and bipolar disorder. Women with FM were at greater risk of gestational diabetes, preterm premature rupture of membranes, and placental abruption. Women with FM more commonly had cesarean deliveries (odds ratios (OR): 1.11, 95% CI: 1.05–1.16) and births complicated by venous thromboembolism (OR: 2.34, 95% CI: 1.91–2.86). Infants of women with FM were more likely to be premature (OR: 1.35, 95% CI: 1.25–1.46) and have intrauterine growth restriction (OR: 1.48, 95% CI: 1.30–1.68).

Conclusions: The prevalence of FM in pregnancy is rising in the US. FM is a high-risk pregnancy condition associated with adverse maternal and newborn outcomes.     

Fatherhood and the meaning of children: an ethnographic study among Puerto Rican partners of adolescent mothers

This study of the male partners of adolescent mothers was conducted in a small urban city in the northeastern United States where adolescent birth rates remain high despite declining national trends. Despite stated opposition to adolescent birth, one third of the fathers interviewed planned their pregnancies with their partners for more than a year. Because poverty and violence were part of life in the community of these fathers, the experience of having children initiated self-reflection. Men did not value absence from their children's lives, and they recognized their own agency in constructing a fatherless reality for their children. Thus, having children gave men an opportunity to consider alternative possibilities for their lives. This study suggests that despite widespread efforts to prevent teenage pregnancy, children born to adolescent mothers provide the fathers of these children with an affirming and valued component of self-identity.     

Birth Centers in Australia: A National Population‐Based Study of Perinatal Mortality Associated with Giving Birth in a Birth Center

ABSTRACT: Background: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in “alongside hospital” birth centers in Australia during 1999 to 2002 using nationally collected data. Methods: This population‐based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4‐year study period separately for first‐time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low‐risk term babies born in hospitals compared with deaths of term babies born in birth centers. Results: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low‐risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low‐risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. Conclusions: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother’s parity. (BIRTH 34:3 September 2007)     

Pregnancy and neonatal characteristics of opioid-dependent Indigenous Australians: A rural and metropolitan comparison

Aims: To identify maternal, obstetric and neonatal characteristics of opioid-dependent Indigenous Australians in rural and metropolitan settings.
Methods: Retrospective cohort study of 232 metropolitan and 67 rural infants born to mothers maintained on methadone throughout pregnancy for the treatment of opiate dependency, between January 2000 and December 2006. Medical records of identified mother/infant dyads were reviewed by evaluating 20 different maternal, obstetric and neonatal parameters.
Results: The number of infants of opiate-dependent mothers (IODMs) identified to be of Aboriginal ethnicity was 47 in the rural and 50 in the metropolitan setting. This reflected a significantly higher proportion in the rural versus metropolitan areas (70.1% vs 21.6%, P  < 0.05). The effect of rurality was independent of ethnicity with significantly lower rates of neonatal withdrawal requiring treatment ( P  < 0.001), antenatal consultations ( P  < 0.01), department of community services (DoCS) involvement ( P  < 0.001) and shorter infant lengths of stay ( P  < 0.001). There was a non-significant trend towards more intrauterine growth restriction in Aboriginal infants. There were no significant differences in parameters in rural Indigenous versus rural non-Indigenous infants.
Conclusions: Significant differences exist between rural and metropolitan IODMs in terms of less attendance at antenatal consultations, less neonatal withdrawal requiring treatment, shorter average length of hospital stay for the infant and less documented DoCS involvement. These differences maybe a reflection of a different diagnostic and management approach. Ethnicity had no major clinical impact in either the rural or the metropolitan settings. Future research comparing the long-term outcomes would be of interest.     

Does young maternal age increase the risk of adverse obstetric,fetal and neonatal outcomes: A cohort study

Objective

To determine whether young maternal age is associated with increased risks of adverse obstetric, fetal and perinatal outcomes.

Study design

Register-based study using the data from a computerized database of a University Hospital for the years 1994–2001. The study population included 8514 primiparous women aged less than 31 who delivered a singleton infant. Using maternal age as a continuous variable, crude and adjusted relative risks (RRs) were estimated for each maternal and perinatal outcome.

Results

Crude and adjusted RRs of anaemia during pregnancy and fetal death consistently increased with younger maternal age. After adjustment for confounding factors, RRs (95% confidence interval) of fetal death and anaemia were respectively 1.37 (1.09–1.70) and 1.27 (1.15–1.40) for a 16-year-old compared to a 20-year-old mother. Younger mothers had significantly decreased risks of obstetric complications (preeclampsia, caesarean section, operative vaginal delivery and post-partum haemorrhage). Higher prevalence of prematurity and low birth weight in infants born to teenagers were not attributable to young maternal age after adjustment for confounding factors.

Conclusion

In our population, younger maternal age was significantly and consistently associated to greater risks of fetal death and anaemia and to lower risks of adverse obstetric outcomes.     

Hyperemesis gravidarum and neonatal outcomes: A systematic review of observational studies

Hyperemesis gravidarum (HG) is associated with adverse somatic and psychological effects. The impact of HG on neonatal outcomes is debatable given that disagreeing research results have appeared. The objective of this study was to systematically review, according to the PRISMA guidelines, and synthesize the available evidence from observational studies on the relationship between HG and neonatal outcomes. The PubMed, Scopus, and Science Direct databases were systematically reviewed, with the last search carried out in April 2020. The quality of the studies was estimated using the Newcastle–Ottawa Scale (NOS) for non-randomized studies. The databases search yielded 516 studies 15 of which (n = 112.372 HG cases) matched eligibility criteria while the majority of the studies were of moderate quality (n = 12). We observed heterogeneity among the studies regarding the definition of HG and characteristics of the samples. The results of this systematic review suggest that it is still uncertain whether HG has an adverse impact on neonatal outcomes, fact that requires more studies to be conducted.     

Cortisol level and perinatal outcome in pregnant women with posttraumatic stress disorder: a pilot study

Posttraumatic stress disorder (PTSD) affects 12% of women in the United States and could affect childbearing via behavioral and neuroendocrine mechanisms. This pilot study collected preliminary data about the extent to which the low cortisol profile found in patients with PTSD also occurs in the hormonal context of pregnancy, as well as the association between PTSD and less optimal processes and outcomes of pregnancy. Standardized psychiatric diagnostic telephone interviews, salivary cortisol assays, and medical records review were evaluated in a community sample of 25 women pregnant with their first child. Higher PTSD symptom counts correlated with worse overall perinatal outcomes summarized by an Optimality Index Score (n = 22; r = -.725; P < .001). The women whose symptoms met diagnostic criteria for PTSD or partial PTSD had lower peak basal salivary cortisol concentrations (n = 14; mean = .4584 versus .8123; P = .010). Further research on the effects of PTSD on pregnancy processes and outcomes is warranted. Differences in cortisol levels were consistent with the pattern seen in nonpregnant women with PTSD. This finding suggests that salivary cortisol would be a useful biological measure to include in perinatal research on PTSD and childbearing.     

Benefits and risks of low molecular weight heparin use on reproductive outcomes: A retrospective cohort study

ObjectiveLow molecular weight heparin (LMWH) has been given to reproductive-age women with various indications. This study aims to assess the benefits and risks of such use.Materials and methodsWe retrospectively reviewed data (n = 204) between Jan 2016 and May 2019. Logistic regression analysis was conducted to evaluate the correlation between indications and reproductive outcomes.ResultsLMWH use had higher odds of live birth in women less than 30 years of age (OR: 4.98; 95% CI = 1.13–21.98; p = 0.034) and with protein S deficiency (OR: 3.90; 95% CI = 1.77–8.59; p = 0.001). For the subgroup of recurrent pregnant loss, LMWH use was only advantageous to women with protein S deficiency (OR: 2.45; 95%:1.01–5.97; p = 0.048). Risks such as preterm delivery, small-for-gestational-age, placental abruption, antepartum/postpartum hemorrhage were not significantly increased among subgroups. Women treated with LMWH and who had successful live births (n = 171) had a slightly increased risk of postpartum hemorrhage compared to controls (n = 8058) during this period in our institution (2.9% vs 1.2%, p < 0.001).ConclusionLMWH administration produces a higher chance of live-birth to women younger than 30 years of age or with protein S deficiency. However, risk of postpartum hemorrhage is increased.     

Pregnancy and perinatal outcomes among women with multiple sclerosis: a retrospective case-controlled study in South Hungary

Abstract

Objective: The aim of this study was to investigate the connections between multiple sclerosis (MS) and fertility, pregnancy.

Methods: The case histories and pregnancy complications in a sample of 65 treatment-naive pregnant women with MS in the period 1998–2012 were compared with an age-matched case-controlled analysis. Comparisons were made between primigravidas and multigravidas subjects.

Results: Our results revealed a higher rate of miscarriage (18.46%) in the first trimester in women with MS, and intrauterine death (7.69%) in the third trimester, as compared with women without MS (p?<?0.001 and p?=?0.035).

Conclusions: These findings suggest that, the risk of miscarriages and intrauterine death may be disease-related not drug-related feature. Further studies are needed to determine to possible associated factors of miscarriages.     

Increased incidence of obstetric and perinatal complications in pregnancies achieved using donor oocytes and single embryo transfer in young and healthy women. A prospective hospital-based matched cohort study

In this single-center matched-cohort study, women who underwent IVF/ICSI with donor oocytes between 2007 and 2014 (n?=?259) were compared to women undergoing autologous cycles during the same time period (n?=?515). The matching (1:2) took into consideration the women’s age, type of treatment (IVF/ICSI), and year of embryo transfer. All women were healthy and below 40?years of age at the time of IVF/ICSI, and the treatments were performed using a strict policy of single embryo transfer. Multiple logistic regression analysis, adjusted for body mass index (BMI), smoking, and parity, showed a four times increased risk of gestational hypertensive disorders (adjusted odds ratio, AOR 4.25; 95% confidence interval (CI), 2.61–6.92) and pre-eclampsia (AOR 3.99; 95% CI 2.27–7.00) in pregnancies achieved with donor oocytes. There was also a higher rate of cesarean section in women who gave birth after oocyte donation (AOR 1.69; 95% CI 1.22–2.35) and a higher risk of postpartum hemorrhage >1000?mL (AOR 1.59; 95% CI, 1.11–2.27). After further adjustment for preeclampsia in the logistic regression analysis, no additional increased perinatal risks were found. The incidence of preterm delivery, low weight at birth, need of neonatal intensive care, Apgar scores, and incidence of perinatal death were also similar between the groups.