Isolated fetal intracardiac hyperechogenic focus associated with neonatal outcome and triple test results

Objective To investigate the relationship between isolated intracardiac hyperechogenic focus (IHF) in the mid trimester of pregnancy with neonatal outcomes and triple test results. Materials and methods The study included low-risk pregnant women who came for routine follow-up to our antenatal clinic between years 2000 and 2005. A detailed structural survey by ultrasound (USG) of the fetal heart was performed on each fetus in the mid-trimester of pregnancy. All patients had mid-trimester triple tests performed between the 16th and 18th weeks’ of pregnancy. We recruited a total of 40 pregnancies that had fetal IHF in the level II USG examination and a control group of 100 healthy pregnant women those which were followed-up during the same period. Twenty-nine fetuses (72.5%) had left, 8 (20%) had right whereas 3 (7.5%) had bilateral ventricular IHF. We compared the perinatal and neonatal outcomes and triple test results of the fetuses that had right and left IHF, and the controls. Results Cytogenetic amniocentesis was performed to 6 (15%) women in the study and 5 (5%) in the control group and all were normal. During follow-up IHF spontaneously disappeared in 30 fetuses [right (n: 5), left (n: 23) or bilateral (n: 2)]. We did not observe any cardiac problem in the postnatal period in all newborns. Only one infant (2.5%) in the study group was admitted to neonatal intensive care unit because of prematurity. Median delivery weeks (P = 0.023), head circumference (P = 0.013), 5-min Apgar score (P = 0.021] and apnea (P = 0.042) were significantly higher in fetuses with right IHF. Compared to the controls, median delivery weeks (P = 0.038) was significantly higher in fetuses with right IHF, but head circumference (P = 0.004), 1-min (P = 0.003) and 5-min (P < 0.001) Apgar scores were lower in fetuses with left IHF. However no difference was observed in second-trimester serum human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and estriol (E₃) levels, in the three groups. There was no correlation between serum HCG, AFP and E₃ levels and the presence of IHF. Conclusions Isolated IHF in the fetal heart in the mid-trimester of pregnancy seems not associated with adverse neonatal outcome and does not correlate with triple test results.     

Placental pathologies associated with intra-uterine fetal growth restriction complicated with and without oligohydramnios

Purpose  To compare the placental pathologies and perinatal outcomes in fetal growth restriction (FGR) pregnancies with and without oligohydramnios. Methods  A retrospective cohort study, comparing placental findings in all singleton deliveries with FGR. Results  Macroscopic placental findings were available for 1,104 singleton FGR pregnancies. A total of 397 placentas were microscopically examined; of which 89 placentas were of FGR neonates who had oligohydramnios. No significant differences in placental vascular mal-perfusion were found between pregnancies with and without oligohydramnios (69.3 vs. 74.3%; P = 0.357). Likewise, no significant differences were noted between the groups regarding diffuse villous fibrosis (10.1 vs. 4.9%; P = 0.573), and amnion cell metaplasia (65.9 vs. 64.3%; P = 0.779). Cases of FGR complicated with oligohydramnios had significantly higher rates of perinatal mortality (9.9 vs. 5.9%; P = 0.028), preterm deliveries (34.9 ± 3.4 vs. 35.4 ± 3.1 weeks of pregnancy; P = 0.041), and lower birth weight (1,737 ± 542 vs. 1,845 ± 467 g; P = 0.002) compared to FGR without oligohydramnios. Conclusions  Oligohydramnios is a significant risk factor for adverse perinatal outcome in FGR pregnancies; nevertheless, no significant differences in placental pathologies were noted. Presented in part at the 29th Annual Meeting of the Society of Maternal Fetal Medicine (SMFM), San Diego, CA, USA, 26–31 January 2009.     

Mode of childbirth and neonatal outcome after external cephalic version: A prospective cohort study

Objectiveto assess the mode of childbirth and adverse neonatal outcomes in women with a breech presentation with or without an external cephalic version attempt, and to compare the mode of childbirth among women with successful ECV to women with a spontaneous cephalic presentation.Designprospective matched cohort study.Setting25 clusters (hospitals and its referring midwifery practices) in the Netherlands. Data of the Netherlands perinatal registry for the matched cohort.Participantssingleton pregnancies from January 2011 to August 2012 with a fetus in breech presentation and a childbirth from 36 weeks gestation onwards. Spontaneous cephalic presentations (selected from national registry 2009 and 2010) were matched in a 2:1 ratio to cephalic presentations after a successful version attempt. Matching criteria were maternal age, parity, gestational age at childbirth and fetal gender. Main outcomes were mode of childbirth and neonatal outcomes.Measurements and findingsof 1613 women eligible for external cephalic version, 1169 (72.5%) received an ECV attempt. The overall caesarean childbirth rate was significantly lower compared to women who did not receive a version attempt (57% versus 87%; RR 0.66 (0.62–0.70)). Women with a cephalic presentation after ECV compared to women with a spontaneous cephalic presentation had a decreased risk for instrumental vaginal childbirth (RR 0.52 (95% CI 0.29–0.94)) and an increased risk of overall caesarean childbirth (RR 1.7 (95%CI 1.2–2.5)).Key conclusionswomen who had a successful ECV are at increased risk for a caesarean childbirth but overall, ECV is an important tool to reduce the caesarean rate.Implication for practiceECV is an important tool to reduce the caesarean section rates.     

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.     

General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study

Objective.?To compare neonatal short-term outcome in patients who underwent spinal, general anaesthesia and conversion from spinal to general anaesthesia.

Methods.?One hundred seventy-nine pregnant women undergoing elective caesarean section were allocated randomly to general (n?=?89) or spinal anaesthesia (n?=?90) and compared with 63 patients who required conversion to general anaesthesia. Umbilical cord artery pH, Apgar score as well as its individual parameter and need for assisted ventilation were evaluated.

Results.?No differences were found in pH values (p?=?0.35), while the need for assisted ventilation differed significantly (p?=?0.001). The rate of depressed newborns was 1.1% in the spinal group, 25.9% in the general group and 12.7% in the conversion group with a significant difference for all comparisons. At 5-min, all newborns were vigorous. At 1?min, a higher score for each parameter was found in spinal group with respect to general group, while ‘activity’, ‘grimace’ and ‘respiration’ showed a higher score in conversion group than in general group. At 5?min, a difference was found only for ‘activity’.

Conclusions.?All kinds of anaesthesia seem to be safe, but loco-regional blockade shows more advantages on the neonatal outcome also when a conversion is necessary.     

The effects of high parity and socioeconomic status on obstetric and neonatal outcome

Summary We studied the interaction of social status and high partiy in 15,102 consecutive births in one inner-city hospital, of which 1874 (12.4%) occurred in mothers who had given birth to seven or more infants (Grand multiparae). Group 1 consisted of 1258 grand multiparae from a socioeconomically stable and homogeneous ultra-orthodox Jewish community in Jerusalem, and group 2, included all other grand multiparae of relatively greater age and lower socioeconomic status. A significantly higher rate of small for gestational age, low birth weight and preterm infants was found in group 2 compared with group 1. The results suggest that grand multiparity is not of itself a risk factor, but reflects the confounding effect of environmental conditions.     

Short- and long-term outcome of infants born after maternal (pre)-eclampsia, HELLP syndrome and thrombophilia: a retrospective, cohort study

Objectives

To investigate the short- and long-term outcome of children born from mothers with pre-eclampsia, eclampsia and/or HELLP syndrome, and to determine the differences between children born from mothers with and without underlying thrombophilic disorder.

Study design

Four hundred and nine infants (from 370 women) born between February 1991 and January 2006 were eligible for evaluation and were classified into group A (n = 162) and group B (n = 247). Thirty-four infants were not admitted to the hospital. Between-group differences were tested with regard to neonatal mortality, morbidity and follow-up measurements for neuromotor and mental development at 9 months and 2 years of age, using two-tailed Student's t-tests, Fisher's exact tests and logistic regression models.

Results

Of the 409 infants, 44 infants (10.8%; n = 20 group A/n = 24 group B) died. The mean gestational age in both groups was 31.9 (SD: 3.5) weeks. Of the 375 admitted infants 152 (40.5%) were related to a thrombophilic mother and 223 (59.5%) were not. Six children were lost to follow-up. At 9 months and 2 years of age development was assessed in 326 surviving children. At 9 months of age, 193 (59.2%; n = 66 group A/n = 127 group B) children showed a normal (52% group A versus 63.8% group B, P = 0.046), 24 (7.4%; n = 9 group A/n = 15 group B) a suspect and 14 (4.3%; n = 6 group A, n = 8 group B) an abnormal development during follow-up assessment. Ninety-five children (29.1%; n = 46 group A/n = 49 group B) did not have a follow-up assessment. At 2 years of age, 112 children (34.4%; n = 43 group A/n = 69 group B) had a normal, 21 (6.4%; n = 11 group A/n = 10 group B) a suspect and 17 (5.2%; n = 5 group A/n = 12 group B) an abnormal development. 176 children (54%; n = 70 group A/n = 106 group B) did not have a follow-up assessment.

Conclusion

Short-term outcome was not different between infants from mothers with or without thrombophilic disorders. At 9 months of age, the probability of having a normal development was significantly lower in children born from a mother with an underlying thrombophilic disorder than in those without. At 2 years of age, no differences in development were observed.     

Placental weight and neurologic outcome in the infant: a review

Objective: To review the agreement of published standards on placental weights (PW) and fetal–placental (F/P) ratios, examine factors contributing to PW and ask whether aberrant placental weight is associated with adverse neurologic outcome. Methods: We conducted a literature search for standards of PW, F/P ratio and the relationship of PW to perinatal death, neonatal encephalopathy or cerebral palsy. We reviewed 17 studies of normative PW and 10 of F/P ratios. Since 1990, seven studies compared mean and extreme percentile bounds between 35 and 42 weeks of gestation. Nine publications examined PW and neurologic outcome. Results: Untrimmed placentas were heavier by 131–193 g. F/P ratios differed by 0.2–2.34 between trimmed and untrimmed placentas. Fresh, frozen or fixed preparation prior to weighing had minimal effect on weight. Gender and race had negligible affect. Placentas from caesarean sections averaged 75 g heavier than vaginal deliveries. There were no consistent associations of aberrant PW and neurologic outcome. Conclusions: Reference standards of recent studies on trimmed placentas were largely in agreement. Current findings relating aberrant PW and adverse neurologic outcome are inconclusive. Further study of the relationship between placental weight and neonatal encephalopathy or cerebral palsy is warranted, in representative populations using within-study controls.     

Obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproductive technology compared with twin pregnancies conceived spontaneously: a prospective follow-up study

Objective

To compare the obstetric and neonatal outcomes of twin pregnancies conceived by assisted reproduction technology (ART) with spontaneously conceived (SC) twin pregnancies.

Study design

A prospective cohort study compared all dichorionic twin pregnancies in nulliparous women following fresh in vitro fertilization/intra-cytoplasmic sperm injection (ICSI) or ICSI cycles at Royan Institute (n = 320) with SC dichorionic twin pregnancies in nulliparous women at Arash Women's hospital (n = 170) from January 2008 to October 2010. These pregnancies were followed-up until hospital discharge following delivery. Obstetric and neonatal outcomes of SC and ART twin pregnancies were compared.

Results

Multivariate analysis, adjusted for maternal age and body mass index, revealed that the obstetric outcomes were similar in both groups. However, the risks of very preterm birth [odds ratio (OR) 5.2, 95% confidence interval (CI) 2.1–12.9], extremely low birth weight (OR 2.2, 95% CI 1.0–3.9), admission to a neonatal intensive care unit (OR 2.0, 95% CI 1.2–3.2) and perinatal mortality (OR 2.3, 95% CI 1.2–4.0) were higher in the ART group.

Conclusions

The maternal outcomes of ART dichorionic twins were comparable with those of SC twins. However, despite the same obstetric management, the rates of very preterm birth, extremely low birth weight, admission to a neonatal intensive care unit and perinatal mortality were significantly higher in the ART group.     

过期与延期妊娠胎盘形态学变化及其与妊娠结局的关系

目的 探讨过期、延期妊娠胎盘绒毛和胎盘床螺旋动脉的病变特点及其与胎儿预后的关系。方法 应用图像分析技术对过期妊娠２０例（过期组）、延期妊娠１５例（延期组）和正常足月妊娠２９例（对照组）,进行形态计量学观察。结果 过期组的胎盘重量减轻,绒毛合体细胞结节增多,细胞滋养细胞增生,基底膜增厚,纤维素样坏死,血管合体细胞膜形成,绒毛直径、周长、面积,胎盘床螺旋动脉管壁增厚,以及羊水过少和羊水粪染的发生率均与     

Twins and triplets: the effect of plurality and growth on neonatal outcome compared with singleton infants

OBJECTIVE: Information on outcome by gestational age from large numbers of twins and triplets is limited and is important for counseling and decision-making in obstetric practice. We reviewed one of the largest available neonatal databases to describe mortality and morbidity rates and growth in newborn infants from multiple gestations and compared these data with data for singletons. STUDY DESIGN: Data from a large prospectively recorded neonatal database that incorporated neonatal records from January 1997 to July 2002 were reviewed. We evaluated birth weight and neonatal mortality and morbidity rates that affected long-term outcome for each week of gestational age from 23 to 35 weeks of gestation for all nonanomolous inborn twins and triplets who were admitted to the neonatal intensive care unit and compared these data to all singletons who met similar criteria during the same time period. RESULTS: There were 12,302 twin and 2155 triplet births that met the entry criteria. The data for these newborn infants were compared with 36,931 singletons. Average birth weights at each gestational week were similar for all gestational ages until 29 weeks of gestation for triplets and 32 weeks of gestation for twins. After these gestational ages, the entire difference between twins and singletons was due to the weight of the smaller twin; the larger twins' mean weights were similar to singletons at all weeks that were studied. Birth order at each week also did not affect neonatal mortality rates, even when corrected for route of delivery and antenatal steroids. Neonatal morbidities associated with adverse long-term outcomes (intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis) were also not different between multiple infants and singletons. Intrauterine growth restriction (IUGR) was associated with increased mortality rates at all gestational ages, but in the absences of IUGR, discordance was not. CONCLUSION: Data on a large number of twins and triplets provide reassurance that neonatal outcome at all viable premature weeks of gestation are similar to singletons. Intrauterine growth restriction and prematurity are therefore the principal issues that drive neonatal mortality and morbidity rates in multiple gestations. These data are important for obstetric decision-making and patient counseling.     

Neonatal outcome following pregnancy exposure to antidepressants: a prospective controlled cohort study

Objective  To determine the incidence of early adverse effects associated with antidepressant drug use during pregnancy.
Design  Prospective, controlled cohort study.
Setting  A Drug and Health Information Centre in Milan, Italy.
Population  A total of 200 neonates exposed to antidepressants in utero and 1200 controls.
Methods  Women who took antidepressants during pregnancy and delivered liveborn children between 1995 and 2003 were selected. Each case was matched for maternal age and gravidity to six randomly selected controls (not exposed to teratogenic drugs or drugs known to cause neonatal side effects). Odds ratio was estimated for attributable risks.
Main outcome measures  Neonatal adverse events and Special Care Unit admission rate, assessed through an interview with the mothers.
Results  Of the 200 neonates exposed to antidepressants in utero , 14 had adverse events and 3 required Special Care Unit admission. Jaundice ( n = 5), agitation ( n = 3) and respiratory distress ( n = 2) were the most common symptoms. In the control group, 50 newboms had side effects and no statistically significant differences in the prevalence rate compared to the exposed group were found, even after stratification for drugs and pregnancy period of exposure. Only the prematurity rate was significantly higher in exposed compared to non-exposed newborns (OR = 2.31; 95% CI 1.14–4.63).
Conclusions  These results do not support an association between antidepressant exposure and unsafe fetal and neonatal outcomes in newborns. However, a collaborative international multicentre epidemiological monitoring of the use of psychotropic drugs during pregnancy is needed in order to guarantee pregnant women and their children safe and effective treatments, both at brief and long time from exposure.     

Maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria: A 3-year observational study

Objective: To assess the maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria.

Methods: This was a prospective 3-year observational study carried out at Menoufia University Hospital and included 106 patients with gestational hypertension and 124 patients with gestational proteinuria after 20 weeks’ gestation. Enrolled patients were followed to assess the maternal and fetal outcome. Data were collected and tabulated.

Results: There was a highly significant difference between the two groups regarding the development of preeclampsia (PE) and persistence of the condition after the end of the puerperium (p < 0.001) with more women progressed to PE and lower number suffered persistence of the disorder in the gestational hypertension group. There was no significant difference between the two groups regarding other maternal complications (p > 0.05). There was a significant difference between the two groups regarding preterm delivery, admission to NICU, and neonatal mortality (p < 0.05) which were higher in the gestational proteinuria group. There was no significant difference between the two groups regarding other fetal and neonatal complications (p > 0.05).

Conclusions: Although gestational hypertension progressed more frequently to PE than gestational proteinuria, poorer fetal outcome was more encountered in women with gestational proteinuria. Larger studies are warranted to confirm these findings.