Risk factors and perinatal outcome of pregnancies complicated with cephalopelvic disproportion: a population-based study

Objectives  

To characterize risk factors and perinatal outcome following cephalopelvic disproportion (CPD).     

Obstetric risk factors for stress urinary incontinence: a population-based study

OBJECTIVE: To evaluate obstetric and maternal risk factors for stress urinary incontinence. METHODS: We linked three national, Swedish, population-based registries with the use of unique personal identification numbers. All women born between 1932 and 1977 and operated on for stress urinary incontinence between 1987 and 1996 were identified from the Hospital Discharge Registry. This information was linked with the Medical Birth Registry (for the years 1973-1995), containing information on antenatal care, delivery, and the newborn, and the Fertility Registry (for the years 1932-1997), containing information on the number of children delivered by each Swedish woman. For determination of odds ratios (ORs) and approximate 95% confidence intervals (CIs), we used the Mantel-Haenszel method and a test-based method after suitable stratifications and exclusions. RESULTS: Diabetes mellitus, body mass index (BMI), age at first delivery, parity, birth weight, and epidural analgesia were positively associated with incontinence surgery. In contrast, cesarean delivery, forceps/vacuum extraction, and episiotomy were negatively associated with incontinence surgery. No association was found between surgery for stress incontinence and age at last delivery, smoking during pregnancy, level of education, multiple birth, large perineal tear, or breech presentation at any vaginal delivery. The OR for incontinence surgery was similarly decreased for nulliparous women and for uniparous women delivered by elective cesarean. CONCLUSION: Vaginal delivery, notably the first, is strongly associated with later surgery for stress incontinence, but the association is modified by maternal conditions and interventions during delivery. No association was found between surgery for stress incontinence and pregnancy per se.     

Obstetric morbidity in gestational carrier pregnancies: a population-based study

PurposeWe sought to characterize severe obstetric morbidity among women who are gestational carriers compared to other patients.MethodsThis was a population-based study comparing gestational carrier pregnancies to non-surrogate pregnancies (non-surrogate IVF pregnancies, all non-gestational carrier pregnancies, and a cohort of matched controls) delivering in Utah between 2009 and 2018, using birth certificate data. Our primary outcome was a composite of severe morbidity, including death, ICU admission, eclampsia, HELLP syndrome, transfusion, and unplanned hysterectomy. Our secondary outcomes were cesarean delivery (CD) and hypertensive disorders of pregnancy.ResultsDuring the study period, 361 gestational carrier pregnancies and 509,015 other pregnancies resulted in live births. Severe morbidity was less common among gestational carrier pregnancies than IVF pregnancies (1.7% versus 5.5%, odds ratio [OR] 0.29, 95% confidence interval [CI] 0.12–0.70), but was not different when compared to all other pregnancies (1.0%, OR 1.61, 95% CI 0.72–3.60), or a cohort of matched controls (1.0%, OR 1.37, 95% CI 0.55–3.40). CD was less common among gestational carrier pregnancies than IVF pregnancies, but not different than all other pregnancies or matched controls. While frequency of hypertensive disorders of pregnancy was lower among gestational carrier pregnancies than IVF pregnancies, it was higher than all other women who delivered and comparable to matched controls.ConclusionSevere obstetric morbidity is uncommon among gestational carrier pregnancies. Women who are gestational carriers are at lower risk of morbidity and CD than others who conceive through IVF and do not appear to be at increased risk compared to matched controls.     

Obstetric outcome of in vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study

Objective: To assess the outcome of pregnancies conceived with the use of IVF that are complicated by severe ovarian hyperstimulation syndrome (OHSS).

Design: A retrospective nationwide multicenter study.

Setting: Sixteen of 19 tertiary care medical centers in Israel.

Patient(s): All patients undergoing IVF who were hospitalized for severe OHSS between January 1987 and December 1996.

Main Outcome Measure(s): Pregnancy rate (PR) and rates of multiple gestation, miscarriage, ectopic pregnancy, obstetric complications, and intervention.

Result(s): A total of 163 patients who had severe OHSS after IVF treatment were identified, of whom 142 (87.1%) had undergone ET. The clinical PR was 73.2%; 42.3% were singletons, 33.6% were twins, 17.3% were triplets, and 6.7% were quadruplets. The miscarriage rate was 29.8%, whereas the incidence of ectopic pregnancy was 1.9%. Forty-four percent of all births were premature, and 62.1% of all newborns had low birth weight. The most common antenatal complications were pregnancy-induced hypertension (13.2%), gestational diabetes (5.9%), and placental abruption (4.4%). The rate of cesarean section was 44.1%.

Conclusion(s): Among patients who have severe OHSS after IVF treatment, the pregnancy rate and the rates of multiple gestation, miscarriage, prematurity, low birth weight, pregnancy-induced hypertension, gestational diabetes, and placental abruption are significantly higher than those reported previously for pregnancies conceived with the use of assisted reproductive techniques.     

Obstetric outcome of in vitro fertilization pregnancies compared with normally conceived pregnancies.

OBJECTIVE: To compare the obstetric outcome of in vitro fertilization pregnancies with normally conceived pregnancies. STUDY DESIGN: The obstetric outcome of in vitro fertilization pregnancies achieved in 763 British residents at two in vitro fertilization clinics resulting in the births of 961 babies were compared by means of the relative risk statistic with a control group of naturally conceived primiparous pregnancies matched by maternal age and multiplicity of pregnancy. RESULTS: Twenty-five percent of in vitro fertilization pregnancies were multiple pregnancies. The incidence of singleton term breech presentation was similar to that among controls. As compared with controls there was an increased incidence among in vitro fertilization pregnancies of vaginal bleeding and hypertension requiring hospitalization (p less than 0.001) and cesarean births (p less than 0.001) and, among in vitro fertilization singleton pregnancies, an increased incidence of intrauterine growth retardation (p less than 0.05), placenta previa (p less than 0.05), and preterm delivery (p less than 0.001). The congenital malformation, stillbirth, and perinatal mortality rates were comparable with maternal age-standardized national rates. CONCLUSIONS: Although the majority of in vitro fertilization pregnancies have a satisfactory obstetric outcome, there are a number of increased obstetric risks that may reflect the history of infertility, the relatively high incidence of poor obstetric history, and the lower threshold for obstetric intervention in in vitro fertilization patients.     

产后出血相关因素分析

目的 分析与产后出血相关的因素，提出合理的防治措施。方法 以2002年1月1日至12月31日在中国福利会国际和平妇幼保健院分娩的产妇6194例作为观察对象，将胎儿娩出后2h内出血量达到或超过400mL，或胎儿娩出后24h内出血量达到或超过500mL定义为产后出血，采用容积法 称重法测量产后出血量。通过非条件Logistic回归分析筛选出与产后出血相关的主要危险因素。结果 在6194例分娩数中，符合产后出血的有77例，占1．24％，单因素分析中有10个因素有统计学意义，多因素分析中有7个因素进入多因素回归模型，分别为子宫收缩乏力(OR=999．000)，前置胎盘(OR=40．073)，胎盘粘连植入残留(OR=28．532)，产道损伤(OR=15．190)，胎次(OR=5．523)，剖宫产(OR=3．882)，早接触早吸吮(OR=0．069)。结论 加强孕前宣教及孕期管理、严格掌握剖宫产指征、提高医务人员助产技术、同时提倡早接触早吸吮对于降低产后出血及孕产妇死亡起着重要的作用。     

阴道分娩产后出血发病率及影响因素的队列研究

目的探讨上海市孕产妇阴道分娩产后出血相关的影响因素。方法将2015年6月—2016年5月期间在上海市4家医院首次建卡产检的孕妇纳入队列,随访至分娩,收集其建卡、初次产检和分娩的资料。计算阴道分娩产后出血的发生率,并用独立样本t检验或方差分析进行单因素分析,用多元线性回归分析探讨阴道分娩产后出血量的影响因素。结果共收集到阴道分娩孕产妇资料3 495份,产后出血(500 mL)发生率为1.5%(53/3 495),产后出血量平均为(255.6±156.4)mL。多元线性回归分析显示,产次每增加1次,产后出血量下降13.3 mL;合并妊娠期高血压疾病和分娩巨大儿分别可使产后出血量升高42.3 mL和22.3 mL。结论上海市孕产妇阴道分娩产后出血发生率较低,提倡孕期的合理增重有利于控制产后出血量,对于初产妇和合并妊娠期高血压疾病的孕妇应积极防范产后出血的发生。     

Obstetric complications and perinatal outcome in triplet pregnancies.

The incidence of multiple pregnancies with more than two fetuses has significantly increased since the introduction of ovulation agents and assisted reproductive technologies. Over a 15-year period there were 35 triplet pregnancies beyond 24 weeks that delivered at the King Fahad Hospital, an incidence of 1 in 1,099 deliveries. Early diagnosis is important for improving the rate of fetal salvage in triplet pregnancy. These pregnancies were managed on an outpatient basis. Prophylactic interventions were not utilised. A total of 91% of the pregnancies had at least one antenatal complication, pre-term labour being the most common (80%) followed by anaemia (43%). The average gestational age at delivery was 31.7 weeks (SD 4.2 weeks). A total of 94.3% of the patients were delivered by lower segment caesarean section. The mean birth weight of the neonates was 1,552 g (SD 510 g) and mean 5-min Apgar score was 7.6 (SD 0.8). The corrected perinatal mortality rate in the study was 152/1,000. Pregnancy outcome did not vary with birth order or mode of conception. Higher rate of pre-term births among triplet pregnancies make considerable demands on the neonatal intensive care unit. All methods of assisted reproduction should aim at prevention of multifetal pregnancies.     

Obstetric factors in the causation of early periventricular--intraventricular hemorrhage

On routine fontanelle scanning of neonates weighing less than or equal to 2000 g within the first 24 hours of life, 21% had abnormal findings related to peri/intraventricular hemorrhage. These findings occurred almost exclusively in patients who were in labor, with one exception, and were not observed without labor. Once labor ensued, the performance of cesarean section did not prevent periventricular and intraventricular hemorrhage. Other obstetric factors including fetal heart rate monitoring and umbilical artery pH values were not related to early periventricular and intraventricular hemorrhage. The practical significance of these findings is discussed.     

Perinatal outcome of twin pregnancies complicated with preeclampsia.

Twenty-five mild and 19 severe preeclampsia cases in twin pregnancies (12.5%) were compared to 44 matched for gestational age controls. All three groups were similar with respect to maternal age, intertwin birthweight differences, and rates of abdominal deliveries and low (less than 7) 5-minute Apgar scores. The frequency of primiparas in the severe preeclampsia group was significantly higher compared with controls (p less than 0.03). Severe preeclampsia patients delivered at a significantly earlier gestational age (p less than 0.005) and had a significantly lower mean twin birthweight (p less than 0.003) compared with the mild preeclamptic group. The mean twin birthweight of the severe preeclamptic cases was also significantly lower compared with that of controls. All three neonatal deaths occurred in severely discordant second twins born to severe preeclamptic patients. It is concluded that adverse perinatal outcome is associated with severe but not with mild preeclampsia in twin gestations.     

Obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas

OBJECTIVE: To determine the rate, obstetric characteristics and perinatal outcome of pregnancies with uterine leiomyomas. STUDY DESIGN: A population-based study comparing all singleton deliveries between the years 1988 and 1999 in women with and without uterine leiomyomas was performed. Patients lacking prenatal care were excluded from the analysis. Multivariable analysis, adjusting for possible confounders, such as maternal age, parity and gestational age, was performed to investigate associations between uterine leiomyomas and selected outcomes. RESULTS: There were 105,909 singleton deliveries with 690 (0.65%) complicated by uterine leiomyomas during the study period. Using a multivariable analysis, the following conditions were significantly associated with uterine leiomyomas: nulliparity (odds ratio [OR]=4.0, 95% confidence interval [CI] 3.3-4.7, P<.001), chronic hypertension (OR=1.9, 95% CI 1.6-2.4, P<.001), hydramnios (OR=1.5, 95% CI 1.2-2.0, P<.001), diabetes mellitus (OR=1.4, 95% CI 1.1-1.7, P=.001) and advanced maternal age (OR=1.2, 95% CI 1.1-1.2, P<.001). Higher rates of perinatal mortality (2.2% vs. 1.2%, OR=1.8, 95% CI 1.1-3.2, P<.001) were found in the uterine leiomyoma group as compared to the control group. While adjusting for maternal age, parity, gestational age and malpresentation, pregnancies with uterine leiomyomas had higher rates of cesarean deliveries (OR=6.7, 95% CI 5.5-8.1, P<.001), placental abruption (OR=2.6, 95% CI 1.6-4.2, P<.001) and preterm deliveries (<36 weeks' gestation, OR=1.4, 95% CI 1.1-1.7, P=.009) as compared to pregnancies without uterine leiomyomas. Conversely, no significant differences were noted regarding perinatal mortality (OR=1.4, 95% CI 0.7-2.8, P=.351) after controlling for maternal age, parity and gestational age using a multivariable analysis. CONCLUSION: Uterine leiomyomas increase the risk of adverse pregnancy outcomes, thus emphasizing the importance of appropriate intrapartum management of these high-risk pregnancies.     

产后出血的危险因素与预防措施的临床研究

目的 了解产后出血的发生率、危险因素及预防措施。方法 2002年10月～2004年10月，将2362例正常足月妊娠阴道分娩、非高危妊娠的孕产妇按第三产程处理方式不同随机分为应用缩宫素组、米索前列醇组和期待处理组，记录第三产程时间、是否产后出血、出血量以及产后出血危险因素，研究在自然分娩的第三产程应用缩宫素及米索前列醇预防产后出血的疗效。结果 在2362例孕产妇中，发生产后出血45例，发生率1.9％，胎盘粘连植入残留（OR=9.12）、产程延长（OR=5．18）、精神过度紧张（OR＝3．58）、妊高征（OR=3.01）是产后出血的主要危险因素，第三产程应用缩宫素10u或米索前列醇400μg后，第三产程时间明显缩短（P〈0.01），产后出血比例明显降低（P〈0．01），产后孕产妇的平均出血量明显减少（P〈0．01）缩宫素组和米索前列醇组差异无显著性。结论 胎盘粘连植入残留、产程延长、精伸过度紧张、妊高征是产后出血的主要危险因素。第三产程应用缩宫素或米索前列醇可以减少产后出血的发生率和出血量。     

Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study

BACKGROUND: The aim of the study was to evaluate the obstetric and neonatal outcome of pregnancies after assisted reproduction technology (ART) in comparison with matched controls from spontaneous pregnancies. METHODS: A total of 12 920 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, from 1 January 1995 to 31 December 2001 were subjected to retrospective analysis. Two hundred and eighty-four singleton, 75 twin and 17 triplet pregnancies after ovulation induction (n = 114; 30.3%), intrauterine insemination (n = 33; 8.8%) and in vitro fertilization (n = 229; 60.9%) were evaluated. The pregnancy outcome of the singleton and twin pregnancies was compared with that for controls matched with regard to age, gravidity and parity and previous obstetric outcome after spontaneous pregnancies. RESULTS: Twenty-four percent of the assisted reproductive pregnancies were multiple pregnancies. The incidences of singleton intrauterine growth retardation (IUGR) and preterm birth were reasonably similar to those among the controls (IUGR: 6.3% vs. 4.2%; preterm births: 13.0% vs. 9.9%, for the cases and the controls, respectively). As compared with the controls, there was an increased incidence of cesarean section among the singleton (41.2% vs. 34.5%, p = 0.12; OR 1.33; 95% CI 0.95-1.87) and twin assisted reproduction pregnancies (66.7% vs. 60.0%), but without significant differences. CONCLUSIONS: Increased obstetric risk could be observed concerning threatened preterm delivery and cesarean section rate in the study group. The perinatal outcome of singleton and twin pregnancies following assisted reproductive techniques is comparable with that of spontaneously conceived, matched pregnancies.     

Patients with high-risk pregnancies and complicated deliveries have an increased risk of maternal postpartum readmissions

Objective

Postpartum readmission after initial hospitalization for delivery can be diminished if better understood. The aim of this study was to determine the risk factors and indications for maternal re-hospitalization after delivery, in order to identify preventable factors.

Study design

This was a case control study based on retrospective cohort of patients who delivered at our institution. The patients that were readmitted within 2 weeks of their delivery were included in the study group while the control group was conducted from patients who delivered at the same time but were not re-hospitalized and included twice the number of patients. Demographic characteristics as well as pregnancy, labour and postpartum courses were compared between the two groups.

Results

A total of 227 women were re-hospitalized within 14 days after initial discharge. The control group consisted of 450 women. The demographic characteristics were similar among the two groups, so were the rates of obesity, gestational weight gain and smoking. The major indication for readmission was postpartum infections, most of which were not related to immediate postpartum febrile morbidity. Emergency cesarean section was found to be an independent risk factor for readmission.

Conclusions

The rate of patients with high-risk pregnancies and complicated deliveries is higher among postpartum maternal readmissions. These data might suggest more cautious postpartum care for those patients.