Pregnancy and myelodysplastic syndrome: an analysis of the clinical characteristics,maternal and fetal outcomes

Objective: To investigate the clinical characteristics, management, maternal and fetal outcomes in pregnant patients with myelodysplastic syndrome (MDS).

Methods: A retrospective analysis was conducted on 25 pregnant women with MDS between June 1998 and January 2013. The clinical data were summarized. These patients were divided into poor outcome group and control group, and regression analysis was conducted to find the risk factors for maternal and fetal outcomes.

Results: Five patients developed premature birth, five patients developed postpartum hemorrhage, one patient developed postpartum acute cardiac failure and one patient developed postpartum cerebral infarction. Twenty out of the 25 patients underwent complete follow-up and 17 newborns were normal during follow-up. The regression analysis shows anemia and gestational hypertension are the primary risk factors for poor outcomes, whereas age, first onset of hematological disease, WBC count and platelet count are not significantly associated with the outcomes.

Discussion: Anemia and gestational hypertension may be the primary risk factors for poor maternal and fetal outcomes in pregnant patients with MDS. To avoid maternal and neonatal complications, a minimum of hemoglobin level >70?g/L, platelet count >30?×?10⁹/L and WBC count >3?×?10⁹/L, are recommended. Close monitoring on blood routine, maternal complications and active supportive treatment are recommended.     

Maternal and fetal outcome of pregnancy complicated by HELLP syndrome

Objective.?The study evaluated the maternal and fetal outcome in 64 pregnancies complicated by HELLP syndrome.

Methods.?A retrospective analysis of the medical records was performed of patients with HELLP syndrome managed at this tertiary Obstetric unit between January 1996 and December 2005, who were admitted for preeclamsia/eclampsia and had documented evidence of hemolysis, elevated liver enzymes and low platelet count. Maternal and neonatal complications were recorded and analyzed.

Results.?The incidence of HELLP syndrome in the study was 8.3%. Mean gestational age at delivery was 32.4?±?4.2 weeks and mean birth weight was 1851?±?810?g. Forty-two percent of the patients had deliveries <32 weeks and 28% IUGR. Respiratory distress syndrome was the main indication for NICU admissions (33.9%). The PNM rate was 20%. Maternal morbidity rate was 34%. The most common maternal complications were abruptio placentae (36.4%) and DIC (31.8%). There was no maternal death.

Conclusion.?Once the diagnosis of HELLP syndrome is confirmed, the management depends on several obstetric and maternal variables like gestational age, severity of laboratory abnormalities and fetal status. As soon as the maternal condition is stabilized and fetal assessment is obtained, prompt delivery of the fetus is indicated. It is not yet established whether expectant management in preterm pregnancies with HELLP syndrome would improve perinatal outcome.     

Reference intervals of embryos/fetuses heart rate between 6 and 14 weeks of pregnancy

Abstract

Objective: To determine reference intervals for the embryos/fetuses heart rate (HR) between 6 and 14 weeks of pregnancy.

Methods: A retrospective cross-sectional study was carried in a single center with singleton pregnancies of embryos/fetuses with a crown-rump length (CRL) between 5 and 85?mm. The HR was assessed by real time M-mode or spectrum Doppler ultrasound. To evaluate the correlation between embryo/fetal HR and CRL, polynomial equations were calculated, with adjustment by the determination coefficient (R²).

Results: A total of 5867 pregnancies were assessed. The mean gestational age was 10.37?±?2.12 weeks. The mean maternal age was 26.41?±?6.78 years. The mean embryo/fetal HR (bpm) for the CRL (mm) intervals 5├15; 15├25; 25├35; 35├45; 45├55; 55├65; 65├75; 75├85 was 145.1?±?18.7; 167.2?±?10.1; 166.9?±?8.7; 165.5?±?6.9; 162.2?±?6.8; 159.2?±?6.4; 157.1?±?6.4; 154.9?±?7.3; respectively. The following third-order equation best represented the correlation between embryo/fetal HR and CRL: HR?=?119.25?+?3.596*CRL-0.07954*CRL^2?+?0.00051*CRL³ (R^2?=?0.36).

Conclusion: Reference intervals of HR in embryos/fetuses in a large sample were determined. These reference intervals can be used in high-risk early pregnancy losses.     

Placental volume relative to fetal weight estimated by sonography in diabetic pregnancies

Objective: Our purpose was to analyze the fetal weight and placental volume (PV) ratio in diabetic pregnancies during mid-pregnancy.

Method: One hundred and forty nine diabetic pregnancies [75 gestational diabetes mellitus (GDM) and 74 diabetes mellitus type I (T1DM) with good glycemic control] and 232 healthy patients were analyzed by three-dimensional sonographic volumetry of the placenta, while fetal weight was estimated by two-dimensional technique.

Results: The gestational age-specific estimated fetal weight (EFW) [EFWGDM: 1840.8?±?932.82?g; EFWT1DM: 1475.6?±?914.7?g (mean?±?standard deviation) and placental ratio (PR)] was significantly higher (p?<?0.05) in pregnancies complicated by GDM and T1DM (PRGDM: 5.5?±?1.67?g/cm³, PRT1DM: 4.56?±?3.2?g/cm³) compared to control group (Q) (EFWQ: 532?±?186.49?g; PRQ: 2.2?±?0.8?g/cm³), whereas PV was significantly higher (p?<?0.05) only in GDM (PVGDM: 334.3?±?111.5?cm³) compared to control data (PVQ: 232?±?78.9?cm³). In contrast to GDM, T1DM with good glycemic control did not predispose to any changes in placental sonographic volumetric differences compared to control values.

Conclusions: Fetal weight related to the PV is already elevated in second trimester in pregnancies complicated by gestational diabetes mellitus and type I diabetes mellitus compared to normal pregnancies.     

Lower placental growth factor and higher free β-hCG and PAPP-A levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia

Background: An imbalance between anti- and angiogenic factors during early placentation is key for the development of preeclampsia. Nevertheless, the majority of studies addressing this issue relate to maternal blood and not the fetal circulation.

Objective: To measure placental growth factor (PlGF), free beta human chorionic gonadotropin (β-hCG), and pregnancy-associated plasma protein-A (PAPP-A) levels in the fetal circulation of near-term pregnancies complicated with severe preeclampsia (n?=?20), and their controls matched for parity, and maternal and gestational age.

Method: Upon delivery, a blood sample was withdrawn from the umbilical artery and vein of each case and its control in order to measure the proposed analytes using direct fluoroimmunoassay.

Results: Preeclampsia cases showed significantly lower median PlGF levels in fetal circulation as compared to controls (25.2 versus 36.9 and 23.6 versus 33.9?pg/mL, artery and vein, respectively, p?0.05). Contrarily, cases displayed higher concentrations of PAPP-A (1024.0 versus 720.9 [median] and 1027.0?±?298.4 versus 690.3?±?401.9 mIU/L, artery and vein, respectively, p?<?0.05), and free β-hCG (mean: 33.9?±?4.3 versus 17.2?±?4.0 and 30.1?±?5.2 versus 13.7?±?3.3?ng/mL, artery, and vein respectively, p?<?0.05).

Conclusion: Lower PlGF and higher PAPP-A and free β-hCG levels were found in the fetal circulation of near-term severe preeclamptic pregnancies. There is a need for more research in this regard.     

Does platelet mass influence the effectiveness of ibuprofen treatment for patent ductus arteriosus in preterm infants?

Objective: The aim of this study is to evaluate whether the platelet mass in the first 24?h of life is effective on closure of patent ductus arteriosus (PDA) or not.

Study design: Preterm infants with a gestational age of?<?32 weeks, hospitalized at a tertiary neonatal intensive care unit (NICU) and requiring medical treatment (intravenous or oral ibuprofen) for hemodinamically significant PDA (hsPDA) were enrolled in this study. The patients were divided into two groups after first course of pharmacologic treatment according to closure of PDA (Group 1: PDA closure, Group 2: PDA without closure). Groups were compared in terms of demographics findings, morbidities, platelet measurements like counts, mean platelet volume (MPV) and platelet mass (platelet count?×?mean platelet volume).

Results: The study included 77 preterm newborns in Group 1, and 30 preterms in Group 2. There were no differences in birth weight, gestational age, gender and maternal risk factors between the study groups. The mean platelet count in the first postnatal blood count was in Group 1: 211.3?±?89.2?×?10³/mm³ and in Group 2: 216.5?±?26?×?10³/mm³, respectively (p?=?0.783). The mean platelet volumes (MPV) were similar in both groups (p?=?0.535). No statistically significant difference between platelet mass values was detected (Group 1: 1811?±?884 fl/nl, Group 2: 1868?±?717 fl/nl) (p?=?0.753).

Conclusion: Our data suggest that platelet count, MPV and platelet mass did not affect the closure of hsPDA with ibuprofen.     

Maternal cardiovascular profiling in the first trimester of pregnancies complicated with gestation-induced hypertension or fetal growth retardation: a pilot study

Abstract

Objective: In this study, we determine whether maternal cardiovascular (CV) profiling can detect first trimester differences between women with uncomplicated pregnancies (UP) and those who will develop gestational hypertensive disorders (GHD) or normotensive fetal growth retardation (FGR).

Methods: Cardiac, arterial, and venous function were evaluated in 242 pregnant women around 12 weeks of gestation, using impedance cardiography (ICG) and combined electrocardiogram – Doppler ultrasonography. After postnatal determination of gestational outcome, first trimester measurements were compared between groups using Mann–Whitney U test for continuous data or Fisher’s Exact test for categorical variables (SPSS 20.0).

Results: Compared to UP, first trimester aortic flow velocity index [71?±?0.96 versus 61?±?4.91 1/1000/s (p?=?0.016)], acceleration index [133?±?2.25 versus 106?±?11.26 1/100/s² (p?=?0.023)] and Heather index [23.1?±?0.35 versus 19.2?±?1.70?Ω/s² (p?=?0.019)] were lower in GHD pregnancies, and first trimester stroke volume [77?±?1.16 versus 67?±?3.97?ml (p?=?0.033)] and cardiac output [7.3?±?0.10 versus 6.2?±?0.31?l/min (p?=?0.025)] were lower in FGR pregnancies.

Conclusions: Maternal CV function in the first trimester of pregnancy differs between UP and those destined to develop GHD or FGR. This can be assessed with non-invasive maternal CV profiling, opening perspectives for the application of this technique in early gestational screening for GHD and FGR.     

Asymmetric dimethylarginine in normotensive pregnant women with isolated fetal intrauterine growth restriction: a comparison with preeclamptic women with and without intrauterine growth restriction

Objective.?The aim of this study was to evaluate maternal asymmetric dimethylarginine (ADMA) levels in pregnancies complicated by isolated fetal intrauterine growth restriction (IUGR), in preeclamptic pregnancies with and without IUGR, and in healthy normotensive pregnant women with proper weight fetuses.

Patients and methods.?The study was carried out on 54 normotensive pregnant patients with pregnancy complicated by IUGR, 35 patients with IUGR in the course of preeclampsia, 29 preeclamptic patients with appropriate-for-gestational-age weight infants and 54 healthy normotensive pregnant patients. The ADMA concentrations were evaluated using an ELISA assay.

Results.?The preeclamptic women and normotensive patients with pregnancy complicated by isolated IUGR revealed higher levels of maternal serum ADMA. The mean values of maternal serum ADMA were 0.5730?±?0.1769?μmol/l in the P group, 0.5727?±?0.1756?μmol/l in the PI group, 0.6129?±?0.1517?μmol/l in the IUGR group, and 0.5017?±?0.1116?μmol/l in the control group. The levels of ADMA were additionally higher in the patients with HELLP syndrome and in patients with pregnancy complicated by eclampsia.

Conclusions.?It seems that ADMA is an active agent not only in preeclamptic patients, but also in normotensive pregnant women with isolated fetal IUGR and could be a marker of severity of preeclampsia.     

The maternal thiol/disulfide homeostasis does not change in pregnancies complicated by preterm prelabor rupture of membranes

Purpose: To evaluate the maternal thiol/disulfide homeostasis in pregnant women complicated by preterm prelabor rupture of membranes (PPROM) and to compare the results with healthy pregnancies.

Materials and methods: This cohort study consisted of thirty-nine pregnancies complicated by PPROM and 44 gestational age-matched healthy pregnancies in the third trimester of gestation. Maternal serum samples were obtained at the day of diagnosis, and thiol/disulfide profiles were measured by using an automated assay method. The patients were followed till delivery, and perinatal outcomes were noted.

Results: The maternal native thiol (319.9?±?30.5?μmol/L versus 305.1?±?49.2?μmol/L, p: .100), total thiol (379.2?±?38.8?μmol/L versus 363.6?±?56.4?μmol/L, p: .142) and disulfide (29.7?±?11.7?μmol/L versus 29.3?±?10.1?μmol/L, p: .864) levels were similar between the groups. Maternal disulfide/native thiol, disulfide/total thiol and native thiol/total thiol ratios were similar between the groups (p: .610, p: .565 and .562, respectively). The maternal serum thiol/disulfide profiles were not significantly correlated with maternal serum C-reactive protein, white blood cell count values and ongoing pregnancy outcomes (p?>?.05).

Conclusions: The current study demonstrated that there was not any disturbance in maternal thiol/disulfide homeostasis in pregnancies complicated by PPROM at the time of initial diagnosis. Follow-up studies with larger sample size are needed to confirm our results.     

Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal electrocardiogram and Doppler telemetry

Objective: To compare intra-partum performance of trans-abdominal electrocardiogram with Doppler telemetry. Methods: In this prospective longitudinal study, simultaneous monitoring with trans-abdominal ECG and Doppler telemetry was performed in 41 uncomplicated term singleton pregnancies during labour. Results: The overall success rate for FHR monitoring was similar between trans-abdominal ECG and Doppler telemetry (88.5?±?16.7% vs 89.4?±?7.6%), except for the second stage of labour. A significantly higher rate of confusion (p?<?0.001) between fetal and maternal heart was found for Doppler telemetry (4.5?±?4.5%) compared with trans-abdominal ECG (1.3?±?1.9%), especially in the second stage and during maternal movements. Conclusions: Trans-abdominal ECG monitoring is feasible, with comparable success rate to traditional Doppler telemetry, without interfering with maternal mobility or requiring midwife intervention. The reduction in maternal\fetal heart rate confusion from trans-abdominal ECG could reduce incorrect obstetric interpretation.     

Hyperuricemia facilitates the prediction of maternal and perinatal adverse outcome in patients with severe/superimposed preeclampsia

Objective.?Hyperuricemia has received much attention and debate recently with regard to its utility as a marker for preeclampsia and as a predictor of adverse maternal–fetal outcome. This investigation was undertaken in patients with severe/superimposed preeclampsia to determine whether the maternal uric acid (UA) level at initial hospital admission is a useful predictor of subsequent adverse maternal and/or perinatal outcomes.

Methods.?Retrospective analysis of all patients diagnosed with severe preeclampsia, superimposed preeclampsia or HELLP syndrome during 2005 at the University of Mississippi Medical Center (UMMC). Clinical and laboratory data were collected, entered and stored electronically in a password protected, secure system.

Results.?Adverse maternal outcomes occurred in 15.3% of 258 patients in the cohort. Mean UA concentration in the absence of adverse maternal outcomes was 342.6?±?77.3 compared to 396.1?±?117.2?μmol/l in pregnancies with complications (p?<?0.001). The positive likelihood ratio (LR) for adverse maternal outcome was 5.3 with UA?≥?76.3 μmol/l and creatinine ≥1.0 mg/dl. LRs rose in association with other abnormal preeclampsia serum markers. Adverse perinatal outcomes occurred in 45.2% of births. The LRs for adverse perinatal outcomes remained unchanged around 1.0. Mean UA was 363.4?±?91.0 compared to 339.0?±?80.9?μmol/l in pregnancies without adverse outcomes (p?=?0.021).

Conclusions.?Maternal hyperuricemia is a better predictor of maternal than perinatal risk and adverse outcome.     

Transplacental transfer and metabolism of bupropion

Objective.?In order to evaluate the potential use of bupropion as smoking cessation therapy during pregnancy, the aim of this investigation was to determine transplacental transfer and metabolism of bupropion and its distribution among placental tissue and maternal and fetal circuits of the dually perfused placental lobule.

Methods.?Placentas obtained from healthy term pregnancies were perfused with bupropion at two concentrations 150?ng/ml and 450?ng/ml, along with the marker compound antipyrine 20?μg/ml. Radioactive isotopes of the two drugs were co-transfused to enhance their detection limits. Concentrations of bupropion and its metabolite were determined by liquid chromatography and liquid scintillation spectrometry.

Results.?The fetal/maternal concentration ratio of bupropion was 1.07?±?0.22. Following 4?h of its perfusion, 48?±?6% of bupropion was retained by placental tissue, 32?±?5% remained in the maternal circuit, and 20?±?6% was transferred to the fetal circuit. A metabolite of bupropion, threohydrobupropion, was identified.

Conclusions.?Bupropion was transferred from the maternal to fetal circuit and was biotransformed by placental tissue enzymes to its metabolite threohydrobupropion. Bupropion and its metabolite did not affect placental tissue viability or functional parameters. These data suggest that bupropion has the potential of being used for smoking cessation during pregnancy and should be further investigated for its safety and efficacy.     

Maternal and umbilical venous adrenomedullin and nitric oxide levels in intrauterine growth restriction

Objective.?To verify whether adrenomedullin (AM) and nitric oxide (NO) concentrations are changed in the maternal and fetal circulation in pregnancies complicated by intrauterine growth restriction (IUGR) compared to normal pregnancies, and to determine any relationship between them.

Methods.?Forty-six small for gestational age (SGA) and 34 appropriate for gestational age (AGA) infants were included in the study. Umbilical and maternal venous AM and NO concentrations were determined.

Results.?Umbilical NO concentrations in SGA infants (mean ± SD; 176.2 ± 75.8 μmol/L) were significantly greater than in AGA infants (143.4 ± 39.2 μmol/L) (p = 0.015). However, umbilical AM concentrations were similar in SGA and AGA infants with 14.2 ± 4.4 pmol/mL and 14.5 ± 6.2 pmol/mL, respectively (p > 0.05). There was no relationship between NO and AM levels in umbilical blood (r = 0.09, p = 0.40). No difference was found between either AM or NO levels in the maternal plasma of the two groups.

Conclusions.?We suggest that NO is increased in the fetoplacental circulation in SGA infants probably as a response to decreased blood flow, whereas AM is not. Additionally, increased NO in the fetoplacental circulation was found to be independent from AM secretion.     

Pregnancy outcomes among women with hemoglobin E trait

Objective: To compare the maternal and fetal outcomes between pregnant women complicated with hemoglobin E (HbE) trait and normal controls.

Patients and methods: A retrospective cohort study was conducted by assessment of the database of maternal–fetal medicine units from January 2003 to December 2013 to identify singleton pregnant women complicated by HbE trait. Pregnancies with medical complications or fetal anomalies were excluded. The normal controls were low-risk pregnancies and were non-carrier status for thalassemia and hemoglobinopathy.

Result: During the study period, 1073 women with HbE trait and 2146 normal controls were included. The baseline characteristics of the two groups were comparable except that the number of prenatal visit was statistically higher in study group (8.55?±?3.03 versus 7.85?±?4.33, p?=?<0.001). Most pregnancy outcomes were not significantly different. However, the rate of asymptomatic bacteriuria was minimally higher in the study group, 3.5% versus 2.3%; p?=?0.042 (relative risk 1.19; 95%CI: 0.98–1.43). Note that the rates of gestational diabetes tend to be higher in the group of HbE trait (7.6% versus 6.8%), but did not reach a statistical level.

Conclusion: The HbE trait does not significantly increase risk of common adverse pregnancy outcomes, except for minimal increase in asymptomatic bacteriuria.     

The association between maternal weight gain and spontaneous preterm birth in twin pregnancies

Abstract

Objective: To estimate the association between maternal weight gain and SPTB in twin pregnancies.

Methods: A case-control study of patients with twin pregnancies and a normal prepregnancy BMI (18.5–24.9?kg/m²) in one maternal-fetal medicine practice from 2005 to 2013. We reviewed maternal weight in six time periods: prepregnancy, 12–15 6/7 weeks, 16–19 6/7 weeks, 20–23 6/7 weeks, 24–27 6/7 weeks and 28–31 6/7 weeks. We compared maternal weight gain patterns across pregnancy between patients who did and did not have SPTB <32 weeks. Student’s t-test and chi-square were used for analysis.

Results: In total, 382 patients were included, 29 (7.6%) of whom had SPTB <32 weeks. The baseline height, weight and BMI did not differ between the groups, nor did maternal age, IVF status, race or chorionicity. Patients with SPTB <32 weeks had significantly less weight gain as early as 15 6/7 weeks (2.9?±?4.6 versus 7.3?±?6.6?lb, p?<?0.001), and this continued until 31 6/7 weeks (25.3?±?8.7 versus 30.8?±?10.9?lb, p?=?0.037).

Conclusions: In twin pregnancies with a normal prepregnancy BMI, there is a significant association between SPTB <32 weeks and lower maternal weight gain, particularly prior to 16 weeks. Future studies are needed to test if prepregnancy or early nutritional interventions in twin pregnancies can reduce the risk of preterm birth and improve neonatal outcomes in this high-risk population.     

Correlation between maternal serum-amniotic fluid anti-angiogenic factors and uterine artery Doppler indices

Purpose: Elevated sFlt-1 and sEng is usually a clue for impending preeclampsia and intrauterine growth restriction. Likewise, uterine artery Doppler ultrasound is being investigated for prediction of similar conditions. In this study, we aimed to explore the possible relations of these two proteins in different body compartments with uterine artery Doppler indices (UtAD) in a healthy second trimester obstetric population.

Methods: Levels of sFlt-1 and sEng were measured in serum and amniotic fluid samples of 43 patients. UtAD were measured on the days of sample collections. Findings were then analyzed for possible correlation.

Results: There was a positive correlation between the levels of maternal serum sFlt-1 (MSsFlt-1) and sEng levels (MSsEng) (r=?0.516, pr=??0.371, p=?0.016). No correlation was found between UtAD and studied protein levels in amniotic fluid. Mean MSsFlt-1 level was 305.2?±?220.1?pg/ml and mean AFsFlt-1 was 48.9?±?11.8?ng/ml. Mean MSsEng level was 4.5?±?1.3?ng/ml, mean AFsEng level was found 0.7?±?0.3?ng/ml. Mean values for UtAD were 1.3?±?0.4, 0.6?±?0.1 and 3.5?±?1.3 for PI, RI, and S/D, respectively.

Conclusion: In normal second trimester pregnancies, there is a positive correlation between serum levels of sFlt-1 and sEng levels. Amniotic fluid levels of sEng and sFlt-1 are not correlated with UtAD in uncomplicated pregnancies.     

Pregnancy after liver transplantation. How safe? A retrospective case-series study in a large tertiary hospital

Objective: To study pregnancies achieved after liver transplantation in terms of obstetric complications, maternal, neonatal outcomes and post-pregnancy allograft function.

Methods: A retrospective study of prospectively collected data was conducted, enrolling women with a history of liver transplantation performed in the Transplantation Unit of our hospital that delivered in our department. Obstetric characteristics and antenatal complications were reviewed. Apgar score, admission to Neonatal Intensive Care Unit (NICU) and need for emergency intubation were analyzed. Outcomes of regular follow-up concerning all complications of allograft function observed after pregnancy were also studied.

Results: There were five cases of allograft recipients delivering their pregnancies during the study period. Mean maternal age was 32.2?±?5 years. Interval from transplantation to delivery ranged from 40 to 219 months. Mean gestational week at delivery was 34.4?±?2.5 weeks. Antenatal complications observed were pre-eclampsia (3 of 5 cases) and vaginal bleeding (1 of 5 cases). All preterm neonates were admitted to NICU, but no emergency intubation was demanded. One patient died a month after delivery, while three others were complicated by implant dysfunction up to 5 years after the delivery.

Conclusion: Pregnancy in a liver transplant recipient is associated with complications for mother and infant.     

Is antenatal depression associated with adverse obstetric and perinatal outcomes?

Objective: To examine whether a pre-gestational diagnosis of depression is a risk factor for adverse obstetric and neonatal outcome.

Study design: A retrospective cohort study investigating maternal characteristics, obstetrical and perinatal outcomes in singleton pregnancies of women with and without a diagnosis of depression was conducted. A pre-gestational diagnosis of depression was made by a psychiatrist or family physician and was recorded in the patients’ chart. Multiple logistic regression models were used to control for possible confounders.

Results: During the study period, 256?312 deliveries occurred. Of which, 221 women (0.1%) had a pre-gestational diagnosis of depression. When examining obstetric outcomes, women with a diagnosis of depression were older (32.05?±?5.772 versus 28.56?±?5.851) and smokers (7.2% versus 1.1%), had a higher rate of preterm deliveries (37.99?±?2.989 versus 39.02?±?2.249) and cesarean sections (CS; 28.5% versus 13.6%) in comparison to the control group. When examining neonatal outcomes, neonates of women diagnosed with depression had a lower birth mean weight (3.038.47?±?649.6 versus 3183.44?±?551.8) and increased rates of perinatal mortality (3.2% versus 1.3%). Using a multiple logistic regression model, with perinatal mortality as the outcome variable to control for cofounders such as maternal age, preterm birth, chronic hypertension and gestational diabetes mellitus, a diagnosis of depression was not found to be an independent risk factor for perinatal mortality. Another multiple logistic regression model found advanced maternal age, smoking, preterm birth and labor induction to be associated with a diagnosis of depression.

Conclusion: Pregnant women diagnosed with depression are at an increased risk for preterm birth, low birth weight, and CSs. However, it was not associated with increased rates of perinatal mortality.     

Comparison of induction of labor with vaginal misoprostol plus oxytocin versus oxytocin alone in term primigravidae

Objective.?To compare the efficacy and complications of intravaginal misoprostol application before starting oxytocin infusion with oxytocin infusion alone for labor induction in term primigravidae pregnancies with low-Bishop score.

Methods.?This randomized study included 101 primigravidae women with singleton pregnancies >38 weeks and a Bishop score of <6. Group 1 (50 patients) received a 50-μg dose of intravaginal misoprostol, with an oxytocin infusion started 3?h later. Group 2 (51 patients) received only an oxytocin infusion for labor induction. The time from induction to delivery, the route of delivery and complications were analyzed.

Results.?The mean time from induction to delivery was 10.4?±?2.1?h in Group 1 and 13.7?±?3.4 in Group 2 (p?<?0.001). The rates of vaginal delivery, Apgar scores at 1st and 5th min, placental abruption, and postpartum hemorrhage were similar between the two groups.

Conclusion.?Intravaginal application of 50-μg misoprostol before starting oxytocin infusion is a more effective method of labor induction than oxytocin infusion alone in term primigravidae pregnant women with low-Bishop scores.