The umbilical coiling index and adverse perinatal outcome.

OBJECTIVE: Evaluation of the relationship between umbilical coiling index (UCI) and adverse perinatal outcome. METHOD: A prospective study was performed on 699 pregnant women who were 37-40 weeks. UCI was determined by dividing the total number of the complete vascular coiling by the total umbilical cord length in centimeters. Then the relationship between UCI and neonatal weight, amniotic fluid index, meconium, Apgar score, and fetal distress were evaluated. RESULTS: There was a significant difference between normo- and hypocoiled groups according to the Apgar score less than 7 in minute 5, AFI相似文献   

Third trimester abnormal oral glucose tolerance test and adverse perinatal outcome

Objective: To compare perinatal outcome of women after third trimester oral glucose tolerance test (GTT) following normal glucose challenge test (GCT) stratified by test results.

Study design: Retrospective cohort study of women delivered in a tertiary, university affiliated medical center (2007–2012). Inclusion criteria were women with a normal 50?g GCT (<140?mg/dl) followed by GTT, who delivered a live-born fetus >28 gestational weeks. Gestational diabetes mellitus (GDM) was defined as ≥2 pathological values on GTT (Carpenter and Coustan’s criteria). Perinatal outcome was stratified by GTT results: normal (if all 4 values were normal), single pathological value or GDM. Logistic regression analysis was utilized to adjust outcomes to potential confounders.

Results: Overall, 323 women met inclusion criteria. Of them, 277 (85.8%) had 4 normal values, 32 (9.9%) had a single pathological value and 14 (4.3%) had late-onset GDM. Infants of mothers diagnosed and treated as GDM had lower birth weights, compared to non-diabetics and those with a single pathological value GTT. Mothers with GTT ≥1 pathological values had statistically insignificant higher rates of cesarean delivery. However, this difference was not significant after adjustment to potential confounders.

Conclusion: Treatment of late-onset GDM may lead to lower birthweights, presumably due to glucose control. No association was found with cesarean delivery or neonatal outcome.     

Diagnosis and outcome of pregnancies with prenatally diagnosed fetal dextrocardia

Objective: To evaluate the incidence, associated cardiac and extracardiac malformations and clinical outcome of fetuses with dextrocardia.

Method: A retrospective review of 3556 fetal echocardiograms between 2000 and 2011 revealed 39 cases of dextrocardia. Dextrocardia was defined as right-sided positioning of the fetal heart. Prenatal and postnatal records of the fetuses were reviewed.

Results: The incidence was 1.1%. Of the 39 fetuses, 22 were primary dextrocardia and 17 were dextroposition. Diaphragmatic hernia was the most common cause of dextroposition with the incidence of 76%. Of the fetuses with dextroposition 35.5% had a cardiac anomaly. The survival rate of dextroposition was 31.2% and none of the survivors had an associated cardiac anomaly. Primary fetal dextrocardia was most common with situs solitus (45.4%), followed by situs ambiguous (36.3%) and then situs inversus totalis (18.1%). Structural cardiac malformations were found in 100%, 80% and 25% of fetuses with situs ambiguous, solitus and inversus, respectively. Of the dextroposition, 47.6% terminated pregnancy, 14.2% resulted in intrauterine death, 9.5% died after birth, and 28.5% survived.

Conclusion: A wide spectrum of complex cardiac malformations are associated with fetal dextrocardia. Fetal echocardiography enables detection of complex cardiac anomalies so that parents can be appropriately counselled.     

Advanced maternal age and adverse perinatal outcome: a review of the evidence

Objective

to examine the evidence in relation to advanced maternal age (35–39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries.

Background

this review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35–39 years is sketchy and often contradictory.

Methods

a systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35–39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria.

Findings

evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35–39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood.

Key conclusions and implications for practice

although risk and rates of adverse perinatal outcome are increased among women aged 35–39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association.     

Maternal and perinatal outcome in obese pregnant patients

Introduction.?Obesity represents a rapidly emerging epidemic amongst pregnant patients in South Australia, in particular in Adelaide's Northern suburbs, one of the poorest urban areas in Australia. The aim of the current study was to prepare a comprehensive overview of maternal and perinatal outcome in overweight, obese and morbidly obese pregnant patients.

Material and methods.?Retrospective review of women with singleton pregnancies delivering in the first 6 months of 2006; 100 with normal BMI (group I: BMI 19.1–25 kg/m²), 100 overweight (group II: BMI 25.1–30 kg/m²), 110 obese (group III: BMI 30.1–40 kg/m²) and 60 morbidly obese women (group IV: BMI >40 kg/m²) were identified with access to complete medical records. Outcome measures included booking demographics, booking blood pressures, glucose challenge and glucose tolerance results, hypertensive complications, pre-existing and gestational diabetes, instrumental deliveries, caesarean deliveries, blood loss, birth weights, Apgar scores, post-partum complications and psychological problems.

Results.?Women in group II, III and IV were characterised by higher systolic booking blood pressure (mean differences: 3.92, 9.94 and 9.84 respectively for group II, III and IV) and higher diastolic booking blood pressures (mean differences 3.02, 6.92 and 9.22 respectively). As a combined group II–IV, women were at increased risk for pre-existing morbidity (OR 2.33) and requiring medication (OR 2.13). Pregnancy hypertension occurred significantly more in group III and IV with OR 2.38 and 3.75. Women without pre-existing hypertension were also found to be at increased risk to develop gestational hypertension only if they belonged to group IV (OR 3.69). Women in group III and IV are at increased risk at gestational diabetes with OR 8.82 and 27.38. Women in group III and IV are less likely to have a spontaneous onset of labour with ORs of 2.18 and 3.51 for not having spontaneous onset of labour. Induction of labour occurred more often in group IV (OR 3.17). Requirement of instrumental deliveries or lower segment caesarean section occurred more often in group II, III and IV with OR 2.20, 3.28 and 5.47 respectively. Significant more blood loss was found in group III and IV with mean differences of 135.42 and 207.94 ml compared with group I. The birthweight in group III and IV are significantly higher with mean differences of 104.86 and 324.94 g. Macrosomia occurred more often in group IV (OR 4.04). Women in group III and IV had a longer overall hospital stay with mean differences of 0.58 and 1.09 days. Mental health issues were more common in group II, III and IV with OR 3.16, 3.53 and 4.17 respectively.

Conclusion.?These South Australian data from a socio-economically deprived area in Adelaide's Northern suburbs confirm that obesity during pregnancy represents a major risk for adverse outcome for patients with a whole spectrum of adverse pregnancy outcomes; obesity represents a major challenge for health care providers.     

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.     

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.

Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.

Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p?=?.02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p?=?.02 and p?p?p?=?.02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p?=?.002), seizures (OR 4.33, 95%CI 1.60–11.77, p?=?.004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p?=?.049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p?Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.     

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.     

Intrauterine fetal death of one twin of diamnionic twins is associated with adverse perinatal outcome of the co-twin

Objective: To determine whether intrauterine fetal death (IUFD) of one twin of diamnionic twins after 22 weeks of gestation is associated with adverse perinatal outcome to the co-twin. Method: A retrospective case-control study (n?=?4070), including all twin births delivered between the years 1988 and 2010, was conducted. Perinatal outcome of the co-twin in diamnionic pregnancies complicated by IUFD were compared with the first twin from a pair of live-born diamnionic twins. A multiple logistic regression model was constructed to determine the association between IUFD of one twin and postpartum death (PPD) of the co-twin while controlling for confounders such as gestational age. Results: Pregnancies complicated with IUFD of a co-twin (n?=?116) had higher rates of adverse perinatal outcomes such as PPD (9.5% vs. 2.3%, p?<?0.001), low Apgar scores (<7) at 1 and 5?min (30.2% vs. 10.6%, p?<?0.001 and 6.9% vs. 1.8%, p?<?0.001, respectively), lower birth weight (1953?±?746?g vs. 2299?±?559?g), and higher rates of preterm birth before 34 weeks of gestation (38.8% vs. 16.4%, p?<?0.001). Using a multivariate analysis with PPD as the outcome variable, mortality was attributed to gestational age (adjusted OR?=?0.58; 95% CI 0.5–0.6, p?<?0.001) and not to the IUFD per se (adjusted OR?=?1.3, 95% CI 0.5–3.3, p?=?0.552). Conclusion: Intrauterine fetal death of one twin (of diamnionic twins) is associated with adverse perinatal outcome of the co-twin mainly due to prematurity.     

母体-胎盘-脐带因素导致双胎妊娠胎儿生长不一致和生长受限抗凝措施的选择

目前关于双胎妊娠胎儿生长不一致和生长受限,讨论更多地集中在对发病者的监测和分娩时机的选择上。发病者不论是双卵双胎还是单卵双胎,都有相当部分发病与母体-胎盘-脐带因素有关。文章就母体-胎盘-脐带因素的针对性监测和抗凝措施进行阐释,旨在展示除了对发病者的被动性监测之外的主动性预防和干预措施的可选择性。     

Maternal,fetal and perinatal characteristics of preeclampsia cases with and without abnormalities in uterine artery Doppler indexes

Abstract

Objective: To compare the maternal and fetal characteristics and perinatal outcome in mild and severe preeclampsia cases with and without uterine artery Doppler abnormalities.

Methods: Two hundred and fifty-nine mild and severe preeclampsia cases were evaluated retrospectively. Doppler measurements were done in the section where uterine artery raised from the hypogastric artery. Pulsatility index above the 95th percentile of the corresponding gestational age was accepted as abnormal.

Results: In mild and severe preeclampsia cases with abnormal Doppler (AD), the rate of intrauterine growth restriction, preterm birth and low birth weight was higher than, but the neonatal intensive care unit stay was similar to the cases with normal Doppler. Base excess was higher in the AD group, in mild and severe preeclampsia. The rate of low Apgar score at 5?min and perinatal mortality was higher in the AD group, in the mild preeclampsia. The strongest independent predictor of the perinatal morbidity and mortality was the presence of prematurity and of the prematurity was the presence of abnormal uterine artery Doppler.

Conclusions: Maternal and perinatal morbidity and perinatal mortality increase in mild to severe preeclampsia cases with abnormal uterine artery Doppler. The abnormal uterine artery Doppler increases the morbidity and mortality by increasing the risk of prematurity.     

Comparison of perinatal outcome between adolescent and adult pregnancies

Abstract

Objective: The aim of this study was to compare perinatal outcomes between adolescent and adult pregnancies.

Material and methods: In 527 adolescent and 1334 adult pregnant women who delivered at Ondokuz Mayis University Obstetrics and Gynecology Department between 2006 and 2013, perinatal outcomes were retrospectively compared in terms of including spontaneous abortion, induced abortion rate, dilatation and curettage (D&C), pregnancy-induced hypertension, premature prelabor and prelabor rupture of membranes, polihydramnios, oligohydramnios, maternal anemia, delivery modes and also neonatal outcomes including 5th minute Apgar score and fetal birth weight.

Results: The ratio of pregnancy induced hypertension and postpartum hemorrhage was higher in adults, but, anemia was more common in adolescents. There was statistically significant difference in the mode of delivery; the ratio of cesarean section was higher in adults whereas the rate of induced abortions and D&C significantly increased in adolescents. Low birth weight (LBW) and extremely LBW rates were significantly higher in adolescents, however, 5th minute Apgar scores were found to be higher than adult group.

Conclusion: These results show that the perinatal care is fairly improved in Turkey.     

Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage,preeclampsia, and placental malposition

Objective: To evaluate the potential impact of adenomyosis on the pregnancy outcomes by retrospectively investigating adenomyosis-complicated pregnancy cases.

Methods: We performed a retrospective case–control study. Forty-nine singleton pregnancy cases complicated with adenomyosis were included in this study. The controls (n?=?245) were singleton pregnant women without adenomyosis and were frequency matched to adenomyosis cases by age, parity, and the need for assisted reproductive technology for this conception. The incidence of obstetrical complications and delivery and neonatal outcomes were examined.

Results: Patients in the adenomyosis group were significantly more likely to have a second trimester miscarriage (12.2% versus 1.2%, odds ratio (OR): 11.2, 95% confidence interval (95% CI): 2.2–71.2), preeclampsia (18.3% versus 1.2%, OR: 21.0, 95% CI: 4.8–124.5), placental malposition (14.2% versus 3.2%, OR: 4.9, 95% CI: 1.4–16.3), and preterm delivery (24.4% versus 9.3%, OR: 3.1, 95% CI: 1.2–7.2), compared with the control group.

Conclusion: Adenomyosis was associated not only with an increased incidence of preterm delivery, as previously reported, but also with an increased risk of second trimester miscarriage, preeclampsia, and placental malposition, which could lead to poor perinatal outcomes.     

Comparison of perinatal grief after dilation and evacuation or labor induction in second trimester terminations for fetal anomalies

OBJECTIVE: This study was undertaken to compare grief resolution after dilation and evacuation (D&E) or induction of labor (IOL) for second-trimester pregnancy termination. STUDY DESIGN: A prospective cohort of 49 women choosing second-trimester abortion caused by fetal anomalies by either medical IOL or D&E. Depression was evaluated by using the Edinburgh Postnatal Depression Scale and bereavement was assessed by using the Perinatal Grief Scale with follow-up to 12 months after pregnancy termination. Data were analyzed with chi 2 tests, Mann-Whitney U tests, and independent and paired sample t tests. RESULTS: There was no significant difference in depression incidence on enrollment (61.9% D&E, 53.8% IOL, P = .579), at 4 months (23.5% D&E, 14.3% IOL, P = .252) or 12 months (27.3% D&E, 20.0% IOL, P = .696) or on the PGS at 4 months (74.1 vs 90.2, P = .351) or 12 months (73.3 vs 86.4, P = .658). CONCLUSION: There is no significant difference in grief resolution among women who terminate a desired pregnancy by either medical or surgical abortion.