Obstetric outcome of adolescent pregnancies

Background: To determine if adolescent pregnancies are at increased risk of poor obstetrical outcome compared with a general obstetrical population.Methods: A five-year retrospective review of the Toronto Hospital for Sick Children's Teenage Pregnancy Unit was carried out. Information was available on 209 patients < 19 years age between January 1994 and December 1998. This was compared to information available from a database of all women delivering at the same hospital, The Toronto Hospital General Division, during the same time period (n = 13,557). The Chi-square test of independence was used to compare the data and is reported as adolescent group vs. hospital group.Results: Labour was induced in 25.5% vs. 21.8% (p = 0. 20). Epidural anaesthesia was received by 63.5% vs. 53% (p < 0.05). The incidence of preterm delivery (<37 wks) was 13.5% vs. 8.1% (p < 0.05), low-birth-weight babies (< 2500 g) 13.4% vs. 8.6% (p < 0.05) and small-for-gestational-age babies (<2 SD) 1.9%. The incidence of post-term delivery (>41 wks) was 12.5% vs. 4.3% (p < 0.001), macrosomia (>4000 g) 1.9% vs. 9.2% (p < 0.001) and large-for-gestational-age babies (>2 SD) 0.5%. Operative delivery (forceps or vacuum) occurred in 19.7% vs. 19.9% (p = 0.94) and caesarian section in 6.2% vs. 20.1% (p < 0.001). APGARs <7 at five minutes were found in 2.4% vs. 3.1% (p = 0.60). 12.0% of infants were admitted to the neonatal nursery. There were no stillbirths. Conclusions: Both preterm deliveries and low-birth-weight babies were more frequent in the adolescent group although the incidence of SGA babies was low. The low caesarian section rate also likely reflects these findings. Postterm delivery was also more common, yet macrosomia occurred less frequently.     

体外受精-胚胎移植后妊娠产科结局分析

目的　研究体外受精 胚胎移植 (IVF ET)术后妊娠的母儿围生期特点。方法　采用病例对照方法 ,选择行IVF ET术后妊娠并于 1993年 1月至 2 0 0 2年 12月分娩的妇女 2 5 5例 ,与同期分娩的自然受孕的妇女17175例对照 ,研究IVF ET术后妊娠的围生期情况。结果　IVF ET单胎妊娠的早产、前置胎盘、糖耐量试验(OGTT)异常、产后出血、剖宫产率高于自然受孕组 ,P <0 0 5。IVF ET双胎妊娠的分娩孕周、新生儿体重低于单胎妊娠 ,P <0 0 5 ;中度及重度妊娠期高血压疾病 (妊高征 )、胎膜早破发生率高于单胎妊娠 ,P <0 0 5。结论　IVF ET妊娠是高危妊娠 ,多胎妊娠率高是导致早产和低体重儿显著增多的主要原因 ,加强孕期保健 ,及时治疗并发症可获得良好的妊娠结局。     

Obstetric outcome of teenage pregnancies in North Jordan

Objective: The purpose of this study was to investigate obstetric outcomes of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls. Methods: A review of hospital records from 1997—1999 was done to compare the obstetric outcome in 760 teenage first pregnancies (study group) with that in control group i.e. 20 years to 29 years selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls. Results: Revealed that incidence of complications of pregnancy like anemia, pregnancy induced hypertension and antepartum hemorrhage were similar in study and control groups. Pregnancy weight gain, prelabour rupture of membranes and gestational diabetes were significantly lower among teenage mothers. The normal mode of delivery was commoner in teenagers (89.5%) in comparison to control group (72%), probably because of higher number of low birthweight babies. Although in study group the mean birthweight was lower and the incidence of preterm labour and small for gestational age infants higher, there was also increased incidence of large for gestational age infants. While there was no difference in the types of labour, there were lower caesarean and instrumental deliveries. A statistically non-significant higher incidence of perinatal deaths was observed in teenagers. Conclusions: These results indicated that the course and outcome of pregnancy in teenage mothers had in most respects better obstetric outcomes, despite the higher incidence of preterm labour. Received: 26 May 2000 / Accepted: 26 July 2000     

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 outcome after fetal reduction to singleton pregnancies

OBJECTIVE: To study the outcome after fetal reduction or selective termination to singleton pregnancies for various indications. METHODS: Fetal reduction or selective feticide to singleton pregnancies was performed in 80 multiple gestations (congenital malformations, 17 cases; high-risk obstetric conditions, 25 cases; or social/psychological indications, 38 cases). RESULTS: The overall pregnancy loss rate was 10%; however, pregnancy failure was significantly higher in selective reductions performed for preterm prelabor rupture of membranes (PPROM) (4/8) compared with monochorionic twin and bad obstetric history. Fetal reduction to singletons for psychological reasons resulted in a pregnancy wastage of 5.3% (2/38). Procedures performed at < or =14 weeks showed a significantly lower fetal loss rate (2/61; 3.3%), a higher mean gestational age at delivery (38.3+/-2.2 weeks), and a decreased prematurity rate (p< or =0.001). The number of reduced fetuses, prenatal diagnosis by chorionic villus sampling before the reduction and maternal age did not interfere with pregnancy outcome. CONCLUSION: Fetal reduction to singleton pregnancies has a favorable outcome, especially when performed before 14 weeks of gestation.     

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.     

Skin conductance activity in post-term pregnancies

Objective: The pain threshold in humans rises during late pregnancy, and the woman becomes less sensitive to stress. The aim of this study was to investigate whether monitoring the sympathetic nervous system response to stimuli by skin conductance activity might be a useful predictor of spontaneous onset of labour in post-term pregnancies.

Study design: A prospective observational study. Fifty-two healthy pregnant women were consecutively asked for inclusion in the study at their post-term pregnancy examination. Initially, a Ctg (cardiotocography) registration was performed, followed by 5?min of skin conductance measurement including a “cold pressor test”. Finally, a vaginal examination with a cervical assessment were performed according to clinical guidelines.

Results: A statistically significant lower pain reaction during the period of provocation was seen in deliveries close to spontaneous onset of labour compared with induced deliveries with an non-spontaneous onset of labour before 294 days (p?=?0.02). Sixty-three per cent (19/30) of the women with spontaneous onset had a negative value at provocation compared with 30% (6/20) in the induced group.

Conclusions: Decreased response to pain stimuli, as an indication of decreased activity in the sympathetic nervous system, has a correlation to spontaneous onset of labour in post-term pregnancies.     

Placental apoptosis is increased in post-term pregnancies

Placentae were obtained at delivery in 14 pregnancies complicated by post maturity (gestational age ≥ 40 weeks and 10 days) and in 23 uncomplicated pregnancies (gestational age c 40 weeks). The incidence of apoptotic nuclei was significantly greater in the placentae from the postmature pregnancies.     

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.     

Seventy-one quadruplet pregnancies: management and outcome

This article reviews the epidemiology, management, and outcome of 71 quadruplet pregnancies that occurred between 1980 and 1989. A study of detailed medical questionnaires and medical records revealed that 67 (94%) of the pregnancies followed ovulation induction therapy. A majority of the pregnancies were diagnosed by 9.3 weeks' gestation and bed rest was instituted by 16.7 weeks; 14% of women had cervical cerclages. Tocolytic agents were used in 59 (83%) of the group beginning at 24.5 weeks' gestation. The mean gestational age at delivery was 31.4 weeks and the mean birth weight was 1482 gm. Cesarean sections were performed in 89% of the cases. The average maternal weight gain was 45.8 pounds. Of the 284 fetuses, there were six first-trimester losses (including one ectopic pregnancy), 10 stillbirths and 33 neonatal deaths, resulting in a stillbirth rate of 29 per 1000, and corrected neonatal and perinatal mortality rates of 37 per 1000 and 67 per 1000, respectively. Other than premature labor, the most common maternal complications were first-trimester bleeding (35%), toxemia (32%), and anemia (25%). The quadruplet fetal growth curve parallels the singleton 25th percentile until 34 weeks, when it drops below the 10th percentile. These data suggest that a majority of quadruplets are delivered after 28 weeks and a viable outcome is expected. Because of retarded growth after 34 weeks, delivery should be considered at 34 weeks in most cases.     

Obstetric outcome of the malformed uterus. Study of 155 pregnancies

Gynecological and obstetrical pathologies are considered in 155 pregnancies involving uterine deformity. Evaluation of their relative importance shows that maintenance of pregnancy is more important than pregnancy per se. Certain rules are proposed for treatment and obstetrical management of such pregnancies.