Low molecular weight heparin treatment during subsequent pregnancies of women with inherited thrombophilia and previous severe pregnancy complications

Objectives.?The aim of this study was to investigate the effect of low molecular weight heparin (LMWH) on incidence of adverse outcome in women with thrombophilias and previous severe pregnancy complications.

Materials and methods.?The study included 116 women with history of severe preeclampsia, fetal growth restriction (FGR)?≤5th percentile, severe placental abruption and stillbirth?>20 weeks carrying factor V Leiden or prothrombin mutations, or protein S or C deficiency. Eighty-seven women referred to us for follow-up were treated with LMWH starting from weeks 5–15 (study group, A). Twenty-nine non-treated women referred only for delivery in our institution constituted the control group (B).

Results.?The incidence of severe pregnancy complications in previous pregnancies was similar in both groups. Following treatment with LMWH, the incidence of severe preeclampsia was 4.6% in group A compared to 21% in group B, p?=?0.007. The incidence of FGR was 2.3% in group A compared to 21% in group B, p?=?0.03. The incidence of stillbirth or placental abruption was 0% in group A compared to 7% in group B, p?=?0.06. The total incidence of adverse outcome was 7% in group A compared to 55% in group B, p?=?0.0001.

Conclusion.?LMWH treatment of women with previous severe pregnancy complications and thrombophilias significantly reduces the rate of recurrence.     

Perinatal outcomes in post-thyroidectomy pregnancies

Objective.?To investigate pregnancy outcome in patients post-total thyroidectomy.

Methods.?A retrospective study comparing pregnancy outcome of women post-total thyroidectomy (n?=?50), patients with hypothyroidism due to other reasons (n?=?1015) and pregnancies without hypothyroidism (n?=?200,000) was performed.

Results.?A significant linear association was documented between the three groups and adverse outcomes such as placental abruption (6.1% in the total thyroidectomy group, 1.0% in hypothyroidism and 0.8% in the no-hypothyroidism group; p?=?0.002), and caesarean delivery (33.3% in the total thyroidectomy, 30.4 in hypothyroidism and 14.4% in the no-hypothyroidism group; p?<?0.001). Total thyroidectomy was independently associated with placental abruption and fertility treatment in a multivariable model controlling for maternal age. No significant differences were noted between the groups in terms of perinatal outcomes such as low Apgar score (<7) at 1?min (6.1% vs. 4.5% and 4.3%; p?=?0.846) and 5?min (3.0% vs. 0.6% and 3.0%; p?=?0.198); perinatal mortality (0.0% vs. 0.9% and 0.01%; p?=?0.293).

Conclusions.?Women post-total thyroidectomy and women with hypothyroidism due to other reasons are at increased risk for adverse obstetric outcomes, while the risk is higher for pregnancies with total thyroidectomy as compared to hypothyroidism due to other reasons.     

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth

Objective.?To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent.

Method.?The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared.

Results.?Of 38 151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27–0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups.

Conclusion.?Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.     

Association between placental pathology and neonatal outcome in preeclampsia: a large cohort study

Objective: To study associations between placental histopathology and neonatal outcome in preeclampsia (PE). Study design: The cohort consisted of 544 singleton pregnancies complicated by PE and managed at Karolinska University Hospital, Stockholm, Sweden during 2000–2009. Evaluation of placental histopathology was made by one senior perinatal pathologist, blinded to outcome. Clinical outcome was obtained from prospectively collected medical registry data and medical records. Main outcome measures were intrauterine fetal death, smallness for gestational age, admission to neonatal unit, major neonatal morbidity (defined as presence of intraventricular hemorrhage ≥grade 3, retinopathy of prematurity ≥grade 3, necrotizing enterocolitis, cystic periventricular leucomalacia and/or severe bronchopulmonary dysplasia) and neonatal mortality. Logistic regression analyses including gestational age were performed. Results: Abnormal placental weight, both low (adjusted odds ratio (OR) [95% confidence interval] 5.2 [1.1–24], p?=?0.03) and high (adjusted OR 1048 [21–51?663], p?p?=?0.02). Decidual arteriopathy increased the odds for admission to neonatal care (adjusted OR 2.7 [1.1–6.5], p?=?0.03). Infarction involving ≥5% of the placenta was associated with intrauterine fetal death and small for gestational age infants (adjusted OR’s 75 [5.5–1011], p?=?0.001 and 3.2 [1.7–5.9], p?Conclusion: Placental pathology in PE reflects adverse perinatal events and deviant placental weight predicts adverse neonatal outcome in preeclamptic women delivering preterm. Placental investigation without delay can contribute to neonatal risk assessment.     

Maternal pre-gravid body weight and risk for placental abruption among twin pregnancies

Abstract

Objectives.?Placental abruption is a major cause of fetal and neonatal death and has been reported more frequently in twin pregnancies than among singleton gestations. The purpose of this article is to investigate the role of maternal pre-gravid body mass index (BMI) on the risk for placental abruption among twin pregnancies.

Methods.?We used the Missouri maternally linked cohort files (years 1989–1997) consisting of twin live births (gestational age 20–44 weeks). Maternal pre-gravid weight was classified based on the following BMI-based categories: normal (18.5–24.9), underweight (<18.5), overweight (25–29.9), and obese (>30). We used logistic regression for generated adjusted odds ratios with correction for the presence of intra-cluster correlation using generalized estimating equations.

Results.?Overall, 261 cases of placental abruption were registered over the entire study period, yielding a placental abruption rate of 14.9/1000. The frequency of placental abruption correlated negatively with maternal BMI in a dose–effect pattern: underweight (19.3/1000); normal weight (16.1/1000); overweight (13.9/1000); and obese (9.5/1000) mothers (p for trend?<?0.01). After adjusting for confounders, the likelihood of placental abruption was still lower in obese women (OR?=?0.58; 95% CI?=?0.38–0.87). By contrast, women who were underweight had a 20–30% greater likelihood for placental abruption when compared with normal weight mothers, although these findings were statistically not significant.

Conclusions.?There is an inverse relationship between pre-gravid maternal BMI and placental abruption. The mechanism by which obesity impacts the likelihood of placental abruption in twin pregnancies requires further study.     

Risk of Fetal Death Associated With Maternal Drug Dependence and Placental Abruption: A Population-Based Study

ObjectiveSubstance use in pregnancy is associated with placental abruption, but the risk of fetal death independent of abruption remains undetermined. Our objective was to examine the effect of maternal drug dependence on placental abruption and on fetal death in association with abruption and independent of it.MethodsTo examine placental abruption and fetal death, we performed a retrospective population-based study of 1 854 463 consecutive deliveries of liveborn and stillborn infants occurring between January 1, 1995 and March 31, 2001, using the Canadian Institute for Health Information Discharge Abstract Database.ResultsMaternal drug dependence was associated with a tripling of the risk of placental abruption in singleton pregnancies (adjusted odds ratio [OR] 3.1; 95% confidence intervals [CI] 2.6–3.7), but not in multiple gestations (adjusted OR 0.88; 95% CI 0.12–6.4). Maternal drug dependence was associated with an increased risk of fetal death independent of abruption (adjusted OR 1.6: 95% CI 1.1–2.2) in singleton pregnancies, but not in multiples. Risk of fetal death was increased with placental abruption in both singleton and multiple gestations, even after controlling for drug dependence adjusted OR 11.4 in singleton pregnancy; 95% CI 10.6–12.2, and 3.4 in multiple pregnancy; 95% CI 2.4–4.9).ConclusionMaternal drug use is associated with an increased risk of intrauterine fetal death independent of placental abruption. In singleton pregnancies, maternal drug dependence is associated with an increased risk of placental abruption.     

Placental abruption: critical analysis of risk factors and perinatal outcomes

Objective.?To investigate risk factors and pregnancy outcome of patients with placental abruption.

Methods.?A population-based study comparing all pregnancies of women with and without placental abruption was conducted. Stratified analysis using multiple logistic regression models was performed to control for confounders.

Results.?During the study period there were 185,476 deliveries, of which 0.7% (1365) occurred in patients with placental abruption. The incidence of placental abruption increased between the years 1998 to 2006 from 0.6 to 0.8%. Placental abruption was more common at earlier gestational age. The following conditions were significantly associated with placental abruption, using a multivariable analysis with backward elimination: hypertensive disorders, prior cesarean section, maternal age, and gestational age. Placental abruption was significantly associated with adverse perinatal outcomes such as Apgar scores?<7 at 1 and 5?min and perinatal mortality. Patients with placental abruption were more likely to have cesarean deliveries, as well as cesarean hysterectomy.Using another multivariate analysis, with perinatal mortality as the outcome variable, controlling for gestational age, hypertensive disorders, etc., placental abruption was noted as an independent risk factor for perinatal mortality.

Conclusions.?Placental abruption is an independent risk factor for perinatal mortality. Since the incidence of placental abruption has increased during the last decade, risk factors should be carefully evaluated in an attempt to improve surveillance and outcome.     

Should apparently uncomplicated monochorionic twins be delivered electively at 32 weeks?

Objectives.?We aimed to estimate the optimal time of delivery and investigated the residual risk of fetal death after viability in otherwise uncomplicated monochorionic diamniotic twin pregnancies.

Study design.?A database of 576 completed multiple pregnancies that were managed in our tertiary referral fetal medicine department between 1996 and 2007 was reviewed and the uncomplicated 111 monochorionic and the 290 dichorionic diamniotic twin pregnancies delivered after 24 weeks were selected. The rate of fetal death was derived for two-week periods starting at 24 weeks’ gestation and the prospective risk of fetal death was calculated by determining the number of intrauterine fetal deaths that occurred within the two-week block divided by the number of continuing uncomplicated monochorionic twin pregnancies during that same time period.

Results.?The unexpected single intrauterine deaths rate was 2.7% versus 2.8% in previously uncomplicated monochorionic and dichorionic diamniotic pregnancies, respectively. The prospective risk of unexpected stillbirth after 32 weeks of gestation was 1.3% for monochorionic and 0.8% for dichorionic pregnancies.

Conclusions.?In otherwise apparently uncomplicated monochorionic diamniotic pregnancies this prospective risk of fetal death after 32 weeks of gestation is lower than reported and similar to that of dichorionic pregnancies, so does not sustain the theory of elective preterm delivery.     

Incidence,obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis

Objective: To determine obstetric risk factors for the occurrence of preterm placental abruption and to investigate its subsequent perinatal outcome. Study design: A retrospective comparison of all singleton preterm deliveries complicated with placental abruption, between the years 1990-1998, to all singleton preterm deliveries without placental abruption, in the Soroka University Medical Center. Results: Placental abruption complicated 300 (5.1%) of all preterm deliveries (n = 5934). A back-step multivariable analysis found the following factors to be independently correlated with the occurrence of preterm placental abruption: grandmultiparity (more than five deliveries), early gestational age, severe pregnancy-induced hypertension, previous second-trimester bleeding and non-vertex presentation. These pregnancies had a significantly lower rate of preterm premature rupture of membranes than preterm pregnancies without placental abruption. Pregnancies complicated with preterm placental abruption had significantly higher rates of cord prolapse, non-reassuring fetal heart rate patterns, congenital malformations, Cesarean deliveries, perinatal mortality, Apgar scores lower than 7 at 5 min, postpartum anemia and delayed discharge from the hospital than did preterm deliveries without placental abruption. In order to assess whether the increased risk for perinatal mortality was due to the placental abruption, or due to its significant association with other risk factors, a multivariable analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR 3.0, 95% CI 2.1-4.1) as well as cord prolapse, previous perinatal death, low birth weight and congenital malformations were found to be independent risk factors for perinatal mortality. Conclusion: Preterm placental abruption is an unpredictable severe complication associated with significant perinatal morbidity and mortality. Factors found to be independently associated with placental abruption were grandmultiparity, severe pregnancy-induced hypertension, malpresentation, earlier gestational age and a history of second-trimester vaginal bleeding.     

Risk factors for placental abruption in a socio-economically disadvantaged region

Objective. This study was undertaken in order to determine the risk factors for pregnancies complicated by placental abruption in a socio-economically disadvantaged region in metropolitan Adelaide.

Methods. This was a retrospective case–control study including all singleton pregnancies resulting in placental abruption between 2001 and 2005.

Results. The overall incidence of placental abruption was 1.0%; the overall perinatal mortality among the births with abruption was 13%. Univariate analyses showed the following significant risk factors for placental abruption: preterm pre-labor rupture of the membranes (PRE-PROM; odds ratio (OR) 4.79, 95% confidence interval (CI) 1.52–15.08), non-compliance with antenatal care (OR 2.93, 95% CI 1.06–8.90), severe intrauterine growth restriction (IUGR), and elevated homocysteine levels (OR 45.55, 95% CI 7.05–458.93). Severe IUGR was significantly more common in the abruption group compared with the control group (p = 0.032). In the multivariate analysis, PRE-PROM remained a significant independent risk factor for placental abruption. Marijuana use, domestic violence, and mental health problems were more common (borderline significance) in the abruption group. Smoking and preeclampsia were not found to be associated with placental abruption in this study.

Conclusions. In this high-risk population, PRE-PROM and elevated homocysteine levels appear to represent the major risk factors for placental abruption.     

A case-control study of 1253 twin pregnancies from a 1982-1987 perinatal data base

In one regional perinatal network between 1982-1987, 101,506 women delivered infants greater than 500 g, of which 1253 were twin pregnancies (1.2%). This latter group was compared statistically with a 5% random sample of the singletons (N = 5119). The results showed that the women with twin pregnancies were slightly older, had a higher parity, gained more weight during the gestation, and had a heavier body weight at delivery. Twin pregnancies were complicated by increases in hypertension (odds ratio 2.5; 95% confidence interval 2.1-3.1), abruption (odds ratio 3.0; 95% confidence interval 1.9-4.7), and anemia (odds ratio 2.4; 95% confidence interval 1.9-3.0). There was no increased risk of pyelonephritis, placenta previa, or diabetes mellitus in mothers with twins. The twin pregnancies delivered earlier and the infants were smaller, had lower Apgar scores, and were at increased risk for congenital anomalies. Fetal and neonatal mortality rates were significantly increased in the twin infants; the perinatal mortality rates for twin A and twin B were 48.8 and 64.1, respectively, compared with 10.4 per 1000 births for the singleton controls. When the twin infants A and B were of similar weight, they had a similar perinatal mortality (odds ratio 1.0; 95% confidence interval 0.6-1.8). For infants less than 2500 g, twins A and B had lower fetal and neonatal mortality rates than did singletons, but twins heavier than 2500 g were at increased risk of perinatal death.     

Placental histologic patterns and neonatal seizure,in preterm premature rupture of membrane

Objective: To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM).

Methods: We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery.

Results: Mean gestational age at membrane rupture was 29.5?±?3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p?=?0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1?min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242–20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617–34.653).

Conclusions: Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.     

Perinatal and neonatal mortality in Northwest Greece (1996–2004)

Objective.?An improvement in perinatal mortality is reported in various countries. This is a retrospective analysis of perinatal and neonatal mortality in Northwest (NW) Greece.

Methods.?Analysis was made of the births and deaths register in NW Greece and records of the regional referral tertiary care center and the National Hospitals at the same area for the period 1996–2004. Perinatal mortality was analysed according to birthweight (BW) and gestational age (GA) for two separate periods, 1996–1999 (I) and 2000–2004 (II), corresponding to an increase in antenatal steroid use from 20% to 63%.

Results.?Neonatal mortality improved between the two periods in infants with very low BW [very low birth weight (VLBW),?<1500?g] and the very preterm infants (<28 weeks GA). Severe respiratory distress syndrome (RDS) decreased (p?<?0.001) for infants with GA ≤ 34 weeks and those with BW 751–1500?g (p?<?0.02), and perinatal asphyxia is no longer a leading cause of death. Intrauterine transfer increased (p?<?0.001) for infants with BW ≤ 1500?g. The main cause of death as derived from birth records and neonatal intensive care unit records is prematurity, alone or with complications.

Conclusions.?With the introduction of antenatal steroids and increase in intrauterine transfer there has been a decrease in neonatal mortality of VLBW infants in NW Greece.     

Neonatal outcome of the pregnancies associated with placental villous thrombosis – thrombophilic status of the mothers and the infants

Objective: To analyze the relationship of obstetric complications and neonatal outcomes with the thrombophilic status of the mother–infant couples in case of demonstrated placental villous thrombosis in histopathological evaluation after delivery. Methods: Placentas of high-risk pregnancies, unexplained fetal loss or infants who needed neonatal intensive care unit (NICU) admission were collected at the time of delivery. Results: In a 6 months period, placental villous thrombosis was detected in 30 among 800 placentas. Half of the mothers had a bad obstetric outcome previously, such as at least one abortus or stillbirth. Eighteen neonates (60%) were premature. Seventy-five percent of the neonates (n = 24) needed NICU admission and the mortality rate was 9.3 %. Five of the patients had congenital anomalies. Thrombophilic mutations could be evaluated in seven mothers-infant couples, all of whom had at least one positive mutation for thrombosis. Conclusions: Severe fetal vasculopathy appears to be a predisposing factor for adverse neonatal outcomes. Analyzing placentas will yield advantages as the same pathological process may repeat in subsequent pregnancies. Thrombophilic mutations should be evaluated to provide the etiology of the adverse outcome and to give prophylaxis for the future pregnancies.     

Social disparity affects the incidence of placental abruption among multiparous but not nulliparous women: a register-based analysis of 1,162,126 singleton births

Objectives

To identify risk factors for placental abruption and to evaluate associations between adverse perinatal outcomes and placental abruption stratified by parity among women with singleton births from 1991 to 2010 in Finland.

Study design

A retrospective population-based case–control study of singleton births in Finland from 1991 to 2010 (n = 1,162,126 from the Finnish Medical Birth Register). We modelled the group-specific risk factors for placental abruption in unadjusted and adjusted models.

Results

In total 3.5 and 3.7 per 1000 nulliparous and multiparous women, respectively, were affected by placental abruption. The recurrence rate was 8.6 per 1000 births. The adjusted risk for placental abruption increased in pregnancies characterised by advanced maternal age, low birth weight, smoking, major congenital anomaly, preeclampsia and male foetal sex in both parity groups. In vitro fertilisation increased the risk only in nulliparae whereas anaemia, a prior caesarean section and the lowest socioeconomic status increased the risk in multiparae. Births affected by placental abruption were associated with an increased admission for neonatal intensive care, preterm birth, low birth weight (<2500 g), small for gestational age infants, low Apgar scores, and low newborn umbilical vein pH (<7.15). Placental abruption resulted in increased risks of stillbirth and early neonatal death in both parity groups.

Conclusions

The burden of placental abruption is equal in nulliparae and multiparae, but risk factors vary substantially. Social disparity only affects the incidence of placental abruption among multiparous women, indicating that factors related to lifestyle and health behaviour have different effects on the parity groups.     

Evaluation of a rapid optical immunoassay-based test for group B streptococcus colonization in intrapartum patients

Objective.?To investigate the association between cleft lip and/or palate and perinatal mortality.

Methods.?A retrospective review was performed of cases of cleft lip/palate born to West Midlands residents from 1995 to 1997. Perinatal mortality for identified cases was compared with all births from 1995 to 1997.

Results.?347 cases of cleft lip and/or cleft palate were delivered from 1995 to 1997. Thirty-six pregnancies were terminated due to parental wishes - 2 were registerable births. There were 310 spontaneous registerable births (stillbirths/livebirths) with cleft lip and/or palate and 1 further late fetal loss. In 220 (70.5%), the lesion was isolated. Of these, there were 7 perinatal deaths, 5 had post mortems and no additional anomalies were identified. In 92 (29.5%) cases other abnormalities were identified. The overall perinatal mortality rate (PNMR) in the West Midlands, was 10.0/1000 total births. The overall PNMR for babies with facial clefts was 89.7/1000 total births. The PNMR for those with associated anomalies was 228.3/1000 live/still births. The PNMR for isolated facial clefts was 31.8/1000 live/still births, significantly higher than the background population (OR 3.3, 95% CI: 1.5–7.0).

Conclusion.?Consideration should be given to screening the fetus at 20–24 weeks for facial deformity. This has implications for detection both of fetal anomalies and of a population at risk for adverse outcome.     

Birth weight discordancy and adverse perinatal outcomes among twin gestations in the United States: the effect of placental abruption

OBJECTIVE: We evaluated whether the relationship between birth weight discordancy of twins and stillbirth, neonatal deaths, and preterm births was modified by the presence of abruption. STUDY DESIGN: We used the 1995 to 1997 matched multiple birth file for United States twin births (n = 269287). Birth weight discordancy was defined as the ratio of the difference in birth weight of the heavier from the lighter twin to that of the heavier twin and was categorized as <5%, 5% to 9%, 10% to 14%, 15% to 19%, 20% to 29%, 30% to 39%, and >or=40%. We evaluated the risks of stillbirth (>or=20 weeks of gestation), neonatal deaths (within 28 days after birth), and preterm birth (< 32 weeks) in the presence and absence of abruption. Associations between birth weight discordancy and these perinatal outcomes were expressed as adjusted relative risks and were derived from multivariable logistic regression models, based on the method of generalized estimating equations. Risk of these outcomes were derived for each stratum of birth weight discordancy and abruption status, with the <5% birth weight discordancy, nonabruption status labeled as the reference group. All analyses were performed separately for same and different sex twins. RESULTS: A birth weight discordancy of >or=20% among same sex (adjusted relative risk, 1.2; 95% CI, 1.1, 1.4), and >or=40% among different sex twins (relative risk, 2.2; 95% CI, 1.7, 2.8) conferred increased risk for abruption. Among nonabruption births, a birth weight discordancy of >or=15% among same sex and >or=30% among different sex twins increased the risk of stillbirths, neonatal deaths, and preterm births. Among abruption births, however, the risks were increased even in the lowest birth weight discordancy category (<5%). The relative risks of stillbirths and neonatal deaths among abruption births were significantly higher for each birth weight discordancy group, both for same and different sex twins, compared with the reference group. The association between birth weight discordancy and preterm birth was not modified by either the presence or absence of abruption. CONCLUSION: Birth weight discordancy of >or=15% for same sex and >or=30% for different sex confer greatest risk of adverse perinatal outcomes in the absence of abruption. In the presence of placental abruption, these risks are further compounded. The results underscore the need for careful monitoring of twin pregnancies.     

Pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy

Objective.?The study was designed to investigate obstetric risk factors and pregnancy outcome of patients with pruritic urticarial papules and plaques of pregnancy (PUPPP).

Methods.?A population-based study comparing all pregnancies of women with and without PUPPP was conducted. Deliveries occurred during the years 1988–2002 at the Soroka University Medical Center. A multivariable logistic regression model was constructed in order to find independent risk factors associated with PUPPP.

Results.?During a 15-year period, 159 197 deliveries took place. PUPPP complicated 42 (0.03%) of all pregnancies. Using a multivariable analysis, the following conditions were significantly associated with PUPPP: multiple pregnancies (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.7–14.1), hypertensive disorders (OR = 2.2, 95% CI 1.1–4.7), and induction of labor (OR = 7.6, 95% CI 4.0–14.5). Higher rates of 5-minute Apgar scores lower than 7 (OR = 8.0, 95% CI 4.4–14.9) and of cesarean deliveries (OR = 2.9, 95% CI 1.5–5.6) were noted in the PUPPP as compared to the comparison group. While investigating other perinatal outcome parameters such as oligohydramnios, intrauterine growth restriction, meconium-stained amniotic fluid and perinatal mortality, no significant differences were observed between the groups.

Conclusion.?Pruritic urticarial papules and plaques of pregnancy is a condition significantly associated with multiple pregnancies, hypertensive disorders, and induction of labor. Perinatal outcome is comparable to pregnancies without PUPPP.     

Outcome of preterm and term neonates of mothers with malignant diseases diagnosed during pregnancy

Objective.?To investigate the outcome of preterm and term neonates born to mothers with malignant diseases diagnosed during pregnancy.

Methods.?A retrospective analysis with a matched-paired control group in a third level obstetric department and third level neonatal department of the University Hospital Frankfurt. Patients were preterm and term neonates from mothers with oncologic diseases diagnosed during pregnancy and matched-paired preterm and term neonates from healthy mothers.

Measurements and results.?Nineteen preterm and three term (1 × twins) neonates from 21 mothers with oncologic diseases and matched-paired neonates from 21 healthy mothers were included. With the exception of one case, pregnancy was terminated because of the necessity for maternal oncological treatment. Children from mothers with malignant diseases had a significantly lower birth weight and a tendency towards a higher incidence of high-grade respiratory distress syndrome. No significant differences concerning Apgar scores, red blood cell (RBC), white blood cell (WBC), and platelet (PLT) counts postpartum, and duration of hospital days between the two groups of neonates were observed.

Conclusion.?Direct perinatal outcome of preterm or term neonates from mothers with malignant diseases diagnosed during ongoing intact pregnancy does not differ from the outcome of a comparable group of neonates from healthy mothers. This might be in contrast to the long-term outcome of this special patient group. In our study we could find no elevated mortality in neonates where pregnancy was terminated because of the need for maternal chemotherapeutic therapy.