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.     

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.     

Obstetrical and neonatal outcomes of triplet births – spontaneous versus assisted reproductive technology conception

Objective: To determine the average gestational age at birth and to compare obstetrical and neonatal outcomes of triplet births conceived spontaneously versus via assisted reproductive technology (ART).

Methods: A retrospective chart review of triplet pregnancies that resulted in three live babies was conducted at Mount Sinai Hospital (Toronto, Canada) from January 2000 to June 2013.

Results: A total of 230 women and 690 fetuses were identified. The mean gestational age at birth was 32.0?±?3.8 weeks. Obstetrical outcomes included preterm premature rupture of the membranes in 29%, preterm labor in 26%, preeclampsia or HELLP syndrome in 19% and gestational diabetes in 10%. The mean birth weight of infants born after 24 weeks was 1655?±?550?g and the rate of small for gestational age was 28%. The neonatal mortality rate prior to discharge was 7%. Aside from respiratory distress syndrome (30.6 versus 46.6%; p?=?0.02), there were no differences in gestational age at birth, obstetrical or neonatal outcomes between spontaneous versus ART triplet conception. Monochorionicity carried a higher risk of small for gestational age, congenital anomalies and neonatal mortality compared to trichorionicity.

Conclusion: Rates of preterm birth and related complications remain high in triplet gestation. However, obstetrical and neonatal outcomes were similar for triplets conceived spontaneously versus via ART.     

Borderline amniotic fluid index and perinatal outcomes in the uncomplicated term pregnancy

Objective: To determine perinatal outcomes in uncomplicated term pregnancies with a borderline amniotic fluid index (AFI).

Methods: A retrospective review was conducted of uncomplicated singleton pregnancies at term (>37 weeks). Borderline and normal AFI were defined as 5.1?≤?AFI?≤?8.0?cm and 8.1?≤?AFI?≤?24?cm, respectively. Adverse perinatal outcomes, cesarean delivery for non-reassuring fetal heart rate testing, meconium-stained amniotic fluid, a 5-min Apgar score of <7, admission to the neonatal intensive care unit (NICU), and whether the neonate was small for gestational age were compared between the borderline and normal AFI groups.

Results: Borderline AFI was not significantly associated with cesarean delivery for non-reassuring fetal heart rate testing (p?=?0.513), meconium-stained amniotic fluid (p?=?0.641), admission to the NICU (p?=?0.368), or a 5-min Apgar score of <7 (p?=?1.00). However, the number of neonates who were small for gestational age (p?=?0.021) and rates of induction of labor (p?<?0.001) were significantly higher in the borderline group. Multiple logistic regression analysis showed that borderline AFI was not associated with cesarean delivery for non-reassuring fetal heart rate testing (odds ratio [OR]?=?0.72, 95% confidence interval [CI] 0.27–1.91, p?=?0.52).

Conclusion: In uncomplicated term pregnancies, a borderline AFI does not increase the risk of adverse perinatal outcomes.     

Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants

Objective: To determine independent perinatal and intrapartum factors associated with neonatal hypoglycemia.

Method: Of singleton pregnancies delivered at term in 2013; 318 (3.8%) neonates diagnosed with hypoglycemia were compared to 7955 (96.2%) neonate controls with regression analysis.

Results: Regression analysis showed that independent prenatal factors were multiparity (odds-ratio [OR]?=?1.61), gestational age (OR?=?0.68), gestational diabetes (OR?=?0.22), macrosomia (OR?=?4.87), small for gestational age neonate [SGA] (OR?=?6.83) and admission cervical dilation (OR?=?0.79). For intrapartum factors, only cesarean section (OR?=?1.57) and last cervical dilation (OR?=?0.92) were independently significantly associated with neonatal hypoglycemia. For biologically plausible risk factors, independent factors were cesarean section (OR?=?4.18), gentamycin/clindamycin in labor (OR?=?5.35), gestational age (OR?=?0.59) and macrosomia (OR?=?5.62).

Mothers of babies with neonatal hypoglycemia had more blood loss and longer hospital stays, while neonates with hypoglycemia had worse umbilical cord gases, more neonatal hypoxic conditions, neonatal morbidities and NICU admissions.

Conclusion: Diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia. Cesarean section and decreasing gestational age were the most consistent independent risk factors followed by treatment for chorioamnionitis and SGA. Further studies to evaluate these observations and develop preventive strategies are warranted.     

The impact of fetal middle cerebral artery Doppler on the outcome of congenital hydrocephalus

Objectives: The objective of this study is to investigate the impact of abnormal middle cerebral artery (MCA) Doppler on the perinatal mortality in fetuses with congenital hydrocephalus (CH).

Methods: A prospective study of all fetuses with CH who delivered at our hospital over a period of 7 years. Data were obtained from the ultrasound, Labor room and intensive neonatal care unit (NICU) database. The Perinatal mortality rates were evaluated in relation to the following measures, associated congenital anomalies, cortical mantle thickness (CMT), and MCA Doppler abnormalities (absent or reversed diastole). The main outcome measure was perinatal mortality rate in relation to MCA Doppler changes.

Results: A total of 85 cases of CH were diagnosed and managed. The birth prevalence of CH was 2.44 per 1000 live births. On one hand, the perinatal mortality rate was higher in those fetuses with non-isolated hydrocephalus, (37.25% (19/51) versus (35.29% (12/34, p?=?0.854 and in those cases with CMT <10?mm, 38.78% (19/49) versus 33.33% (12/36) in those with CMT >10?mm, p?=?0.607. On the other hand, the perinatal mortality rate was significantly higher in those fetuses with abnormal MCA Doppler, (100% (13/13) versus 25% (18/72), OR?=?78.0, 95% CI (5.52–44085124.60), p?Conclusions: Abnormal fetal MCA Doppler (absent or reversed diastole) appears to be a poor prognostic indicator with significantly high perinatal mortality in fetuses with CH.     

The impact of antenatal cocaine use on maternal characteristics and neonatal outcomes

Objective: To determine the risk factors and evaluate maternal and neonatal outcomes associated with antenatal cocaine use.

Methods: This was a retrospective case–control study of 200 cocaine-exposed maternal–neonatal pairs and 200 controls from 1991 to 2000.

Results: Cocaine-using mothers tended to be older, African American, multiparous and incarcerated and they utilized less prenatal care. However, 79% of Hispanics abusing cocaine were primarily English speaking. Cocaine use correlated with syphilis (36 vs. 1%, p?=?0.000) and premature rupture of membranes (23 vs. 0%, p?=?0.000), fetal demise (5 vs. 0%, p?=?0.004), preterm delivery (40 vs. 6%, p?=?0.000). Cocaine-exposed infants delivered earlier (36 vs. 39 weeks, p?=?0.000), had lower birth weights (2660 vs. 3305?g, p?=?0.000), more respiratory distress syndrome (14 vs. 4%, p?=?0.001), congenital syphilis (12 vs. 1%, p?=?0.000) and longer hospital stays (10 vs. 3 days, p?=?0.000); 75% were placed in foster care or adoption and 37.5% had neonatal withdrawal syndrome. There was a stronger positive correlation between neonatal withdrawal and maternal urine toxicology (ρ?=?0.443, p?=?0.000) than with neonatal urine screen (ρ?=?0.278, p?=?0.003).

Conclusion: Cocaine use in pregnancy is associated with acculturation, lack of prenatal care, and significant social and obstetric complications resulting in increased neonatal morbidity secondary to prematurity, congenital infection and withdrawal syndrome.     

The impact of route of delivery and presentation on twin neonatal and infant mortality: a population-based study in the USA, 1995–97

Objective: We examined whether the route of delivery for near-term (???34 weeks' gestation) twins, as candidates for vaginal delivery, affected neonatal and infant mortality rates. We further evaluated whether these mortality rates were modified by fetal presentation.

Methods: A population-based retrospective cohort study based on the matched multiple births data in the USA (1995–97) was performed. Analyses were restricted to non-malformed liveborn twins delivered at ??34 weeks' gestation. Twins with breech–breech and breech–vertex presentations were excluded, since they are not candidates for vaginal delivery. Neonatal mortality rates (death within the first 27 days) and post-neonatal mortality rates (death between 28 and 365 days) per 1000 twin live births, by route of delivery and fetal presentation, were derived. The associations between neonatal mortality, post-neonatal mortality and the route of delivery for vertex–breech versus vertex–vertex presentations were expressed based on relative risks (RR) and 95% confidence intervals (CI) derived from logistic regression models based on the method of generalized estimating equations.

Results: Of the 177?622 twins analyzed, 87% (n?=?154?531) presented as vertex-vertex. Fifty-five per cent (n?=?97?692) of twins were both delivered vaginally, 41% (n?=?72?825) were both delivered by Cesarean section and, of the remaining 4% (n?=?7105), the first twin was delivered vaginally and the second by Cesarean section. Twins with vertex–breech presentations delivered by Cesarean–cesarean sections, as well as those with vertex–vertex presentations delivered vaginally, had the lowest neonatal mortality rate (1.6 per 1000 live births). The highest neonatal mortality rate in the vertex–breech pairs occurred with vaginal–Cesarean deliveries (2.7 per 1000 live births). Among twins with vertex–vertex presentations, twins delivered via the vaginal–Cesarean route experienced the highest neonatal mortality (3.8 per 1000 live births). The RR for neonatal mortality in this group was 2.24 (95% CI 1.35, 3.72) compared with twins both delivered vaginally.

Conclusion: Route of delivery and fetal presentation both confer an impact on twin infant mortality rates. Strategies to reduce discordant routes in complicated vaginal deliveries may lead to improved neonatal survival.     

Multifetal gestations with assisted reproductive technique before the single-embryo transfer legislation: obstetric,neonatal outcomes and congenital anomalies

Objective: To compare perinatal, neonatal outcome and congenital anomalies of multiple gestations conceived by means of assisted reproductive techniques with spontaneously conceived multiples before the limitation of number of embryo transfer.

Methods: Cases consisted of assisted reproductive technique (ART) multifetal gestations and control group comprised of spontaneously conceived multifetal gestations delivered in the same time period. Outcomes were perinatal, neonatal outcome, long-term outcomes and congenital anomalies of multiple gestations. There were 270 multifetal pregnancies for analysis, of which 137 were achieved by ART and 133 were spontaneous in this prospective study.

Results: Incidences of preeclampsia, gestational diabetes, deep vein thrombosis, thrombocytopenia, intrahepatic cholestasis and preterm premature rupture of membranes were similar in ART and spontaneous groups. There was no difference in fetal malformation rates between ART and control group, but higher rates of central nervous system malformation were observed (4 (1.5%) in control, 0 in ART group, p?=?0.04) in spontaneous group. No difference was seen in the perinatal mortality.

Conclusions: Neonatal and maternal outcomes are comparable between ART and spontaneous multifetal gestations. Congenital fetal malformation rates between ART and spontaneous multifetal pregnancies were similar except central nervous system malformation that was more likely in spontaneously conceived ones.     

Birth weight centiles,risk of intrapartum compromise,and adverse perinatal outcomes in term infants

Objective: The objective of this study is to evaluate the association between birth weight centiles and the risk of intrapartum compromise and adverse neonatal outcomes in term pregnancies.

Methods: Retrospective study of 32?468 term singleton births at a major tertiary maternity hospital in Australia. Data comprised gestation, mode, and indication for delivery and adverse perinatal outcomes. Fetal sex and gestational age-specific birth weight centiles were the main exposure variable.

Results: Neonates?<21st birth weight centile had an increased risk of intrapartum compromise, the highest risk was in babies?<3rd centile (OR 4.04, 95% CI 3.34–4.89). The risk of adverse perinatal outcomes was increased in neonates?<21st and?>91st birth weight centiles. The highest risk was in those?<3rd centile (OR 2.35, 95% CI 2.00–2.75).

Conclusions: Fetal size measurements near term may be used as part of screening test for identifying fetuses at an increased risk of intrapartum compromise and adverse perinatal outcomes.     

Early-onset preeclampsia is associated with perinatal mortality and severe neonatal morbidity

Objective: To evaluate neonatal outcomes of pregnancies complicated by early-onset preeclampsia (PE) and compare these outcomes to those of gestational age matched neonates born to mothers whose pregnancy was not complicated by early-onset PE.

Methods: We analyzed the outcome in 97 neonates born to mothers with early-onset PE (24–32 weeks amenorrhea at diagnosis) and compared it to that of 680 gestational age-matched neonates born between 25–36 weeks due to other etiologies and admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary referral hospital in the Netherlands. We used Chi-square test, Wilcoxon test, and logistic regression analyses.

Results: Neonates born to PE mothers had a higher perinatal mortality (13% vs. 7%, p?=?0.03) and infant mortality (16% vs. 9%, p=?0.03), a 20% lower birth weight (1150 vs. 1430?g, p<0.001), were more often SGA (22% vs. 9%, p?Conclusions: Overall adverse perinatal outcome is significantly worse in neonates born to mothers with early-onset PE. The effect of early-onset PE on perinatal mortality seems partially due to SGA. Whether these differences are due to uteroplacental factors or intrinsic neonatal factors remains to be elucidated.     

Perinatal Outcome in 41 Sets of Triplets in Jordan

Background: Triplet births, which have increased greatly throughout the world in recent years, have a much greater risk of poor birth outcome than singleton births. The purpose of this study was to determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery. Methods: We conducted a retrospective study of 41 sets of triplets born between January 1, 1994, and June 30, 1999, at the Princess Badee'a Teaching Hospital in Amman, Jordan. The primary outcome measures were perinatal mortality and early neonatal complications. Results: Of these sets, 21 triplets were delivered vaginally and 20 triplets were delivered by cesarean section. The perinatal mortality rate was 260 per 1000 live births in this series, primarily due to respiratory distress syndrome. The perinatal deaths occurred to infants whose birthweights were primarily 500 to 1500 g (90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5% vs 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0% vs 22.2%). Conclusions: These results suggested that cesarean delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal mortality rate was significantly higher than that in other recent series due to limited resources in Jordan.     

Pregnancy in patients with sickle cell disease: maternal and perinatal outcomes

Objective: To compare obstetrical, hematological and neonatal outcomes of pregnant women with or without sickle cell disease (SCD).

Methods: A prospective study of 60 pregnancies of 58 women with SCD (29 SCD-SS and 29 SCD-SC) compared with 192 pregnancies in 187 healthy pregnant women was carried out from January 2009 to August 2011.

Results: Compared to controls, the SCD group had higher rate of preterm delivery (p?p?p?=?0.003), and urinary infection (p?=?0.001, OR?=?3.31, CI 1.63–6.73), higher prevalence of small for gestational age babies (p?=?0.019, OR?=?2.66, CI 1.15–6.17), and more frequent baby admissions to progressive care unit (p?p?=?0.056). All adverse events were more frequent in the SS subgroup. Babies from the SS subgroup had the lowest weight at birth (2080?g) compared to SC (2737?g; p?Conclusion: SCD pregnant women – especially those in the SS subgroup – are more prone to experience perinatal and maternal complications in comparison with pregnant women without SCD.     

Maternal ethnicity influences on neonatal respiratory outcomes after antenatal corticosteroid use for anticipated preterm delivery

Objective.?To explore the influence of maternal ethnicity on neonatal outcomes after antenatal corticosteroid administration.

Methods.?A retrospective review of ethnicity, maternal factors, and neonatal birth outcomes was performed for preterm births at a single institution. Cases were limited to women who received antenatal corticosteroids. The impact of ethnicity on specific neonatal respiratory outcomes and mortality was analyzed by bivariate comparisons and by logistic regression analysis.

Results.?Complete ethnicity data were obtained for 548 women. Controlling for gestational age at delivery, diabetes, whether the subject completed a course of steroids, and the dosing of the steroids, logistic regression demonstrated that ethnicity was independently associated with respiratory distress syndrome (compared to Caucasians: African-Americans OR 0.49 (95% CI 0.29–0.85); Filipinos OR 0.45 (95% CI 0.21–0.96).

Conclusions.?Ethnicity is independently associated with neonatal respiratory outcomes after antenatal corticosteroid use. Perhaps individualized dosing of antenatal corticosteroids is needed to further improve neonatal outcomes.     

Immediate perinatal outcomes of postterm deliveries

Objective: To investigate whether postterm pregnancy (≥42 0/7 weeks’ gestation) increases the risk for adverse perinatal outcome.

Study design: In this population based cohort study, all singleton deliveries occurring between 1991 and 2014 in a tertiary medical center were included. Pregnancy and perinatal outcomes were compared between postterm and term deliveries (37 0/7 to 41 6/7 weeks’ gestation). Preterm deliveries, unknown gestational age, congenital malformations, and multiple gestations, were excluded. The association between postterm and adverse perinatal outcomes was evaluated using a general estimation equation (GEE) multivariable analyses.

Results: During the study period, 226,918 deliveries were included in the analysis. Of them, 95.9% (n?=?217,544) were term and 4.1% (n?=?9374) were postterm. Post-term pregnancies were more likely to be complicated with oligohydramnios, macrosomia, meconium stained amniotic fluid, shoulder dystocia, low Apgar scores, and hysterectomy (p?Conclusions: Post-term delivery involves higher rates of adverse perinatal outcomes and is independently associated with significant perinatal mortality.     

Perinatal risk factors and mode of delivery associated with mortality in very low birth weight infants

Objective: To investigate the association of perinatal risk factors including delivery mode with mortality in very low birthweight (VLBW) in a tertiary hospital setting.

Methods: Medical records of 241 live-born VLBW infants (≤1500?g) were retrospectively reviewed. Details of maternal, obstetrical, perinatal risk factors and their associations with infant mortality were evaluated.

Results: The overall infant mortality rate was 23.2%. Mortality was significantly higher for infants born at ≤27 gestational weeks and with a birthweight of ≤750?g (p?=?0.000 and p?=?0.000, respectively), showing a steep decrease thereafter. On ROC analysis, a cut off of 26.5 weeks was determined for mortality with a sensitivity of 57.1% and a specificity of 90.3% (area under the curve?=?0.792, 95% CI: 0.719–0.866). On multivariate regression analysis, gestational week at birth, birthweight, antenatal steroid treatment and pathologic Doppler ultrasound findings were found as independent risk factors for mortality.

Conclusions: Gestational week at birth, birthweight and antenatal steroid treatment remain the most important perinatal risk factors for infant mortality in VLBW infants. Mode of delivery does not seem to be associated with mortality when adjusted for other perinatal risk factors.     

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.     

Analysis of perinatal mortality at a teaching hospital in Dar es Salaam, Tanzania, 1999-2003

We conducted a retrospective analysis of perinatal mortality at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania 1999-2003 in order to categorise/classify perinatal deaths as well as to identify key factors in perinatal care that could be improved. Data were retrieved from the MNH obstetric database and causes of early neonatal deaths were traced from the neonatal ward register. The study includes all foetuses weighing =500g. A modified Nordic-Baltic classification was used for classification of perinatal deaths. Over a 5-year period there were 77,815 babies born with a perinatal mortality rate of 124 per 1000 births, 78% of which was labour related stillbirth. The PMR was 913/1000 for singleton births and 723/1000 for multiple births for babies weighing less than 1500 grams and 65/1000 for singleton births and 116/1000 for multiple births for babies weighing 2500 grams or more. Babies weighing less than 1500 grams contributed 26% of PMR, whereas 41% occurred in babies weighing 2500 grams or more. The majority (79%) of neonatal deaths had Apgar score <7 at 5 minutes and the most common causes of neonatal mortality were birth asphyxia (37%) and prematurity (29%). Labour related deaths were more common in multiple pregnancies. The majority of the perinatal deaths should be essentially avoidable through improved quality of intrapartum care. Establishment of perinatal audit at MNH can help identify key actions for improved care.     

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.     

Costs of maternal and neonatal medical care for triplet and quadruplet pregnancies in Japan

Aims  It is well documented that maternal morbidity and neonatal morbidity and mortality increase alike in high-order multiple (HOM) births. There have, however, been few reports concerning the costs of maternal and neonatal medical care associated with HOM births. This is the first such report on the situation in Japan. Materials and methods  All triplet and quadruplet pregnancies managed at this institution from before 16 weeks’ gestation, and delivered at no earlier than 22 weeks’ gestation, between 1997 and 2002 were included. Prophylactic cervical ligature, hospitalization to prevent premature labor from 23 weeks’ gestation until delivery, and delivery by cesarean section, were all routine for HOM pregnancies. All women with singleton and twin pregnancies, who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and also delivered their babies at no earlier than 22 weeks’ gestation at this institution, between 1997 and 2002, were also examined as controls. Prophylactic cervical ligature, preventive hospitalization, and cesarean section were not routine in the control group. Results  The average gestational ages at delivery in singleton (n = 58), twin (n = 21), triplet (n = 14) and quadruplet (n = 1) pregnancies, were 39.4, 35.6, 31.9 and 25.1 weeks, respectively (P < 0.001 by Anova). Birthweights were 2886 ±425 g, 2117 ± 623 g, 1430 ± 373 g, and 633 ± 77 g (mean ± SD), respectively (P < 0.001). The average inpatient medical care cost for mother and child(ren), from maternal admissions after 12 weeks’ gestation to the discharge of all family members from hospital, was ￥703 279 yen (∼US$5861), ￥4 903 270 (∼US$40 861), ￥11 810 327 (∼US$98 419), and ￥44 961 000 (∼US$374 675), respectively (P< 0.001). Conclusion  The present study outlined the high costs of medical care for HOM pregnancies. Not only from a medical viewpoint, but also from the viewpoint of medical costs, it is important to avoid HOM pregnancies as a result of infertility treatment.