Cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix: PRISMA compliant systematic review and meta-analysis

Background: Preterm births occur frequently in multiple pregnancies with a short cervix. The cervical pessary is a potential intervention for prevention of preterm births.

Objective: To assess the effectiveness of cervical pessary in the prevention of preterm births in multiple pregnancies with a short cervix (<25?mm).

Search strategy: Major databases from 2006 to 20th November 2016 were searched for relevant terms.

Selection criteria: We included randomized controlled trials that assessed the effectiveness of cervical pessary on pregnancy outcomes in multiple pregnancies with a short cervix.

Data collection and analysis: Risk ratio was used as the summary measure with random effects model. We assessed heterogeneity between studies using the I² index. Quality assessment was done based on Cochrane Handbook Method.

Main results: Pooled data showed no benefit of using cervical pessary in the prevention of preterm births, birth weights less than 1500?g, less than 2500?g, adverse neonatal events and fetal/neonatal deaths in twin pregnancies with a short cervix.

Conclusion: We are unable to show benefit of using cervical pessary in preventing preterm births in twin pregnancies with a short cervix. However, as cervical pessary is a reasonable intervention, there is a need for more randomized controlled trials in this area.     

Trauma in pregnancy,obstetrical outcome in a tertiary centre in the Netherlands

Purpose: To determine obstetrical outcome and predictive value of obstetrical symptoms and diagnostic examinations on adverse outcome after maternal trauma in pregnancy.

Materials and methods: Retrospective study in a Dutch tertiary medical center, including women admitted for trauma in pregnancy between 1995 and 2005 and infants born from these pregnancies. Characteristics at trauma (type of trauma, severity) and obstetrical outcome were recorded, as well as prevalence and severity of trauma; prevalence of obstetrical symptoms and abnormal diagnostic examinations. Composite adverse obstetrical outcome was defined as fetal death, placental abruption, birth?<37 weeks and/or birth weight <10th percentile. The predictive value of obstetrical symptoms or abnormal diagnostic tests on an adverse pregnancy outcome was analyzed (logistic regression analysis).

Results: Trauma admissions occurred in 10 per 1000 deliveries. Injuries were non-severe in 147/159 (92%). Obstetrical symptoms and/or abnormal diagnostic tests were present in 64/159 (40%) and 12/159 (8%) respectively. Adverse pregnancy outcome was encountered in 17/80 cases, mainly preterm births (13/80 (16%)). Severe injuries were predictive for an adverse pregnancy outcome.

Conclusions: We found a considerable rate of trauma during pregnancy. There was an increased risk for preterm birth and severity of injuries was predictive for adverse outcome.     

Maternal,Fetal, and Neonatal Outcomes of Elective Fetal Reduction Among Multiple Gestation Pregnancies: A Systematic Review

ObjectiveTo review the existing literature on fetal and maternal health outcomes following elective pregnancy reduction.Data SourcesMEDLINE, EMBASE, CINAHL, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register.Study SelectionStudies involving women pregnant with dichorionic twins, trichorionic triplets, or quadra-chorionic quadruplets who underwent elective fetal reduction of 1 or more fetuses to reduce the risks associated with multiple gestation pregnancies.Data ExtractionThe main fetal health outcomes measured were gestational age at delivery, preterm birth, miscarriage, birth weight, and small for gestational age at delivery. The main maternal health outcomes measured were gestational diabetes, hypertensive disorders of pregnancy, and cesarean delivery.Data SynthesisOf 7678 studies identified, 24 were included (n = 425 dichorionic twin pregnancies, n = 2753 trichorionic triplet pregnancies, and n = 111 quadra-chorionic quadruplet pregnancies). Fifteen studies (62.5%) did not report maternal health outcomes, while every study reported at least 1 fetal health outcome. Fetal reduction was associated with higher gestational age at birth, lower preterm birth, higher birth weight, and lower rates of small for gestational age infants and intrauterine growth restriction. No consistent pattern was observed for miscarriage and neonatal mortality rates. Following fetal reduction, cesarean delivery rates were lower in most studies. There were no appreciable trends with respect to gestational diabetes or hypertensive disorders of pregnancy.ConclusionFetal reduction reliably optimizes gestational age at birth and neonatal birth weight. Miscarriage rates and other adverse procedural outcomes did not increase following transabdominal reduction. Further research on maternal outcomes is needed given a paucity of information in the literature.     

Antepartum Risk Score Predicts Adverse Birth Outcomes

ObjectiveStandardized risk assessment plays an important role in providing medical care of uniform quality to pregnant women, even though it is not a substitute for clinical judgement. This study was designed to determine whether the antepartum risk score currently used across Alberta is associated with neonatal morbidity and adverse pregnancy outcomes for singleton live births and to examine whether the current classification of “lower risk” pregnancies (score < 3) is justified.MethodsA retrospective study was conducted of the delivery records for a cohort of all live singleton births in Alberta from 2001 to 2005 that contained a completed antenatal risk assessment. Adverse neonatal condition or pregnancy outcome was assessed by Apgar score, transfer of the infant to a neonatal intensive care unit, “serious” resuscitation measures, preterm birth, and low birth weight. The population-attributable fraction of any of the adverse outcomes was calculated.ResultsAll outcome measures except for NICU admissions were available for the entire 2001 to 2005 period (n = 191 686); NICU admissions were consistently recorded only from 2002 to 2005 (n = 154 924). The incidence of complications increased steadily as the risk score increased and increased more steeply above a score of 4. Approximately one third of the complications were associated with risk scores of between 2 and 6.ConclusionThe antepartum risk score currently used in Alberta is a useful tool for identifying women at higher risk of an adverse pregnancy outcome. Current categorization of pregnancies with an antepartum risk score of 2 as lower risk should be reconsidered in light of these findings.     

Effects of Women’s Weight Changes on Adverse Outcomes in a Second Pregnancy

ObjectiveTo estimate the effects of women’s weight changes in four sequential perinatal periods across first and second pregnancies (pregravid, first gestation, interpregnancy, second gestation) on adverse maternal and neonatal outcomes in the second pregnancy while accounting for interdependencies in weight across the four periods (Aim 1) and to test the influence of the sequential path of weight changes through the four perinatal periods of risk on maternal and neonatal outcomes in the second pregnancy (Aim 2).DesignSecondary data analysis.SettingThirty-one Wisconsin hospitals.SampleWomen with 24,795 linked records from first and second births from 2006 through 2013.MethodsWe used a fully recursive system of linear and logistic regression equations to examine the relationships among weight changes in the four perinatal periods with maternal (gestational diabetes mellitus, gestational hypertension, cesarean birth) and neonatal (macrosomia, small for gestational age, large for gestational age, low birth weight, congenital anomalies, and perinatal death) adverse outcomes in the second pregnancy.ResultsPregravid weight was weakly and inconsistently associated with weight changes in subsequent periods. Each 5-kg incremental weight change in the first pregnancy, interpregnancy, and second pregnancy contributed to a 0.75- to 5-kg weight change in subsequent periods, 9% to 25% change in risk for adverse maternal outcomes, and 8% to 47% change in risk for adverse neonatal outcomes in the second pregnancy. Fluctuations in weight across pregnancies and associations with outcomes were strongest among normal-weight and overweight women.ConclusionWeight changes across two pregnancies affected maternal and neonatal outcomes in the second pregnancy in all body mass index categories; the larger weight fluctuations observed in normal and overweight women were associated with greater risk of adverse outcomes. Attention to pregnancy weight during and between pregnancies is important for targeted weight counseling to reduce risks in subsequent pregnancies.     

Experiences,Knowledge, and Preferences of Canadian Parents Regarding Preterm Mode of Birth

ObjectivesTo describe Canadian parents’ experiences with mode of birth for preterm singleton pregnancies; knowledge about maternal and infant risks of the different modes of preterm birth, particularly breech birth; and communication preferences with respect to mode of birth.MethodsWe conducted an online survey of Canadian parents who had experienced the preterm birth of a live-born infant between 2010 and 2019. Data were collected from August to September 2019. The sample size was calculated as requiring 96 participants.ResultsOf the 153 respondents, 152 were mothers. Respondents were approximately evenly split between those who had experienced an extremely preterm birth (<28 wk), a very preterm birth (28–31 wk), or a moderate-to-late preterm birth (32–36 wk). Most parents reported that mode of birth was discussed before the birth (61.7%, 73.3% and 77.3% for extremely, very, and moderate-to-late preterm births, respectively). The minority of parents reported being given a choice about mode of birth (20.8%, 23.0%, and 36.4% for extremely, very, and moderate-to-late preterm births, respectively). The use of written material during discussion on mode of birth was rare (2.1%, 3.3% and 6.8% for extremely, very, and moderate-to-late preterm births, respectively). Of women who had a cesarean delivery, 39.6% (36/91) were unaware of the maternal risks. Many parents expressed preference for both oral and written communication during counselling on mode of birth (62.6%).ConclusionFew Canadian parents reported receiving a choice about mode of preterm birth, being aware of associated risks, or receiving written information. There is an urgent need to develop tools that provide information for parents facing preterm birth.     

Pregnancy outcomes in a randomised controlled trial of periconceptional multivitamin supplementation

The effect of periconceptional multivitamin/trace element supplementation on pregnancy outcomes was evaluated in a randomised controlled trial. The final data-base included 5,502 females with confirmed pregnancy. A multivitamin including 0.8 mg folic acid or a trace element were supplemented for at least 28 days before conception and continuing for at least until the second missed menstrual period. Number of pregnancies, terminations of pregnancies, four types of fetal deaths, livebirths including low birth weight, preterm birth and sex ratio were analysed. Periconceptional multivitamin supplementation increased fertility (higher rates of cumulative conceptions and multiple births), had no significant effect on the rate of different groups of fetal deaths, low birth weight and preterm birth in singletons. This primary preventive method can reduce the occurrence and recurrence of neural-tube defects and had no other significant effect on pregnancy outcomes except multiple births.     

Perinatal outcome in pregnancy with polyhydramnios in comparison with normal pregnancy in department of obstetrics at Shiraz University of Medical Sciences

Objective: Polyhydramnios can lead to maternal and fetal complication during pregnancy, so diagnosis and management can decrease some perinatal complications.

Study design: One hundred and fourteen singleton pregnancies were diagnosed with idiopathic polyhydramnios in the department of obstetrics at Shiraz University of Medical Sciences between January 2000 and January 2011 and were compared with 114 normal pregnancies for their perinatal outcome. Variables include birth weight, admission to neonatal intensive care unit (NICU), meconium staining, respiratory distress, fetal death, neonatal death, low 1-min and 5-min APGAR score, primary cesarean section (C/S), preterm delivery (<37?weeks), postpartum bleeding, and placental abruption.

Results: Low birth weight (<2500?g), macrosoma (>4000?g), NICU admission, fetal distress, fetal death, lower 1-min and 5-min APGAR score, preterm delivery, and neonatal death were higher in the case group. However, meconium staining and malpresentation were equal between the two groups. Except for prematurity and 1-min and 5-min APGAR scores, there were no significant differences in other maternal or fetal outcomes considering the severity of polyhydramnios.

Conclusion: Idiopathic polyhydramnios should be considered as a high-risk pregnancy that warrants close surveillance. More studies should be done to detect the best time and interval of fetal surveillance in these patients. Chromosomal and torch studies can determine the definite cause of polyhydramnios.     

Prevalence and outcome of higher order multiple pregnancies in Lagos,Nigeria

Abstract

Objective: To determine the prevalence and outcome of higher order multiple (HOM) pregnancies in Lagos, Nigeria.

Methods: The mode of delivery, gestational age, pregnancy and neonatal outcome of babies delivered from HOM pregnancies were reviewed retrospectively from the labor ward and theater registers, neonatal unit admission records and medical notes in a tertiary referral centre from April 2009 to March 2012.

Results: Twenty-two (15, 6 and 1 set of triplets, quadruplets and quintuplet, respectively) of 6521 pregnancies delivered during the period were HOM pregnancies giving a prevalence of 3.37/1000. All the 74 babies except 12 were delivered by cesarean section. There were 18 perinatal deaths giving a perinatal mortality rate of 243 per 1000. Overall mortality was significantly associated with no antenatal booking (21 versus 5, OR: 21.0, 95% CI: 2.1–72.3, p?=?0.000), gestational age ≤30 weeks (21 versus 5, OR: 46.2, 95% CI: 11.2–189.9, p?=?0.000) and birth weight <1000?g for live births (p?=?0.000). Mode of delivery and number of fetuses >3 were however not significantly associated with mortality.

Conclusion: Reduction of early preterm births by proper antenatal care and close feto-maternal monitoring of HOM pregnancies will significantly reduce the resultant immediate poor outcomes for these pregnancies and their newborns.     

Myasthenia gravis and pregnancy

Three pregnancies in two women with myasthenia gravis (MG), are presented. The first woman expressed no antenatal complications and delivered a full-term 3350 g baby by caesarean section, because of a previous caesarean. The second woman had two preterm births in subsequent pregnancies, which were complicated by hydramnios. Her first pregnancy ended in neonatal death of a 860 g female with multiple congenital anomalies. In her second pregnancy there was an exacerbation of MG and the baby, an 880 g male died soon after birth, due to respiratory failure.     

Pregnancy and delivery outcomes in the women who have received adenomyomectomy: Performed by a single surgeon by a uniform surgical technique

ObjectiveAlthough adenomyomectomy for fertility-sparing is an expanding procedure worldwide, there is no guideline or consensus about how to manage the pregnant women who have previously received conservative surgery for adenomyosis. The aim of this study is to evaluate antenatal care and delivery outcomes in pregnant women after adenomyomectomy.Materials and methodsBetween May 2011 and May 2019, the medical record was reviewed in all delivery of pregnant women received adenomyomectomy performed by a single surgeon by a uniform surgical technique. The evaluating parameters consisted of antenatal care outcomes, delivery outcomes, intrapartum outcome, and neonatal outcomes.ResultsTwenty-two patients were evaluated to monitor pregnancy and delivery outcomes after the adenomyomectomy. Mean age of delivery was 37.0 years old (SD = 3.1, range 32–45, median 37). All were delivered by cesarean section. Mean gestational age was 36.2 weeks (SD = 3.6, range 27.4–39.4, median 37.3). The mean birth weight was 2560.9 g (SD = 771.8, range 1100–3920, median 2550) and the number of preterm births admitted for prematurity care was seven (31.8%, 7/22). Placental abnormality was found in the four cases, which included two placenta accreta and two previa. However, there were no cases of hysterectomy or intervention. We identified one case of uterine rupture during pregnancy (4.5%, 1/22) at 27 weeks of gestation. Except for preterm birth, adverse neonatal outcomes were not found in this study.ConclusionDelivery of pregnant women who received adenomyomectomy can obtain safe perinatal outcomes under close monitoring of preterm labor and surveillance of catastrophic pregnancy related complications.     

Obstetric and neonatal outcomes of adolescent primiparous singleton pregnancies: a cohort study in the South of Reunion Island,Indian Ocean

Objectives: To describe the maternal and neonatal outcomes of a large cohort of adolescent pregnancies in a tertiary care hospital at Reunion Island. Methods: Retrospective study of all primiparous singleton pregnancies over 10.5 years. Adolescent (<18 years) were compared to 18–29 years pregnancies. The maternal outcomes were obstetric illness, labor complications, and way of delivery. Neonatal outcomes were preterm birth, low birth weight (LBW), small for gestational age, birth asphyxia, need for mechanical ventilation, and mortality. Results: We analyzed 1839 adolescent pregnancies and 11,445 controls. Adolescents had worse prenatal care than older mothers, (4.4 vs. 1.4%; p < 0.0001), higher rates of smoking and alcohol assumption (13 vs. 11% and 0.7 vs. 0.4%, both p < 0.05). They showed less pregnancy-related illness and labor complications and higher rates of normal vaginal delivery (80 vs. 69%; p < 0.0001), without increased risk of episiotomy or postpartum hemorrhage. Offspring mortality, preterm birth, and LBW were higher in adolescent pregnancies (3.3 vs. 2.2%; p = 0.001, 14 vs. 12%; p = 0.0008; 17 vs. 14%; p = 0.002). Conclusions: In this population, adolescents had an obstetrical outcome better than controls, but their offspring short-term outcomes were unfavorable. Furthers studies are needed to better elucidate the link between adolescent pregnancy and impaired neonatal outcome.     

Predicting Preterm Birth in Twin Pregnancy: Was the Previous Birth Preterm? A Canadian Experience

ObjectiveMost studies determining risk of preterm birth in a twin pregnancy subsequent to a previous preterm birth are based on linkage studies or small sample size. We wished to identify recurrent risk factors in a cohort of mothers with a twin pregnancy, eliminating all known confounders.MethodsWe conducted a retrospective cohort study of twin births at a tertiary care centre in Montreal, Quebec, between 1994 and 2008, extracting information, including chorionicity, from patient charts.To avoid the effect of confounding factors, we included only women with a preceding singleton pregnancy and excluded twin-to-twin transfusion syndrome, fetal chromosomal/structural anomalies, fetal demise, and preterm iatrogenic delivery for reasons not encountered in both pregnancies. We used multiple regression and sensitivity analyses to determine recurrent risk factors.ResultsOf 1474 twin pregnancies, 576 met the inclusion criteria. Of these, 309 (53.6%) delivered before 37 weeks. Preterm birth in twins was strongly associated with preterm birth of the preceding singleton (adjusted OR 3.23; 95% CI 1.75 to 5.98). The only other risk factors were monochorionic twins (adjusted OR 1.82; 95% CI 1.21 to 2.73) and oldest or youngest maternal ages. Chronic or gestational hypertension, preeclampsia, and insulin-dependent diabetes during the singleton pregnancy did not significantly affect risk.ConclusionPreterm birth in a previous singleton pregnancy was confirmed as an independent risk factor for preterm birth in a subsequent twin pregnancy. This three-fold increase in risk remained stable regardless of year of birth, inclusion/exclusion of pregnancies following assisted reproduction, or defining preterm birth as < 34 or < 37 weeks’ gestational age. Until the advent of optimal preventive strategies, close obstetric surveillance of twin pregnancies is warranted.     

Adolescent Pregnancy Outcomes in the Province of Ontario: A Cohort Study

ObjectiveFew Canadian studies have examined the association between adolescent pregnancy and adverse pregnancy outcomes The objective of this cohort study was to characterize the association between adolescent pregnancy and specific adverse maternal, obstetrical, and neonatal outcomes, as well as maternal health behaviours.MethodsWe conducted a retrospective population-based cohort study of all singleton births in Ontario between January 2006 and December 2010, using the Better Outcomes Registry & Network database Outcomes for pregnant women < 20 years of age (adolescent) were compared with those of women 20 to 35 years old (adult).ResultsThis study included 551 079 singleton birth records, 23 992 (4.35%) of which derived from adolescent pregnancies. Adolescents had a higher rate of smoking and substance use than adult women and were within the lowest education and family income quintiles. Adolescents had a significantly lower risk of gestational hypertension (adjusted relative risk [aRR] 0.73) and gestational diabetes (aRR 0.34), placental abruption (aRR 0.80), and placenta previa (aRR 0.36), but their risk of preterm premature rupture of membranes was significantly higher (RR 1.16). Adolescents had a significantly higher proportion of spontaneous vaginal delivery (aRR 1.76), significantly lower rates of use of epidural analgesia (aRR 0.93), of Caesarean section (aRR 0.57), and of assisted vaginal delivery (aRR 0.76), but a significantly higher risk of emergency CS (aRR 1.31). Neonates with an adolescent mother had significantly higher risks of admission to NICU (aRR 1.08) and very preterm birth (aRR 1.16). There was no significant difference between the two groups in rates of small for gestational age babies, low birth weight, preterm birth, and fetal death. Adolescents had significantly lower rates of prenatal class attendance, prenatal visits in the first trimester, and breastfeeding.ConclusionThis large Canadian cohort study confirms that, compared with adults, adolescents have improved outcomes such as lower rates of gestational hypertension, gestational diabetes, antepartum hemorrhage, and operative deliveries However, adolescents also have higher sociodemographic risk factors and seek prenatal care later than adults These risk factors in combination with young age, lead to other important maternal, obstetrical, and neonatal adverse outcomes. These findings highlight the importance of multidisciplinary prenatal management in the adolescent population to address their high-risk needs, to ensure healthy pregnancies, and to reduce adverse perinatal outcomes.     

Reproductive Outcomes following Use of Barbed Suture during Laparoscopic Myomectomy

Study ObjectiveTo review pregnancy outcomes after laparoscopic myomectomy with the use of barbed suture.DesignRetrospective cohort study and follow-up survey.SettingSingle, large academic medical center.PatientsPatients who underwent laparoscopic myomectomy with the use of barbed suture for myometrial closure between 2008 and 2016.InterventionLaparoscopic myomectomy and a follow-up survey regarding pregnancy outcome.Measurements and Main ResultsA total of 486 patients met inclusion criteria and underwent a laparoscopic myomectomy between 2008 and 2016. Of the 428 with viable contact information, 240 agreed to participate (56%). Of those who responded to the survey, 101 (42%) attempted to get pregnant, and there were 4 unplanned pregnancies. There were 110 pregnancies among 76 survey respondents. In total, of the women attempting a postoperative pregnancy, 71% had at least 1 pregnancy. Comparing the women who did and did not conceive postoperatively, the group who got pregnant was on average younger, 33.8 ± 4.5 years vs 37.5 ± 6.5 years (p = .001); had fewer myomas removed, median = 2 (range 1-9) vs median = 2 (range 1-16) myomas (p = .038); and had a longer follow-up period, 30 months ( vs 30 (11-93 months) ± 20 (p <.001). The mean time to first postoperative pregnancy was 18.0 months (range 2–72 months). Of the 110 reported postoperative pregnancies, there were 60 live births (55%), 90% by means of cesarean section. The mean gestational age at birth was 37.8 weeks. In the cohort, there were 8 preterm births, 3 cases of abnormal placentation, 2 cases of fetal growth restriction, 3 cases of hypertensive disorders of pregnancy, and 2 cases of myoma degeneration requiring hospitalization for pain control. There were no uterine ruptures reported.ConclusionAccording to our findings, pregnancy outcomes after laparoscopic myomectomy with barbed suture are comparable with available literature on pregnancy outcomes with conventional smooth suture.     

Central nervous system lupus and pregnancy: 11-year experience at a single center

Objective: To describe the pregnancy outcomes in women with central nervous system (CNS) manifestations of lupus. Methods: Between 1991 and 2002, the outcome of five pregnancies in four patients with CNS lupus were retrospectively reviewed. All patients had an established history of systemic lupus erythematosus (SLE), and either a history of CNS lupus or active CNS lupus. Pregnancy outcomes assessed included term and preterm birth, intrauterine growth restriction, abnormal antepartum testing, perinatal mortality, pre-eclampsia and other maternal morbidities. Results: Evidence of active CNS lupus symptoms developed in three of the five pregnancies. Two pregnancies were complicated by early onset pre-eclampsia, abnormal antepartum testing and extreme prematurity, with one subsequent neonatal death. The remaining three pregnancies had good neonatal outcomes, but were complicated by severe maternal post-pregnancy exacerbations, and the eventual death of one patient. Conclusions: CNS lupus in pregnancy represents an especially severe manifestation of SLE, and may involve great maternal and fetal risks.     

Effects of Asherman Syndrome on Maternal and Neonatal Morbidity with Evaluation by Conception Method

Study ObjectiveCreate a comprehensive summary of maternal and neonatal morbidities from patients previously treated for Asherman syndrome and evaluate for differences in perinatal outcomes based on conception method.DesignRetrospective cohort.SettingCommunity teaching hospital affiliated with a large academic medical center.PatientsTotal of 43 singleton births identified from 40 patients previously treated at our institution for Asherman syndrome.InterventionsReview of fertility and obstetric data to summarize the maternal and neonatal outcomes in singleton births from patients with Asherman syndrome who had been treated with hysteroscopic adhesiolysis.Measurements and Main ResultsPrimary outcomes of maternal morbidity (i.e., hypertensive disease, gestational diabetes, ruptured membranes, postpartum hemorrhage, morbidly adherent placenta [MAP]) and secondary outcomes of neonatal morbidity (i.e., gestational age at birth, method of delivery, weight, length, 1- and 5-minute Apgar score oxygen requirement, anatomic malformations, length of neonatal admission) were evaluated. We identified 40 patients who completed successful treatment of Asherman syndrome and went on to carry a singleton gestation within our institution: 20 (50%) with mild disease, 18 (45%) with moderate disease, and 2 (5%) with severe disease under the March classification system. In total, 43 singleton births were examined, with 27 of 43 (62.8%) conceived without in vitro fertilization (IVF) (group A: non-IVF conception) and 16 of 43 (37.2%) conceived through IVF (group B: IVF conception). The overall rate of preterm birth in Asherman pregnancies was 11.6%, with no difference between the 2 conception groups. We documented 9.3% cases with intrauterine growth restriction, with no difference based on conception groups. The rate of MAP in patients with Asherman syndrome was 14.0%, and the rate of postpartum hemorrhage was 32.6%, with no differences between the conception groups. Newborn anatomic malformations of any cause were documented in 18.6% of all singleton births, with no difference between the conception groups.ConclusionOur series indicates a higher incidence of intrauterine growth restriction, MAP, postpartum hemorrhage, and newborn anatomic malformations in Asherman syndrome pregnancies than that reported in pregnancies within the general population. However, we found no significant differences in the maternal and neonatal outcomes of patients with Asherman syndrome who conceived with or without IVF after being treated with hysteroscopic adhesiolysis.     

Pregnancy Outcomes in Women With Spinal Cord Lesions

ObjectiveWomen with spinal cord lesions present special challenges during pregnancy. We studied their pregnancy outcomes with regard to medical, obstetrical, and social concerns.MethodsWe reviewed the records of pregnant women with spinal cord injury who attended our institution between 1999 and 2009.ResultsThirty-two women with a total of 37 pregnancies were identified. Most were nulliparous (65%) with either thoracic or lumbar spinal cord lesions due to neural tube defects (69%), trauma (19%), tumours (9%), or iatrogenic injury (3%). Most had undergone orthopedic surgery (63%) or neurosurgery (53%). The most common medical conditions were neurogenic bladder (53%), anemia (16%), autonomic hyperreflexia (9%), and elevated BMI > 30 (6%).Recurrent urinary tract infection occurred in 32%. Antibiotic suppression against bacteriuria was used in 35%. Antenatal hospitalization occurred in 46%, most often because of threatened preterm labour (19%).There were 33 live births and two stillbirths (6%). Preterm birth < 37 weeks occurred in 24%. Vaginal birth occurred in 33%.ConclusionPregnant women with spinal cord lesions generally have successful pregnancy outcomes. However, their pregnancies are at significant risk for preterm birth, infection, and Caesarean section. Coordinated multidisciplinary care is recommended for optimal management of these pregnancies.     

Risk Factors and Birth Outcomes Associated with Teenage Pregnancy: A Canadian Sample

Study ObjectiveTo examine the extent to which socioeconomic status, mental health, and substance use are associated with teenage pregnancies in Southwestern Ontario (SWO), and whether these pregnancies are at an elevated risk for adverse birth outcomes, after controlling for medical, behavioral, and socioeconomic status factors.DesignRetrospective cohort study using perinatal and neonatal databases.SettingTertiary care hospital in SWO.ParticipantsWomen residing in SWO who gave birth to singleton infants without congenital anomalies between 2009 and 2014. Teenage pregnancies (19 years of age or younger) were compared with pregnancies of women 20-34 years and 35 years or older.InterventionsNone.Main Outcome MeasuresLow birth weight (LBW), very LBW, term LBW, preterm birth, very preterm birth, low and very low Apgar score, and fetal macrosomia.ResultsOf 25,263 pregnant women, 1080 (4.3%) were 19 years of age or younger. Approximately 18% of teenage mothers lived in socioeconomically disadvantaged neighborhoods, compared with 11% of mothers aged 20-34 and 9% of women 35 years of age or older (P < .001). Teenage mothers had higher rates of depression during pregnancy (9.8%) than mothers 20-34 years (5.8%) and those 35 years of age or older (6.8%; P < .001). Young mothers self-reported higher tobacco, marijuana, and alcohol use during pregnancy than adult mothers (P < .001). Teenage pregnancy increased the risk of a low Apgar score (adjusted odds ratio, 1.56; 95% confidence interval, 1.21-2.02), but was not associated with other birth outcomes after adjusting for covariates.ConclusionTeenage pregnancy is associated with a higher risk of socioeconomic disadvantage, mental health problems, and substance use during pregnancy, but is largely unrelated to adverse birth outcomes in SWO.     

体外受精-胚胎移植术后单胎妊娠早产相关因素的临床研究

目的探讨体外受精-胚胎移植术(in vitro fertilization and embryo transfer,IVF-ET)后单胎妊娠孕妇早产的相关因素及新生儿结局。 方法回顾性分析2013年8月至2015年8月在中山大学孙逸仙纪念医院分娩的250例孕产妇临床资料,其中IVF-ET后单胎妊娠早产组(A组)50例,自然妊娠单胎早产组(B组)100例,IVF-ET后单胎妊娠足月分娩组(C组)100例。记录妊娠期糖尿病、妊娠期高血压、胎膜早破、前置胎盘或低置胎盘发生率,以及新生儿结局等资料,分析IVF-ET术后单胎妊娠早产相关因素。记录和分析孕期因宫颈机能不全行宫颈环扎术操作的情况。 结果妊娠期并发症、早产儿出生体重和分娩孕周,A组和B组差异无统计学意义。妊娠期高血压(A组14%、C组3%),胎膜早破(A组42%、C组14%),前置胎盘或低置胎盘(A组12%、C组2%),新生儿出生体重[A组(2225±622)g、C组(3231±482)g]、1 min Apgar评分[A组(8.61±1.77)分、C组(9.49±0.94)分],5 min Apgar评分[A组(9.66±0.94)分、C组(9.93±0.29)分],A组和C组比较差异均有统计学意义(P<0.05)。Logistic多因素回归分析显示妊娠期高血压、胎膜早破、前置胎盘或低置胎盘、宫颈机能不全与IVF-ET术后单胎妊娠早产相关。孕期因宫颈机能不全,需行宫颈环扎术的患者,A组为22%,B组为9%,C组为4%,A组与B、C组比较差异均有统计学意义(P均<0.05)。 结论妊娠期高血压、胎膜早破、前置或低置胎盘、宫颈机能不全是IVF-ET术后单胎妊娠早产的高危因素。IVF-ET术后单胎妊娠早产儿与足月儿相比,出生体重、1 min Apgar评分、5 min Apgar评分均较差。