Perinatal outcomes of pregnant women with cervical intraepithelial neoplasia

Objective

To investigate the perinatal outcomes of pregnant women with cervical intraepithelial neoplasia (CIN).

Method

The women in this retrospective case–control study were recruited from Beijing Obstetrics and Gynecology Hospital from August 1, 2007 to February 28, 2010. All the cases were 13–32 gestational weeks, who were diagnosed by colposcopy conducted cervical biopsy. A total of 108 cases were followed-up to the day of delivery.

Results

(1) Complications of colposcopy conducted cervical biopsy: there were two cases of pregnant women, who suffered cervical local compression after undergoing colposcopy conducted cervical biopsy, as the bleeding could not be stopped, the wound was treated by local suture. The incidence of such event was 1.8 % (2/108), without any colposcopy and biopsy-related adverse event. (2) Cesarean section rate was 63.6 % (56/88) in CIN, which was higher than 30.0 % (6/20) in cervicitis, and the cesarean section rate increased as CIN grades elevated, and gestational weeks of delivery advanced.(P < 0.05). (3) We did not detect significant difference for the incidence of polyhydramnios, premature rupture of fetal membranes, placental abruption, cervical laceration and postpartum hemorrhage, low birth weight infants, amniotic fluid II–III degree, neonatal deformity and neonatal asphyxia between pregnant women with CIN and cervicitis (P > 0.05); however, the incidence of oligohydramnios and premature infants in pregnant women with CIN group were higher than that in cervicitis group (P = 0.007; P = 0.020). (4) Vaginal delivery and HR–HPV infection did not increase the incidence of perinatal complication; the volume of postpartum hemorrhage within 2 h after birth in vaginal delivery was less than in cesearean section for pregnancies with CIN (P = 0.000).

Conclusion

Pregnant women with CIN can be diagnosed by colposcopy conducted cervical biopsy, and they should be carefully monitored oligohydramnios and preterm during pregnancy. Pregnant women with CIN during pregnancy, excluding other obstetric operation indications may choose vaginal delivery first.     

Effect of placenta previa on fetal growth restriction and stillbirth

Aim

To examine the association between placenta previa and adverse perinatal outcomes such as low birth weight, preterm delivery, stillbirth and fetal growth restriction (FGR).

Methods

This retrospective cohort study includes 12,034 delivered pregnant women who were recruited for the study between 2004 and 2010 in Ege University Hospital. Data were collected by browsing the clinic??s archives. The association between placenta previa and adverse perinatal outcomes was determined via Chi-square tests and Student??s t test. Logistic regression analysis was used to adjust for confounding factors in evaluating the association between placenta previa and the adverse perinatal outcomes.

Results

There was no significant relationship between placenta previa and FGR or stillbirth. Low birth weight and preterm delivery were significantly higher in the placenta previa group. According to logistic regression analysis, low birth weight was associated with an OR of 3.01 (95?% CI 2.05?C4.52) and preterm delivery was associated with an OR of 8.14 (95?% CI 5.60?C11.83); while, placenta previa did not affect FGR and stillbirth significantly.

Conclusion

Although there is no consensus on the association between placenta previa and FGR in previous studies, we suggest that placenta previa is not a reason for placental insufficiency. Management of placenta previa especially depends on maternal hemodynamic parameters such as heavy hemorrhage and hypotensive shock rather than fetal well-being protocols based on serial growth ultrasound and fetal Doppler investigation.     

Validation of Tamil Version of Cranley’s 24-Item Maternal–Fetal Attachment Scale in Indian Pregnant Women

Background

Maternal–fetal attachment has not been formally studied among pregnant Indian women using Cranley’s 24-item maternal–fetal attachment scale.

Objective

The purpose of this study was to validate the Cranley’s 24-item maternal–fetal attachment scale (MFAS-24).

Methods

Consecutive pregnant Indian women of all trimesters were studied in Pondicherry, India.

Statistical Analysis

The mean, standard deviation (SD), Cronbach’s alpha, content validity index (CVI), correlation coefficient, and simple correlation analyses were calculated.

Results

230 pregnant women of various sociodemographic, religious and educational background formed the sample. Mean age of sample was 23 (SD ± 3) years, mean MFAS scores was 87.4 (SD ± 10), mean GHQ scores was 14 (SD ± 1.2), and mean gestational age was 27.2 (SD ± 7) weeks. Cronbach’s reliability alpha of MFAS was high (0.71). There was no correlation between MFAS scores and gestational age or the pregnancy trimester. CVI of the scale, for the Tamil version was 0.72 and for the English version was 0.78.

Conclusions

This study shows applicability of MFAS-24 in Indian settings also for measuring maternal–fetal attachment.     

An analysis of the meanings of pre-eclampsia for pregnant and postpartum women and health professionals in Rio Grande do Norte, Brazil

Objective

to understand the meanings of pre-eclampsia for pregnant and postpartum women and health-care professionals.

Design

a word-association test and semi-structured interviews.

Setting

a maternity hospital located in Natal, Rio Grande do Norte, Brazil that serves pregnant and postpartum women considered to be at high risk.

Participants

51 pregnant women, 10 postpartum women and 87 health-care professionals completed a word-association test; 18 pregnant women, two postpartum women and 20 health-care professionals for the interviews.

Measurements and findings

thematic categories based on the word-association test and the interviews were created to help the data analysis. χ² test was used to compare the categories raised by both groups in the word-association test to determine the association between the frequencies of these categories. The meanings of pre-eclampsia to pregnant and postpartum women were fear, risk, care and lack of information. To the health-care professionals, the meanings were care, fear, risk, high blood pressure, oedema and proteinuria. The frequencies of the categories ‘fear’, ‘care’ and ‘risk’ were statistically different (χ²=31.84, 14.5, 38.19, respectively; df=2, p<0.001) between the group of pregnant and postpartum women and the group of health-care professionals. For the first group, the most significant meanings were fear and risk, compared with care for the second group. The analysis of the interviews confirmed and deepened the results of the word-association test, and also demonstrated that the pregnant and postpartum women had no information about pre-eclampsia.

Key conclusions and implications for practice

there is a gap between how women and health professionals view their experiences of pre-eclampsia. A warm welcome to the health-care facility, with clear explanations about the disease and the procedures to be performed during the visits and hospitalisation would be important aspects for the physical and mental well-being of pregnant and postpartum women.     

Serum screening with Down's syndrome markers to predict pre-eclampsia and small for gestational age: Systematic review and meta-analysis

Background

Reliable antenatal identification of pre-eclampsia and small for gestational age is crucial to judicious allocation of monitoring resources and use of preventative treatment with the prospect of improving maternal/perinatal outcome. The purpose of this systematic review was to determine the accuracy of five serum analytes used in Down's serum screening for prediction of pre-eclampsia and/or small for gestational age.

Methods

The data sources included Medline, Embase, Cochrane library, Medion (inception to February 2007), hand searching of relevant journals, reference list checking of included articles, contact with experts. Two reviewers independently selected the articles in which the accuracy of an analyte used in Downs's serum screening before the 25^th gestational week was associated with the occurrence of pre-eclampsia and/or small for gestational age without language restrictions. Two authors independently extracted data on study characteristics, quality and results.

Results

Five serum screening markers were evaluated. 44 studies, testing 169,637 pregnant women (4376 pre-eclampsia cases) and 86 studies, testing 382,005 women (20,339 fetal growth restriction cases) met the selection criteria. The results showed low predictive accuracy overall. For pre-eclampsia the best predictor was inhibin A>2.79MoM positive likelihood ratio 19.52 (8.33,45.79) and negative likelihood ratio 0.30 (0.13,0.68) (single study). For small for gestational age it was AFP>2.0MoM to predict birth weight < 10^th centile with birth < 37 weeks positive likelihood ratio 27.96 (8.02,97.48) and negative likelihood ratio 0.78 (0.55,1.11) (single study). A potential clinical application using aspirin as a treatment is given as an example. There were methodological and reporting limitations in the included studies thus studies were heterogeneous giving pooled results with wide confidence intervals.

Conclusion

Down's serum screening analytes have low predictive accuracy for pre-eclampsia and small for gestational age. They may be a useful means of risk assessment or of use in prediction when combined with other tests.     

Environmental tobacco smoke and stress as risk factors for miscarriage and preterm births

Back ground

Exposure of pregnant women to environmental tobacco smoke has been shown to be associated with low birth weight. Many studies have suggested that stress have a role in the etiology of preterm birth.

Aims

This study carried out from June 2008 to March 2009 to find the relation between environmental tobacco smoke, stress and miscarriage and preterm births.

Methods

A total of 33 subjects consisted of multiparous pregnant women that were in their early third trimester were chosen for this investigation. Subjects were divided into test group women with adverse pregnancy outcome, control group women with successful pregnancy. Four ml of unstimulated whole saliva were collected. The concentrations of cotinine and cortisol were evaluated using commercially available ELISA kit.

Results

Pregnancies in which the average standardized cortisol during history of previous miscarriage(s) which occurred within 6th–27th week or/and history of preterm labor which occurred within 28th–36th weeks of gestation, demonstrated higher cortisol level (1.0201?±?0.1855?ng/ml) compared to control group 0.9757?±?0.2860?ng/ml (P?=?0.323); statistical analysis showed no significant differences. Women of control group were more likely to be environmental tobacco smoke exposed (1.2714?±?1.7639?ng/ml) than women with miscarriage and preterm births (0.9889?±?0.5498?ng/ml).

Conclusion

The results from this primarily study demonstrated no association between cotinine, cortisol, miscarriage and preterm births.     

Maternal underweight status and association with preterm contractions

Objective

The purpose of the study is to investigate whether underweight pregnant women are more likely to be admitted for preterm contractions compared to normal or overweight women.

Study design

This is a retrospective, cohort study of patients who presented for preterm contractions from January 1, 2000, through January 1, 2008. Body mass index (BMI) categories include index rating of ??19 as underweight, 20?C25 as normal, and >25 as overweight, based on the National Institutes of Health standards. Preterm contractions were documented using an external tocodynamometer. Exclusion criteria included multiple gestations, gestational age under 24?weeks or over 37?weeks, neonatal anomalies, and premature rupture of membrane. Data was analyzed using SPSS 14.0. Statistical data was analyzed using a probability model. ??² testing compared the probability of admission as a function of weight groups as well as age and race variables.

Results

Of the 840 patients identified with preterm contractions, 7% were admitted while 93% were discharged. Of the total patients, 15% were underweight, 43% normal weight, and 42% overweight. Admission for preterm contractions was highest in underweight pregnant women (95%), followed by normal weight (5%). None were overweight. Both basic and augmented probability models showed that normal weight patients were less likely to be admitted for preterm contractions compared to underweight patients even after controlling for age and race.

Conclusion

These results suggest that underweight patients are more likely to be admitted for preterm contractions compared to normal weight patients. No overweight patients were admitted for preterm contractions.     

Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence

Objective

to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.

Background

this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.

Methods

established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.

Data extraction

data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.

Findings

this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease.

Key conclusions

although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.     

Short cervix syndrome: current knowledge from etiology to the control

Background

Preterm delivery is one of the most serious public health problems and is the most important factor relating to neonatal morbidity and mortality. The strategies for preventing it include understanding the risk factors, with specific interventions. Recently, uterine cervix measurements using ultrasonography and vaginal administration of progesterone have gained importance in predicting and secondarily preventing spontaneous preterm delivery.

Objective

To describe the short cervix syndrome, including its etiology, diagnosis, and possible therapies.

Methods

Research in ISI, Pubmed, and Scielo database using the words short cervix, preterm delivery, sludge, cervical funneling, cervical gland area, progesterone, cerclage, and pessary.

Results

We found a lot of articles about this topic, including randomized controlled trials. The etiology is multifactorial, being the diagnosis based in a cervix shortening at 20–24 weeks. The history and measurement of cervix length by transvaginal ultrasound have been shown to be effective to select the high risk pregnancies. The progesterone, cervical cerclage, and cervical pessary showed to be effective to reduce the preterm delivery in pregnant women with short cervix.

Conclusion

The successful management of pregnant women presenting a short cervix depends on the understanding that cervical shortening is the final common path for several causes of preterm delivery. The best approach should be individualized to each patient.     

Outcomes of pregnancies complicated by hyperemesis gravidarum

Objectives

To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG).

Methods

In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth.

Results

There were no statistical differences in the mean of age, parity, the number of artificial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5?±?595.4 vs. 3,164?±?664.5?g) and gestational age (38.1?±?2.3 vs. 38.1?±?2.6?weeks), relative to infants from the control group (p?=?0.67 and 0.91, respectively). In addition, no statistical significant differences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p?>?0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p?=?0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5?min, there were no statistically significant differences between two groups (p?=?0.16 and 0.42, respectively).

Conclusion

Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.     

Perinatal outcomes of immigrant women of Turkish,Middle Eastern and North African origin in Berlin,Germany: a comparison of two time periods

Purpose

Publications based on data from perinatal health registries reported worse perinatal health outcomes among women of Turkish origin. The aim of this study was to compare the perinatal outcomes of women of German and Turkish origin in Berlin in two time periods and to analyze if the situation among the women of Turkish origin has improved over time.

Methods

Datasets of all singleton deliveries from Berlin hospitals for the time periods 1993–1997 (n = 144,600) and 2003–2007 (n = 147,559) were used. Incidence rates resp. prevalences of perinatal health outcomes were computed for women of German and a group of immigrant women mostly of Turkish origin stratified for ‘parity’ and ‘having a partner’. Logistic regression models were computed to test for a change in the odds for adverse perinatal outcomes over time.

Results

The chances for adverse perinatal outcomes were decreasing in the later time period for most measures. For stillbirth, preterm birth and congenital malformations, no differences between women of Turkish and German origin could be found. Differences exist in the utilization of perinatal health care and in the risk for anemia. Among women of Turkish origin, the chance for being anemic is even higher in 2003–2007 compared to 1993–1997.

Conclusions

The perinatal health measures of women of Turkish origin have improved over time. The lower utilization rates of antenatal health care could be the expression of barriers to access the health care for pregnant women with migration background as offered in Germany. A risk group which needs a special focus by health care providers are women without a partner, irrespective of their origin.     

Pre-eclampsia following chemotherapy for breast cancer during pregnancy: case report and review of the literature

Purpose

There has been some discussion about the effect of antineoplastic agents on the trophoblast, and whether this is associated with abnormal placental function such as an increased risk of pre-eclampsia/eclampsia. We discuss a possible causal relationship between chemotherapy for breast cancer during pregnancy and the development of pre-eclampsia based on the occurrence of both in a recent pregnancy.

Methods

We report the case of a 34-year-old gravida 4, para 1 with unilateral ductal invasive breast cancer, treated by surgery and subsequent chemotherapy during pregnancy. At 36?+?2?weeks of gestation a growth restricted male infant (1,680?g, <5th percentile) was born by urgent caesarean section because of acute pre-eclampsia, pathologic CTG and umbilical end-diastolic reverse flow. This case is reported in detail, and literature and databases reviewed.

Results

So far there have been no reports suggesting an increased risk of pre-eclampsia following chemotherapy for breast cancer in pregnancy from the second trimester onwards, and the most probable is an accidental occurrence from pre-eclampsia and chemotherapy.

Conclusions

Whenever possible, pregnant patients with breast cancer should receive the same treatment as those who are not pregnant. Should chemotherapy for breast cancer be indicated in pregnancy from the second trimester onwards only, contraindications would be other risks for pre-eclampsia and intrauterine growth restriction, such as smoking and gestational diabetes.     

Antenatal screening for Group B Streptococcus: A diagnostic cohort study

Background

Information on the extent of postpartum maternal morbidity in developing countries is extremely limited. In many settings, data from hospital-based studies is hard to interpret because of the small proportion of women that have access to medical care. However, in those areas with good uptake of health care, the measurement of the type and incidence of complications severe enough to require hospitalisation may provide useful baseline information on the acute and severe morbidity that women experience in the early weeks following childbirth. An analysis of health services data from Lusaka, Zambia, is presented.

Methods

Six-month retrospective review of hospital registers and 4-week cross-sectional study with prospective identification of postpartum admissions.

Results

Both parts of the study identified puerperal sepsis and malaria as, respectively, the leading direct and indirect causes of postpartum morbidity requiring hospital admission. Puerperal sepsis accounted for 34.8% of 365 postpartum admissions in the 6-month period. Malaria and pneumonia together accounted for one-fifth of all postpartum admissions (14.5% & 6% respectively). At least 1.7% of the postpartum population in Lusaka will require hospital-level care for a maternal morbidity.

Conclusions

In developing country urban settings with high public health care usage, meticulous review of hospital registers can provide baseline information on the burden of moderate-to-severe postpartum morbidity.     

Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetric cholestasis: An Indian scenario

Objective

To determine the prevalence of liver disease in pregnant Indian women and the risk of adverse pregnancy outcomes resulting from intrahepatic cholestasis.

Methods

We analyzed 5947 pregnant women, A total of 79(1.32%) patients had abnormal liver tests. 47 (0.79%) women who gave birth at Sant Parmanand Hospital from January 1997 to August 2008 had pregnancy complicated by cholestasis. Fisher’s exact 2-Tail p-value analysis was used to compare pregnancy characterstics of this group with those of the general obstetric population (n = 5300).

Results

Obstetric cholestasis started at a mean ± SD of 31 ± 4 weeks’ gestation, with pruritus as the leading symptom.. Affected pregnant women had meconium stained liquor significantly more often (40.4%) than the general obstetric population (18.86%). Intrahepatic cholestasis increased the low basic risk of preterm delivery, thereby increasing the need for neonatal care in the general population. Increased incidence of postpartum hemorrhage was also significant(29.78%) p<0.0004.

Conclusion

Intrahepatic cholestasis of pregnancy has an adverse effect on maternal and fetal prognosis, and affected pregnancies merit closer surveillance.     

A Prospective Cohort Study to Assess and Correlate the Maternal Periodontal Status with Their Pregnancy Outcome

Background

There is an overwhelming body of evidence strongly suggesting that periodontal infection may have a significant negative impact on pregnancy outcome in some women. The aim of this study was to determine the association between periodontal disease and preterm low birth weight of babies.

Materials and Methods

A total of 300 pregnant women, between 20 and 24 weeks of gestation i.e., second trimester, were considered for the study. The periodontal status was recorded using the following parameters: probing pocket depth, clinical attachment level, oral hygiene index and plaque index. After initial examination in the second trimester, the pregnant women were followed till delivery of the baby. Postpartum data i.e., weight of baby, gestational age of pregnancy and type of delivery, were recorded.

Results

Out of 300 pregnant women, 248 women had full-term delivery (12 low birth weight and 236 normal birth weight) while 52 had preterm delivery (6 normal birth weight and 46 low birth weight). There was significant association between body mass index and level of periodontal disease severity of pregnant women with birth weight of babies, gestational age of pregnant women and mode of delivery, respectively. As the level of periodontal disease severity increased, the proportion of delivering preterm and low birth weight babies also increased.

Conclusion

The conclusions obtained revealed that Periodontal disease is a potential risk factor for preterm low birth weight babies of pregnant women.

     

Does immediate postpartum curettage of the endometrium accelerate recovery from preeclampsia–eclampsia? A randomized controlled trial

Objectives

To evaluate the effect of immediate postpartum curettage on rapid resolution of clinical and laboratory indices in pre-eclampsia and eclampsia women.

Methods

A randomized controlled study, comprised of 420 pre-eclamptic or eclamptic women with singleton pregnancy 24 weeks gestation and more. Patients were divided into two groups: 220 patients underwent immediate postpartum curettage and 200 patients as a control group.

Results

The clinical and laboratory prenatal parameters showed no statistical significant differences between both groups. The follow-up for the postnatal clinical and laboratory data showed significant improvement for the mean arterial blood pressure in the curettage group over 6, 12, and 24 h after delivery and significant improvement in the platelet count as well. The average time required for MAP to reach 105 mmHg or less was significantly shorter (P < 0.05) in the curettage group (40 ± 3.15 h) than the control group (86 ± 5.34 h). Two patients in the curettage group developed convulsions versus 11 patients in the control group within the first 24 h after delivery. No maternal mortalities were reported in both groups.

Conclusion

Immediate postpartum curettage is a safe and effective procedure and can accelerate recovery from pre-eclampsia or eclampsia.     

Prediction of Pre-Eclampsia by a Combination of Maternal History, Uterine Artery Doppler, and Mean Arterial Pressure (A Prospective Study of 200 Cases)

Objective

To determine the clinical value of uterine artery Doppler Pulsatility index (PI) at 22–24 + 6 weeks scan and importance of maternal history and mean arterial pressure (MAP) in the prediction of pre-eclampsia.

Materials and Methods

This was a prospective screening study of 200 women with singleton pregnancy. Maternal history and blood pressure were recorded, and MAP was calculated. Transabdominal Doppler ultrasound of uterine artery was performed. Mean PI was calculated, and the presence or the absence of bilateral early diastolic notch was noted. Women were then followed up through pregnancy and delivery for the development of pre-eclampsia, gestational hypertension, and SGA.

Results

The mean ± SD PI value for subjects who had an adverse pregnancy outcome was significantly higher (0.84 ± 0.28) than mean ± SD PI value for subjects who had normal pregnancy outcome (0.71 ± 0.16) with P value <0.000.

Conclusion

Second trimester uterine artery Doppler is a useful screening method for identification of high risk pregnancy in women who can be kept under close surveillance for better maternal and neonatal outcome. This test works better when combined with previous history of pre-eclampsia and MAP.     

Variation of Papp-A Level in the First Trimester of Pregnancy and Its Clinical Outcome

Introduction

Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11–13 weeks of gestation, is associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and pre-eclampsia in chromosomally normal fetuses, while a raised nuchal translucency is associated with specific structural abnormalities and genetic syndromes. We have studied the serum Papp-A level in 560 pregnant patients (11–13 weeks gestation) registered at Bharati Hospital and Research Centre, Pune. All patients undergoing testing were followed till the delivery and their neonatal outcome was also taken into consideration.

Aims and Objectives

Our aim is to study the pregnancy outcome in relation to the variations of Papp-A level in the first trimester of pregnancy.

Materials and Methods

Every patient visiting the antenatal OPD was counseled for testing of First Trimester Screening to assess fetal well-being. Patients who were registered for delivery at our hospital were taken into the trial. Blood samples were taken at 11–13 weeks of pregnancy and sent to the PerkinElmer lab for analysis. Results were expressed in Multiple of Median and patients having MOM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician.

Observations

524 patients were included in the trial out of which 452 patients were found to have a normal Papp-A level of >0.5 MOM. All these patients were followed further during the antenatal period where 18 patients developed preterm labor and few patients developed pregnancy-induced hypertension. The obstetric outcome of patients with a normal Papp-A level was fairly uneventful as compared to others with a low Papp-A level.

Conclusions

Though Papp-A level in the first trimester of pregnancy (11–13 weeks) is an important predictor of future obstetric outcome, it has poor positive predictive value. Patients having a Papp-A level less than 0.5 MOM have a high risk for preterm delivery, fetal growth restriction, and stillbirths along with increased incidence of hypertensive disorders of pregnancy. A low Papp-A level is a useful indicator of risk of preterm delivery and future chance of development of pregnancy-induced hypertension.     

Risk factors for postpartum hemorrhage requiring transfusion in cesarean deliveries for Japanese twins: comparison with those for singletons

Objective

The aim of this study was to identify the factors associated with the increased risk of postpartum hemorrhage requiring transfusion in Japanese twin pregnancies in comparison with those in Japanese singleton pregnancies.

Methods

We reviewed the obstetric records of all singleton and twin deliveries after 22?weeks’ gestation at the Japanese Red Cross Katsushika Maternity Hospital from 2003 through 2011. Potential risk factors for transfusion due to hemorrhage after cesarean delivery were selected according to previous studies of postpartum hemorrhage or transfusion or both after delivery: maternal age, parity, previous cesarean deliveries, history of infertility therapies such as in vitro fertilization, gestational age at delivery, neonatal birth weight, placenta previa, uterine myoma ≥6?cm, hypertensive disorders, placental abruption, emergency cesarean deliveries and general anesthesia.

Results

Using multiple logistic regression, the independent risk factors for postpartum hemorrhage requiring transfusion in singleton pregnancies were preterm delivery [odds ratio (OR) 2.40, 95?% confidence interval (CI) 1.2–4.6, p?<?0.01], placenta previa (OR 8.08, 95?% CI 3.9–16, p?<?0.01) and placental abruption (OR 12.8, 95?% CI 2.3–76, p?<?0.01). In twin pregnancies, however, the independent risk factors for postpartum hemorrhage requiring transfusion were gestational age at ≥41?weeks (OR 8.20, 95?% CI 1.3–40, p?<?0.01) and hypertensive disorders (OR 5.45, 95?% CI 2.2–14, p?<?0.01).

Conclusions

The factors associated with postpartum hemorrhage requiring transfusion in cesarean deliveries of twins seemed to be different from those in singleton cesarean deliveries.