Maternal risk factors for chorioamnionitis in preterm neonates born before 34 weeks: a gestational age–adjusted analysis

First, to investigate the additive value of second-trimester placental growth factor (PlGF) for the prediction of a small-for-gestational-age (SGA) neonate. Second, to examine second-trimester contingent screening strategies. This was a prospective observational study in women with singleton pregnancy undergoing routine ultrasound examination at 19-24 weeks' gestation. We used the competing-risks model for prediction of SGA. The parameters for the prior model and the likelihoods for estimated fetal weight (EFW) and uterine artery pulsatility index (UtA-PI) were those presented in previous studies. A folded-plane regression model was fitted in the dataset of this study to describe the likelihood of PlGF. We compared the prediction of screening by maternal risk factors against the prediction provided by a combination of maternal risk factors, EFW, UtA-PI and PlGF. We also examined the additive value of PlGF in a policy that uses maternal risk factors, EFW and UtA-PI. The study population included 40 241 singleton pregnancies. Overall, the prediction of SGA improved with increasing degree of prematurity, with increasing severity of smallness and in the presence of coexisting pre-eclampsia. The combination of maternal risk factors, EFW, UtA-PI and PlGF improved significantly the prediction provided by maternal risk factors alone for all the examined cut-offs of birth weight and gestational age at delivery. Screening by a combination of maternal risk factors and serum PlGF improved the prediction of SGA when compared to screening by maternal risk factors alone. However, the incremental improvement in prediction was decreased when PlGF was added to screening by a combination of maternal risk factors, EFW and UtA-PI. If first-line screening for a SGA neonate with birth weight < 10th percentile delivered at < 37 weeks' gestation was by maternal risk factors and EFW, the same detection rate of 90%, at an overall false-positive rate (FPR) of 50%, as that achieved by screening with maternal risk factors, EFW, UtA-PI and PlGF in the whole population can be achieved by reserving measurements of UtA-PI and PlGF for only 80% of the population. Similarly, in screening for a SGA neonate with birth weight < 10th percentile delivered at < 30 weeks, the same detection rate of 90%, at an overall FPR of 14%, as that achieved by screening with maternal risk factors, EFW, UtA-PI and PlGF in the whole population can be achieved by reserving measurements of UtA-PI and PlGF for only 70% of the population. The additive value of PlGF in reducing the FPR to about 10% with a simultaneous detection rate of 90% for a SGA neonate with birth weight < 3rd percentile born < 30 weeks, is gained by measuring PlGF in only 50% of the population when first-line screening is by maternal factors, EFW and UtA-PI. The combination of maternal risk factors, EFW, UtA-PI and PlGF provides effective second-trimester prediction of SGA. Serum PlGF is useful for predicting a SGA neonate with birth weight < 3rd percentile born < 30 weeks after an inclusive assessment by maternal risk factors and biophysical markers. Similar detection rates and FPRs can be achieved by application of contingent screening strategies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Preeclampsia and associated hypertensive disorders of pregnancy represent a leading cause of global maternal and neonatal morbidity and mortality. Identification of women at high risk for developing preterm-preeclampsia and prophylaxis with low-dose aspirin has the potential to significantly reduce the rate of preterm-preeclampsia. In addition, risk assessment and monitoring of women in the second and third trimester of pregnancy, to aid in early detection of evolving disease, timely referral to specialist care, and active monitoring of women with confirmed or suspected preeclampsia is essential for improving maternal and neonatal outcomes. The angiogenesis-related biomarkers sFlt-1 and PlGF have been shown to have clinical value to aid in the prediction, diagnosis, and risk stratification of preeclampsia when used either alone or in combination with other risk factors. However, currently there is no consensus on the optimum strategy to link first trimester screening for preterm-preeclampsia with appropriate second and third trimester risk assessment strategies. This opinion paper will outline the current evidence for first trimester preeclampsia screening and prevention, as well as the evidence for various risk stratification approaches for detection of evolving preeclampsia through the second and third trimesters of pregnancy, and proposes a potential model integrating these tools. This article is protected by copyright. All rights reserved.

PURPOSE:Retinopathy of prematurity (ROP) is a preventable blinding disorder affecting preterm infants. To date, maternal risk factors have not been studied in Saudi Arabia. This study aims to identify possible maternal risk factors for any stage and type 1 ROP.MATERIALS AND METHODS:A total of 295 preterm infants screened for ROP between November 2013 and December 2018 at a Saudi Arabian tertiary-care hospital were included. We included infants with a gestational age ≤ 32 weeks and/or birth weight (BW) ≤1500 g. We analyzed 28 maternal and neonatal risk factors.RESULTS:The incidence of ROP at any stage and Type 1 were 31.9% and 7%, respectively. In the univariate analysis, the only maternal factor associated with any stage of ROP was spontaneous vaginal delivery (P = 0.049), but no maternal factor was an independent risk factor for type 1 ROP. Multivariate logistic regression analysis identified lower BW, lower gestational age and longer neonatal intensive care unit stay as independent risk factors for the development of ROP at any stage (P < 0.05). For Type 1 ROP, lower BW, and intraventricular hemorrhage were significant independent risk factors (P < 0.05).CONCLUSION:The only maternal risk factor related to ROP was spontaneous vaginal delivery, which increased the risk of any stage of ROP. The single most predictive risk factor for any stage of ROP and Type 1 ROP was low BW. These findings emphasize the role of the obstetrician in promoting health care and modifying maternal risk factors to prevent preterm births related to a low BW.

P-214: Cytogenetic study of chorionic villi in ectopic pregnancy

The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention.

We sought to compare maternal and neonatal risk factors in cases with previable premature rupture of membranes (pPPROM, between 14-24 weeks) for optimal counselling. Therefore, 192 pregnancies of 485 cases which met selection criteria and agreed to follow-up were retrospectively analysed. Mean gestational age at pPPROM was 20.45 weeks. Live births occurred in 171 cases, but 67 (39.2%) of them died in the neonatal period (neonatal death group) and 104 cases (60.8%) constituted surviving neonate group. Of the surviving neonates, 37 (33.7%) experienced at least one complication. Most seen maternal complications were chorioamnionitis (24.48%) and placental abruption (8.33%). Although amniotic fluid volume, length of pPPROM period, completing antibiotherapy and CRP values were significant, amniotic fluid volume and length of pPPROM showed also significance for multivariate regression analysis for maternal risk factors. Risk factors for birth were gestational age at pPPROM, gestational age at birth, new-born weight at birth, 1st and 5th minute Apgar scores, umbilical cord pH value and need for neonatal resuscitation. Furthermore, development of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage and retinopathy of premature were additional risk factors for neonate. Of them, gestational age at birth, new-born weight at birth, respiratory distress syndrome and retinopathy of prematurity were also significant in multivariate regression analysis. Impact Statement What is already known on this subject? Management of previable premature rupture of membranes is controversial and there is no definite consensus on the approach. The factor that best predicts neonatal survival is the gestational age at birth (Deutsch et al. 2010). What do the results of this study add? Appropriate counselling for pPPROM cases is important especially during antenatal period (maternal factors) and postpartum period (neonatal factors). Maternal infection risk is increased with an increased latency period of PPROM. As the gestational age at birth increases, the survival rate increases and neonatal complication rates decrease. Other important determinants of neonatal survival and well-being are the presence of oligo-anhydramnios and latency period of previable PPROM to delivery. What are the implications of these findings for clinical practice and/or further research? Counselling the patient with previable PPROM about pregnancy complications and paediatric outcome is challenging because of the small size, different gestational age ranges, and retrospective nature of the multiple studies on this subject. The most important feature of our study was the relatively high number of patients compared to other series. Thus, we can counsel pregnant women with PPROM prior to 24 weeks of gestation about the maternal antenatal factors and neonatal postnatal factors with related outcomes and help make an informed decision regarding termination or conservative follow-up. Nevertheless, there is a need for larger multicentric prospective studies to validate our data and to establish the prognosis of previable PPROM for both mother and foetus.

To determine whether first-trimester biomarkers of placental function can be used to screen for spontaneous preterm birth (sPTB), and to develop prediction models using maternal factors, obstetric history and biomarkers of placental function at 11-13 weeks for the calculation of patient-specific risk for sPTB. This was a retrospective secondary analysis of data derived from a prospective cohort study on first-trimester screening for pre-eclampsia in singleton pregnancies attending for routine Down syndrome screening at 11 + 0 to 13 + 6 weeks' gestation at a tertiary obstetric unit between December 2016 and September 2019. A split-sample internal validation method was used to explore and develop prediction models for all sPTB at < 37 weeks and for PTB at < 37 weeks after preterm prelabor rupture of membranes (PPROM) using maternal risk factors, uterine artery Doppler indices, serum placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A) and β-human chorionic gonadotropin (β-hCG). Screening performance was assessed using receiver-operating-characteristics (ROC)-curve analysis, with calculation of the areas under the ROC curves (AUCs). A total of 9298 singleton pregnancies were included in this study. sPTB at < 37 weeks occurred in 362 (3.89%) cases, including 231 (2.48%) cases of PPROM. sPTB at < 34 weeks occurred in 87 (0.94%) cases, including 39 (0.42%) cases of PPROM. Identified maternal risk factors for sPTB at < 37 weeks included chronic hypertension, conception using in-vitro fertilization and history of PTB. Maternal risk factors for PPROM at < 37 weeks included conception using in-vitro fertilization and history of PTB. Median PlGF multiples of the median (MoM) and PAPP-A MoM were significantly reduced in women with sPTB at < 37 weeks, as well as in those who had PPROM, compared to those who delivered at term. Screening by a combination of maternal risk factors, PAPP-A and PlGF achieved better performance in predicting sPTB at < 37 weeks (AUC, 0.630 vs 0.555; detection rate (DR), 24.8% vs 16.6% at a false-positive rate (FPR) of 10%; P ≤ 0.0001) and PPROM at < 37 weeks (AUC, 0.643 vs 0.558; DR, 28.1% vs 17.0% at a FPR of 10%; P ≤ 0.0001) than using maternal risk factors alone. Both models were successfully applied to the internal validation dataset, with AUCs of 0.628 and 0.650, respectively. We demonstrated that low levels of maternal serum PAPP-A and PlGF in the first trimester are associated with increased risks of sPTB and PPROM at < 37 weeks. However, further research is needed to identify additional biomarkers to improve the screening performance of the combined model that includes maternal risk factors, PAPP-A and PlGF before clinical application. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Background Necrotizing enterocolitis (NEC) remains a leading cause of morbidity in hospitalized neonates—particularly preterm infants—yet its multifactorial etiology and the relative roles of maternal versus neonatal factors are not fully defined. We assessed whether prematurity, neonatal sepsis, and maternal conditions, including preeclampsia, are independently associated with NEC. Objective To evaluate for associations between maternal and neonatal risk factors and the development of necrotizing enterocolitis (NEC) in hospitalized neonates. Methods This case-control study with a retrospective analytical observational design included 235 neonates hospitalized in the Neonatology Unit of the Víctor Lazarte Echegaray Hospital (HVLE) from 2016 to 2023. Clinical records were randomly selected. Seventy-eight neonates with a confirmed diagnosis of NEC comprised the case group, while 157 neonates without NEC comprised the control group. Various maternal and neonatal factors present in this population were analyzed for potential associations with NEC.The influence of potential confounding variables was also considered. Data collection was carried out through a review of neonatal medical records. Results Multivariate analysis identified three factors significantly associated with NEC. Prematurity (P&lt; 0.05) emerged as the main neonatal risk factor, followed by neonatal sepsis (P&lt;0.05). Among maternal factors, preeclampsia showed a significant association with NEC (P&lt;0.05). These variables were considered independent risk factors for NEC. On the other hand, no statistically significant association was found between NEC and other maternal conditions analyzed in this study, such as maternal obesity, sepsis, gestational diabetes, or chronic hypertension (P&gt;0.05). Conclusion Prematurity and neonatal sepsis are neonatal factors significantly associated with a higher risk of NEC. Likewise, preeclampsia emerged as a significant maternal risk factor associated with NEC.

Retinopathy of Prematurity (ROP) is a significant cause of visual impairment in premature infants worldwide. In Bangladesh, increasing survival rates of preterm infants highlight the urgency of ROP screening and treatment. Early detection and intervention are crucial to prevent blindness and improve outcomes for affected children in both contexts. We aimed to identify the prenatal risk factors for ROP admission to the Institute of Child and Mother Health's NICU. Retinopathy of Prematurity (ROP) is a multifactorial condition affecting premature infants, with significant associations with gestational age, birth weight, and maternal, and perinatal risk factors. This study analyzed the incidence, risk factors, and outcomes of ROP among neonates. Infants with ROP had significantly lower gestational age (32.89 ± 2.24 weeks vs. 34.37 ± 1.68 weeks, p = 0.001) and birth weight (1291.27 ± 419.41 g vs. 1744.63 ± 429.89 g, p &lt; 0.001) compared to those without ROP. Maternal risk factors such as antepartum hemorrhage (APH, p = 0.03) and prolonged rupture of membranes (p = 0.007) were significantly associated with ROP, with odds ratios of 5.561 (95% CI: 1.276-24.228) and 4.518 (95% CI: 1.654-12.340), respectively. Among perinatal factors, apnea emerged as the most significant risk factor (OR: 4.348, 95% CI: 1.077-17.552), while sepsis, respiratory distress syndrome (RDS), and blood transfusions were also more prevalent in infants with ROP (p &lt; 0.05). Outcomes for infants with ROP included spontaneous regression in 31/55 cases, while 23/55 required intervention. Post-treatment complications were reported in 15 cases (65.21%), with refractive errors (52.17%) and squint (13.04%) being the most common. These findings emphasize the importance of monitoring maternal and perinatal risk factors, particularly APH and apnea, to identify at-risk infants. Early intervention and follow-up are crucial to managing ROP and its complications and improving outcomes for affected neonates.

Syndromes, Disorders and Maternal Risk Factors Associated with Neural Tube Defects (III)

Syndromes, Disorders and Maternal Risk Factors Associated With Neural Tube Defects (VI)

Risk factors for and survival of singleton preterm births may vary according to geographical locations because of socioeconomic differences and lifestyle. The aim was to describe maternal risk factors and survival-to-discharge rate for singleton preterm births at the University of Nigeria Teaching Hospital and determine the relationship between maternal risk factors and the survival of singleton preterm babies. A comparative retrospective review of singleton preterm and term births from January 2009 to December 2013 was carried out. Statistical analysis involved descriptive and inferential statistics at 95% level of confidence using the Statistical Package for Social Sciences (SPSS) version 15 for Windows. P≤0.05 was considered significant. A total of 784 births including 392 singleton preterm births (aged 26-36+6) and 392 singleton term births were studied. The mean age of mothers who delivered singleton preterm babies did not differ significantly from that of mothers who delivered singleton term babies (30.2±4.9 years vs. 30.8±4.7; P=0.06). Lack of antenatal care (adjusted odds ratio [aOR]=2.63; 95% confidence interval [CI] 1.92, 6.07), Previous preterm birth (aOR=5.06; 95% CI: 2.66, 9.12), having pregnancy complications including antepartum hemorrhage, preeclampsia/eclampsia or premature rupture of membranes (aOR=5.12; 95% CI: 2.4, 11.8), being unmarried (aOR=2.41; 1.56, 3.71) and nulliparity (aOR=2.08, 95% CI: 1.22, 4.91) were independent risk factors for singleton preterm births. The average survival-to-discharge rate for preterm babies during the period was 38.4%. The mean duration of admission for singleton preterm babies was 16±5.8 days (range: 2-75 days). Whereas survival was dependent on, gestational age at birth (P<0.001) and mode of delivery (P=0.01), it was not dependent on maternal risk factors of parity, marital status, complications of pregnancy, and antenatal care. There was a low rate of survival of singleton preterm babies at the study center and survival was dependent on gestational age at birth and mode of delivery, but not on maternal sociodemographic risk factors for singleton preterm births. Active collaboration between the obstetrician and the neonatologist in deciding when and how to deliver these babies may provide improved chances of survival.

Maternal Risk Factors for Congenital Urinary Anomalies: Results of a Population-based Case-control Study

Maternal and perinatal risk factors of hypospadias: A case-control study.

Objective: To determine if there are any maternal factors that might be linked to low birth weight (LBW). Methodology: This cross-sectional study was done at Al-Batool Teaching Hospital from January and March 2022 with 150 mothers who gave birth to babies who lived. Within 24 hours of being born, all babies were weighed. A birth weight of less than 2500 grams was thought to be low. All mothers were interviewed within 24 to 72 hours of giving birth, and the results were recorded. Results: There was significant differences (p&lt;0.05) among socio demographic characteristics of mothers, except residence. There were significant differences (p&lt;0.05) among maternal risk factors, except infant’s sex. There were significant differences (p&lt;0.05) among disorders that associated with mothers. Conclusion: In Diyala province, LBW is linked to maternal socioeconomic status, risk factors, and disorders. Antenatal visits by well-educated and well-off women may decrease LBW.