Pregnancy-specific injury severity score for predicting adverse pregnancy outcomes after maternal trauma.

Psychologically traumatic experiences can have long-lasting physical and mental health effects on pregnant people, increasing the risk of adverse pregnancy, childbirth, and neonatal outcomes. The effect of maternal psychological trauma, assessed prenatally, on offspring outcomes throughout development is understudied. This secondary analysis of a systematic review investigated the scope of research examining links between prenatally assessed maternal trauma and offspring outcomes to identify areas of focus and those needing further investigation. Of 576 studies identified in the systematic review, 80 included offspring measures. Of these, 70 investigated associations between maternal trauma and offspring outcomes. We examined these studies for the type of maternal psychological trauma (including post-traumatic stress disorder [PTSD]), type and timing of assessment of offspring outcomes, and regional variations reported. Most studies used a cross-sectional assessment of offspring outcomes (80%). The most common type of offspring outcome was birth or neonatal outcome (n = 40), which aligned with the most frequently examined time period. Interpersonal trauma (n = 41) and general trauma (n = 41) were the most common maternal trauma types examined prenatally, followed by childhood abuse (n = 37). Only 31.4% of studies measuring offspring outcomes included data on maternal PTSD status. Future research should longitudinally measure the impact of maternal psychological trauma on offspring outcomes through childhood and adolescence, providing insights for clinicians and policymakers. Pregnancy represents a critical period for the assessment and treatment of psychological trauma/PTSD, and further research will improve two-generation interventions across development to improve family health and well-being.

Major trauma in pregnancy: prediction of maternal and perinatal adverse outcomes

Pregnancies complicated by late-onset fetal growth restriction (FGR) are at increased risk of short- and long-term morbidities. Despite this, identification of cases at higher risk of adverse perinatal outcome, at the time of FGR diagnosis, is challenging. The aims of this study were to elucidate the strength of association between fetoplacental Doppler indices at the time of diagnosis of late-onset FGR and adverse perinatal outcome, and to determine their predictive accuracy. This was a prospective study of consecutive singleton pregnancies complicated by late-onset FGR. Late-onset FGR was defined as estimated fetal weight (EFW) or abdominal circumference (AC) < 3rd centile, or EFW or AC < 10th centile and umbilical artery (UA) pulsatility index (PI) > 95th centile or cerebroplacental ratio (CPR) < 5th centile, diagnosed after 32 weeks. EFW, uterine artery PI, UA-PI, fetal middle cerebral artery (MCA) PI, CPR and umbilical vein blood flow normalized for fetal abdominal circumference (UVBF/AC) were recorded at the time of the diagnosis of FGR. Doppler variables were expressed as Z-scores for gestational age. Composite adverse perinatal outcome was defined as the occurrence of at least one of emergency Cesarean section for fetal distress, 5-min Apgar score < 7, umbilical artery pH < 7.10 and neonatal admission to the special care unit. Logistic regression analysis was used to elucidate the strength of association between different ultrasound parameters and composite adverse perinatal outcome, and receiver-operating-characteristics (ROC)-curve analysis was used to determine their predictive accuracy. In total, 243 consecutive singleton pregnancies complicated by late-onset FGR were included. Composite adverse perinatal outcome occurred in 32.5% (95% CI, 26.7-38.8%) of cases. In pregnancies with composite adverse perinatal outcome, compared with those without, mean uterine artery PI Z-score (2.23 ± 1.34 vs 1.88 ± 0.89, P = 0.02) was higher, while Z-scores of UVBF/AC (-1.93 ± 0.88 vs -0.89 ± 0.94, P ≤ 0.0001), MCA-PI (-1.56 ± 0.93 vs -1.22 ± 0.84, P = 0.004) and CPR (-1.89 ± 1.12 vs -1.44 ± 1.02, P = 0.002) were lower. On multivariable logistic regression analysis, Z-scores of mean uterine artery PI (P = 0.04), CPR (P = 0.002) and UVBF/AC (P = 0.001) were associated independently with composite adverse perinatal outcome. UVBF/AC Z-score had an area under the ROC curve (AUC) of 0.723 (95% CI, 0.64-0.80) for composite adverse perinatal outcome, demonstrating better accuracy than that of mean uterine artery PI Z-score (AUC, 0.593; 95% CI, 0.50-0.69) and CPR Z-score (AUC, 0.615; 95% CI, 0.52-0.71). A multiparametric prediction model including Z-scores of MCA-PI, uterine artery PI and UVBF/AC had an AUC of 0.745 (95% CI, 0.66-0.83) for the prediction of composite adverse perinatal outcome. While CPR and uterine artery PI assessed at the time of diagnosis are associated independently with composite adverse perinatal outcome in pregnancies complicated by late-onset FGR, their diagnostic performance for composite adverse perinatal outcome is low. UVBF/AC showed better accuracy for prediction of composite adverse perinatal outcome, although its usefulness in clinical practice as a standalone predictor of adverse pregnancy outcome requires further research. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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.

Factors Influencing Adverse Perinatal Outcomes in Pregnancies Achieved Through Use of Assisted Reproductive Technology (ART)

Motor Vehicle Accidents in Pregnancy: Implications and Management

Background Previous studies have found a relationship between overall systemic lupus erythematosus (SLE) activity and adverse pregnancy outcomes. We sought to investigate whether 5 types of specific types of SLE activity either in the 6 months prior to conception or during pregnancy were related to adverse pregnancy outcome. Materials and methods 149 pregnancies occurred in 114 women with mean age 23.7 (SD 6.8) years at SLE diagnosis and 31.0 (SD 5.3) at conception. 68% were White, 15% Hispanic, 11% Black, 7% Asian. Seven women had a history of antiphospholipid syndrome and 23 had a prior adverse pregnancy outcome. During the study period, 40 (27%) pregnancies had an adverse outcome. Cytopenias (15%) and nephritis (11%) were the most common types of SLE activity during pregnancy. In univariable analyses, nephritis 6 months before conception (OR 7.3, 95% CI: [1.5, 35.2]) and during pregnancy OR 4.4 (1.3–14.9) and cytopenias during pregnancy (OR 4.8 [1.7, 14.0]) were significantly associated with adverse outcome. Hispanic ethnicity, prior adverse pregnancy outcome, and steroid and/or azathioprine use during pregnancy were also associated with adverse outcome. In multivariable analyses, nephritis (OR 3.5 [1.0–12.2]), cytopenias (OR 4.2 [1.4,12.2]) and serositis (OR 5.7 [1.1–30.3]) during pregnancy were associated with adverse outcome (Table 1) Results 149 pregnancies occurred in 114 women with mean age 23.7 (SD 6.8) years at SLE diagnosis and 31.0 (SD 5.3) at conception. 68% were White, 15% Hispanic, 11% Black, 7% Asian. Seven women had a history of antiphospholipid syndrome and 23 had a prior adverse pregnancy outcome. During the study period, 40 (27%) pregnancies had an adverse outcome. Cytopenias (15%) and nephritis (11%) were the most common types of SLE activity during pregnancy. In univariable analyses, nephritis 6 months before conception (OR 7.3, 95% CI: [1.5, 35.2]) and during pregnancy OR 4.4 (1.3–14.9) and cytopenias during pregnancy (OR 4.8 [1.7, 14.0]) were significantly associated with adverse outcome. Hispanic ethnicity, prior adverse pregnancy outcome, and steroid and/or azathioprine use during pregnancy were also associated with adverse outcome. In multivariable analyses, nephritis (OR 3.5 [1.0–12.2]), cytopenias (OR 4.2 [1.4,12.2]) and serositis (OR 5.7 [1.1–30.3]) during pregnancy were associated with adverse outcome (Table 1). Conclusions The majority of pregnancy outcomes were favourable in this SLE cohort. After adjusting for ethnicity, prior adverse pregnancy outcomes, and medications during pregnancy, nephritis, cytopenias and serositis disorders during pregnancy were associated with an elevated risk of adverse pregnancy outcome. Prior studies have suggested variable impact of lupus nephritis on pregnancy outcomes, but this study uniquely demonstrates an additional association between cytopenias and serositis during pregnancy and adverse pregnancy outcomes.

Adverse pregnancy outcomes, which can be caused by multiple factors, present a significant threat to the health of mothers and their babies. Cell-free fetal DNA (cffDNA) from placental trophoblast cells might be able to reflect placental and fetal status. Previous studies have yielded controversial results regarding the association of FF or cffDNA with various adverse pregnancy outcomes. A previous study has attempted to systematically assess the association between low fetal fraction (FF) and adverse pregnancy outcomes, but it failed to perform quantitative analyses due to the few studies included. In the present study, we attempted to quantitatively assess the association of FF (or cffDNA) with adverse pregnancy outcomes and further analyze the causes of heterogeneity. To investigate the association of high/low FF or cffDNA with adverse pregnancy outcomes. We searched the databases of PubMed, Embase, Cochrane, and Web of Science from January 1, 1990, to June 15, 2022 in this meta-analysis. Studies on the relationships of adverse pregnancy outcomes in women with FF or cell free DNA were included. Non-English literature was excluded. Data about pregnancy outcomes and cell free DNA were extracted and meta-analyzed. Subgroup analysis was performed by different outcomes. There were 11 studies included involving 8280 participants. No significant heterogeneity was observed among the studies (I2 = 27%, 25%), and a fixed-effect model was used for weighted quantitative analysis. The results revealed that the FF or cffDNA during pregnancy was significantly associated with adverse pregnancy outcomes in pregnant women (OR = 1.57, 95% CI [1.24, 1.99], P = 0.233). The overall incidence of the maternal adverse outcomes was 8% (95% CI: 5-13). Subgroup analysis of different outcomes showed an evident association between low FF or cffDNA and hypertensive disorders of pregnancy (HDP) (OR = 1.76, 95% CI [1.36, 2.27], P = 0.581). There was no evidence that the occurrence of spontaneous preterm birth (sPTB) and placental abnormality was associated with FF or cffDNA. No association was observed between low FF or cffDNA during pregnancy and adverse outcomes in fetuses (OR = 1.39, 95% CI [0.99, 1.94], P = 0.242). The overall incidence of adverse outcomes in fetuses was 8% (95% CI: 6-11). There were controversies over the association between high FF or cffDNA and HDP, and sPTB and small for gestational age infant, among different studies. Pregnant women with low FF or cffDNA during the first or second trimester of pregnancy have an overall increased risk of adverse pregnancy outcomes, especially HDP. However, the association between FF and various pregnancy outcomes needs to be further explored by more prospective studies.

Prolonged time to pregnancy is associated with a greater risk of adverse outcomes

This study was conducted to determine whether UK obstetrics trainees transitioning from directly to indirectly supervised practice have a higher likelihood of recording adverse patient outcomes in operative deliveries compared with other indirectly supervised trainees, and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial practice under indirect supervision. We examined all deliveries (13856) conducted by obstetricians at a single centre over 6years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss (EBL), maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly supervised year with those for trainees in all other years of indirect supervision. Outcomes for trainees in their first indirectly supervised 3months were compared with their outcomes for the remainder of the year. Linear regression was used to examine the relationship between number of procedures performed under direct supervision and initial outcomes under indirect supervision. Trainees in their first indirectly supervised year had a higher likelihood of recording EBL of >2L at any delivery (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.01-1.64; p<0.05) and of failed instrumental delivery (OR 2.33, 95% CI 1.37-3.29; p<0.05) compared with other indirectly supervised trainees. Other measured outcomes showed no significant differences. In the first 3months of indirect supervision, the likelihood of operative vaginal deliveries with EBL of >1L (OR 2.54, 95% CI 1.88-3.20; p<0.05) was higher than in the remainder of the first year. Performing more deliveries under direct supervision prior to beginning indirectly supervised training was associated with decreased risk for recording EBL of >1L (p<0.05). Obstetrics trainees in their first year of indirectly supervised practice have a higher likelihood of recording immediate adverse delivery outcomes, which are primarily maternal rather than neonatal. Undertaking more directly supervised procedures prior to transitioning to indirectly supervised practice may reduce adverse outcomes, which suggests that experience is a key consideration in obstetrics training programme design.

Spontaneous abortion is unintentional pregnancy loss before 20 weeks of gestation. This study was done to find out the association between one spontaneous pregnancy loss and adverse pregnancy outcomes in the subsequent pregnancy and to compare these pregnancy outcomes in patients with prior one full term normal delivery.: It is a case control study. 70 G2A1 were taken as cases, 70 G2P1L1 were considered as Control. The adverse pregnancy outcomes like preterm labour, PROM, IUGR and oligohydramnios and neonatal outcomes like poor Apgar score, low birth weight, NICU admissions and neonatal complications were noted compared and analysed between the two groups. Chi-square was used to find association between clinical variables. Independent t-test was used to compare the outcome measures between the groups.: Comparing the pregnancy outcomes of the case and control groups case group had a higher number adverse pregnancy or neonatal outcome, compared to the control group (p value = 0.05), adverse outcome were higher in case population, adverse outcomes which were independently associated with initial spontaneous abortion were oligohydramnios (p = 0.02), GDM (p = 0.05), LSCS (p = 0.01), low birth weight (p = 0.03), low Apgar scores 1 minute (p = 0.009), low Apgar score at 5 minute (p = 0.03) and babies requiring NICU care (p = 0.001).: Study shows that there is increase in adverse obstetric and perinatal outcomes in pregnancies which are following a single spontaneous abortion. Hence a prior spontaneous miscarriage is a risk factor for the adverse outcome in subsequent pregnancy, therefore careful prenatal care in such pregnancies are mandatory to avoid adverse pregnancy outcomes.

Association Between Timing of Major Trauma in Pregnancy and Adverse Outcomes Related to Placental Dysfunction

Can hemoglobin A1c in early pregnancy predict adverse pregnancy outcomes in diabetic patients?

Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa

Neurobehavioural outcome in 6-18 year old children after trauma in pregnancy: Case-control study.