Adverse Perinatal Outcomes In Patients Research Articles

Frequency of adverse perinatal outcomes in patients with pregnancy related acute renal (kidney) injury in a tertiary care hospital

Background & Objective: Pregnancy related acute kidney injury (Pr-AKI) is coupled with adverse feto-maternal outcomes. Adverse perinatal outcome comprising of still births, intrauterine growth retardation, neonatal deaths are indicators of severity of underlying obstetrical conditions ending on Pr-AKI. These perinatal outcomes can also serve as potential predictors for long term outcomes of Pr-AKI. Our study aimed to determine frequencies of adverse perinatal outcomes and to evaluate adverse perinatal outcome as predictor for persistent renal injury in patients with pregnancy induced acute renal injury (Pr-AKI). Method: A descriptive case series including 100 women with Pr-AKI, was conducted in a tertiary care hospital of Peshawar from 1st August 2021 to 31st July 2022. Included patients were followed for three months period, from their date of delivery. Adverse perinatal outcome included stillbirths, and early neonatal deaths. Results: The mean age of study sample was 29.20±6.40. The pre dominant etiology for Pr-AKI was primary postpartum hemorrhage, occurring in 52% women. Still births were seen in 48% cases, while early neonatal deaths were seen in 7% cases. Adverse perinatal outcome had statistically significant association with persistent renal failure (p-0.01). Other factors having statistically significant association with persistent renal injury (PRF) were multiparity and cesarean births. (p<0.05) Association of adverse perinatal outcome with persistent renal injury persisted on multivariate logistic regression. a OR 6.14; CI 1.15-32.29, p-0.033. Conclusion: Almost half of the cases with Pr-AKI have still births. Still birth in patients with Pr-AKI is associated with persistent renal injury at 12 weeks follow up period. doi: https://doi.org/10.12669/pjms.40.10.9228 How to cite this: Mohammad N, Qazi Q, Liaqat N. Frequency of adverse perinatal outcomes in patients with pregnancy related acute renal (kidney) injury in a tertiary care hospital. Pak J Med Sci. 2024;40(10):2267-2270. doi: https://doi.org/10.12669/pjms.40.10.9228 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The role of the cerebro-placental-uterine ratio in predicting composite adverse perinatal outcomes in patients with pregnancy-induced hypertension

ObjectivesTo examine the role of the cerebro-placental-uterine ratio (CPUR) in predicting composite adverse perinatal outcomes (CAPO) in patients with pregnancy-induced hypertension (PIH). Study designThis prospective, case-control study was conducted at a tertiary hospital with 110 cases of PIH, including 70 patients with preeclampsia and 40 with gestational hypertension, and 110 healthy controls. The middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and uterine artery pulsatility index (UtA-PI) were measured, and the cerebro-placental ratio (CPR=MCA-PI/UA-PI) and CPUR (CPR/UtA-PI) were calculated. Main outcome measureThe role of CPUR in predicting CAPO in preeclampsia and gestational hypertension. ResultsThe CPR and CPUR values were lower in the PIH group compared to the control group (p < 0.001). CAPO had a negative correlation with CPR and CPUR (p < 0.001). Univariate regression analysis revealed that the likelihood of CAPO was increased four times by a low CPR value and six times by a low CPUR value. In the ROC analysis, the optimal cut-off value of CPR in predicting CAPO was 1.33 with 74 % sensitivity and 66 % specificity (area under the curve [AUC] = 0.778; p < 0.001) in PIH. For CPUR, the optimal cut-off value was 1.32, at which 82 % sensitivity and 79 % specificity in predicting CAPO (AUC=0.826; p < 0.001). ConclusionCPUR was determined to be successful with high sensitivity in predicting adverse perinatal outcomes in the presence of PIH. In addition, CPUR was more effective in predicting CAPO in patients with preeclampsia compared to gestational hypertension. CPUR can be used to predict adverse outcomes in patients with PIH.

Prenatal ultrasound findings and clinical outcomes of uniparental disomy: a retrospective study

BackgroundUniparental disomy is the inheritance of a homologous chromosome pair or part of homologous chromosomes from only one parent. However, the clinical significance of uniparental disomy and the difference among the prognosis of involvement of different chromosomes remain unclear.ObjectiveTo assess the associated prenatal ultrasound presentations and clinical outcomes of uniparental disomy on different chromosomes and to analyze the relationship between prenatal ultrasound markers and clinical outcomes.Study designWe retrospectively analyzed data from fetuses with uniparental disomy diagnosed using chromosome microarray analysis with the Affymetrix CytoScan HD array at our institution between January 2013 and September 2022. The relationship between prenatal ultrasound findings, the involved chromosome(s), and clinical outcomes was evaluated.ResultsDuring the study period, 36 fetuses with uniparental disomy were diagnosed, and two cases were excluded for non-available postnatal data. Finally, 34 fetuses were included in our study, of which 30 (88.2%) had uniparental disomy occurring on a single chromosome, while four (11.8%) were identified with uniparental disomy on different chromosomes. The most frequently involved chromosomes were chromosomes 16, X and 2, which presented in 8 (23.5%), 5 (14.7%) and 4 (11.8%), respectively. Prenatal ultrasound abnormalities were detected in 21 fetuses, with the most common category being multiple abnormalities (12 (57.1%)). Fetal growth restriction was identified in 14 (41.2%) fetuses, all of which coexisted with other abnormal findings. The rate of adverse perinatal outcomes in patients with uniparental disomy and fetal abnormalities was significantly higher than those without abnormalities (76.2% versus 15.4%, P = 0.002). The incidence of fetal or neonatal death was significantly higher in fetuses with fetal growth restriction than those without (85.7% versus 30.0%, P = 0.004).ConclusionsThe prognosis of fetuses with uniparental disomy combined with fetal abnormalities, especially fetal growth restriction, was much poorer than those without.

Influence of ovarian reserves on assisted reproductive and perinatal outcomes in patients with endometriosis: a retrospective study.

To investigate the association between different ovarian reserves and reproductive and adverse perinatal outcomes in patients with endometriosis. Retrospective study. Reproductive Medicine Center in a hospital. Patients surgically diagnosed with endometriosis were divided into three groups according to their ovarian reserve: diminished ovarian reserve (DOR) group (n=66), normal ovarian reserve (NOR) group (n=160), and high ovarian reserve (HOR) group (n=141). None. Live birth rate (LBR), cumulative live birth rate (CLBR), and adverse perinatal outcome for singleton live births. There were significantly higher live birth and cumulative live birth rates in endometriosis patients with NOR or HOR than in those with DOR. For adverse perinatal outcomes, patients with NOR or HOR had no significant association with preterm birth, gestational hypertension, placenta previa, fetal malformation, abruptio placentae, macrosomia, or low birth weight, except for a decreased risk of gestational diabetes mellitus. Our study revealed that although patients with endometriosis with NOR and HOR had increased reproductive outcomes, patients with endometriosis with DOR had still an acceptable live birth rate and a similar cumulative live birth rate with available oocytes. Moreover, patients with NOR and HOR might not exhibit a decreased risk of abnormal perinatal outcomes, except for gestational diabetes mellitus. Multicenter prospective studies are needed to further clarify the relationship.

RELATIONSHIP BETWEEN HEMOGLOBIN A1C LEVELS IN EARLY PREGNANCY AND ADVERSE OUTCOMES AMONG NON-DIABETIC PATIENTS

This study was designed to assess the effects of increased hemoglobin A1c in the first trimester on adverse perinatal outcomes in patients without gestational diabetes mellitus. A prospective study was conducted in the Obstetrics and Gynecology Department of Buch International Hospital Multan from January 2022- January 2023. A total of 160 women with singleton pregnancies in their first trimester and elevated hemoglobin A1c were included in the study. The following outcomes were evaluated in patients: miscarriage, shoulder dystocia, preterm delivery &lt;37 weeks, macrosomia, small or large for gestational age, hypertensive disorders of pregnancy, third- or fourth-degree lacerations, operative vaginal delivery, cesarean delivery, neonatal hypoglycemia, neonatal jaundice, NICU admission, and intrauterine fetal demise. The multivariate analysis evaluated the relationship between hemoglobin A1c and adverse outcomes. The Hb1Ac level in patients ranged from 5.7-6.4%. Elevated levels were noted in elderly patients who were multiparous, obese, and diagnosed with chronic hypertension. 5.6% of patients had a preterm delivery, and 31.2% had a c-section delivery. 7.5% had a likelihood of hypertensive pregnancy disorder, and 10.6% were likely to deliver a macrosomic infant. Based on the results, it can be concluded that elevated hemoglobin A1c levels are significantly associated with preterm birth in patients without gestational diabetes.&#x0D;

Determining the risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes in patients with antenatal lower threshold blood pressure elevations: A retrospective cohort study

BACKGROUND: Diagnosing hypertensive disorders in pregnancy utilizes systolic blood pressure (BP) of &gt;140 mmHg and/or diastolic of &gt;90 mmHg. However, since 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) have been endorsing lower BP thresholds for diagnosing hypertension. OBJECTIVES: This study determines if antenatal lower threshold BP elevations under elevated BP and Stage 1 hypertension from ACC/AHA show an increased risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes. MATERIALS AND METHODS: This retrospective cohort study included service patients with prenatal consultations and deliveries at a private tertiary-level hospital from February 2016 to 2020. Antenatal BP measurements, categorized into “normal,” “elevated BP,” and “Stage 1 hypertension” under ACC/AHA classifications, had crude and adjusted relative risks (aRRs) and 95% confidence intervals (CIs) estimated to determine their associations with hypertensive disorders of pregnancy. RESULTS: Stage 1 hypertension was twice more likely to develop gestational hypertension (aRR: 2.314, 95% CI: 1.08–4.98) and thrice more likely to develop preeclampsia (aRR: 3.673, 95% CI: 2.30–5.86), whether without (aRR: 3.520, 95% CI: 1.33–9.29) or with severe features (aRR: 3.717, 95% CI: 2.16–6.41). There was a slightly increased risk for adverse perinatal outcomes from Stage 1 hypertension, as well as all outcomes from elevated BP, but was not statistically significant. Majority of BP elevations were during the third trimester. CONCLUSION: Lower threshold Stage 1 hypertension showed an increased risk of developing hypertensive disorders of pregnancy, with a three-fold increased risk for preeclampsia. There may be advantages in its application for diagnosing preeclampsia or having increased monitoring for these patients.

Прогнозирование риска неблагоприятных перинатальных исходов у беременных с задержкой роста плода

Objective. Development of additional Doppler criteria for predicting the risk of adverse perinatal outcomes in pregnant women with fetal growth restriction (FGR) Patients and methods. 161 patients with singleton pregnancies were examined: 100 women were diagnosed with АПК, and 31 women had fetuses that were low in weight by gestational age; The control group consisted of 30 patients with normal fetal growth. Ultrasound, in addition to fetometry, included Doppler sonography of blood flow in the uterine arteries, umbilical arteries and the fetal middle cerebral artery. The cerebroplacental ratio (CPR) and cerebro-placental-uterine ratio (CPUR) were determined. Reference values of CPUR in patients with FGR have been developed. Results. The ROC analysis in 100 patients with FGR showed that using of CPUR predict a high risk of adverse perinatal outcomes with a sensitivity of 60% and a specificity of 82%. The positive predictive value of CPUR was 91% (83% for CPR). In pregnant women with severe FGR (&lt;3rd centile), the positive prognostic value was – 97%, the highest values were founded in patients with an early phenotype – 100% (with late – 93%). Conclusion. CPUR has a high prognostic significance in relation to the risk of adverse perinatal outcomes in patients with FGR, which indicates the using this indicator along with CPR in the examination of patients with low fetal weight. Key words: fetal growth restriction, early phenotype, late phenotype, cerebro-placental ratio, cerebro-placental-uterine

Pulse pressure and adverse perinatal outcomes in patients with mild chronic hypertension during pregnancy

Pulse pressure (PP) – the difference between systolic and diastolic blood pressure (BP) – is significantly associated with cardiovascular events including death. However, the relationship between PP and pregnancy outcomes is unknown. We evaluated the association between PP and maternal and perinatal outcomes in women with mild chronic hypertension (cHTN). Secondary analysis of The CHAP Trial – an open-label randomized controlled trial of antihypertensives (vs. none) for mild cHTN (BP< 160/105 mmHg). Participants without PP information or outcomes were excluded. Visit count and average PP per patient in active treatment and control groups were compared. The primary analysis evaluated the association between PP during post-randomization clinic visits (5mmHg increments), CHAP primary composite outcome, and small for gestational age (SGA). Logistic regression models were adjusted for randomization assignment. Of 2,325 eligible participants, 50.3% (n=1170) were randomized to active treatment and 49.7% (n=1155) to control. Participants in the active group had marginally more BP assessments per patient (7.4 ± 3.0 vs 7.1 ± 2.9, p = 0.02). Average PP per patient was lower in the active compared to control group (49.9 ± 7.8 vs 50.6 ± 8.0, p=0.03) (Figure). Mean PP was positively associated with the composite outcome, severe preeclampsia and indicated preterm birth (PTB)< 35 weeks while active treatment was protective in the adjusted model (Table). Conversely, PP was negatively associated with SGA< 5th percentile but not SGA< 10th; active treatment was associated with neither. Mean PP was lower in pregnant participants with mild CHTN who were randomized to active treatment. Higher mean PP was associated with the CHAP primary composite outcome, severe preeclampsia and indicated PTB< 35 weeks, but negatively associated with SGA < 5th. Given potential variation in the relationship between treatment of CHTN in pregnancy and SGA, the role of PP as a mediator should be investigated in future studies to reduce adverse HTN-related outcomes without increasing SGA.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effect of preoperative low-normal cervical length on perinatal outcome after laparotomy-assisted fetoscopic spina bifida repair.

To determine if preoperative cervical length in the low-normal range increases the risk of adverse perinatal outcome in patients undergoing fetoscopic spina bifida repair. This was a retrospective cohort study of patients who underwent fetal spina bifida repair between September 2014 and May 2022 at a single center. Cervical length was measured on transvaginal ultrasound during the week before surgery. Eligibility for laparotomy-assisted fetoscopic spina bifida repair was as per the criteria of the Management of Myelomeningocele Study, although maternal body mass index (BMI) up to 40 kg/m2 was allowed. Laparotomy-assisted fetoscopic spina bifida repair was performed, with carbon dioxide insufflation via two 12-French ports in the exteriorized uterus. All patients received the same peri- and postoperative tocolysis regimen, including magnesium sulfate, nifedipine and indomethacin. Postoperative follow-up ultrasound scans were performed either weekly (< 32 weeks' gestation) or twice a week (≥ 32 weeks). Perinatal outcome was compared between patients with a preoperative cervical length of 25-30 mm vs those with a cervical length > 30 mm. Logistic regression analyses and generalized linear mixed regression analyses were used to predict delivery at less than 30, 34 and 37 weeks' gestation. The study included 99 patients with a preoperative cervical length > 30 mm and 12 patients with a cervix 25-30 mm in length. One further case which underwent spina bifida repair was excluded because cervical length was measured > 1 week before surgery. No differences in maternal demographics, gestational age (GA) at surgery, duration of surgery or duration of carbon dioxide uterine insufflation were observed between groups. Cases with low-normal cervical length had an earlier GA at delivery (median (range), 35.2 (25.1-39.7) weeks vs 38.2 (26.0-40.9) weeks; P = 0.01), higher rates of delivery at < 34 weeks (41.7% vs 10.2%; P = 0.01) and < 30 weeks (25.0% vs 1.0%; P < 0.01) and a higher rate of preterm prelabor rupture of membranes (PPROM) (58.3% vs 26.3%; P = 0.04) at an earlier GA (mean ± SD, 29.3 ± 4.0 weeks vs 33.0 ± 2.4 weeks; P = 0.05) compared to those with a normal cervical length. Neonates of cases with low-normal cervical length had a longer stay in the neonatal intensive care unit (20 (7-162) days vs 9 (3-253) days; P = 0.02) and higher rates of respiratory distress syndrome (50.0% vs 14.4%; P < 0.01), sepsis (16.7% vs 1.0%; P = 0.03), necrotizing enterocolitis (16.7% vs 0%; P = 0.01) and retinopathy (33.3% vs 1.0%; P < 0.01). There was an association between preoperative cervical length and risk of delivery at < 30 weeks which was significant only for patients with a maternal BMI < 25 kg/m2 (odds ratio, 0.37 (95% CI, 0.07-0.81); P = 0.02). Low-normal cervical length (25-30 mm) as measured before in-utero laparotomy-assisted fetoscopic spina bifida repair may increase the risk of adverse perinatal outcomes, including PPROM and preterm birth, leading to higher rates of neonatal complications. These data warrant further research and are of critical relevance for clinical teams considering the eligibility of patients for in-utero spina bifida repair. Based on this evidence, patients with a low-normal cervical length should be aware of their increased risk for adverse perinatal outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Evaluation of cerebroplacental ratio as a new tool to predict adverse perinatal outcomes in patients with isolated oligohydramnios

Aim: There is conflicting information in the literature regarding perinatal outcomes and management of isolated oligohydramniotic (IO) pregnancies. Recent studies show that IO is associated with poor perinatal outcomes. However, there is still no definitive method for deciding the optimal delivery timing for these patients. In this study, we aimed to assess the relationship between Doppler parameters, especially cerebro-placental ratio, and perinatal outcomes in isolated oligohydramnios (IO) patients. Methods: This prospective case control study was conducted between October-November 2018. A total of 98 patients were recruited and divided into two groups, as pregnant women with normal amounts of amniotic volume and the isolated oligohydramnios group. Oligohydramnios diagnosis was made by amniotic fluid index measurement (AFI<5 cm). Pregnancies with hypertension, fetal growth restriction, thrombophilia, preeclampsia, diabetes mellitus, preterm births and chromosomal/structural abnormalities were excluded. Cerebro placental ratios of groups were compared in terms of composite adverse outcomes, low APGAR score in 1st and 5th minutes, C/S operation due to non-reassuring fetal heart rate patterns, admission to neonatal intensive care unit and still births. Results: In the isolated oligohydramnios group (n=45) cerebro-placental ratio (CPR) was lower compared to control group (P<0.001). IO was associated with lower (APGAR score<7) 1st (55.6% vs. 7.5%, P<0.001) and 5th (13.3% vs. 1.9% P=0.028) minute APGAR scores and higher rates of NICU admission (26.7% vs. 3.8% P=0.001). Number of fetal distress cases was higher in patients with low CPR in the IO group (9 vs. 6 P=0.023). Conclusion: Measurement of CPR among IO patients seems useful for detection of fetuses with higher risk for poor neonatal outcomes.

Frequency of adverse perinatal outcome in patients with poor biophysical profile.

Objectives: To find out the frequency of adverse perinatal outcome among patients having poor BPP. Study Design: Descriptive study. Setting: Nishtar Hospital Multan. Period: From August 2018 to November 2019. Material &amp; Method: In this study, 273 cases fulfilling the inclusion criteria were enrolled. They were screened on the basis of biophysical profile on ultrasonography to confirm the poor biophysical profile. Patients were followed till delivery. Adverse perinatal outcome i.e. cesarean section and poor APGAR score were recorded. Stratification was done to control effect modifier like maternal age, gestational age and parity. Results: A total of 273 patients with poor biophysical profile were included. The mean age of patients was 27+4.2 years whereas mean gestational age was 37.8+2.0 weeks. Out of 273 patients, 197 (72.2%) patients had cesarean section. A total of 246 (90.1%) patients had poor APGAR score at 5 minutes. Conclusion: Frequency of adverse perinatal outcome such as cesarean section and Apgar score at 5 minutes in patients with poor BPP was high.

Increased syndecan-1 and glypican-3 predict poor perinatal outcome and treatment resistance in intrahepatic cholestasis

BackgroundIntrahepatic cholestasis of pregnancy (ICP) increases the risk of adverse pregnancy outcomes. This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid (UDCA). MethodsThis prospective, case control study included 88 pregnant women (44 women with ICP and 44 healthy controls). The primary end points were the perinatal outcome and the response to UDCA therapy. A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy. ResultsWomen with ICP had significantly higher serum syndecan-1 (1.27 ± 0.36 ng/mL vs. 0.98 ± 0.50 ng/mL; P = 0.003), glypican-3 (1.78 ± 0.13 ng/mL vs.1.69 ± 0.16 ng/mL; P = 0.004), AST (128.59 ± 1.44 vs. 13.29 ± 1.32 U/L; P < 0.001), and ALT (129.84 ± 1.53 vs. 8.00 ± 3.67 U/L; P < 0.001) levels compared with the controls. The increased levels of syndecan-1 (OR = 4.715, 95% CI: 1.554–14.310; P = 0.006), glypican-3 (OR = 8.465, 95% CI: 3.372–21.248; P = 0.007), ALT (OR = 1.382, 95% CI: 1.131–1.690; P = 0.002), and postprandial bile acid (PBA) (OR = 3.392, 95% CI: 1.003–12.869; P = 0.026) were correlated to ICP. The adverse neonatal outcome was related to increased glypican-3 (OR = 4.275, 95% CI: 2.726–5.635; P = 0.039), and PBA (OR = 3.026, 95% CI: 1.069–13.569; P = 0.037). Increases of syndecan-1 (OR = 7.464, 95% CI: 2.130–26.153, P = 0.017) and glypican-3 (OR = 6.194, 95% CI: 2.951–13.002; P = 0.025) were the risk factors of decreased response to UDCA treatment. ConclusionSyndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP, and they can be used to predict the response to the UDCA treatment.

Could high levels of cell-free DNA in maternal blood be associated with maternal health and perinatal outcomes?

The aim of this study was to evaluate the maternal and foetal factors affect higher cell-free DNA (cfDNA) levels and to investigate a possible relationship between high cfDNA levels and adverse perinatal outcomes. From a total of 4594 women who underwent non-invasive prenatal testing from January 2016 to March 2018 in our hospital, 112 women had high levels of cfDNA, which was not appropriate for testing. Maternal characteristics and perinatal outcomes were compared between patients with high levels of cfDNA and normal levels of cfDNA. Patients with high levels of cfDNA had greater risks than patients with normal cfDNA levels of pregnancy complications but no statistically significant difference was found. Patients with high cfDNA levels had higher foetal death rates with a statistically significant difference (9.8% versus 1.8%, p = .024). An increase in foetal death could be expected in patients with increased cfDNA levels; therefore, these patients should be carefully followed up during pregnancy.IMPACT STATEMENTWhat's already known about this topic? Most studies about cfDNA levels are focussed on the foetal fraction. There are new arguments about maternal health and cfDNA. It is known that autoimmune diseases as systemic lupus erythematosus (SLE) and maternal obesity increase cell turnover. There are also clinical studies suggesting a relationship between low molecular weight heparin therapy and the amount of cfDNA.What do the results of this study add? This is the first study evaluating the maternal and foetal biological factors affecting cfDNA concentrations and investigating the possible relationship between high cfDNA levels and adverse perinatal outcomes in patients with high levels of cfDNA compared to patients with normal levels of cfDNA. In the present study, it was found that an increase in foetal death could be expected in patients with higher cfDNA levels.What are the implications of these findings for clinical practice and/or further research? If potential effects and underlying causes of increased cfDNA could be explained, cfDNA might be used as a biomarker for adverse perinatal outcomes.

Impact of Endometriomas and Deep Infiltrating Endometriosis on Pregnancy Outcomes and on First and Second Trimester Markers of Impaired Placentation.

Background and objective: Previous studies did not draw a definitive conclusion about the influence of the role of deep endometriosis (DE) and ovarian endometrioma (OE) as risk factor for developing adverse perinatal outcomes in patients affected by endometriosis. This study aimed to investigate if adverse fetal and maternal outcomes, and in particular the incidence of small for gestational age (SGA) infants, are different in pregnant women with OE versus pregnant women with DE without OE. Material and methods: This study was based on a retrospective analysis of a database collected prospectively. The population included in the study was divided into three groups: patients with OE, patients with DE without concomitant OE, and patients without endometriosis (controls). The controls were matched on the basis of age and parity. Demographic data at baseline and pregnancy outcomes were recorded. Results: There was no statistically significant difference in first trimester levels of PAPP-A, first and mid-pregnancy trimester mean Uterine Artery Doppler pulsatile index, estimated fetal weight centile, and SGA fetuses’ prevalence for patients with OE, and those with DE without OE in comparison to health women; moreover, there was no statistically significant difference with regard to SGA birth prevalence, prevalence of preeclampsia, and five-minute Apgar score between these three groups. Conclusions: The specific presence of OE or DE in pregnant women does not seem to be associated with an increased risk of delivering an SGA infant. These data seem to suggest that patients with endometriosis should be treated in pregnancy as the general population, thus not needing a closer monitoring.

499: Depression is associated with increased rates of adverse perinatal outcomes in women with gestational diabetes

There is a known relationship of depression and pre-existing diabetes. We sought to determine the rates adverse perinatal outcomes in patients with gestational diabetes (GDM) and depressive disorder in comparison to non-depressed women. A retrospective cohort study comparing the rate of maternal and neonatal outcomes among singleton, non-anomalous births in California to women with or without the diagnosis of depression between 2007 and 2011. Among women with GDM, perinatal outcomes were analyzed using Chi square and multivariate logistic regression to compare frequencies of characteristics and outcomes and to determine the strength of association of depression and adverse perinatal outcomes. Statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance. Of the 170,572 women with GDM who delivered in California, 2,090 (1.22%) were diagnosed with depression. Depressed women with GDM had significantly increased rates of perinatal adverse outcomes including hypertensive disorders of pregnancy (preeclampsia or gHTN) (Adjusted Odds Ratio [aOR] 1.25, 95% CI 1.09- 1.43), cesarean delivery (aOR 0.99, 95% CI 0.88-1.11), stillbirths (aOR 1.28, 95% CI 0.68-2.42), and preterm delivery at <37, <34, and <32 weeks gestational age (aOR 1.33, 95% CI 1.18-1.50; 1.36, 95% CI 1.15-1.61; 1.22, 95% CI 0.99-1.51 respectively) (Table 1 and Figure 1). Women with GDM and a diagnosis of depression have higher frequencies of perinatal adverse outcomes. Whether early testing and diagnosis of GDM in this population can improve perinatal outcomes is unknown but should be considered a high-risk population for GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Perinatal outcome and placental apoptosis in patients withlate-onset pre-eclampsia and abnormal uterine artery Doppler at diagnosis.

To determine the rate of placental apoptosis and adverse perinatal outcome in patients with late-onset pre-eclampsia (PE) and abnormal uterine artery (UtA) Doppler at diagnosis. This was a prospective cohort study of women with singleton pregnancy diagnosed with late PE, performed between August 2011 and January 2014 at the Maternal-Fetal Medicine Unit of Hospital Carlos Van Buren. Patients were stratified according to UtA Doppler status at diagnosis (pulsatility index (PI) ≤ or > 95th percentile). Logistic regression analysis was performed to identify associations between abnormal UtA Doppler and adverse maternal and perinatal outcomes. In a subset of this cohort for whom placental samples were available, immunohistochemical analysis of the placenta was performed to identify the rate of apoptosis and its association with UtA Doppler by comparing samples from those with normal and those with abnormal UtA Doppler and normotensive controls. Non-parametric linear trend analysis was performed for assessment of the apoptotic index. Eighty-six patients were included in the final analysis. Of these, UtA-PI was above the 95th percentile in 33 (38.4%) patients. Gestational age at diagnosis and delivery were significantly lower in this group compared with patients with normal UtA Doppler. Abnormal UtA Doppler was associated with increased risk of severe PE (odds ratio (OR) = 7.5; 95% CI, 2.76-20.46; P < 0.001), late preterm delivery (OR = 13.7; 95% CI, 4.53-41.46; P < 0.001), small-for-gestational age at birth (OR = 12.3; 95% CI, 3.17-47.57; P < 0.001) and admission to the neonatal intensive care unit (OR = 12.8; 95% CI, 2.61-62.36; P = 0.002). Moreover, UtA Z-score demonstrated a significant inverse correlation with birth-weight Z-score (r = -0.34; P = 0.0013). Mean placental apoptotic index demonstrated an ascending linear trend according to UtA Doppler status (P = 0.04). In patients with late PE, UtA Doppler was useful for clinical classification and as an indicator of placental histological findings. Correlation between UtA Doppler and the apoptotic index provides new evidence of a subgroup of late PE with a placental origin. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Optimal Management and Delivery Time for Intrahepatic Cholestasis of Pregnancy: Meta-analysis [37D

INTRODUCTION: To determine the risk of adverse perinatal outcomes in patients with intrahepatic cholestasis of pregnancy (IHCP) with gestational age at delivery and treatment modalities. METHODS: A systematic search of MEDLINE, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials was performed. The inclusion criteria consisted of randomized controlled clinical trials (RCTs) consisting of ursodeoxycholic acid (UDCA) compared with other treatments like placebo, dexamethasone, cholestyramine and SMAe for IHCP. RESULTS: 11 RCTs were eligible for analysis. Data was analyzed on 542 patients, of which 281 received UDCA and 261 received other treatments. Use of UDCA delayed gestational age at delivery by 6 days {SMD=0.59 (95% CI: 0.08-1.09); p &lt; 0.001}. Risk for preterm delivery and NICU admission decreased in group treated with UDCA compared to other treatments {RR=0.52 (95% CI: 0.38-0.72); p &lt; 0.001 and RR=0.53 (95% CI: 0.29-0.97); p=0.038}, respectively. Risk of adverse perinatal outcomes was decreased for delivery at 36 weeks {RR=0.59 (95% CI: 0.39-0.90); p=0.013} compared for delivery at 37 weeks. UDCA treatment decreased the risk of meconium staining and c-section with increased birth weight but these results did not show statistical significance. CONCLUSION: Treatment choice of IHCP should be UDCA and 36 weeks appeared to be the optimal time of delivery.​

Role of obstetric Doppler in prediction of adverse perinatal outcome in intrauterine growth retardation

Background: Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome. Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation.Methods: 200 singleton pregnancies between 34 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Results: Out of 200 cases, 169 were live born and 24 were neonatal death. There were 5 cases of intrauterine death of foetuses and 2 were still born. Out of the live born 32 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia.Conclusions: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse foetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised foetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised foetuses and helps to determine the optimal time of delivery.

Associations between first-trimester uterine artery Doppler velocimetry indices and adverse perinatal outcomes in women conceiving via in vitro fertilization

Aim: To explore if first-trimester uterine artery Doppler velocimetric values might predict adverse perinatal outcomes in patients conceiving via in vitro fertilization (IVF).Methods: We evaluated pregnancies in women who conceived via IVF (Group 1, n = 62) and compared these subjects to a control group (spontaneous pregnancies; Group 2, n = 53) in terms of first-trimester uterine artery Doppler velocimetric data. We explored whether these data predicted adverse perinatal outcomes (need for cesarean delivery, preterm birth, low birth weight, lower APGAR score, and need for referral to a neonatal intensive care unit [NICU]).Results: The mean age of Group 1 patients was 29.9 ± 4.7 years and that of Group 2 was 27.2 ± 4.2 years. Gestational age at birth, first-minute APGAR scores, NICU referral rate, birth weight, preterm birth rate, abortion rate, delivery type, the left-side uterine arterial systole–diastole ratio (LUASD), the left-side uterine arterial resistance index (LUARI), the right-side uterine arterial systole–diastole ratio (RUASD), and the right-side uterine arterial resistance index (RUARI) differed significantly between the two groups (all p values < 0.05). In the study group, positive correlations were evident between LUASD, LUARI, RUASD, and RUARI, preterm birth rates, and NICU referral rates. Also, birth weight correlated negatively with LUASD, LUARI, RUASD, and RUARI in the study group.Conclusions: First-trimester uterine artery Doppler velocimetric indices, including the resistance index and systole–diastole ratio, usefully predict adverse perinatal outcomes of IVF pregnancies.

582: The effect of race/ethnicity on adverse perinatal outcomes in patients with pregestational diabetes mellitus

582: The effect of race/ethnicity on adverse perinatal outcomes in patients with pregestational diabetes mellitus