Complete Pregnancy Research Articles

Prevalence, Risk Factors, and Clinical and Biochemical Characteristics of Alemtuzumab-Induced Graves Disease.

Atypical Graves disease (GD) is a common complication in multiple sclerosis (MS) patients treated with alemtuzumab. We present epidemiological, clinical, and biochemical characteristics of alemtuzumab-induced GD. Retrospective follow-up study of MS patients treated with alemtuzumab from 2014 to 2020, including clinical course of GD, pregnancy outcome, and thyroid eye disease (TED). We enrolled 183 of 203 patients (90%, 68% women) treated with alemtuzumab at 4 hospitals in Norway. Seventy-five (41%) developed thyroid dysfunction, of whom 58 (77%) had GD. Median time from the first dose of alemtuzumab to GD diagnosis was 25 months (range, 0-64). Twenty-four of 58 GD patients (41%) had alternating phases of hyper- and hypothyroidism. Thyrotropin receptor antibodies became undetectable in 23 of 58 (40%) and they could discontinue antithyroid drug treatment after a median of 22 (range, 2-58) months. Conversely, 26 (44%) had active disease during a median follow-up of 39 months (range, 11-72). Two patients (3%) received definitive treatment with radioiodine, 6 (10%) with thyroidectomy. Nine developed TED (16%), 7 had mild and 2 moderate to severe disease. Four patients completed pregnancy, all without maternal or fetal complications. Patients who developed GD had a lower frequency of new MS relapses and MRI lesions than those without. GD is a very common complication of alemtuzumab treatment and is characterized by alternating hyper- and hypothyroidism. Both remission rates and the prevalence of TED were lower than those reported for conventional GD. Pregnancies were uncomplicated and GD was associated with a lower risk of subsequent MS activity.

Imaging in gynecological disease (25): clinical and ultrasound characteristics of intramural pregnancy.

To describe the clinical and sonographic characteristics of intramural pregnancy, as well as the available management options and treatment outcomes. This was a retrospective single-center study of consecutive patients with a sonographic diagnosis of intramural pregnancy between November 2008 and November 2022. An intramural pregnancy was diagnosed on ultrasound when a pregnancy was implanted within the uterine corpus, above the level of the internal cervical os and separate from the interstitial section of the Fallopian tube, and extended beyond the decidual-myometrial junction. Clinical, ultrasound, relevant surgical and histological information and outcomes were retrieved from each patient's record and analyzed. Eighteen patients were diagnosed with an intramural pregnancy during the study period. Their median age was 35 (range, 28-43) years and the median gestational age at diagnosis was 8 + 1 (range, 5 + 5 to 12 + 0) weeks. Vaginal bleeding with or without abdominal pain was the most common presenting symptom, recorded in eight patients. Nine (50%) patients had a partial and nine (50%) had a complete intramural pregnancy. Embryonic cardiac activity was present in eight (44%) pregnancies. The majority of pregnancies (n = 10 (56%)) were initially managed conservatively, including expectant management in eight (44%) cases, local injection of methotrexate in one (6%) and embryocide in one (6%). Conservative management was successful in nine of the 10 (90%) pregnancies, with a median time to serum human chorionic gonadotropin resolution of 71 (range, 35-143) days. One patient with an ongoing live pregnancy had an emergency hysterectomy for a major vaginal bleed at 20 weeks' gestation. No other patient managed conservatively experienced any significant complication. The remaining eight (44%) patients had primary surgical treatment, comprising transcervical suction curettage in seven (88%) of these cases, while one patient presented with uterine rupture and underwent emergency laparoscopy and repair. We describe the ultrasound features of partial and complete intramural pregnancy, demonstrating key diagnostic features. Our series suggests that, when intramural pregnancy is diagnosed before 12 weeks' gestation, it can be managed either conservatively or by surgery, with preservation of reproductive function in most women. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Heredity of pregnancy-related pelvic girdle pain in Sweden.

Pelvic girdle pain during and after pregnancy is a major public health problem with significant daily problems for affected women and their families. There is now accumulating evidence that pregnancy-related pelvic girdle pain originates from the sacroiliac joints and the pubic symphysis as well as their extra-articular ligaments. However, the heritability of the disease remains to be determined. We hypothesized that there is an increased familial risk of pregnancy-related pelvic girdle pain. A population-based national database linkage registry study of approximately 9.3 million individuals within 4.2 million families in Sweden with a recruitment period from 1997 to 2018. The Swedish Multi-generation register was used to find female pairs of twins, full siblings, half-siblings and first cousins where both in the pairs had a completed pregnancy. The outcome measure was diagnosis of pregnancy-related pelvic girdle pain (International Classification of Diseases-10 O26.7 [1997-2018]) in the first pregnancy. Data was obtained from the Swedish Hospital Discharge Register, the Swedish Outpatient Care Register, the Swedish Medical Birth Register, the Primary Healthcare Register, and Medical Treatment Register. Cox regression analysis was used to calculate adjusted estimated effect of the exposure variable familial history of pregnancy-related pelvic girdle pain on the outcome variable pregnancy-related pelvic girdle pain at first birth. From the registers, 1 010 064 women pregnant with their first child within 795 654 families were collected. In total, 109 147 women were diagnosed with pregnancy-related pelvic girdle pain. The adjusted hazard ratio for a familial risk of pregnancy-related pelvic girdle pain was 2.09 (95% CI 1.85-2.37) among twins (monozygotic and dizygotic), 1.78 (95% CI 1.74-1.82) in full siblings, 1.16 (95% CI 1.06-1.28) in half-siblings from the mother, 1.09 (95% CI 1.024-1.16) in half-siblings from the father and 1.09 (95% CI 1.07-1.12) in first cousins. This nationwide observational study showed a familial clustering of pregnancy-related pelvic girdle pain. The hazard ratio for the condition was associated with the degree of relatedness, suggesting that heredity factors contribute to the development of pregnancy-related pelvic girdle pain. There is no causal treatment available for pregnancy-related pelvic girdle pain and further studies are now encouraged to clarify the specific genetic factors that contribute to the disease and for future targeted interventions.

Glutathione-Responsive Methotrexate Polymersomes for Potential Management of Ectopic Pregnancy.

The first-line treatment for ectopic pregnancy (EP), the chemotherapeutic methotrexate (MTX), has a failure rate of more than 10%, which can lead to severe complications or death. Inadequate accumulation of administered MTX at the ectopic implantation site significantly contributes to therapeutic failure. This study reports the first glutathione-responsive polymersomes for efficient delivery of MTX to the implantation site and its triggered release in placental cells. Fluorescence and photoacoustic imaging have confirmed that the developed polymersomes preferentially accumulate after systemic administration in the implantation site of pregnant mice at early gestational stages. The high concentrations of intracellular glutathione (GSH) reduce an incorporated disulfide bond within polymersomes upon internalization into placental cells, resulting in their disintegration and efficient drug release. Consequently, MTX delivered by polymersomes induces pregnancy demise in mice, as opposed to free MTX at the same dose regimen. To achieve the same therapeutic efficacy with free MTX, a sixfold increase in dosage is required. In addition, mice successfully conceive and birth healthy pups following a prior complete pregnancy demise induced by methotrexate polymersomes. Therefore, the developed MTX nanomedicine can potentially improve EP management and reduce associated mortality rates and related cost.

Trends and patterns of antiseizure medication prescribing during pregnancy between 1995 and 2018 in the United Kingdom: Acohort study.

To examine antiseizure medication (ASM) prescription during pregnancy. Population-based drug utilisation study. UK primary and secondary care data, 1995-2018, from the Clinical Practice Research Datalink GOLD version. 752 112 completed pregnancies among women registered for a minimum of 12 months with an 'up to standard' general practice prior to the estimated start of pregnancy and for the duration of their pregnancy. We described ASM prescription across the study period, overall and by ASM indication, examined patterns of prescription during pregnancy including continuous prescription and discontinuation, and used logistic regression to investigate factors associated with those ASM prescription patterns. Prescription of ASMs during pregnancy and discontinuation of ASMs before and during pregnancy. ASM prescription during pregnancy increased from 0.6% of pregnancies in 1995 to 1.6% in 2018, driven largely by an increase in women with indications other than epilepsy. Epilepsy was an indication for 62.5% of pregnancies with an ASM prescription and non-epilepsy indications were present for 66.6%. Continuous prescription of ASMs during pregnancy was more common in women with epilepsy (64.3%) than in women with other indications (25.3%). Switching ASMs was infrequent (0.8% of ASM users). Factors associated with discontinuation included age ≥35, higher social deprivation, more frequent contact with the GP and being prescribed antidepressants or antipsychotics. ASM prescription during pregnancy increased between 1995 and 2018 in the UK. Patterns of prescription around the pregnancy period vary by indication and are associated with several maternal characteristics.

Perioperative Considerations for Hysterectomy in Second-Trimester Molar Pregnancy.

Second-trimester complete molar pregnancies are rare. Due to a later presentation, means to reduce surgical and long-term morbidity from hemorrhage, hyperthyroidism, and gestational trophoblastic neoplasia risk should be considered. A 48-year-old woman presented at 17 6/7 weeks of gestation with vaginal bleeding, with a human chorionic gonadotropin (hCG) level of 483,906 milli-international units/mL, biochemical hyperthyroidism, and ultrasonographic suspicion for complete molar pregnancy. The patient received preoperative uterine artery embolization and antithyroid medication before undergoing total abdominal hysterectomy. Her thyroid function and hCG level normalized by 1 week and 69 days postoperatively, respectively. Uterine artery embolization and hysterectomy may reduce surgical blood loss and lower the risk of malignancy for patients at high risk for gestational trophoblastic neoplasia. Preoperative treatment of hyperthyroidism with gestational trophoblastic disease can reduce morbidity from thyrotoxicosis.

Chronic Pancreatitis in Females is Not Associated With Adverse Pregnancy Outcomes: A Retrospective Analysis.

The effects of chronic pancreatitis (CP) on pregnancy and vice versa have not been studied well. We aimed to study the impact of CP on pregnancy-related outcomes and the effect of pregnancy on clinical profile of CP. We did a retrospective analysis of all female patients of CP of child-bearing age (above 18 y). The pregnancy-related outcomes of patients with CP were compared with the age-matched 115 controls from the low-risk pregnancy group identified using a simplified antepartum high-risk pregnancy scoring form. The clinical course of CP during pregnancy was compared with the pre-pregnancy course. Among the 338 eligible patients, 46 patients were included after exclusions. All these 46 patients had at least 1 conception and 41 had at least 1 completed pregnancy with a total of 117 conceptions and 96 completed pregnancies. The pregnancy-related outcomes in patients with CP like abortions (21.7% vs. 11.3%; P =0.087), preterm deliveries (14.6% vs. 10.4%; P =0.47), antepartum course (82.7% vs. 82.6%; P =0.58), stillbirths (4.9% vs. 4.3%; P =0.88), cesarean section (36.6% vs. 34%; P =0.849) were comparable with controls. There was overall improvement in the severity and frequency of pain during pregnancy as compared with the pre-pregnancy symptoms ( P =0.001). CP is not associated with adverse pregnancy outcomes. Also, there is trend toward improvement in the clinical symptoms because of CP during the pregnancy.

Opportunities for predicting adverse pregnancy outcomes in severe COVID-19

Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22–42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality; the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters – lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein; coagulation parameters – prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio; the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6); ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (χ2 = 12.84; p ≤ 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II; most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (χ2 = 5.41; p ≤ 0.05; odds ratio (OR) = 5.0; 95 % confidence interval (CI) = 1.23–20.3); lack of leukocytosis at the initial stages (χ2 = 4.91; p ≤ 0.05; OR = 50; 95 % CI = 5.43–460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (χ2 = 19.79, p ≤ 0.05, OR = 50; 95 % CI = 5.43–460.54); severe lymphopenia (χ2 = 8.09; p ≤ 0.05; OR = 7.29; 95 % CI = 1.74–30.56), neutrophilia (χ2 = 10.17; p ≤ 0.05; OR = 10.29; 95 % CI = 2.21–47.84); high LDH values (χ2 = 17.99; p ≤ 0.05; OR = 31.88; 95 % CI = 5.09–199.49); increased IL-6 level at the peak of the disease (χ2 = 9.66; p ≤ 0.05; OR = 18; 95 % CI = 1.99–162.62) and in dynamics, as well as stably high D-dimer values (χ2 = 9.53, p ≤ 0.05; OR = 11.33; 95 % CI = 2.07–62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.

N06 The Introduction of Nurse Led Preconception and Pregnancy Education Clinics for patients with Inflammatory Bowel Disease

Abstract Background •The Inflammatory Bowel Disease Centre in the Mercy University Hospital ( MUH) has a patient population of approximately 4000 patients with IBD, of these roughly half are women and many are diagnosed during their reproductive years. • Caring for this patient cohort can be a challenge due to patient lack of knowledge surrounding IBD and pregnancy misinformation that can occur. • The aim of this project was to identify the unmet education needs of patients in relation to pregnancy and IBD. Subsequent aims were to improve patient care through the establishment of IBD preconception and pregnancy education clinics Methods •An audit was carried out at the IBD infusion suite and Nurse led clinics over a 20-week period between April- August 2021. 448 patients between the ages of 18-45 were identified during this timeframe and asked to complete and IBD and pregnancy questionnaire. • The questions to assess education needs were Q1) Are you planning pregnancy in the next 2years? Q2 Has your diagnosis of IBD affected your family planning in any way? Q3) Do you feel well informed/prepared from an IBD perspective to start/continue your family? Q4) Do you have any questions or concerns regarding IBD and pregnancy e.g. Disease flare up impact on pregnancy, mediation queries/concerns, impact of pregnancy disease process Q5) What do you feel the percentage risk of your baby developing IBD would be ( 0-10%, 10-20%,20-40% or >40%) Q6 Would you be interested in attending a pregnancy education clinic led by and Advanced Nurse Practitioner? Results •55% of respondents were women. • 89% of respondents felt they needed more education on IBD and pregnancy. • 70% of respondents were concerned about the impact of an IBD flare up on fetal health with 19% remaining voluntarily childless. • 95% of patients had questions/concerns about the effects of biologic drugs on pregnancy outcomes. • 90% of patients said they would attend IBD ANP led preconception and pregnancy education clinics. • 84% of patients overestimated the percentage risk of their offspring developing IBD, with 59% estimating the risk to be greater than 20% Conclusion •This audit identified the need for preconception and pregnancy education clinics for patients with IBD to improve patient education, care and outcomes. ANP led preconception and pregnancy education clinics have been established since October 2021 & are ongoing. Currently between 8-12 patients attend exclusively for preconception counselling per month. Referrals are received from Consultants within the IBD Centre MUH

A One-Year Epidemiological Perspective of Molar Pregnancies at Orotta Maternity Referral Hospital: Asmara, Eritrea

Gestational trophoblastic diseases (GTD) are a group of diseases originating from the placenta, with significant morbidity and mortality, especially in developing countries. A one-year prospective study on GTD was done to determine the incidence of GTD identify the risk factors; explain the clinical presentation; describe the management; and record the outcomes at Orotta Maternity Referral Hospital (OMRH) Asmara, Eritrea; A protocol for the prospective study of GTD was prepared with involvement of colleagues. All collected data was reviewed and finalized by the author. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS). During the study period a total of 6845 deliveries and 45 cases of GTD were recorded at OMRH. This gives an incidence of 6.6 per 1000 deliveries. Primgravid mothers were more affected. The majority of cases were complete molar pregnancy (87%) and vaginal bleeding was the main presentation. Pregnancy test result was read as negative in 7% of cases. Of the cases followed, 77.7% recovered while 11.1% required chemotherapy because of persistent disease and 8.9% were lost to follow up. The study confirms higher incidence, of GTD in Eritrea as compared to results of some African countries. The need to strengthen histological services and quantitative serum tests were identified as crucial in the effective management of GTD at OMRH. A standard and systematic approach of diagnosis, treatment and strict fellow-up of cases is required for better outcome.

Twin pregnancy: Live fetus with complete hydatidiform molar—A case report

Gestational trophoblastic disease encompasses a range of lesions, each culminating in varied clinical manifestations. Among these, the simultaneous occurrence of molar changes within the placenta and a viable fetus remains a particularly elusive and challenging presentation, posing intricate dilemmas for obstetricians. In this article, we delineate a distinct case involving a 21-year-old woman with a history of consanguineous marriage. She was referred from Médecins Sans Frontières to the Rafic Hariri University Hospital during her 19th week of gestation. With an unremarkable medical history and uncomplicated previous pregnancies, her presentation to the Rafic Hariri University Hospital was punctuated by symptoms of premature labor. Clinical evaluations revealed ruptured membranes, a fetus-positioned breech, and discernible complications tied to the placental morphology. Given these clinical findings, a decision was made in favor of a Cesarean delivery. Prior to this, the patient had been administered corticosteroids and tocolytics. Subsequent delivery produced a live male infant at 34 + 5 gestational days, and further assessment unveiled a complete molar pregnancy. The coexistence of a viable fetus alongside a complete molar pregnancy is an infrequently documented phenomenon, underlining the clinical significance of this case. A comprehensive literature survey reinforced the exceptional nature of our findings. Postpartum, both the mother and neonate were monitored for a month, ensuring their well-being. This case accentuates the paramountcy of prompt and precise diagnostic interventions when faced with atypical presentations. It further underscores the imperative for obstetricians to possess nuanced expertise in confronting the intricate challenges posed by gestational trophoblastic disease, ensuring optimal maternal and neonatal outcomes.

Historical aspects of diabetes, morbidity and mortality

It has been an entire century since the introduction of insulin into clinical practice, which, among other, led to improvements of fertility and pregnancy outcomes of women suffering from gestational diabetes. The prevalence of diabetes worldwide and in Serbia is high and tends to increase as a consequence of modern lifestyle. Nevertheless, modern diagnostic and therapeutic approaches enable people with diabetes to achieve and complete pregnancies without adverse outcomes. Gestational diabetes can be considered as non-communicable disease and efforts should be made to determine its effects on offspring. In the context of COVID-19 pandemic, diabetes mellitus was identified as an important risk factor for severe forms of the disease.

Успешная реализация репродуктивной функции у женщины с полным удвоением матки

Aim. Demonstration of a clinical case of twice successfully completed surgical delivery in a patient with uterus didelphys. Key points. Uterus didelphys is the result of an embryological violation of the Muller ducts fusion process. It is associated with a deterioration in the reproductive function of a woman. Despite the significant correlation of uterine development abnormalities with infertility and miscarriage, this article demonstrates a clinical case of both functional uterine bodies in complete uterus doubling. And the second successfully completed pregnancy was in the hemiuterus with the presence of a scar from perforation of the right body. It should also be noted that both pregnancies occurred naturally. Conclusion. This clinical case demonstrates the possibility of spontaneous occurrence and termination of pregnancy with favorable maternal and perinatal outcomes in women with uterus didelphys. Key words: complete doubling of the uterus, reproductive function, cesarean section.

Understanding of already known fact: Evaluating frequency and determinants of Hydatidiform Molar Pregnancy

Introduction: Sporadic presentation of hydatidiform has been reported previously as 1 in 1000 pregnancies. In rare cases asymptomatic molar pregnancies can cause problems if not identified in early radiological investigations. The aim of this study is to evaluate the frequency of hydatidiform (molar pregnancy) presenting with associated symptoms, analysis of determinants and management in Sindh, Pakistan. Methodology: This is a cross sectional study, patients were divided into categories according to maternal age, gravida while Beta HCG values were reported along with radiological investigation reporting to confirm hydatidiform molar pregnancy. Statistical package of social science version 21 was used to analyze the data. Results: Total 51 patients were identified with hydatidiform molar pregnancy during study period of 12 months from more than 1000 full term reported pregnancies, indicating 5.1% prevalence of disorder. The diagnosis has been confirmed only 1 (1.9%) case of partial molar pregnancy while 50 (99.1%) were complete molar pregnancy cases, managed by suction evacuation method, risks factors of hydatidiform molar pregnancy with advanced maternal age, recurrent molar pregnancy and positive family history the odds ratio has indicated positive association between first two determinants with OR of 1.71 and 1.21 respectively. Conclusion: Overall recorded frequency of hydatidiform in our institute is 5.1% within 1 year. Advanced maternal age and previous history of molar pregnancies are risk factors of hydatidiform.

RARE CASE OF PARTIAL MOLE WITH LIVE FETUS PROGRESSION TO INVASIVE MOLE WITH LUNG METASTASIS FOLLOWING SPONTANEOUS CONCEPTION

Hydatiform mole belongs to a group of diseases classified as gestational trophoblastic disease,that results from an impaired fertilization.Moles have been divided into complete or partial moles on the basis of distinctive histopathological features and genetic abnormalities.Partial molar pregnancy with coexisting fetus is a rare complication with an incidence of 0.005%-0.01% of all the pregnancies.It usually derives from dispermic fertilization of all a haploid normal oocyte and produce a triploid set of chromosomes (69XXX69XXYor 69XYY)and is most commonly associated with the presence of a malformed fetus. We report a case of 21 year old primigravida with 19week +1dyay gestational age with pregnancy induced hypertension with? complete molar pregnancy with anemia presented to delivery room which was referred from private hospital in view of molar pregnancy for termination and correction of anemia.

COVID-19 Severity Among Non-Vaccinated Pregnant Women During the Delta Wave in Tunisia: A Retrospective Monocentric Study

Introduction: Pregnant women are vulnerable to SARS-CoV2 infection, particularly with the Delta variant. The aim of our study is to describe the COVID-19 syndrome among non-vaccinated pregnant women during the delta wave and to investigate risk factors for severe forms. Methods: In this study, we included all non-vaccinated pregnant women who tested positive for COVID-19 and who required hospital admission at any stage of gestation during the Delta wave in the maternity of Sfax, Tunisia. Patients were divided into 2 groups according to the mode of delivery in case of completed pregnancies and according to the severity of the disease. Severe COVID-19 is considered when the pregnant woman requires advanced oxygen support or intensive care unit referral. We performed univariate and multivariate logistic regression models to investigate the predictors of severe maternal outcomes among infected pregnant women. The significance level was set top ≤ 0.05. Results: one hundred patients were included. Severe adverse outcomes were observed in 23 patients (group1). The mortality rate during the Delta wave was 6%. The mode of delivery had not influenced the maternal and perinatal outcomes. Age >35 years old [OR 3.16, 95% CI 1.13- 8.84], BMI>30 kg/m2 [OR 2.63, 95% CI 1.0 -6.95], preeclampsia [OR 4.0, CI 95% 1.04- 15.32], dyspnea [OR 7.55, 95% CI 2.62- 21.7], cytolysis [ OR 4.6, 95% CI 1.48- 14.2], and lung injury in CT Scan > 50% [OR9.6, 95%CI 1.48-62.1] were significantly associated with an increased risk of severe maternal outcomes. Conclusions: During the delta wave in Tunisia, non-vaccinated pregnant women seem to be at higher risk of severe maternal outcomes and maternal deaths. The main risk factors for severe outcomes were age 35, obesity, preeclampsia, cytolysis, and severe lung damage in the CT scan.

Interpregnancy interval and preterm delivery: An empirical comparison of between-persons and within-sibship designs.

Short interpregnancy interval has been associated with increased risk of preterm delivery; recent studies employing within-sibship designs suggest that this risk may be exaggerated. There are unresolved issues regarding properties of this design. To compare directly the results, for short intervals, of between-person and within-sibship analyses when applied to the same target population. Cross-sectional data are from the National Survey of Family Growth, a statistically representative survey of women and men in the USA, 2006-2015. Participants provided a complete pregnancy history including outcome, duration and ending date, enabling calculation of interval. Conventional analysis employed log-linear regression, controlling survey design, early life events, demographic variables, pregnancy intendedness, breastfeeding of the previous birth and obstetric history. Within-sibship analyses, utilising conditional log-linear regression, controlled the same variables, except those remaining static within each participant. Among participants with at least three live- or stillbirths, the percentage of pregnancies in each interval, and the percent of deliveries that were preterm following that interval were 9.2%, 14.6% for <6, and 14.7%, 15.4% for 6-11, versus 12.2%, 14.7% for 18-23 months. Among participants with at least three live- or stillborn infants, those in the within-sibship analysis had a higher risk profile than comparably parous, ineligible participants. In a between-participant analysis, among those included in within-sibship models, the adjusted risk ratios (vs 18-23 months) for preterm delivery for intervals <6 and 6-11 months were 0.74 (95% CI 0.63, 0.88) and 0.85 (95% CI 0.74, 0.98). The corresponding risk ratios were 0.56 (95% CI 0.14, 2.30) and 0.49 (95% CI 0.13, 1.80) for those ineligible for the within-sibship models. When comparable analyses were employed, the association between interval and preterm delivery was similar between participants included in the within-sibship analysis and those ineligible for the within-sibship analysis, but differed from those in the full cohort, perhaps due to different target populations.

Abstract 11217: Pregnancy Outcomes in Unrepaired Congenital Heart Disease a Multicenter Experience From 1272 Patients

Introduction: The prevalence of unrepaired congenital heart disease (CHD) before pregnancy is tremendously high, especially in developing countries. And their maternal outcomes haven’t been investigated at scale in a contemporaneous population. This study describes the maternal outcomes among pregnancies with unrepaired CHD. Methods: From 1993 to 2019, we nationally enrolled 2,220 CHD pregnancies from 7 tertiary centers. Patients were subdivided into two groups: pregnancies with unrepaired CHD and with repaired CHD. Maternal and offspring outcomes of completed pregnancies and their demographics, antenatal cardiac situation, and comorbidities were collected. To identify the risk factors for cardiac outcomes, univariate and multivariate analyses were performed through logistic regression. Results: Of 2,220 completed pregnancies with CHD, 1,272 women had unrepaired CHD. The main CHD diagnosis of unrepaired CHD patients was shunt lesion (64.54%). In parturients with unrepaired CHD, the incidence of mortality and heart failure were 1.73% and 14.94%, respectively. Pregnancies with unrepaired CHD had a significantly higher incidence of adverse maternal and offspring events than pregnancies with repaired CHD. Preterm delivery (22.56%) and low birth weight (21.15%) were the most common obstetric and offspring complications. Independent risk factors for maternal cardiac events included having a New York Heart Association functional class III-IV, elevated brain natriuretic peptide level, pulmonary hypertension, delayed first antenatal care visit, absence of strict antenatal supervision, and lack of multidisciplinary team management. Conclusions: In conclusion, pregnant women with unrepaired CHD were associated with significant morbidity and mortality. And they had significantly worse maternal and offspring outcomes than pregnant women with repaired CHD.

Are perinatal measures associated with adolescent mental health? A retrospective exploration with original data from psychiatric cohorts

BackgroundPerinatal markers of prenatal development are associated with offspring psychiatric symptoms. However, there is little research investigating the specificity of perinatal markers for the development of specific disorders. This study aimed to explore if perinatal markers are specifically associated with adolescent substance use disorder (SUDs).MethodsAdolescent participants from two study centers, one for SUD patients (n = 196) and one for general psychopathology (n = 307), were recruited for participation. Since the SUD participants presented with a number of comorbid disorders, we performed a 1-on-1 matching procedure, based on age, gender, and specific pattern of comorbid disorders. This procedure resulted in n = 51 participants from each group. From all participants and their mothers we recorded perinatal markers (mode of birth, weeks of completed pregnancy, birth weight, Apgar score after 5 min) as well as intelligence quotient (IQ). The SUD sample additionally filled out the Youth Safe Report (YSR) as well as the PQ-16 and the DUDIT. We aimed to distinguish the two groups (SUD sample vs. general psychiatric sample) based on the perinatal variables via a logistic regression analysis. Additionally, linear regressions were performed for the total group and the subgroups to assess the relationship between perinatal variables and IQ, YSR, DUDIT and PQ-16.ResultsThe perinatal variables were not able to predict group membership (X2 [4] = 4.77, p = .312, Cox & Snell R² = 0.053). Odds ratios indicated a small increase in probability to belonging to the general psychiatric sample instead of the SUD sample if birth was completed via C-section. After Bonferroni-correction, the linear regression models showed no relation between perinatal markers and IQ (p = .60, R² = 0.068), YSR (p = .09, R² = 0.121), DUDIT (p = .65, R² = 0.020), and PQ-16 (p = .73, R² =0.021).ConclusionPerinatal markers were not able to distinguish SUD patients from patients with diverse psychopathologies. This pattern contradicts previous findings, perhaps because our chosen markers reflect general processes instead of specific mechanistic explanations. Future studies should take care to investigate specific prenatal markers and associate them with psychopathology on the symptom level.

HISTOMORPHOLOGICAL EVALUATION OF TUMOURS OF FEMALE GENITAL TRACT AND ITS CHANGE IN TUMOUR PROFILE OVER A PERIOD OF 12YRS IN A TERTIARY CARE REFERRAL HOSPITAL IN CHENNAI.

Background: The most common cause of morbidity &amp; mortality among females are due to cancers arising from female reproductive organs next to breast cancers. The most common sites include uterine cervix, corpus uteri &amp; ovary followed by least common sites like vulva, vagina, fallopian tubes and gestational trophoblastic diseases. Aim of the study: 1. To evaluate the trend in the prole of benign, premalignant &amp; malignant lesions of female genital tract (FGT) tumours at primary tertiary care hospital in Chennai. 2. To study frequency, age distribution &amp; diverse histomorphological spectrum of tumours of female genital tract. 3. To compare and analyze our data with other published studies in the literature. Materials &amp; Methods: This cross sectional retrospective observational study was conducted at tertiary care gynaecological center at Chennai over a period of 12 years from Jan 2008 to Dec 2019. The medical records were retrieved, data analyzed and the results were expressed in descriptive statistics. Results: During the study period we received 44752 histopathological specimens out of which 12477 cases were gynaecological malignancies. Cervix uteri (66.38%) was the most common site followed by ovary (16.65%), corpus uteri (10.71%), gestational trophoblastic disease (4.13%), vulva (0.82%), vagina (0.36%), fallopian tube (0.02%), and vault carcinoma (0.93%). Squamous cell carcinomas were most common type of malignancy in cervix (93.15%), vulva (91%), vagina (82%) &amp; vault (78%). Endometrial adenocarcinomas (81%) were more frequent tumour in corpus uteri while surface epithelial tumours constitute 78.72% of cases in ovary. For gestational trophoblastic disease, 78.25% of cases had complete molar pregnancy. 41-50yrs of age groups were commonly affected for cervical, ovarian &amp; endometrial malignancies where as in vulval lesions the most common age group was 61-70yrs. In case of gestational trophoblastic disease the majority of patients were presented at 21-30yrs of age. Conclusion: This is one of the largest studies conducted with more than 10000 cases being reported in female genital tract. Cervical carcinomas are the leading gynecological malignancy followed by ovary &amp; corpus uteri at our institute. There is a declining trend in the distribution of cases among cervical cancers were as there is an increasing trend in distribution of cases in other site like ovary &amp; corpus uteri.