Complicated Obstetric History Research Articles

P-064: Measures of thrombodynamics test and fibrin monomer level in pregnant women with complicated obstetric history

P-064: Measures of thrombodynamics test and fibrin monomer level in pregnant women with complicated obstetric history

Персонифицированный подход к коррекции нарушений системы гемостаза и тромбопрофилактике у беременных с осложненным акушерским анамнезом

Персонифицированный подход к коррекции нарушений системы гемостаза и тромбопрофилактике у беременных с осложненным акушерским анамнезом

Значення гетерохроматину і поліморфних варіантів генів фолатного циклу у жінок з репродуктивними втратами

The article presents data from surveys of women of losses of pregnancy (LP) in history, conducted within the medical genetic counseling, given the urgency of specifying genetic factors that actually are in causal connection with the LP specification clinical effects of epigenetic variability. The objective: to clarify the meaning of the changes in women heterochromatin (chromosomal polymorphism) and polymorphic variants of genes folat cycle enzymes as potential risk factors and pathogenic primordial LP. Patients and methods. The study involved two groups of women: I - 154 observations with complicated obstetric history in LP and II - 32 healthy women with uncomplicated reproductive history, held preconception planning to prevent pregnancy. Studied genealogical history, especially of internal organs, genitalia. Special studies included cytogenetic analysis, identification of gene polymorphisms system folat cycle methylentetrahydrofolate reductase [MTHFR] (C677T, A1298C, G1793A); methionine synthase reductase [MTRR] (A66G). Results. Women with a history of LP in 36.4% identified chromosome polymorphisms (SNPs extreme variants of chromosome polymorphism) on the background of various risk alleles of polymorphic variants of genes folat cycle; 7.1% of them is a polymorphism of the 21st chromosome. These genetic features are interpreted as a significant risk factor for LP as grounds for targeted in-depth medical and genetic examination. Prevalence among women with a history of PL undifferentiated forms cjnnective tissue and mesoderm dysplasia, benign tumors and «precancerous» states, as well as the prevalence of cardiovascular and psycho-neurological disease in pedigree suggests pathogenetic link these phenomena, the role of chromosomal polymorphism and polymorphic variants of genes of pathogenic folat cycle as primordial. Conclusion. The data on the place and role of heterochromatin and gene polymorphisms folat cycle in the origin LP should be mandatory option when examining women within the medical genetic counseling. Key words: pregnancy, reproductive losses, chromosomal instability, folat cycle genes, ancestry.

Modern aspects of diagnosis and prevention of complications of pregnancy in women with perinatal loss in history

The objective: the functional state of the autonomic nervous system, cortico1catecholamine hormone levels in pregnant women with complicated obstetric history and their impact on pregnancy is investigated in the study.

P-131: Arterial hypertension and its risk-factors in women population

Objectifs Arterial hypertension (AH) – - a major risk factor for the cardiovascular diseases, and this is a priority for the population of Georgia, which is among the top five countries with the highest rates of high blood pressure., according WHO in the 2002, According to a recent countrywide survey (STEPs-2010) the prevalence of AH is 33.4 % in 18-64 years old population The goal of survey – AH and its risk factors in the spread of the latest figures reveal the women’s population. Methodes The target population – university teachers. Sample size – 300; Sample frame – Women population in the Tbilisi State University. Survey tools – structured quantitative questionnaire, KAB qualitative research elements (knowledge, attitude, behavior), blood pressure measurement, antro-pometry, 12 lead ECG Survey results with the Minnesota Codes, HADS – Anxiety and Depression Hospital Scale. Resultats • Response rate −48,9%; • The average age −51, 2%; • Prevalence of AH −58.9%; • Overweight −33.6%; • Obesity −29.2%; • Excessive salt intake −28.9%; • Tobacco use −23.0%; • Hypodinamy −40.3%; • Complicated obstetric history −43.7%; • Symptoms of anxiety and depression −65.5%; • Defects in management of AH (wrong attitude to the problem, lack of knowledge of normal blood pressure values, lack of information about benefits of long-term treatment, etc.) −94,8%. Conclusion To improve the AH control, in the first place provides a full understanding their clinical condition for individuals with the hypertension or its risks – for successful management indicators. Last improves incentives for participation in such screening surveys, especially asymptomatic individuals

The role of fibrinogen in massive postpartum haemorrhage, a case report

•A G2P1 with a complicated obstetric history of massive postpartum haemorrhage (7L)•Monitoring of fibrinogen levels during pregnancy and labour•Fibrinogen suppletion resulted in only 2L blood loss during the third stage of labour.•This case report and literature show that fibrinogen levels might play a role in massive postpartum hemorrhage.

Tuberous Sclerosis in Pregnancy

Tuberous sclerosis is an autosomal dominant neurocutaenous disorder or neuroectodermatosis affecting multiple organ systems with variable clinical manifestations. We are reporting a case of a 26 years old female with history of epilepsy with mental retardation presented with fever and convulsions following an episode of stillbirth on first time with normal fetal outcome on second time. She had facial angiofibromas, shagreen patch, ash-leaf macules, periungual and subungual fibromas. She also had bilateral renal angiomyolipomas with haemorrhages and sub ependymal cortical tubers in brain. We report such a unique case having all clinically diagnostic physical sings of tuberous sclerosis with complicated obstetric history.

PROGNOSTIC VALUE OF UTEROPLACENTAL CIRCULATION IMPAIRMENT IN 1ST TRIMESTER OF PREGNANCY IN PATIENTS WITH COMPLICATED OBSTETRIC HISTORY

One of the urgent problems of modern obstetrics is the early detection of irregularities in the development of the uteroplacental vessels system in patients with severe disorders in the history. To evaluate the predictive value of re-development of obstetric pathology on the basis of the uterine artery Doppler on 11-14 weeks of pregnancy. 410 patients in I trimester of pregnancy were examined with fetal growth restriction, preeclampsia and/or fetal death and/or a history of preterm delivery were. The influence of physical factors and obstetric history on the state of uterine blood flow in the I trimester of pregnancy was studied. The optimal Doppler indexes was calculated; a high predictive ability of the pulsation index in the uterine arteries with respect to pregnancy complications with early clinical manifestation, severe preeclampsia and combined obstetric complications was detected. Our data support the possibility of preclinical diagnosis of obstetrical complications in patients with complicated obstetric history.

Maternal Characteristics of a Cohort of Preterm Infants with a Birth Weight ≤750 g without Major Structural Anomalies and Chromosomal Abnormalities

Our objectives were to describe the obstetric complications of women who delivered an extremely low-birth-weight infant by comparing two consecutive 5-year periods and infants appropriate for gestational age (AGA) versus infants small for gestational age (SGA). This descriptive study included women ( N = 261) who delivered an infant ≤750 g (major structural and chromosomal anomalies excluded) between 1996 and 2000 (cohort I, N = 145) and 2001 to 2005 (cohort II, N = 116) in the University Hospital Utrecht, the Netherlands. Of these, 84.3% of the multigravidas ( N = 121) had a complicated obstetric history: 46.3% miscarriage(s), 22.3% preterm deliveries, and 16.5% hypertensive disorders. In the index pregnancies ( N = 261), the most prevalent complications were hypertensive disorders (52.1%, P = 0.002; more in cohort II) and SGA ( P = 0.007), fetal distress (39.5%), and intrauterine growth restriction (32.6%) resulting in a caesarean section in 47.9% and a spontaneous vaginal delivery in 19.2%. Intrauterine deaths occurred in 35.2%, merely due to placental insufficiency (59.8%) and termination of pregnancy because of deteriorating hypertensive disorders (23.9%). A high percentage of parous mothers had a seriously complicated obstetric history. The index pregnancy was largely complicated by hypertensive disorders. The majority of infants with a birth weight ≤750 g were growth-restricted due to placental insufficiency. Follow-up is extremely important to evaluate neonatal morbidity and neurodevelopmental outcome.

Outcomes of the first midwife-led birth centre in Italy: 5 years’ experience

To assess the experience of the first 5 years of the first midwife-led birth centre (MLBC) in Italy. Data were prospectively collected to analyse the first 5 years' experience of the MLBC. MLBC is located alongside a University hospital maternity unit and it offers care to women with a straightforward pregnancy and midwives take primary professional responsibility for care. Women with maternal diseases, complicated obstetric history, height < 150 cm, maternal age > 45, or multiple pregnancy were excluded. Transfer was request in case of antenatal, intrapartum and postpartum pathological conditions. During the 5-year period (1 January 2001-31 December 2005), 1,438 low-risk women were admitted in labour to the MLBC. Of these, 203 (14.1%) were transferred during labour to consultant care (138 because of pathologies and 65 because of request of epidural analgesia). Among the transfers, the caesarean sections were 87, corresponding to 6.1% (87/1,438) of the total of women admitted to MLBC, while the operative vaginal deliveries were 14, corresponding to 1.0% (14/1,438) of the total of women admitted to MLBC. Among women who gave birth in the MLBC, episiotomy rate was 17.1%. In Italy, in the passed 10 years, the caesarean section rate reached 60%, in some regions. According to our data, the first 5 years of activity of the first MLBC in Italy had been associated with a low rate of medical interventions during labour and birth, with high rates of spontaneous vaginal birth and without signs of complications. We hope that this experience could be taken as a model to improve the quality of maternity care in Italy.

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

Folic acid supplements are more effective than increased dietary folate intake in elevating serum folate levels

In 1992, recommendations were disseminated aimed at reducing the incidence of neural tube defects. Women were advised to increase consumption of folic acid supplements and dietary folates during the periconceptional period and a major integrated national campaign was launched to help achieve this. In this study we found that only one-quarter of the women with an uncomplicated obstetric history and 51% with a complicated obstetric history took supplements for the recommended time period. Dietary modification was extremely unusual. Serum analysis demonstrated that intake of folic acid supplements provides a greater elevation in serum folate levels than dietary food intake, suggesting dietary manipulation is an ineffective strategy and that efforts would be better focused on increasing supplement intake at a clinically important time. More effective education strategies are required, and since approximately one-third of pregnancies are unplanned, fortification of foods with folic acid is warranted.

Case-Control Study of Intrapartum Care, Cerebral Palsy, and Perinatal Death

Gaffney, Geraldine; Sellers, Susan; Flavell, Valarie; Squier, Marian; Johnson, Ann Author Information

Further evidence for anomalies in the hand-prints of patients with schizophrenia: a study of secondary creases

Finger and palm prints from 46 ICD-9 schizophrenic patients and 43 age sex matched normal controls were examined independently and blind to diagnosis, by four raters. Seven prints were judged to have very high densities of secondary creases. These abnormal prints were all from the schizophrenic group. Patients with high densities of creases were more severely ill, having had more than five admissions to hospital and higher doses of neuroleptic medication. There was a trend for such patients to have had a complicated obstetric history and an earlier onset of their illness.

Case-control study of intrapartum care, cerebral palsy, and perinatal death

To investigate the relation between suboptimal intrapartum obstetric care and cerebral palsy or death. Case-control study. Oxford Regional Health Authority. 141 babies who subsequently developed cerebral palsy and 62 who died intrapartum or neonatally, 1984-7. All subjects were born at term of singleton pregnancies and had no congenital anomaly. Two controls, matched for place and time of birth, were selected for each index case. Adverse antenatal factors and suboptimal intrapartum care (by using predefined criteria). Failure to respond to signs of severe fetal distress was more common in cases of cerebral palsy (odds ratio 4.5; 95% confidence interval 2.4 to 8.4) and in cases of death (26.1; 6.2 to 109.7) than among controls. This association persisted even after adjustment for increased incidence of a complicated obstetric history in cases of cerebral palsy. Neonatal encephalopathy is regarded as the best clinical indicator of birth asphyxia; only two thirds (23/33) of the children with cerebral palsy in whom there had been a suboptimal response to fetal distress, however, had evidence of neonatal encephalopathy; these 23 formed 6.8% of all children with cerebral palsy born to residents of the region in the four years studied. There is an association between quality of intrapartum care and death. The findings also suggest an association between suboptimal care and cerebral palsy, but this seems to have a role in only a small proportion of all cases of cerebral palsy. The contribution of adverse antenatal factors in the origin of cerebral palsy needs further study.

Anticardiolipin antibodies in Sneddon's syndrome

We studied 24 patients (18 women, 6 men), aged 29 to 54, with Sneddon's syndrome. The clinical picture of Sneddon's syndrome was characterized by cerebrovascular disorders, livedo reticularis, disturbance of peripheral circulation, arterial hypertension, cardiac pathology (ischemic heart disease, heart murmurs), complicated obstetric history in women, and disturbed sexual function in men. In 6 of 17 examined patients with Sneddon's syndrome there was a high concentration of anticardiolipin antibodies (ACA) but no antibodies to native DNA and LE cells. The course of the disease in the patients with a high ACA level, when compared with normal ACA level patients, was characterized by a more rapid progression and more severe clinical manifestations. The study demonstrates the similarity of clinical symptoms and immunologic disturbances in Sneddon's syndrome and the antiphospholipid syndrome and suggests the importance of ACA in the pathogenesis of some cases of Sneddon's syndrome.

Observations on 767 clinical pregnancies and 500 births after human in-vitro fertilization

Details of 767 clinical pregnancies and 500 births from Bourn Hall are reported. All treated patients included some over 40 years old, many with ovarian or uterine defects, male infertility, etc. Patients were treated during their natural cycle or stimulated with clomiphene or clomiphene and human menopausal gonadotrophin. Follicular maturation was induced by an endogenous luteinizing hormone surge or human chorionic gonadotrophin. A maximum of three embryos were replaced, except in a few patients receiving four. Twenty-eight percent of pregnancies aborted, occurring more frequently in patients who were over 40, with a complicated obstetric history, and given clomiphene alone. Approximately 18% of fetuses 'vanished' in multi-pregnancies. Seventy-one sets of binovular twins and nine sets of triplets have been born, and seven twins and three triplets are ongoing. Seventeen and a half per cent of patients aged 39 and less with one or more replaced embryos delivered one or more children, rising to almost 25% with three replaced embryos. A mean of 1.3 children were born per delivery when three embryos were replaced. Most deliveries were by Caesarean section. There were two cases of placenta praevia, one stillbirth, four major and eight minor anomalies. All the triplets, and some twins and singletons had low birth weights and were born prematurely. The sex ratio was 247 males to 253 females.