Differences In Neonatal Complications Research Articles

Vitamin D Concentrations at Term Do Not Differ in Newborns and Their Mothers with and without Polycystic Ovary Syndrome.

Studies suggest that non-pregnant women with polycystic ovary syndrome (PCOS) may be at elevated risk of 25 hydroxyvitamin D (25(OH)D) deficiency. Furthermore, there is evidence suggesting that 25(OH)D may also play an important role during pregnancy. Data regarding 25(OH)D deficiency during pregnancy in PCOS patients and its association with perinatal outcome is scarce. The aim of the study was to investigate whether mothers with and without PCOS have different 25(OH)D levels at term, how maternal 25(OH)D levels are reflected in their offspring, and if 25(OH)D levels are associated with an adverse perinatal outcome. Therefore, we performed a cross-sectional observational study and included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS and an ongoing pregnancy ≥ 37 + 0 weeks of gestation who gave birth in our institution between March 2013 and December 2015. Maternal serum and cord blood 25(OH)D levels were analyzed at the day of delivery. Maternal 25(OH)D levels did not differ significantly in women with PCOS and without PCOS (p = 0.998), nor did the 25(OH)D levels of their respective offspring (p = 0.692). 25(OH)D deficiency (<20 ng/mL) was found in 26.9% and 22.5% of women with and without PCOS (p = 0.430). There was a strong positive correlation between maternal and neonatal 25(OH)D levels in both investigated groups (r ≥ 0.79, p < 0.001). Linear regression estimates of cord blood 25(OH)D levels are about 77% of serum 25(OH)D concentrations of the mother. Compared to healthy controls, the risk for maternal complications was increased in PCOS women (48% vs. 65%; p = 0.009), while there was no significant difference in neonatal complications (22% and 22%; p = 1.0). However, 25(OH)D levels were similar between mothers and infants with and without perinatal complications. Although the share of women and infants with 25(OH)D deficiency was high in women with PCOS and without PCOS, it seems that the incidence of adverse perinatal outcome was not affected. The long-term consequences for mothers and infants with a 25(OH)D deficiency have to be investigated in future studies.

The association between low birth weight and outcomes of vacuum assisted vaginal delivery

ObjectiveIt is often hypothesized that poor neonatal outcomes are more frequently observed in low birth weight (LBW) neonates following vacuum assisted vaginal delivery (VAVD). We sought to assess the association between low birth weight (< 2500 g) and neonatal outcomes, following vacuum extraction. Study designThis was a retrospective cohort study, including 1085 deliveries in a tertiary medical center between 2003 and 2015. Maternal and neonatal outcomes, including birth trauma related complications, were compared between women with singleton pregnancies beyond 34 weeks' gestation and fetal weight < 2500 g who were delivered by vacuum extraction (n=345) and a control group (n=740) with fetal weight ≥ 2500 g, matched in maternal age, parity and gestational week. ResultsDuring the study period, 370 women met the inclusion criteria for the study group, with 25 cases eventually excluded due to missing neonatal birth trauma related data. 740 patients were included in the matched control group. Induction of labor and non-reassuring fetal heart rate as an indication for VAVD were more prevalent in the LBW group. The composite birth trauma related adverse outcome was higher in the control group (9.1 % vs. 4.4 %, p = 0.008), mainly due to increased rate of cephalohematoma in this group (6.8 % vs. 2.9 %, p = 0.01). All other adverse neonatal outcomes rates did not differ between the groups. Women in the control group were more prone to post-partum hemorrhage (p < 0.001), had more episiotomies (p = 0.004) and a higher failed VAVD rate (11.4 % vs. 2.6 %, p < 0.001), leading to emergency cesarean delivery. A sub-group analysis of failed VAVD did not reveal a difference in neonatal complications between the LBW and the control group. ConclusionNeonatal birth trauma and adverse outcomes following vacuum extraction are no more common in neonates weighing less than 2500 g than those with higher birth weights, even in failed vacuum cases.

SUN-630 Insulin Pumps Versus Multiple Daily Injections in Type 1 Diabetic Pregnancies

Background: Pregnancy is associated with physiological increased resistance to insulin, leading to increased insulin requirements for diabetic women. Poor glycemic control in pregnancy is associated with neonatal and maternal complications. Insulin has been traditionally administered subcutaneously through multi daily injections (MDIs) however, use of insulin pumps or continuous subcutaneous insulin infusion (CSII) has become more widespread. As glycemic control has direct influence on perinatal and maternal outcomes, comparing MDIs and CSII in pregnant women with Type 1 Diabetes Mellitus (DM1) is of interest. Aim: To investigate whether there is a difference in birth weights in infants born from DM1 mothers who use CSII compared to MDIs. Methods and Results: This is a retrospective cohort study of women diagnosed with DM1 on either MDIs or CSII whose pregnancies were followed at our institution. The following data was collected on chart review: age, years since DM1 diagnosis, BMI and weight gain at each trimester, total daily insulin dose at delivery, presence of retinopathy or nephropathy, gestational age at delivery, delivery method, presence of hypertension, pre-eclampsia or eclampsia, birth weight, sex of infant and neonatal complications. Preliminary analysis of our currently available data demonstrates that in age-matched groups of women on MDI (N=44) compared to CSII (N=8), there was no significant difference in infant birth weights (3491g ± 760 vs. 3554g ± 666, respectively). There was also no significant difference in neonatal complications (jaundice, hypoglycemia, shoulder dystocia, macrosomia, respiratory distress or prematurity). Women on CSII had been diagnosed with DMI for a significantly longer period of time (20 vs. 14 years) and were on higher total daily doses of insulin per body weight at time of delivery (p<0.05). Despite this, there was no significant difference in weight gain during pregnancy between the groups. There was also no significant difference in the presence of hypertension, pre-eclampsia, eclampsia or in C-section rates. Discussion: Given the paucity of studies and the increasing use of pump technology among diabetic women, there remains a need for further research comparing the effects of MDIs and pumps on birthweights as well as other neonatal and maternal outcomes.

Prevention of shoulder dystocia: A randomized controlled trial to evaluate an obstetric maneuver

ObjectiveShoulder dystocia is a major obstetric emergency defined as a failure of delivery of the fetal shoulder(s). This study evaluated whether an obstetric maneuver, the push back maneuver performed gently on the fetal head during delivery, could reduce the risk of shoulder dystocia. Study designWe performed a multicenter, randomized, single-blind trial to compare the push back maneuver with usual care in parturient women at term. The primary outcome, shoulder dystocia, was considered to have occurred if, after delivery of the fetal head, any additional obstetric maneuver, beginning with the McRoberts maneuver, other than gentle downward traction and episiotomy was required. ResultsWe randomly assigned 522 women to the push back maneuver group (group P) and 523 women to the standard vaginal delivery group (group S). Finally, 473 women assigned to group P and 472 women assigned to group S delivered vaginally. The rate of shoulder dystocia was significantly lower in group P (1·5%) than in group S (3·8%) (odds ratio [OR] 0·38 [0·16-0·92]; P = 0·03). After adjustment for predefined main risk factors, dystocia remained significantly lower in group P than in group S. There were no significant between-group differences in neonatal complications, including brachial plexus injury, clavicle fracture, hematoma and generalized asphyxia. ConclusionIn this trial in 945 women who delivered vaginally, the push back maneuver significantly decreased the risk of shoulder dystocia, as compared with standard vaginal delivery.

Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy.

ObjectiveEmergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants.Study DesignRetrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38), ultrasound-indicated (UIC, n = 29) and emergency/ physical examination-indicated (PEIC, n = 33) cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max), neonatal complications (ROP, IVH)). Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group.ResultsNeonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max) and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2). Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM) after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM.ConclusionsIn our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver.

Intrapartum management of twin pregnancies: are uncomplicated monochorionic pregnancies more at risk of complications than dichorionic pregnancies?

To analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins. Retrospective analysis over a 13-year period. Department of Obstetrics, University Hospital, Lille, France. In all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%). We compared the monochorionic and the dichorionic populations. Rate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications). The rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p = 0.025) pregnancies. Birthweight was lower in monochorionic twins (2249 ± 469 g vs. 2329 ± 478 g, p = 0.045). The rate of umbilical artery cord blood values with a pH < 7.10 was similar in monochorionic and dichorionic pregnancies. There was no difference in neonatal complications between the two groups. Monochorionic and dichorionic twin pregnancies had similar delivery outcomes. The neonatal outcome for twin 2 was not different between monochorionic and dichorionic pregnancies. Vaginal birth could be offered to women with twin pregnancies regardless of chorionicity.

The safety of a trial of labor after cesarean section in a grandmultiparous population

The rate of vaginal birth after a cesarean (VBAC) delivery in the multiparous population has decreased largely in recent years because of maternal and neonatal complications. The clinical management of grand multiparous (GMP) women (>5 births) with a prior cesarean delivery is even less clear. The purpose of the present study was to assess the risks of maternal and neonatal complications associated with VBAC compared to that of repeated elective cesarean section (CS) in the GMP population. A retrospective study of 1,102 GMP women with a singleton gestation and a prior single CS was conducted. Data were retrieved from the database of the Department of Obstetrics and Gynecology at the Soroka University Medical Center, Beer Sheva, Israel. Maternal and neonatal outcomes were compared between women who underwent a successful VBAC attempt, women who had failed in a trial of labor and women who had an elective repeated CS. Six hundred and nineteen women (56%) underwent a successful VBAC, 155 (14%) underwent a trail of labor and 328 (30%) had an elective repeated CS. Women who had a successful VBAC required less blood transfusion, and had less puerperal fever diseases (P < 0.001). Induction or augmentation of labor was associated with failure of VBAC (P < 0.001). No significant differences in neonatal complications were observed between the groups. No significant difference in uterine dehiscence, uterine rupture, amnionitis, postpartum hemorrhage, hysterectomy, puerperal fever and thromboembolic diseases was observed between the groups. A successful VBAC in the GMP population was not associated with a higher risk of maternal complications in comparison with a repeated elective CS.

Valacyclovir Prophylaxis to Prevent Recurrent Herpes at Delivery

To measure the efficacy of valacyclovir suppression in late pregnancy to reduce the incidence of recurrent genital herpes in labor and subsequent cesarean delivery. A total of 350 pregnant women with a history of genital herpes were assigned randomly to oral valacyclovir 500 mg twice a day or an identical placebo from 36 weeks of gestation until delivery. In labor, vulvovaginal herpes simplex virus (HSV) culture and polymerase chain reaction (PCR) specimens were collected. Vaginal delivery was permitted if no clinical recurrence or prodromal symptoms were present. Neonatal HSV cultures and laboratory tests were obtained, and infants were followed up for 1 month after delivery. Data were analyzed using chi2 and Student t tests. One hundred seventy women treated with valacyclovir and 168 women treated with placebo were evaluated. Eighty-two percent of the women had recurrent genital herpes; 12% had first episode, nonprimary genital herpes; and 6% had first episode, primary genital herpes. At delivery, 28 women (8%) had recurrent genital herpes requiring cesarean delivery: 4% in the valacyclovir group and 13% in the placebo group (P = .009). Herpes simplex virus was detected by culture in 2% of the valacyclovir group and 9% [corrected] of the placebo group (P =.02). No infants were diagnosed with neonatal HSV, and there were no significant differences in neonatal complications. There were no significant differences in maternal or obstetric complications in either group. Valacyclovir suppression after 36 weeks of gestation significantly reduces HSV shedding and recurrent genital herpes requiring cesarean delivery. I.

The unwanted child

The determinants and outcomes of unwanted pregnancies were explored in a prospective study of 1454 women who delivered in Moscow, Russia, during 1984-85. Mothers were interviewed during their postpartum hospital stay and again 3 years later. 131 women (9%) demonstrated a negative attitude toward their pregnancy. Another 72 women (5%) had a negative attitude initially, but developed positive feelings over the course of the pregnancy. The percentage of unwanted pregnancies was 2.9 times greater among unmarried women (14.9%) than married women (5.1%). Poor marital relationships, inadequate living conditions, tobacco/alcohol use, and low per capita income were found significantly more often among women with unwanted pregnancies. Significantly more infants of mothers with unwanted than wanted pregnancies had infants who were premature (28.3% vs. 9.5%) and low birth weight, but there was no significant difference in neonatal complications. Mothers of unwanted infants also were more likely to delay prenatal care and attend infrequently and, once the child was born, made fewer visits to the pediatrician. Even if unwanted pregnancy has no adverse medical sequelae, being unwanted should be considered a psychosocial risk factor with implications for a child's development.

Hematologic Findings in Mothers and Infants of Patients with Seveke Pre-Eclampsia/Eclampsia

The clinical and hematologic findings in 42 prematurely(< 37 weeks' gestation) delivered patients with severe preeclampsia/ eclampsia were compared to those of a well-matched control group of normotensive patients. Hematocrit, platelet count, white blood count and clinical coagulopathy were evaluated for both mother and infant. The preeclamptic mothers had a significantly higher hematocrit than the control mothers (p < 0.01). There was a moderate correlation (r=0.40) between maternal and neonatal platelet count, but no correlation (r=0.03) between maternal and neonatal thrombo-cytopenia. On comparison of the two infant groups, there was no significant differences in neonatal complications or hematologic findings. Within both groups, abnormal hematologic findings were usually associated with intracranial hemorrhage, perinatal asphysia, sepsis or acidosis.