Differences In Perinatal Outcomes Research Articles

Perinatal Outcomes of Using Ursodeoxycholic Acid to Treat Monochorionic and Dichorionic Twin Pregnancy Complicated by Intrahepatic Cholestasis of Pregnancy

To study the effect of using ursodeoxycholic acid (UDCA) to treat monochorionic and dichorionic twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP) and to examine the differences in perinatal outcomes. A total of 406 twin-carrying pregnant women who had ICP and received care at West China Second Hospital, Sichuan University between January 1, 2015 and November 1, 2018 were included in the study. The clinical data of monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twins with ICP were analyzed. Analysis was done to compare the treatment effect for lowering serum total bile acid (TBA) and the perinatal outcomes with simple UDCA medication or combination medication. There were no statistically significant differences in TBA levels, early-onset ICP, simple UDCA medication or combination medication, neonatal Apgar score, birth weight, length of hospital stay, C-section rate, and perinatal mortality between the MCDA and the DCDA twin groups with ICP. However, maternal age, BMI, scarred uterus, in vitro fertilization-embryo transfer, preeclampsia, twin comorbidity rate of the two groups showed statistical differences. Further comparison between twin pregnancies with mildly-elevated TBA and those with severely-elevated TBA showed significant difference in preterm birth rate ( P<0.05). Simple UDCA medication or combination medication may have the same therapeutic effect on MCDA and DCDA twin pregnancies with ICP. Monochorionic twin pregnancy, twin comorbidities and pregnancy complications were still important factors affecting pregnancy outcomes of twin pregnancies with ICP. Twin pregnancies with slightly elevated TBA have been managed as severe ICP, which may be associated with increased iatrogenic preterm births.

Comparison of Obstetric Outcomes Between IVF cycles with Donor Oocyte and Spontaneous Conception Pregnancies: A Retrospective Cohort study.

Background:Oocyte donation has facilitated couples to achieve pregnancy in conditions like diminished ovarian reserve, premature ovarian failure, and inheritable disorders. However, it is unclear whether pregnancy complications are due to oocyte donation per se or due to confounding factors such as maternal age or the allogenic fetus. In this retrospective comparative cohort, an attempt was made to evaluate and compare multiple obstetric and perinatal outcomes.Methods:The present study comprised all women in the age range of 20–45 years who conceived from oocyte donation (n=102) between 1/12/2011 to 30/09/2017. Control group consisted of spontaneous conception cases (n=306) in ratio of 1:3 with no previous medical or surgery comorbidity. Obstetric and perinatal outcomes were compared between two groups.Results:Mean maternal age was significantly higher in the donor oocyte IVF group (group 1; 35.13 years) as compared to spontaneous conception group (group 2; 31.75 years). Parity between the two groups was comparable. Pregnancy induced hypertension (PIH) was seen in 33.33% of cases in group 1 as compared to 7.18% in group 2. Moreover, gestational diabetes mellitus was seen in 34.31% of cases in group 1 as compared to 9.47% in group 2 (p=0.001). By the same token, there was significant difference in perinatal outcomes between the two groups.Conclusion:Oocyte donation should be treated as an independent risk factor for miscarriage, hypertensive disorder, and gestational diabetes mellitus in pregnancy.

Differences in perinatal outcomes according to age among underserved patients with sexually transmitted infection

Sexually active young adults (12-24 years) are at higher risk of acquiring sexually transmitted infections (STI) than those over 25 years old, particularly among underserved populations. The objective was to determine if younger age was associated with increased perinatal morbidity in a cohort of underserved patients diagnosed with STI during pregnancy.

Perinatal outcomes by race and ethnicity among individuals with Medicaid Insurance

Previous literature shows that women of color have adverse birth outcomes as compared to white women. It has been hypothesized that these outcomes result from socioeconomic differences. We sought to explore differences in perinatal outcomes by race/ethnicity among individuals with Medicaid insurance as such individuals are likely to have similar economic circumstances.

Differences in perinatal outcomes in teenage mothers with their first and third pregnancies and predictors of adverse neonatal events: A cross-sectional study

BackgroundRepeated teenage pregnancy is a major burden on the healthcare system worldwide.ObjectiveWe aimed to compare teenagers with their first and third pregnancies and to evaluate the likelihood of neonatal complications.Materials and MethodsThis cross-sectional study was performed on female teenagers (aged 19 yr) with singleton pregnancies. The subjects (n = 298) were screened over 12 months. Ninety-six women were excluded, based on the exclusion criteria. The remaining subjects (n = 202) were divided into two groups: teenagers with first pregnancy (n = 96) and teenagers with third pregnancy (n = 47). The subjects were observed throughout pregnancy and delivery. The final sample size of the first and third pregnancy groups was 96 and 47, respectively.ResultsThere was a significant risk of preeclampsia in the first pregnancy group (p = 0.01). Low birth weight, five-min Apgar score 7, and neonatal intensive care unit admission were the most significant neonatal outcomes in the first pregnancy group. In the third pregnancy group, significant predictors of neonatal complications included very young age in the first pregnancy ( 15 yr), an inter-pregnancy interval 2 yr, current anemia, and history of obstetric and/or neonatal complications in previous pregnancies.ConclusionBased on the results, teenagers with their first pregnancy had comparable obstetric outcomes (except for preeclampsia) as teenagers with their third pregnancy, whereas neonatal complications occurred more frequently in the first pregnancy group. Overall, we can predict high-risk neonates in the third pregnancy, based on the abovementioned parameters.

Hypoglycemia during the oral glucose tolerance test in pregnancy-maternal characteristics and neonatal outcomes.

To evaluate maternal and neonatal outcomes in pregnancies complicated by hypoglycemia on 100-g oral glucose tolerance test (OGTT). A retrospective cohort analysis of all live-born deliveries in a single medical center during 2018 and 2019 with available OGTT results and birth outcomes. Preterm deliveries (<34weeks), multiple pregnancies and major anomalies were excluded. Hypoglycemia during OGTT was defined as at least one glucose value below 60mg/dl. Maternal characteristics and perinatal outcomes were compared between three groups: Hypoglycemia on OGTT, Normal OGTT and Abnormal OGTT. Univariate followed by multivariate analyses were used to control for confounders. Overall, 2079 women were entered into the analysis. Of these, 216 (10.4%) had at least one hypoglycemic value, 1072 (51.6%) had normal OGTTs and 791 (38%) abnormal OGTTs. Hypoglycemia in OGTT was more prevalent in multiparous women and was associated with fetal male gender. Absolute birth weight, low birth weight and small for gestational age differed between groups; however, there was no difference between groups in overall birth weight centiles (60.1±26.8 versus 63±26 versus 60.9±27; P>0.05). Following adjustment of confounders, hypoglycemia was not associated with rates of low birth weight or small for gestational age (P<0.05). There were no other differences in perinatal outcomes between groups. Hypoglycemia in OGTT is not associated with maternal or neonatal adverse outcomes.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Timing is everything: snoring onset and blood pressure trajectories in pregnancy.

Adverse Perinatal Outcomes Among Grand Multiparous and Low Multiparous Women and Its Associated Factors in North Shewa Zone Public Hospitals: The Role of Parity.

BackgroundAdverse perinatal outcomes are the major cause of neonatal morbidity, mortality, and long-term physical and psychological consequences. Contradicting evidence across studies was reported about the impact of grand multiparity on adverse perinatal outcomes. Older literature reported increased incidence of perinatal complications in grand multiparas, but, recent reports failed to support this finding. In addition, there is a paucity of comparative studies on perinatal outcomes. Thus, the study aimed to compare the perinatal outcomes in grand multiparous (GM) and low multiparous (LM) women who give birth in North Shewa Zone Public Hospitals, Ethiopia, 2021.MethodsA comparative cross-sectional study was done among 540 (180 GM and 360 LM) women from January 1 to March 30, 2021. The data were collected using a structured and pre-tested questionnaire through interviews and reviewing patient charts. SPSS version 25 was used for data analysis. The data were entered using Epi-Data version 4.6. The Hosmer–Lemeshow goodness-of-fit was applied to test for model fitness. The statistical significance level was declared at a p-value of ≤0.05.ResultsIn this study, the prevalence of adverse perinatal outcomes was 14.1% (95% CI: 10.9–17.2). Stillbirth/IUFD (33.3%) and low APGAR score (60%) were frequently occurred complications in grand multiparas. Nevertheless, meconium aspiration (26%), admission to NICU (65.2%), macrosomia (61%), and prematurity (52.2%) were higher in low multiparous women. Age above 35 years (AOR (CI) = 2.61 (1.23–5.53)), rural residence (AOR (CI) = 8.31 (3.05–22.6)), being a government employee (AOR (CI) = 0.19 (0.05–0.69)), lack of antenatal care (AOR (CI) = 9.76 (3.03–31.5)), and previous pregnancy complications (AOR (CI) = 3.10 (1.63–5.90)) were significant predictors of adverse perinatal outcomes. However, parity did not show a statistically significant association with perinatal outcomes.ConclusionMaternal age, residence, occupation, lack of antenatal care, and previous pregnancy complications were significant associates of perinatal outcome. There was no statistically significant difference in perinatal outcome between GM and LM women. Socio-economic development, good antenatal care, and early identification and treatment of complications are needed regardless of parity.

Blastocyst quality and perinatal outcomes in women undergoing single blastocyst transfer in frozen cycles

STUDY QUESTIONIs the morphological grading system for blastocysts associated with perinatal outcomes in women undergoing frozen–thawed single blastocyst transfer (SBT)?SUMMARY ANSWERPreferential transfer of a blastocyst based on their inner cell mass (ICM) and trophectoderm (TE) grading appears to be supported by observed differences in perinatal outcomes.WHAT IS KNOWN ALREADYThe transfer of a morphologically good quality blastocyst is associated with a higher chance of implantation and pregnancy as compared to transfer of a poor quality blastocyst. However, to date, the association of the morphological parameters of the blastocyst with perinatal outcomes after blastocyst transfer remains unknown.STUDY DESIGN, SIZE, DURATIONThis retrospective cohort study started with 27 336 frozen–thawed SBT cycles from January 2013 to December 2019.PARTICIPANTS/MATERIALS, SETTING, METHODSThere were 7469 women with singleton deliveries in Peking University Third Hospital eligible for analysis. Multivariate logistic regression was used to test the risk of factors with the expression of crude odds ratios (ORs) and adjusted OR with 95% CIs.MAIN RESULTS AND THE ROLE OF CHANCETransfer of a blastocyst with a low overall grading was associated with a higher chance of female baby (48% vs 42%, adjusted OR = 1.26 (1.13, 1.39)) and a higher rate of caesarian section (C-section; 71% vs 68%, adjusted OR = 1.15 (1.02, 1.29)). Compared with Grade A ICM blastocyst transfer, Grade B ICM and Grade C ICM blastocyst transfers were associated with a lower chance of a female baby (adjusted OR = 0.83 (0.73, 0.95), 0.63 (0.50, 0.79), respectively) and a higher risk of large for gestational age (LGA; adjusted OR = 1.23 (1.05, 1.45), 1.47 (1.12, 1.92), respectively); Grade C ICM blastocyst transfer was also associated with an increased risk of macrosomia (adjusted OR = 1.66 (1.20, 2.30)). Compared with Grade A TE blastocyst transfer, there was an increased risk of small for gestational age with Grade C TE blastocyst transfer (adjusted OR = 1.74 (1.05, 2.88)). Both Grade B TE and Grade C TE blastocyst transfer had a higher chance of female baby (adjusted OR = 1.30 (1.11, 1.53), 1.88 (1.57, 2.26), respectively) and a lower risk of gestational diabetes mellitus (adjusted OR = 0.74 (0.59, 0.94), 0.67 (0.50, 0.88), respectively) than Grade A TE blastocyst transfer.LIMITATIONS, REASONS FOR CAUTIONThe main limitations of this study were its retrospective nature and the relative subjectivity of blastocyst scoring. The follow-up was conducted through a phone call and some patients may not have reported their obstetrical and neonatal outcomes, leading to a relatively lower rate of several obstetrical outcomes. Due to the missing information in our dataset, we were not able to separate out iatrogenic preterm birth nor adjust for obstetric complications in previous pregnancies as a confounder in the mutivariate analysis. Because the days of blastocyst culture in total were unclear in our dataset, analysis of the association between the time to reach blastocyst expansion and perinatal outcomes was not performed.WIDER IMPLICATIONS OF THE FINDINGSTransfer of a blastocyst with a low overall grading is associated with a higher rate of C-section and a higher chance of a female baby. The association between ICM grading and LGA would suggest that Grade A ICM blastocysts should be transferred preferentially to Grade B/C ICM blastocysts. Our results support the use of current morphological systems for embryo prioritization.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the National Key Research and Development Program of China (2018YFC1004100 to R.L.), the National Science Fund for Distinguished Young Scholars (81925013 to R.L.) and a Zhejiang University Scholarship for Outstanding Doctoral Candidates (to K.-L.H.). All authors have read the journal’s authorship agreement and policy on disclosure of potential conflicts of interest, and have no conflicts of interest to declare.TRIAL REGISTRATION NUMBERN/A.

Perinatal outcomes of pregnant women having SARS-CoV-2 infection

ObjectivesAim of this study is to evaluate the prognosis of pregnant women having SARS-CoV-2 infection and investigate whether there was a difference in perinatal outcomes between pregnant women who had SARS-CoV-2 infection and those who did not. Materials and methodsThis prospective observational study was conducted with 116 singleton pregnancies. Cases enrolling in the study were divided into two groups. While those in the first group had a history of SARS-CoV-2 infection (n = 46) the second group consisted of healthy pregnant women (n = 70). ResultsEmergency Cesarean section was performed on three SARS-CoV-2 infected pregnancies (30, 33 and 34 gestational weeks). Intensive care unit admission was required for all three cases after delivery and two of them died. Among the pregnancies that had an infection in the third trimester, 71.4% (n = 20) of them had delivery in 14 days after diagnosis and 17.4% (n = 8) of their newborns were followed up at newborn intensive care unit. Overall, only one newborn had a positive swab test result for SARS-CoV-2. There was no statistically significant difference between groups regarding their delivery week (37.02 ± 5.85 vs 38.5 ± 2.33). Similarly, there was no significant difference between groups, concerning mean age, parity, and birth weight (P = 0.707, P = 0.092, P = 0.334; P < 0.05). Furthermore, the difference between SARS-CoV-2 infected pregnancies that were followed up as inpatient or outpatient with respect to the delivery week and birth weight was not significant (p > 0.05). Also, APGAR 5 scores of hospitalized women (9.3 ± 1.1) were found to be lower than the outpatient group (9.8 ± 0.8) (P = 0.043; p < 0.05). ConclusionNo significant difference was detected between groups in terms of the delivery week, birth weight, and APGAR scores. The inpatient group was found to have lower APGAR 5 scores.

P–772 Blastocyst quality and perinatal outcomes in women undergoing single blastocyst transfer in frozen cycles

Abstract Study question Is the morphological grading systems of a blastocyst associated with perinatal outcomes in women undergoing frozen-thawed single blastocyst transfer (SBT)? Summary answer Preferential transfer of a blastocyst based on their morphological grading systems appears to be supported by observed differences in perinatal outcomes. What is known already The transfer of a morphologically good quality blastocyst is associated with higher implantation and pregnancy rates as compared with a poor quality blastocyst. However to date, the association of the morphologic parameters of the blastocyst (developmental stage, inner cell mass (ICM), and trophectoderm (TE)) with the perinatal outcomes after blastocyst transfer remains unknown. Study design, size, duration A retrospective cohort study including 21,648 frozen-thawed SBT cycles from January 2013 to March 2019. Participants/materials, setting, methods 6037 women with singleton delivery in Peking University Third Hospital were eligible for analysis. Multivariate logistic regression was used to test the risk of factors with the expression of crude odds ratios (OR) and adjusted OR (aOR) with 95% confidence intervals (CI). Main results and the role of chance Transfer of a blastocyst with grading lower than 3BB was associated with a higher chance of female baby (49% vs 43%, aOR = 1.27 (1.12, 1.43)) and a higher rate of cesarian section (C-section) (69% vs 65%, aOR = 1.17 (1.03, 1.34)). Compared with stage 4 blastocyst, transfer of a stage 3 blastocyst was associated with a higher chance of preterm delivery (PTD) (aOR = 1.77 (1.08, 2.90)). Both stage 3 and stage 6 blastocyst transfer was associated with a lower chance of female baby (aOR = 0.68 (0.48, 0.97), 0.66 (0.47, 0.93), respectively). Compared with grade A ICM blastocyst transfer, Grade B ICM and grade C ICM blastocyst transfer was associated with a lower chance of a female baby (adjusted OR = 0.84 (0.73, 0.96), 0.63 (0.48, 0.83), respectively) and a higher risk of large for gestational age (LGA) (aOR = 1.20 (1.01, 1.42), 1.46 (1.07, 1.98), respectively). Grade C ICM blastocyst transfer was associated with an increased risk of macrosomia (aOR = 1.66 (1.14, 2.42)).Grade B TE and grade C TE blastocyst transfer had a lower risk of gestational diabetes mellitus (GDM) (aOR = 0.76 (0.60, 0.98), 0.69 (0.50, 0.94), respectively) than grade A TE blastocyst transfer. Limitations, reasons for caution The main limitations of this study were its retrospective nature and the relative subjectivity of blastocyst scoring. The follow-up was conducted through a phone call and some patients might not report their obstetrical and neonatal outcomes, leading to a relatively lower rate of several obstetrical outcomes. Wider implications of the findings: Transfer of a poor quality blastocyst is associated with a higher rate of C-section. The association between ICM grading and LGA and macrosomia would suggest that blastocysts with grade A ICM grading should be transferred preferentially and supports the use of current morphological grading systems for embryo prioritisation. Trial registration number N/A

Decision to delivery interval in emergency cesarean section and its association with perinatal outcome

Background: Decision to delivery [DDI] interval is the time interval between decision for caesarean section [CS] and delivery of baby. The ideal DDI for emergency CS is not known; there is controversy over the best DDI to avoid preventable perinatal morbidity and mortality.&#x0D; Aims and Objectives: This study was conducted to find out the DDI we could achieve for Category-1 and Category-2 CS and evaluate our findings against the recommendations by National Institute for Clinical Excellence [NICE]. We also studied the association of DDI with perinatal outcome and explored the reasons for prolongation of DDI.&#x0D; Materials and Methods: This was a prospective study conducted over a period of 6 months. All women who underwent CS and meeting the inclusion criteria were recruited for the study. DDI was calculated as the time interval between decision making and delivery of baby, in minutes [min]. Data was collected for maternal socio-demographic variables, CS indication and complications and perinatal outcome. Analysis was done using SPSS version 21.0.&#x0D; Results: Ninety out of one hundred eighty-one CS was evaluated. Cases were grouped as Group I [including cases where we could achieve the recommended DDI] and Group II [including cases where we could not achieve the recommended DDI]. The average DDI was 55.04 min for category- 1 and 55.13 for category-2 CS. For Category-1 CS, all the cases qualified for entry into Group II because we could not achieve a DDI of 30 min. For Category-2 CS there were 22 cases in Group I and 14 cases in Group II. There was no difference in perinatal outcome between the groups.&#x0D; Conclusion: It was not feasible to achieve the 30 min DDI for Category-1 CS in the present study. The DDI of 30-75 min for Category-2 could be achieved in 61.11% cases. The most common reason for failure to achieve the recommended DDI was related to issues with anaesthesia in the pre-operative room as well as inside the theatre in the pre-induction phase. Delay in category-2 CS was not associated with poor perinatal outcome.

The differences in perinatal outcomes between refugee and resident mother–infant dyads: A retrospective study in Turkey between 2013 and 2018

In this study, we aimed to examine and compare the perinatal outcomes between refugee and resident mother–infant dyads. Data of refugee women who had given birth in a university hospital (n = 924) and matched resident mother–infant dyads (n = 957) were included. Analysis revealed higher adolescent pregnancy rates and lower rates of antenatal care attendance among refugee mothers compared to residents. No significant differences in neonatal outcomes were found, except for a significantly higher number of preterm births among refugee infants. Interventions should be made to ensure antenatal care for all pregnant women, which can also prevent preterm birth.

Differences in Perinatal Outcomes of Birthing People in Same-Sex and Different-Sex Marriages.

It is unknown whether people in same-sex relationships who give birth have different perinatal outcomes than people in different-sex relationships, despite differences in risk factors such as use of assisted reproductive technologies, obesity, smoking, and poor mental health. Marriage equality has established birth certificates as a promising new source of population-based data on births to same-sex married parents. We used birth certificate data from Massachusetts for 201,873 singletons born to married parents from 2012 to 2016. We estimated the associations of several birth outcomes with having a birth parent in a same-sex marriage using propensity score-matched and -unmatched samples. We also tested whether these associations were modified by the use of assisted reproductive technologies. People in same-sex marriages who gave birth had perinatal outcomes related to decreased fetal growth and preterm birth that were similar to those of their peers in different-sex marriages. Use of assisted reproductive technology was associated with decreased fetal growth and increased risk of preterm birth for infants with different-sex parents but not for infants with same-sex parents. More research is needed across other states and to understand why use of assisted reproductive technology is not a risk factor for poor birth outcomes for those in same-sex marriages.

A cohort study of the perinatal outcome of radiofrequency ablation in complicated monochorionic multiple pregnancies based on a different needle insert angle.

ObjectiveTo compare the pregnancy outcomes of radiofrequency ablation (RFA) for complicated multiple pregnancies between fetal abdominal and dorsal needle insertion angles.MethodsWe performed a historical cohort study of patients who underwent selective reduction using RFA through different needle insertion angles from 2015 to 2018 at a local hospital. Dorsal needle insertion cases were consecutively selected and abdominal needle insertion cases were selectively enrolled. The Cox proportional hazards model was constructed to identify predictors of fetal survival time with different needle insertion angles.ResultsThe RFA procedure was performed in 28 women through an abdominal insertion angle and in 28 women through a dorsal insertion angle. There were no significant differences in perinatal outcomes between the two groups. The overall live birth rate after RFA in the two groups was 73.5% and the mean gestation was 31.6 ± 6.5 weeks. The Cox model showed that gestational age at RFA was a predictor of the duration of the period between RFA and delivery.ConclusionRFA conducted through the dorsal insertion angle is technically feasible for selective reduction in complex monochorionic multiple pregnancies. Gestational age at this procedure is an independent risk factor for the duration of pregnancy post-RFA.

The impact of previous cesarean section on the outcome of patients with non-adherent placenta previa

ObjectiveTo evaluate the impact of previous lower segment cesarean section on maternal and fetal outcomes of patients with non-adherent placenta previaMethodsThis is a retrospective study of all patients who delivered at a tertiary referral university hospital by lower uterine cesarean section with non-adherent placenta previa, over a 10-year period. Data were obtained through hospital registry and medical records. The differences in demographic, obstetric characteristics, peripartum complications, and fetal outcome between patients with no previous cesarean and those with previous cesarean section were analyzed.ResultsNinety patients with non-adherent placenta previa were included, 54 patients with no previous cesarean and 36 patients with previous cesarean section. Patients with previous cesarean section were significantly more likely to incur inadvertent organ injury, transfusion of 4 or more units of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy.ConclusionThere is a significant increase in the incidence of inadvertent neighboring viscus injury, transfusion of 4 units or more of packed red blood cells, transfusion of fresh frozen plasma, uterine brace compressive sutures, uterine artery ligation, and peripartum hysterectomy in patients with non-adherent placenta previa and previous cesarean section, compared to those with non-adherent placenta previa and no previous history of cesarean section, with no difference in perinatal outcome.

Obstetric outcomes in pregnancies resulting from in vitro fertilization are not different in fertile, sterilized women compared to infertile women: A Society for Assisted Reproductive Technology database analysis

To compare obstetric and neonatal outcomes resulting from assisted reproductive technology in couples with a history of female sterilization to couples with other infertility diagnoses. Retrospective cohort study. Not applicable. Fresh, nondonor cycles excluding gestational surrogacy from 2004 to 2013 in the United States. None. Preterm birth rates and low birth weight rates from invitro fertilization (IVF) pregnancies in couples with infertility and in couples with prior tubal ligation as their sole indication for IVF. The mean ages of fertile women (N = 8,478) and infertile women (N = 371,488) were 35.3 and 34.6 years, respectively. Of the singletons born to parous women (N = 26,463), the incidence of preterm birth was not significantly different in fertile, sterilized couples compared to infertile couples (13.7% vs. 12.0%). The incidence of low birth weight among term singletons was also not significantly different between fertile couples compared to infertile couples (3.5% vs. 3.2%). Fertile couples have similar preterm birth and low birth weight rates after IVF compared to infertile couples. This suggests that differences in perinatal outcomes may be due to assisted reproductive technology procedures rather than infertility itself.

Assessment of perinatal outcomes of pregnant women with severe versus simple malaria.

ObjectiveMalaria in pregnancy is associated with adverse perinatal outcomes. The objective was to compare outcomes of simple and severe malaria and to determine whether they vary by trimester or severity of infection.MethodsProspective cohort study performed in 3 hospitals in Rwanda. Both hospitalized and non-hospitalized pregnant patients with confirmed malaria were enrolled and followed until 7 days postpartum. Demographic, clinical manifestations and perinatal outcomes were recorded.ResultsThere were 446 pregnant women with confirmed malaria and outcome data; 361 (80.9%) had simple malaria. Severe malaria was more common as pregnancy progressed; out of 85 with severe malaria, 12.9%, 29.4% and 57.6% were in the 1st, 2nd and 3rd trimesters (p<0.0001). Overall, a normal term delivery occurred in 57.6%, with preterm delivery in 24.9% and abortion in 13.5%. Adverse perinatal outcomes increased with trimester of infection (p<0.0001). Eight of the 9 early neonatal deaths had 3rd trimester infection (p<0.0001). There were 27 stillbirths; 63.7% were associated with 3rd trimester infection. A significant difference in perinatal outcomes between simple and severe malaria was seen: 64% of women with simple malaria had a normal term delivery as compared to 30.6% with severe malaria (p<0.0001). All complications were significantly greater with severe malaria.ConclusionOverall poor outcomes are seen in malaria with significant differences in perinatal outcomes between simple and severe malaria and by trimester of infection. In addition to vector control and exposure prevention, efforts need to be made in screening, treatment education and monitoring pregnancies affected by malaria.

Maternal and Perinatal Outcome of Maternal Obesity at RSCM in 2014-2019.

Obesity is a pandemic found in many countries. It is estimated that, in 2025, more than 21% of women in the world will suffer from obesity and its number keeps increasing yearly. Obesity in pregnancy is one of the important challenges in obstetric services given the prevalence and potential adverse effects on the mother and fetus. Obese women have a higher risk of developing gestational diabetes, gestational hypertension, preeclampsia, venous thromboembolism, postpartum hemorrhage, cesarean delivery, and maternal death. The aim of this research is to determine the prevalence of maternal and perinatal complication in various obesity grades. This research was an observational descriptive study using the cross-sectional design. The inclusion criterion is obese pregnant women whose delivery was done in Dr. Cipto Mangunkusumo National General Hospital (RSCM) from 2014 to 2019. The exclusion criterion in this study is the incomplete medical record. A total of 111 subjects were included in the study. Obesity grades in this study were based on World Health Organization (WHO) obesity, divided into 3 classifications which are obese I (30–34.9 kg/m2), obese II (35–39.9 kg/m2), and obese III (≥40 kg/m2). Maternal outcomes in this study were birth method, gestational diabetes, preeclampsia, and premature rupture of membrane (PROM). Perinatal outcomes in this study were preterm birth, birth weight, APGAR score, and postdelivery neonatal care. In this study, obese patients had a mean age of 31.23 years, mean gravida 2, parity 1, and abortion 0. Most of these patients used an intrauterine device (IUD) for family planning (74.8%). There were no differences in age, parity status, and family planning methods in each group of patients with different body mass index (p > 0.05). Maternal characteristics are the majority of deliveries performed cesarean delivery (86.5%), cases of diabetes mellitus are more common in obese I patients (50%), preeclampsia is more prevalent in obese grade II patients (34,4%), and premature rupture of membranes (PROM) is more common in patients with obese II (52,4%). However, there was no difference in the prevalence of maternal outcomes between groups. There was a median gestational age of 37 weeks in all obesity grades, the highest percentage of preterm births owned by obese II patients (32,6%), the mean birth weight of babies tends to increase along with the weighting of the body mass index group, and neonatal intensive care unit (NICU) treatment rooms were mostly occupied from mother with obese II groups (18%). There was no difference in the first-minute and fifth-minute APGAR scores between study groups (p > 0.05). There were no differences in perinatal outcomes between groups. There were no significant differences in maternal and perinatal outcomes prevalence between different obesity grades. However, the rate of maternal and perinatal complications in obese women is higher than the normal population, thus requiring sophisticated prevention and approach toward handling the pregnancy.

Impact of therapeutic rest in early labor on perinatal outcomes: a prospective study

Pain and exhaustion in early labor are important to address, yet treatment options are limited. Therapeutic rest has existed for decades, although medication regimens and management strategies vary. In addition, there are little prospective data on perinatal outcomes and patient satisfaction to support and guide its use as an outpatient pain control option. This study aimed to evaluate whether outpatient therapeutic rest in early labor using intramuscular morphine sulfate and promethazine is associated with differences in perinatal outcomes and to assess patient satisfaction with this therapy. This prospective cohort study was conducted at a tertiary care academic medical center from September 2017 to April 2020. Participants presenting to the hospital for labor evaluation were offered therapeutic rest if they met the following criteria: reassuring modified biophysical profile, cervical dilation of ≤5 cm without contraindications to vaginal delivery, and plan to discharge home after evaluation. The primary outcome was subsequent hospital admission in active labor, defined as cervical dilation of ≥6 cm. Secondary outcomes included hospitalization duration and perinatal outcomes. The outcomes between participants who accepted therapeutic rest and those who declined it were compared. All P values were calculated using the Fisher exact test, and multivariable regression was used to adjust for potential confounding baseline variables with P<.2. In addition, a prespecified sensitivity analysis was performed, limiting subjects to nulliparous participants. Furthermore, postpartum surveys were administered to a subset of women who received therapeutic rest. Of the 82 individuals offered therapeutic rest and consented for the study, 66 (80%) accepted and 16 (20%) declined. Although the rate of active labor at admission to the labor and delivery unit in the treatment group was markedly higher (26% [17 of 66] vs 13% [2 of 16]), this difference was not statistically significant (P=.3) (adjusted relative risk, 1.87; 95% confidence interval, 0.44-7.89). Women who received therapeutic rest were less likely to require induction of labor compared with those who declined therapeutic rest (adjusted relative risk, 0.15; 95% confidence interval, 0.041-0.54). There was no difference between the groups in mode of delivery, epidural use, length of hospitalization, maternal complications, or adverse neonatal outcomes. These findings persisted in our prespecified sensitivity analysis, limiting the study to nulliparous participants. A subset (27 of 66 [40%]) of women were surveyed after receiving therapeutic rest, and all women (n=27) who were surveyed reported satisfaction. There was no detectable difference in the primary outcome of active labor at admission between patients who accepted outpatient therapeutic rest and those who declined it. However, fewer participants in the treatment group eventually required induction of labor, and this group did not experience an increase in adverse perinatal outcomes. Among the participants surveyed, a high rate of treatment satisfaction was reported. This study suggested that therapeutic rest is a well-tolerated and effective option for outpatient pain control in early labor.