Early Delivery Group Research Articles

Timing of elective termination of Pregnancy in Preterm Premature Rupture of membranes, prospective randomized controlled trial.

Background: Rupture of membranes is associated with high incidence of maternal and fetal morbidities as well as the neonatal morbidity and mortality resulting from prematurity if preterm birth ensues.Aim: This study aimed to evaluate maternal and neonatal outcomes of elective delivery at 34 versus 36 weeks of gestations in pregnancies complicated by preterm premature rupture of membranes and had been managed expectantly.Materials and Methods: This is a prospective randomized controlled trial which was conducted at Ain Shams University Maternity hospital between March and August 2019. 140 women pregnant between 30 and 32 weeks and diagnosed with preterm premature rupture of membranes were admitted to receive conservative management and then they were randomly divided into 2 equal groups regarding time of elective delivery either late delivery at 36 weeks or early delivery at 34 weeks.Results: The incidence of intrauterine infections was comparable between both groups. The rate of chorioamnionits was 8.6% in the late delivery group versus 4.3% in the early delivery group while endometritis was diagnosed in 2.9% in the late delivery group and 1.4% in the early delivery group. The incidence of spontaneous onset of preterm labor, cord prolapse and placental abruption was similar in both groups. Neonates of the late delivery group had significantly more Apgar score at 5 minutes (6.4±1.0 versus 5.0±0.9, p 0.05).Conclusion: Early delivery at 34 weeks does not reduce the rate of chorioamnionitis, but does increase the likelihood of respiratory distress syndrome and the rate of neonatal intensive care unit admissions. Our findings support the practice of conservative management in pregnant women with ruptured membranes if there is no contraindication to extending the pregnancy.

Hydroxychloroquine treatment in COVID-19: A descriptive observational analysis of 30 cases from a single center in Wuhan, China.

Hydroxychloroquine (HCQ) garnered scientific attention in early February following publication of reports showing in vitro activity of chloroquine (CQ) against coronavirus disease 2019 (COVID‐19). While studies are mixed on this topic, the therapeutic effect of HCQ or CQ still need more valid clinical evidence. In this descriptive observational study, we aimed to discuss the treatment response of HCQ in COVID‐19 infected patients and 30 cases were included. The demographic, treatment, laboratory parameters of C‐reactive protein (CRP) and interleukin‐6 (IL‐6) before and after HCQ therapy and clinical outcome in the 30 patients with COVID‐19 were assessed. To evaluate the effect of mediation time point, we also divided these cases into two groups, patients began administrated with HCQ within 7 days hospital (defined as early delivery group) and 7 days after hospital (defined as later delivery group). We found that, the elevated IL‐6, a risk factor in severe patients were reduced to normal level after HCQ treatment. More importantly, patients treated with HCQ at the time of early hospital recovered faster than those who treated later or taken as second line choose for their obvious shorter hospitalization time. In summary, early use of HCQ was better than later use and the effect of IL‐6 and CRP level cannot be ruled out.

580: Maternal morbidity after early preterm delivery (23-28 weeks)

To describe the differences in maternal morbidity following preterm birth by gestational age This is a retrospective cohort study of women who delivered at a tertiary care hospital between 1/2013 and 12/2017. Women were included if they delivered between 23w0d to 28w6d and the neonate was admitted to the neonatal intensive care unit. A composite maternal morbidity (blood transfusion, infection, placental abruption, postpartum depression diagnosed or screen positive) was compared for women who delivered between 23w0d to 25w6d (early) and 26w0d to 28w6d (late). T-test, Mann Whitney U or Fisher’s exact test were used where appropriate. During the study period, 82 women met the inclusion criteria. There were 38 women in the early group compared to 44 women in the late group. Maternal age, BMI, delivery type (vaginal vs cesarean), hypertensive disease, membrane status, smoking, drug use and multifetal gestations were similar between the groups. The early delivery group was significantly more likely to experience composite maternal morbidity (60.5% vs 29.5%, p=0.0072). The early group was also more likely to experience maternal infection (42.1% vs 15.9%, p=0.0131). While it is well-established that neonatal morbidity and mortality are increased with decreasing gestational age, our data suggest that maternal morbidity is higher with delivery at early gestational ages. Composite morbidity and maternal infection appear to be a particularly frequent complication in those delivering less than 26 weeks. Because maternal morbidity is an increasing burden with a national focus on reduction, the management of women at risk for imminent delivery at early gestational ages should include a discussion of increased maternal complications.

ALTERED ARTERIAL DOPPLER FLOW PATTERN AND PERINATAL OUTCOME IN INTRAUTERINE GROWTH RESTRICTION

ABSTRACTObjectives: Intrauterine growth restriction (IUGR) is one of the common conditions that interfere with the growth of the fetus accounting for 10-15%of pregnant woman. Literature explores a wide range of incidence of perinatal complication including mortality among IUGR pregnancies. Limiteddata available on these complications confined to coastal Karnataka and its association with abnormal arterial Doppler flow pattern. To study theperinatal complications associated with IUGR pregnancies and its prevalence in comparison to healthy controls of comparable gestational age.Methods: This cohort study screened 53 IUGR fetuses by an antenatal scan at gestational age of 27 weeks or more. The diagnosis of IUGR was madeaccording to established criteria from SOGC clinical practice guidelines August 2013. The data also included 48 appropriate for gestational age fetuseswith healthy mothers with the comparable gestational week. Experienced cardiac sonographer and gynecologist performed fetal echocardiography(ECHO) using Vivid 7, GE health-care system ECHO machine with the convex transducer of frequency 1.7-2.4 MHz. The study was conducted at southIndian tertiary care center.Results: This study included 53 IUGR cases and 48 non-IUGR controls. The mean age was 27±4.37 and 26.88±3.14 years in IUGR and non-IUGRgroups, respectively. Fetal Doppler study variables showed a significant decrease in peak aortic velocity and velocity time integral which was notevident on other valves, though mitral antegrade flow during atrial contraction was found to be lower among IUGR group. In two-dimensional chamberquantification of IUGR group revealed significant increase in pulmonary artery dimension, right ventricular (RV) dimension and RV thickness than thecontrol group (p<0.05). The anthropometric parameters such as weight and length; abdomen circumference was significantly lower in IUGR group,whereas head circumference found to be more in IUGR group (p<0.001). The gestational weeks at delivery was significantly different among twogroups with IUGR group depicting the early delivery group. p<0.001(35.58±2.92 and 38.5±0.96 in IUGR and non-IUGR groups, respectively). IUGRgroup also had prolonged neonatal intensive care unit stay when compared to controls (p<0.001).Conclusions: IUGR carries profound course in altered Doppler indices and cardiac function which explore its prediction on mortality and adverseperinatal outcome. This study showed significant perinatal mortality accounting for 5.6% among IUGR cases when compared to normal. Althoughtissue Doppler indices show normal variants, IUGR possesses significant adverse perinatal outcome, however with lesser incidence compared tosevere form of IUGR subsets who show altered tissue annular velocities.Keywords: Intrauterine growth restriction, Echocardiography, Doppler, Perinatal.

Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes.

Planned early delivery versus expectant management of the term suspected compromised baby for improving outcomes.

404: The impact of delivery timing on neonatal outcomes of infants with gastroschisis

404 The impact of delivery timing on neonatal outcomes of infants with gastroschisis Anna Palatnik, Matthew Loichinger, Tana Kim, Randall Kuhlmann, Erica Peterson Medical College of Wisconsin, Department of Obstetrics and Gynecology, Milwaukee, WI OBJECTIVE: To assess whether earlier delivery of infants with gastroschisis minimizes intestinal damage or improves neonatal outcomes STUDY DESIGN: A retrospective study of 143 newborns born with gastroschisis between 2000-2011 in a single tertiary center was performed. They were divided in two groups: those delivered ‘’early’’ (before 36 weeks) and those delivered “late” (after 36 weeks). These groups were compared in terms of neonatal outcomes, including weight at the time of delivery, rate of primary closure, bowel atresia, necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), length of total parenteral nutrition (TPN), length of ventilation and length of neonatal intensive care unit (NICU) stay. RESULTS: 73 neonates were in the early delivery group with mean gestational age (GA) of 34.3 weeks, and 70 were in the late with mean GA of 36.4 weeks. Mean weight of the early group was 2112g and for the late group 2436g (p 0.0001). The rate of primary closure was not significantly different between the two groups (72.8% in late group vs. 67.1% in early group (p 0.54)). Bowel atresia was more frequent in the early group (10.96% vs 7.1%) as well as NEC (5.5% vs 2.9%) but that difference wasn’t significant (p 0.42, and p 0.43 ). The percentage of RDS and mean length of ventilation wasn’t significantly different between groups (p 0.19, and p 0.2). The length of TPN and NICU stay were longer in the early group (37.6 vs 29.1 days and 45.7 vs 34.3 days respectively) and both were statistically significant (p 0.01). Based on the two variables that were significantly different between the groups (length of stay and TPN), we performed survival analysis to include 3 stillbirth cases. It predicted higher probability of discharge and discontinuation of TPN for the late delivery group. CONCLUSION: Delivery before 36weeks is associated with longer NICU stay and longer time of TPN feeding. At the same time there was no significant difference in rates of primary closure or intestinal complications among the two groups of gestation.

Prediction of spontaneous preterm delivery from endocervical length at 11 to 13 weeks

To define the potential value of endocervical length at 11 to 13 weeks' gestation in the prediction of spontaneous early delivery. The lengths of the endocervix and cervico-isthmic complex were measured by transvaginal ultrasound at 11 to 13 weeks in singleton pregnancies, including 1492 that subsequently delivered after 34 weeks and 16 (1.1%) who had spontaneous delivery before 34 weeks. In 1320 of the cases, the measurements were repeated at 20 to 24 weeks. There were significant associations in the length of the endocervix and cervico-isthmic complex between 11 to 13 and 20 to 24 weeks (r = 0.548, p < 0.0001 and r = 0.194, p < 0.0001), and the respective median lengths were 32.4 and 32.2 mm for the endocervix and 45.3 and 40.4 mm for the cervico-isthmic complex. At 11 to 13 weeks in the early delivery group, compared to unaffected pregnancies, the median endocervical length was shorter (27.5 vs 32.5 mm, p < 0.0001), but there was no significant difference in the length of the cervico-isthmic complex (41.4 vs 45.4 mm, p = 0.054). In the measurement of cervical length, the endocervix should be distinguished from the isthmus. The endocervical length at 11 to 13 weeks is shorter in pregnancies resulting in spontaneous delivery before 34 weeks than in those delivering after 34 weeks.

The effect of gestational age at birth on morbidity in patients with gastroschisis

Infants born with gastroschisis frequently present with an eviscerated intestinal segment that is inflamed and thickened. The damaged segment of intestine displays absorption and motility disturbances for a variable period of time after gastroschisis repair. Clinical and animal research suggests that the damage to the eviscerated intestine is caused by prolonged exposure to amniotic fluid and/or progressive constriction on the intestine and its blood supply by the umbilical ring. Some obstetricians and pediatric surgeons have advocated early elective delivery to decrease the exposure of the bowel to these potentially damaging influences. Fifty-five patients underwent gastroschisis repair at the authors' institution during the last 6 years. Many of these patients had early elective delivery after their pulmonary maturity was judged adequate based on their amniotic lecithin/sphingomyelin ratios. The patients were divided into three groups according to gestational age at the time of delivery. Elective early delivery did not lessen the need for silo closure or hasten the time until enteral feeding could be tolerated. The hospital stay was not shortened for the early delivery group. This retrospective review supports the concept that patients with sonographically identified antenatal gastroschisis are best managed by delivery at full term.

Transplacental passage of recombinant human granulocyte colony-stimulating factor in women with an imminent preterm delivery

OBJECTIVE: We attempted to determine, in a pilot study, whether recombinant human granulocyte colony-stimulating factor, administered to women with an imminent delivery at ≤30 weeks' estimated gestational age, crosses to the fetal circulation and stimulates fetal neutrophil production. STUDY DESIGN: We measured granulocyte colony-stimulating factor and neutrophil concentrations in the blood of the mothers and in the umbilical venous cord blood after a single intravenous dose (25 μg/kg) of recombinant granulocyte colony-stimulating factor given to 11 women in whom preterm delivery was imminent and compared these with values from 34 control women and 35 cord sera. RESULTS: Ten infants were delivered within 30 hours (10.8 ± 8.9, mean ± SD) of the granulocyte colony-stimulating factor administration (”early delivery”), and two were delivered after 54 and 108 hours, respectively. In the early delivery group maternal granulocyte colony-stimulating factor concentrations and blood neutrophil levels were higher than in controls. However, no difference was seen in the cord blood neutrophil concentrations. In the late delivery group, although maternal serum and cord blood granulocyte colony-stimulating factor concentrations did not differ from controls, cord blood neutrophil levels were higher (25,900 and 17,700 cells/μl) than controls (3500 ± 2000 cells/μl, p < 0.05) and remained elevated for 1 week. Specifically, the blood neutrophil levels on days 5 and 8 were 12,000 and 17,000, respectively, for these patients, whereas the reference range upper limit for controls was 6000 cells/μl. CONCLUSION: Administration of recombinant granulocyte colony-stimulating factor to pregnant women with an imminent preterm delivery may result in the transplacental passage of a measurable quantity of granulocyte colony-stimulating factor, an amount that can have a biologic effect on the fetus. These events were most noticeable in those patients who received granulocyte colony-stimulating factor at least 30 hours before being delivered of their infants. (AM J OBSTET GYNECOL 1996;174:1306-11.)