Evaluation Of Pregnancy Outcome Research Articles

Evaluation of Pregnancy Outcome in Women with Rheumatic Mitral Valve Stenosis

Background and Aims: Rheumatic heart disease is still one of the most common heart lesion in developing countries. The maternal and fetal hazards increase with the severity of Mitral stenosis. This study was aimed to determine the fetomaternal outcome in women with mitral stenosis during pregnancy. Methods: This was descriptive cross-sectional study which included all pregnant patients with isolated rheumatic mitral valve stenosis. Major adverse outcomes studied were cardiac failure, thromboembolic event, admission in cardiac care or intensive care unit, atrial fibrillation, endocarditis, pulmonary hypertension and cardiac death. Results: Out of 3194 pregnant women, 31 had mitral stenosis. Their mean age was 27 years, mean mitral valve area 1.43cm2 and majority were primigravida (61.29%). Among them, symptomatic cardiac failure was present in 6.66%, 30% and 66.66% of mild, moderate and severe mitral stenosis respectively. The chances of cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies was high in all patients without having percutaneous trans-luminal mitral commissurotomy than those who underwent the procedure for moderate to severe mitral stenosis during pregnancy. Conclusion: There were high chances of adverse fetomaternal outcome in pregnant women with mitral stenosis. Cardiac failure was found to be increased with the severity of mitral stenosis. PTMC during pregnancy resulted in decreased cardiac failure, atrial fibrillation, preterm delivery and small for gestational age babies.

Evaluation of Pregnancy Outcome and Influencing Factors of Microsurgical Tubal Recanalisation as a Reversal of Tubal Ligation in a Tertiary Hospital

Background: Tubal microsurgical recanalization is a procedure which restores the fertility in women who have undergone sterilization voluntarily, thinking that her family is complete. However due to unforeseen circumstances, 1–3% of these women subsequently demand reversal of sterilization. Aims and Objectives: This study aims to evaluate the pregnancy rate after reversal surgery and to find out the various factors that influence the success of tubal microsurgical recanalization. Materials and Methods: The current study was hospital-based retrospective one involving 48 women undergoing reversal of sterilization at the department of gynecology and obstetrics in tertiary hospital, Kolkata, during the period of 3 years, from July 2015 to June 2018. The women were followed up for a period of 1 year by telephonic contact. Women seeking tubal recanalization was in age group of 20–35 years with normal ovulation and normal semen analysis. Women, >35 years old, anovulation, with obvious pelvic inflammatory disease, endometriosis or fibroid were excluded, women with any contraindications to pregnancy or surgery and any male factor infertility also excluded from the study. Results: Out of 48 study subjects, intrauterine pregnancy was achieved in 27 cases (93.1%)), 2 patients (6.9%) had ectopic pregnancy. Out of 27 intrauterine pregnancies, 4 had abortions (13.8%), 3 (10.3%) are ongoing pregnancies, and 20 patients had live birth (69%). Conclusion: Tubal microsurgery offers good chances of pregnancy outcome which is favored by the age below 30 years, interval between sterilization and its reversal <4 years, isthmo-isthmic anastomosis, reconstructed tubal length being more than 6 cm, and type of previous sterilization were by Pomeroy’s method.

Evaluation of Pregnancy Outcome in Women with First Trimester Vaginal Bleeding: A Longitudinal Study at a Tertiary Care Hospital, Kolkata, India

Introduction: First trimester vaginal bleeding, a serious obstetric challenge to developing embryo, occurs in 15-25% of all pregnant women. It is a matter of great concern to both mother and obstetrician for its increased association of adverse maternal and foetal outcome. Aim: To measure the prevalence of patients with first trimester vaginal bleeding, to evaluate factors associated with it and to assess foeto-maternal outcome in those pregnant women. Materials and Methods: This was a prospective, hospitalbased, longitudinal study carried out among 120 women with first trimester vaginal bleeding having normal bodyweight, and regular cycles and agreeing to follow-up, at Department of Obstetrics and Gynaecology in a tertiary teaching hospital, Kolkata, West Bengal, India, from January 2019 to June 2020. The incidence of vaginal bleeding in first trimester, its risk factors, foeto-maternal outcome in terms of Pregnancy Induced Hypertension (PIH), abortions, preterm deliveries, Antepartum Haemorrhages (APH), birth weight of baby, low APGAR (Appearance or colour of the baby, Pulse, Grimace, Activity, and Respiration) score at birth were assessed. The descriptive statistics to calculate percentage and mean and Chi-square-test with significance value considered at p-value <0.05. Results: Out of 4716 pregnant women attending in Obstetric clinic at their first trimester, 332 had vaginal bleeding, incidence being 7.04%. Out of 332 women, 120 study participants met inclusion criteria. Of 120 cases, 79 (65.8%) were from age group of 21-30 years. Highest incidence was 74 (61.7%) in primigravida. Incidence was high in poor socio-economic status (upper lower and lower) ie., 57 and unplanned cases, 87 (72.5%). On followup of 120 participants, 66 (55%) had threatened abortion, of them 51.5% (34/66) led to term pregnancy followed by preterm labour 39.39% (26/66) and only few, 9.09% (6/66) ended up with incomplete miscarriage. Spotting was most common nature of bleeding per vagina 41.66%, (50/120). On follow-up of 60 (90.9%) viable pregnancies, PIH was in 12 (20%) cases and abruption was seen in one (1.6%). Majority of preterm babies 65.4%, (17/26) Needed Neonatal Intensive Care Unit (NICU) admission. Conclusion: Vaginal bleeding in first trimester is an indicator of the maternal and foetal adverse consequences and results of this study can enrich our knowledge to plan and manage these pregnant women adequately.

Evaluation of pregnancy outcome in cases of intrauterine growth restriction in relation to placenta apoptosis and doppler indices of the umbilical and uterine arteries

Objective: To assess apoptotic changes in trophoblastic cells in normal term placentae and term placentae complicated by either preeclampsia or intrauterine growth restriction (IUGR). Additionally, we aim to examine the correlation between these apoptotic changes and the Doppler velocity of the umbilical and uterine arteries. Methods: This prospective observational study was conducted on 150 pregnant women, including 100 cases with preeclampsia and 50 controls. Placentas were collected at delivery, and apoptotic changes were examined using light microscopy and immunohistochemical staining. Doppler velocimetries were performed to assess umbilical and uterine artery resistance indices. Pregnancy outcomes and neonatal data were recorded. Results: The incidence of apoptosis in placentae was significantly higher in the preeclampsia group compared to the control group (p<0.001). The umbilical and uterine resistance indices were also significantly higher in the preeclampsia group (p<0.001). There was a positive correlation between the incidence of apoptosis and Doppler resistance indices in the preeclampsia group. Fetal birth weight, Apgar scores at 1 and 5 minutes, and gestational age at delivery were significantly lower in the preeclampsia group (p<0.001). Conclusions: Increased placental apoptosis and abnormal Doppler indices are associated with preeclampsia and adverse pregnancy outcomes.

Prospective evaluation of pregnancy outcome in an Italian woman with late-onset combined homocystinuria and methylmalonic aciduria

BackgroundCobalamin metabolism disorders are rare, inherited diseases which cause megaloblastic anaemia and other clinical manifestations. Early diagnosis of these conditions is essential, in order to allow appropriate treatment as early as possible.Case presentationHere we report the case of a patient who was apparently healthy until the age of 20, when she presented with impaired renal function and normocytic anaemia. At the age of 34, when her first pregnancy resulted in an intrauterine death of a morphologically normal growth-restricted foetus, she was diagnosed with homocystinuria and methylmalonic aciduria due to cyanocobalamin C (cblC) defect, which was confirmed by molecular investigation. Consequently, hydroxocobalamin was administered to correct homocysteine plasma levels. This treatment was efficacious in lowering homocysteine plasma levels and restored anaemia and renal function. During a second pregnancy, the patient was also administered a prophylactic dose of low molecular -weight heparin. The pregnancy concluded with a full-term delivery of a healthy male.ConclusionsThis case emphasises the importance of awareness and appropriate management of rare metabolic diseases during pregnancy. We suggest that women with late-onset cblC defect can have a positive pregnancy outcome if this metabolic disease is treated adequately.

Effectiveness and safety of late midtrimester cervical cerclage

Objectives: To evaluate the safety and effectiveness of late cervical cerclage performed beyond 17 weeks of gestation. The outcomes of interest were effectiveness of late cerclage in prolongation of pregnancy and evaluation of pregnancy outcome including maternal and fetal complications.Study design: A total of 30 patients underwent late cervical cerclage during the study period. Of them, two were twin pregnancies. A late cerclage was performed after the diagnosis of cervical shortening or dilatation in 20 patients. We performed a retrospective case series review. One case was lost to follow up (delivery in another medical center). Medical information was retrieved from all cases of patients who underwent a late cervical cerclage between the years 2010 and 2016 at the Soroka University Medical Center, a tertiary medical center. Continuous variables were expressed as mean ± standard deviation. Categorical variables were expressed as proportions.Results: The average gestational age at birth was 35 ± 5.1 weeks of gestation. The mean interval between cerclage and delivery in the study population was 17 ± 5.62 weeks. Nine cases (32.1%) resulted in preterm deliveries, three of them below 34 weeks of gestation (one twin pregnancy and two pregnancies diagnosed with cervical dilation prior to cerclage). Among all the preterm deliveries, there were four cases of preterm prelabor rupture of membranes (13.3%). Of the 28 deliveries, 24 women (85.7%) had a vaginal delivery, while four women (14.3%) underwent a cesarean section. No cases of cervical tear were described. The cerclage was sent to bacteriology after removal, showing positive cultures for Candida species in nine cases (31%).Conclusions: In our study population, late cervical cerclage was found to be a safe procedure resulting in almost 90% of successful vaginal deliveries without maternal or fetal complications. This procedure might be effective in the prolongation of pregnancy in women with cervical dynamics in the late second trimester.

Pregnancy Outcome after Hysteroscopic Treatment of Submucous Myomata. Eight Year Follow Up

Study Objective: Evaluation of pregnancy outcome after hysteroscopic treatment of submucous myomata of all grades.

Evaluation of pregnancy outcome after establishment of single blastocyst transfer (SET) criteria in in vitro fertilization and egg recipient (IVF/ER) embryo transfer (ET) cycles

Evaluation of pregnancy outcome after establishment of single blastocyst transfer (SET) criteria in in vitro fertilization and egg recipient (IVF/ER) embryo transfer (ET) cycles

Glucosamine Use in Pregnancy: An Evaluation of Pregnancy Outcome

Glucosamine (GLS) is an endogenous aminomonosaccharide. It is used as a disease-modifying agent for the treatment of osteoarthritis. There is no information regarding its use in pregnancy. Our objective was to determine whether GLS treatment in pregnancy is associated with an increased risk of major malformations or other adverse outcomes. Pregnant women were recruited from The Motherisk Program at the Hospital for Sick Children, Toronto, Canada. Women exposed to GLS were compared with women exposed to nonteratogenic agents. They were matched for gestational age at time of call, maternal age, and cigarette and alcohol consumption. Rates of major malformations and other end points of interest were compared between the two groups. We were able to ascertain the outcomes of 54 women who used GLS during pregnancy (34 during organogenesis). There were 50 live births (two sets of twins), 4 spontaneous abortions, 1 therapeutic abortion, and 1 stillbirth, with no major malformations. The mean birth weight was 3524 +/- 482 g, and the median gestational age at birth was 39 weeks (range 37-40). These limited data suggest no increased risk for major malformations or other adverse fetal effects following the use of GLS during pregnancy.

Evaluation of pregnancy outcome in euploid fetuses with a screen positive second trimester maternal serum screen for trisomy 18

POSITIVE SECOND TRIMESTER MATERNAL SERUM SCREEN FOR TRISOMY 18 CALLA HOLMGREN, ALEXANDRA GROSVENOR, KRISTY NELSON, NANCY ROSE, University of Utah, Obstetrics and Gynecology, Salt Lake City, Utah, Intermountain Healthcare, Obstetrics and Gynecology, Salt Lake City, Utah OBJECTIVE: Second trimester maternal serum analyte markers in pregnancies that screen positive for trisomy 18 are all profoundly lower than expected. If these low levels of maternal serum analytes are identified in normal, euploid gestations, we hypothesize that this might be associated with adverse pregnancy outcome, and therefore this information might be important for further obstetrical management during gestation. STUDY DESIGN: Between January, 2000 and August, 2004, we identified 65 patients at three tertiary care hospitals with a screen positive risk for trisomy 18 on second trimester serum analyte screening. Forty-three percent of these patients had amniocentesis in the second trimester. Charts from all patients were reviewed for both maternal and fetal outcomes. Statistical analysis was undertaken to evaluate these outcomes. RESULTS: In total, 55 (84.6%) patients had known maternal and fetal outcomes, and, of these, 10 (18.0%) had trisomy 18 identified by amniocentesis. Of the women who had amniocentesis, 35% had trisomy 18. There were two triploidy fetuses with fetal deaths at 19-20 weeks gestation confirmed by autopsy. The remaining 43 patients had euploid gestations with no evidence of fetal abnormalites. There was 1 term stillbirth (2.2%), the cause of which was unknown. For all patients, the mean gestational age at delivery was 37.1 weeks gestation (G4.4 weeks) and mean Apgar scores were 7.5 at 1 minute and 8.6 at 5 minutes. Mean fetal weight at delivery was 3097 gm (G727.8). 6.7% of the infants were delivered preterm secondary to preterm labor or preterm rupture of membranes. Of the total, 4.4% of the pregnancies were complicated by preeclampsia and 6.7% were complicated by IUGR. CONCLUSION: There does not appear to be an increased risk of adverse pregnancy outcome in patients with a euploid gestation and a screen positive second trimester maternal serums screen for trisomy 18.

Trends in Fetal Mortality in the Kingdom of Saudi Arabia: Lessons From 15 Years of Experience

ABSTRACT Using data on hospital deliveries published by the Ministry of Health, trends in fetal mortality in the Kingdom were investigated in this study. The study spanned 1391H through 1405H, corr...