Fetal Complications In Women Research Articles

Accuracy Of Serum Uric Acid In Predicting Complications Of Pre-Eclampsia

Background: Pre-eclampsia is one of the largest causes of maternal and fetal mortality and morbidity. Hyper uricemia is often associated with pre-eclampsia. Objective: to determine the accuracy with which serum uric acid predicts maternal and fetal complications in women with pre-eclampsia.

Evaluation of Maternal and Fetal Outcomes in Pregnant Women with COVID-19 based on Different Trimesters.

COVID-19 is the leading cause of the recent pandemic in the globe. This disease might have different effects on the maternal and fetal outcomes in pregnancy. The aim of this study was to assess these outcomes in pregnant women with COVID-19 infections in different trimesters. This is a prospective cohort study that was performed in February 2020 to August 2021 in Isfahan on 430 pregnant women with definite diagnosis of COVID-19 infection admitted to our medical centers. The included cases were followed based on the gestational age in which they were diagnosed with COVID-19 infection. Patients were divided into three groups (first, second, and third trimesters) based on COVID-19 infection. The frequency of requiring mechanical ventilation was higher in mothers with COVID-19 in the second trimester (P = 0.049) and the frequency of PIH was significantly higher in mothers with COVID-19 in the third trimester compared to other women (P = 0.009). Fetal growth restriction (FGR) was also observed in 22 patients (5.3%) that was mostly observed with COVID-19 in the third trimester (P = 0.012). Oligohydramnios and fetal distress leading to C/S were observed in 19 patients (4.6%) and 12 patients (2.9%), respectively. The majority of maternal mortality was among cases with COVID-19 infection in the third trimester (44.4%). We observed higher maternal and fetal complications in women especially those in the third trimester. Our results were in line with the findings of previous studies. Women with COVID-19 infection in the third trimester had highest frequencies of preterm labor and FGR.

P256 Complications in Pregnancy are Common in Women with Axial Spondyloarthropathy: Data from the Ankylosing Spondylitis Registry of Ireland

Abstract Background/Aims National registries are excellent data sources to allow analysis of inflammatory arthritis such as axial spondyloarthropathy (axSpA). Our understanding of axSpA has evolved rapidly over time resulting in improved recognition of the disease. Unfortunately for women with axSpA, there are limited data on pregnancy outcomes in this population. To address this issue, data were collected on pregnancy within the Ankylosing Spondylitis Registry of Ireland (ASRI), which is a source of epidemiological data on axSpA in Ireland. The aim of this study was to examine the prevalence of pregnancy and fetal complications in women with axSpA. Methods The ASRI records information on baseline demographics, imaging, medications, patient outcomes and comorbidities. For enrolment, all patients must have been diagnosed with axSpA by a rheumatologist and meet the ASAS criteria. Informed consent was obtained from all patients, with ethical approval obtained from local hospital ethics committees. A dedicated section collects data on pregnancy, fertility and breastfeeding. ASRI outcomes data for women with axSpA were recorded retrospectively. Results At the time of analysis, 220 women were enrolled in the ASRI, representing 24.3% of the total population of the registry. Mean age of women was 43.9 years, with a mean disease duration of 18 years and mean delay to diagnosis of 7.86 years. 68.6% (151) had radiographic sacroiliitis, while 49.5% (109) had sacroiliitis on MRI. Mean scores for women in the ASRI were: BASDAI 4.6, BASFI 3.82, BASMI, HAQ 0.6, and ASQoL 7.65. Data on pregnancy were available in 76 women, with 61 women reporting a total of 210 pregnancies resulting in 166 live births. Of these pregnancies, 58.1% (122) were uncomplicated and 41.9% (88) were complicated, with 11.4% (24) of pregnancies encountering multiple complications. The frequency of miscarriage was high, affecting 20.5% (43) of pregnancies overall in 37.7% (23) of women with a history of pregnancy. Of the pregnancies resulting in live births, the most common pregnancy complication was caesarean section in 10.8% (18) followed by preterm delivery in 11.4% (15), while the most common fetal complication was NICU admission in 11.4% (19). Only four women (5.3%) reported difficulty conceiving and the need for fertility specialist referral, but none underwent assisted reproductive therapy. Prevalence of breastfeeding was low, reported in only 33.7% (56) of live births. Conclusion Data from the ASRI indicates a high frequency of pregnancy and fetal complications in women with axSpA. These results represent a preliminary analysis of pregnancy outcomes in axSpA pregnancies collected via a large national registry. Ongoing data collection will allow comparison to national averages. This provides much needed insight into the impact of axSpA on pregnancy, which can be used to improve monitoring and management of women with axSpA during their pregnancies. Disclosure S. Maguire: Grants/research support; Recipient of the Gilead Inflammation Fellowship. F. Wilson: None. P. Gallagher: None. F. O'Shea: None.

Fetomaternal Outcome in Antepartum Hemorrhage; A Cross Sectional Study at Feto-Tertiary Care Hospital of Sindh, Pakistan

Introduction: Antepartum hemorrhage is the bleeding from the genital tract following the completion of 28 weeks of pregnancy till full term. It is an obstetrical emergency and a leading cause of maternal and perinatal death and morbidity. Objectives: This study was conducted to determine the frequency of maternal and fetal complications in women with antepartum hemorrhage. Methods: It was a cross sectional study held at the Department of Gynecology and Obstetrics unit IV, Liaquat University of Medical and Health Sciences, Jamshoro between 2017 and 2019. This study enrolled 158 women with a history of antepartum hemorrhage using non- probability consecutive sampling. The fetal and maternal outcomes of the patients were recorded. Maternal outcomes were assessed according to age, gravidity and gestational week. Data was analyzed in SPSS 20. Results: The average age of the women was 25.77±4.15 years. Anemia was the most common maternal outcome 102(64.6%) followed by disseminated intravascular coagulation (DIC) 24(15.2%), shock 12(7.6%), postpartum hemorrhage (PPH) 11(7%) and maternal mortality 5 (3.1%). Preterm birth and low APGAR score were the most frequently fetal outcomes that were observed in 69 (43.7%) and 50 (31.6%) cases, respectively. There was significant association of DIC with gravidity and gestational age. Anemia was significantly associated with gestational age more frequently among mothers with <37 weeks of gestational age. Conclusion: In conclusion, anemia was the most frequently encountered complication of antepartum hemorrhage, followed by DIC and shock. Multigravidity was a significant etiological factor in antepartum hemorrhage.

Decreasing the main maternal and fetal complications in women undergoing in vitro fertilization (IVF) trained by nutrition and healthy eating practices during pregnancy

Purpose In vitro fertilization (IVF) can lead to undesirable consequences for pregnant women and their newborns. Reducing the adverse maternal (mainly, gestational diabetes mellitus (GDM) and preeclampsia (PE)), and fetal outcomes in IVF-pregnant women (IVF-PW) was aimed with the correct training of nutrition principles during pregnancy. Materials and methods A quasi-experimental clinical trial with 170 IVF-PW in intervention and control groups was conducted. The subjects before the dietary intervention completed questionnaires of nutritional and lifestyle and 24-h food recall. The intervention group was trained with the diet modification programs from early (12–16 weeks) to late (week 34) pregnancy in six weekly, 15–20-min sessions. The GDM diagnosis was based on 75-g OGTT and FBS tests, respectively, in 24–28 weeks’ gestation. Other adverse maternal (e.g. PE, cesarean delivery, and preterm delivery (<37 weeks)), and fetal (e.g. intrauterine growth retardation (IUGR), birth weight, and fetal viability) outcomes were also monitored. The dataset was assessed using both inferential and descriptive statistics. Results A diet modification program with an increased intake of lactose, fiber, and some minerals (e.g. magnesium and zinc) and vitamins (e.g. B3 and B5) in conjunction with a lower intake rate of glucose and lipid could control the prevalence of adverse maternal and neonatal outcomes in IVF-PW. Although the GDM reduction in the two intervention (8.2%) and control (20.0%) groups was statistically insignificant, there was a significant difference in PE prevalence at a lower rate (39.0%) in the intervention group than the control. No significant difference in cesarean delivery (94.1–95.2%), and preterm delivery (45.9%) between the two groups was found. The IUGR (24.7–25.9%), birth weight (2.791–2.820 kg), and fetal viability (95.3–97.6%) also did not change significantly after the healthy eating practices during pregnancy. Conclusions Diet-based interventions in IVF-PW during pregnancy were efficient in improving the outcomes for both mother and baby.

Atrial fibrillation with pregnancy: A prospective controlled study

Background: Atrial fibrillation (AF) has been associated with numerous morbidities and mortalities. Pregnant women are at higher risk to develop AF.Objective: This study aims at investigating the maternal and fetal complications in women who developed AF during pregnancy compared to a control group.Patients and Methods: A prospective study was conducted on 2 groups; women with AF and women without AF. The included women were recruited from Beni-Suef University Hospital and Beni-Suef General Hospital after obtaining their informed consents. The maternal and fetal complications have been reported and compared between both groups.Results: The rates of placental complications, vaginal hematoma, congenital anomalies and the need for neonatal ICU were relatively higher amongst women with AF than those without AF but no statistically significant differences have been noticed (p>0.05). Rupture uterus, abortion and post-partum hemorrhage were statistically higher amongst women with AF in comparison to women without AF; 37.5% versus 2.6%, 50% versus 17.4%, and 37.5% versus 5.3%, respectively (p 0.05).Conclusion: Women who develop AF during pregnancy are more likely to develop maternal complications.

Measurement of the fetal occiput-spine angle during the first stage of labor as predictor of the progress and outcome of labor

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor.Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor.Material and methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications.Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8 ± 2.1 and1.89 ± 0.85 versus 4.16 ± 1.63 and 0.92 ± 0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively.Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126.

Obstetric outcome in patients with rheumatic heart disease: experience of a tertiary hospital.

Background and Aims: Pregnancy in patients with rheumatic heart disease has always been challenging. Haemodynamic changes in pregnancy with diseased heart may cause adverse maternal and fetal outcome.Methods: A prospective study was done in pregnant women with rheumatic heart disease over a period of 2 years from 2015 to 2016 at Tribhuwan University Teaching Hospital, Kathmandu. Baseline data collected at antenatal period were analyzed with obstetric outcomes.Results: A total of 85 women were enrolled in this study. Sixty percent of the women were primigravida. Mitral stenosis was the commonest lesion (69.41%), followed by mitral regurgitation (25.88%) and aortic stenosis (4.71%). Cardiac events were noted in 32 patients out of which 11 developed pulmonary oedema and 6 had new onset of atrial fibrillation. Vaginal delivery (58.82%) was the commonest mode of delivery followed by cesarean section (24.7%). Eighty percent of women remained in NYHA functional class I and II, whereas 20% had deterioration of functional class. There were more maternal and fetal complications in women with NYHA III or IV in comparison to women with NYHA I or II. Low birth weight infants were found in 37.64% of cases. There was one maternal death in a lady with severe mitral stenosis with moderate mitral regurgitation due to congestive heart failure at 34 weeks of gestation. There were 8 fetal and 11 neonatal deathConclusions: Functional cardiac status during pregnancy has a major impact on maternal and fetal outcome. Rheumatic heart disease diagnosed before pregnancy may improve the outcome.Nepalese Heart Journal 2017; 14(2): 31-34

Incidence and predictors of obstetric and fetal complications in women with structural heart disease

ObjectiveWomen with cardiac disease becoming pregnant have an increased risk of obstetric and fetal events. The aim of this study was to study the incidence of events, to validate the...

Pregnancy outcomes in myeloproliferative neoplasms: UK prospective cohort study.

The reported higher risk of maternal and fetal complications in women with myeloproliferative neoplasms (MPN) poses challenge during pregnancy. A national prospective study of maternal and fetal outcomes of pregnant women with a diagnosis of MPN was undertaken via the United Kingdom Obstetric Surveillance System between January 2010 and December 2012. Fifty-eight women with a diagnosis of MPN were identified; 47 (81%) essential thrombocythaemia, five (9%) polycythaemia vera, five (9%) myelofibrosis and one (2%) MPN-unclassified. There were 58 live births. The incidence of miscarriage was 1·7/100 (95% confidence interval [CI]: 0·04-9·24) and the perinatal mortality rate was 17/1000 (95% CI:0·44-92·36) live and stillbirths. Incidence of maternal complications was 9% (5/57) pre-eclampsia, 9% (5/57) post-partum haemorrhage and 3·5% (2/57) post-partum haematoma. There were no maternal deaths or thrombotic events. Delivery was induced in 45% (24/53) of women and the Caesarean section rate was 45% (24/53). The majority (85%, 45/53) delivered at term (>37weeks gestation). Twenty-two percent (12/54) of neonates were below the 10% centile for growth and 13% (7/54) required admission to a neonatal care-unit; there were no neonatal deaths. The findings of this large, UK prospective study suggests women with MPN appear to have successful pregnancies with better outcomes than would be anticipated from the literature.

27 The added value of the biomarkers sFlt-1, PlGF and their ratio on prediction of prolongation of pregnancy and maternal and fetal complications in (suspected) preeclampsia

Introduction The sFlt-1/PlGF ratio has emerged as a biomarker for the timely diagnosis of preeclampsia and prediction of pregnancy outcomes. In most reports the ratio has been compared with the traditional criteria (proteinuria and hypertension) of PE instead of assessment of its additional value. Objectives To assess whether a single determination of the serum values of sFlt-1, PlGF and their ratio improves prediction of pregnancy prolongation in days and maternal and fetal complications in women with suspected or clinically confirmed PE. Methods In this ongoing Dutch multicenter study (600 pts to be enrolled) blood was drawn on admission for suspected or clinically confirmed preeclampsia. Using the automated Elecsys system values of sFlt-1 and PlGF were measured postpartum to prevent influence of this information on decision-making of the treating physicians. Clinical characteristics and pregnancy outcomes were retrieved from medical records. Maternal complications included HELLP syndrome, cerebral/ pulmonary edema, acute renal failure, stroke or hemorrhagic problems. Fetal complications included prematurity, intrauterine growth restriction, admission to neonatal intensive care, infant respiratory distress syndrome and necrotizing enterocolitis. The added value of sFlt-1, PlGF and their ratio on already known predictors as maternal and gestational age, gravidity, blood pressure, proteinuria and diagnosis at inclusion was determined with multivariable regression analysis. Results Complete data of 472 patients (age 18–48 yrs., singleton pregnancies, median pregnancy duration 34 weeks (range 20–41 weeks) were available. Adverse outcome occurred in approximately 99 (21%) of the women and in 188 (40%) of the fetus. The biomarkers sFlt-, PlGF and their ratio showed clear additive value for the prediction of pregnancy prolongation and maternal and fetal complications. Compared to the sFlt-1 and PlGF values the additive value of the ratio to predict fetal complications, was two-fold higher. Prediction of pregnancy prolongation was most improved by PlGF. Conclusions The biomarkers sFlt-1, PlGF and sFlt-1/PlGF ratio are strong predictors for maternal and fetal complications and pregnancy prolongation. Particularly the sFlt-1/PlGF ratio has much added value for the prediction of fetal complications and pregnancy prolongation.

Pregnancy in Paroxysmal Nocturnal Hemoglobinuria

Pregnancy and childbirth associated with a high risk of severe maternal and fetal complications in women with paroxysmal nocturnal hemoglobinuria (PNH). Recently the management of PNH during pregnancy has been challenging and childbearing was practically contraindicated in these patients. Eculizumab treatment improved the prognosis in PNH and made it possible to minimize complications during pregnancy. Establishment of effective and safe algorithms for the management of pregnancy, delivery and postpartum period in PNH patients is crucial to their lives.Since 1999, we have analyzed 15 pregnancies in six women with PNH. The median age at PNH diagnosis was 22 years (18-27), the median age at the start of pregnancy - 25 years (21-34). All of them were diagnosed with PNH following treatment for aplastic anemia (AA) with antithymocyte globulin, cyclosporine A and splenectomy in two cases before pregnancy. The median of PNH granulocyte clone at the start of pregnancy was 74,7% (17,8-94,1). Pregnancy occurred during complete remission of AA with PNH clinical signs in 5 (33,3%) cases. Most patients were in partial remission at the time of pregnancy-7 (46,7%) or continued to receive immunosuppressive therapy with minimal effect-3 (20%). Progression of aplasia observed during 4 (26,7%) pregnancies, but it was not severe and special treatment delayed until the completion of pregnancy. Two patients exposed to eculizumab before conceiving and remained on the treatment during pregnancy. Other women received only symptomatic therapy. Anticoagulation with low molecular weight heparin was used in 5 (33,3%) pregnancies. No thrombotic events during pregnancy and postpartum have been observed. Skin hemorrhages were revealed in 2 (13,3%) patients. During 4 (26,7%) gestations patients underwent erythrocytes and/or platelets transfusion. Pregnancies resulted in the birth of healthy infants in 7 (46,7%) cases - two girls and five boys. There were no adverse effects in the newborns from PNH patients both on eculizumab and without it. Successful outcomes were in 2/2 pregnancies on eculizumab treatment and in 5/13 (38,5%) cases without the drug. Caesarean sections were performed in all of births, early surgical delivery (30-34 weeks)-in 4/7 cases (preeclampsia-2, placenta previa-1, breakthrough hemolysis-1). Adverse pregnancy outcomes occurred only in patients not receiving eculizumab and amounted to 8/13 (61,5%). Only three patients had planned the pregnancy, other 12 cases were unplanned. Consequently, in 4 (30,8%) cases of pregnancy in the midst of illness was performed the abortion for medical reasons. Spontaneous miscarriage was registered in 2 (15,4%) patients. Two pregnancies (15,4%) ended in fetal death on 27th and 20th gestation weeks. Transfusion requirements increased in two pregnancies with symptomatic therapy, but did not increase on eculizumab. One of patients had first pregnancy without eculizumab and developed complications such as preeclampsia, postpartum severe epistaxis and high transfusion requirement (an average of 1,2 units per month). During second pregnancy on eculizumab she had no obstetric complications and transfusion requirements were less (0,5 units monthly). Second patient continued to have evidence of intravascular hemolysis despite the treatment, and so received eculizumab more frequent (one time in 10 days) in the third trimester. PNH granulocyte clone size decreased in both cases of eculizumab treatment during pregnancy.The risk of complications in PNH patients during pregnancy may be minimized by applying the management algorithm with eculizumab treatment. Despite the small number of observations, we can safely conclude that pregnancy outcomes in PNH patients with eculizumab are better than with only symptomatic therapy. Our experience confirms that eculizumab can be safely used in PNH throughout pregnancy to reduce the risk of complications and adverse outcomes. There is no difference in health between infants born by mothers with PNH and the newborns from general population. DisclosuresNo relevant conflicts of interest to declare.

Drugs to block cytokine signaling for the prevention and treatment of inflammation-induced preterm birth.

Preterm birth (PTB) at less than 37 weeks of gestation is the leading cause of neonatal morbidity and mortality. Intrauterine infection (IUI) due to microbial invasion of the amniotic cavity is the leading cause of early PTB (<32 weeks). Commensal genital tract Ureaplasma and Mycoplasma species, as well as Gram-positive and Gram-negative bacteria, have been associated with IUI-induced PTB. Bacterial activation of Toll-like receptors and other pattern recognition receptors initiates a cascade of inflammatory signaling via the NF-κB and p38 mitogen-activated protein kinase (MAPK) signaling pathways, prematurely activating parturition. Antenatal antibiotic treatment has had limited success in preventing PTB or fetal inflammation. Administration of anti-inflammatory drugs with antibiotics could be a viable therapeutic option to prevent PTB and fetal complications in women at risk of IUI and inflammation. In this mini-review, we will discuss the potential for anti-inflammatory drugs in obstetric care, focusing on the class of drugs termed “cytokine suppressive anti-inflammatory drugs” or CSAIDs. These inhibitors work by specifically targeting the NF-κB and p38 MAPK inflammatory signaling pathways. Several CSAIDs are discussed, together with clinical and toxicological considerations associated with the administration of anti-inflammatory agents in pregnancy.

The Challenges and Future Considerations Regarding Pregnancy-Related Outcomes in Women with Pre-Existing Diabetes

Ineffective management of blood glucose levels during preconception and pregnancy has been associated with severe maternal and fetal complications in women with pre-existing diabetes. Studies have demonstrated that preconception counseling and pre-pregnancy care can dramatically reduce these risks. However, pregnancy-related outcomes in women with diabetes continue to be less than ideal. This review highlights and discusses a variety of patient, provider, and organizational factors that can contribute to these suboptimal outcomes. Based on the findings of studies reviewed and authors' clinical and research experiences, recommendations have been proposed focusing on various aspects of care provided, including improved accessibility to effective preconception and pregnancy-related care and better organized clinic consultations that are sensitive to women's diabetes and pregnancy needs.

O406 Accuracy of liver function tests in predicting maternal and fetal complications in women with pre-eclampsia: A systematic review

International Journal of Gynecology & ObstetricsVolume 107, Issue S2 p. S207-S208 Free communication (oral) presentations O406 Accuracy of liver function tests in predicting maternal and fetal complications in women with pre-eclampsia: A systematic review S. Iyengar, S. IyengarSearch for more papers by this authorC. Koopmans, C. KoopmansSearch for more papers by this authorJ. Zamora, J. ZamoraSearch for more papers by this authorK. Ismail, K. IsmailSearch for more papers by this authorB. Mol, B. MolSearch for more papers by this authorK. Kalid, K. KalidSearch for more papers by this authorS. Thangaratinam, S. ThangaratinamSearch for more papers by this author S. Iyengar, S. IyengarSearch for more papers by this authorC. Koopmans, C. KoopmansSearch for more papers by this authorJ. Zamora, J. ZamoraSearch for more papers by this authorK. Ismail, K. IsmailSearch for more papers by this authorB. Mol, B. MolSearch for more papers by this authorK. Kalid, K. KalidSearch for more papers by this authorS. Thangaratinam, S. ThangaratinamSearch for more papers by this author First published: 06 October 2011 https://doi.org/10.1016/S0020-7292(09)60779-7AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume107, IssueS2Abstracts of XIX FIGO World Congress of Gynecology and ObstetricsOctober 2009Pages S207-S208 RelatedInformation

Selective prophylactic transfusion in sickle cell disease

OBJECTIVE. To record feto-maternal complications following the use of selective prophylactic transfusions in women with major sickle cell disease (SCD) and determine whether selective prophylactic transfusion reduces these complications, through a comparison with a population of women who received transfusions for complications only. DESIGN. A retrospective cohort study. SETTING. Public regional referral hospital in western French Guyana. POPULATION. Between 1992 and 2004, in all 29 women, 55 pregnancies, and 56 neonates. METHODS. Close obstetric follow-up and selective prophylactic transfusions after 26 weeks. Main outcome measures. Adverse obstetric outcome (pre-eclampsia, preterm delivery, intrauterine growth restriction (IUGR), intrauterine fetal death (IUFD), cesarean delivery, neonatal and maternal mortality) and end-points for SCD outcome (vaso-occlusive crisis (VOC), acute chest syndrome, and infections). RESULTS. Complications involved the different major SCD types to an equal extent. Comparison with the control group showed that women who had received prophylactic transfusions had lower rates of VOC (p=0.002) and preterm deliveries (p=0.036), but a significant increase in IUGR cases (p=0.048). CONCLUSION. Selective prophylactic transfusion seems to reduce certain maternal and fetal complications in women with severe forms of SCD. These results can only be confirmed through a randomized prospective study.

Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review

BackgroundProteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies.MethodsWe conducted electronic searches in MEDLINE (1951 to 2007), EMBASE (1980 to 2007), the Cochrane Library (2007) and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards.ResultsSixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7) and 0.53 (95% CI 0.27, 1) for stillbirths, 1.5 (95% CI 0.94, 2.4) and 0.73 (95% CI 0.39, 1.4) for neonatal deaths and 1.5 (95% 1, 2) and 0.78 (95% 0.64, 0.95) for Neonatal Intensive Care Unit admission.ConclusionMeasure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia.

Prioritisation of Tests for the Prediction of Preeclampsia Complications: A Delphi Survey

Background: Preeclampsia is associated with several maternal and fetal complications. Numerous tests—including patient history, physical examination findings, and laboratory investigations—are used to predict such complications in women with preeclampsia. At present, there are no robust systematic reviews or large studies examining the accuracy of tests that could predict complications in women with preeclampsia. Objective: To identify the tests (which include items of history, examination, and investigations) that are clinically relevant in predicting maternal and fetal complications in women with preeclampsia. Methods: A two-generational Delphi method was used to prioritize the clinically relevant tests that are considered helpful in predicting the maternal and fetal complications of preeclampsia. Results: Blood pressure was rated as the best predictor of complications with mean score (± SD) of 4.7 (± 0.47), followed by proteinuria 4.6 (± 0.5) and liver function tests 4.5 (± 0.52). Conclusion: The list of tests that have been identified and prioritized will form the basis for future systematic reviews of the literature in this field.

Achieving better outcomes in pregnancies complicated by type 1 and type 2 diabetes mellitus

Background: Pregnancy in type 1 and type 2 diabetes mellitus (DM) is associated with an increased rate of adverse outcomes for both mother and fetus. Objective: This article reviews the data available on achieving better outcomes in pregnancies complicated by DM. Methods: Background materials for this article were gathered based on a PubMed search of English-language articles (up to and including August 2007) using the search terms diabetes mellitus, pregnancy, glycemic control, mortality, and morbidity. This review article was based on a presentation given at a satellite symposium entitled “Realising the Value of Modern Insulins: Reaching Further with Rapid-Acting Insulin Analogues” that was convened during the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa. Results: There is clear evidence that optimized metabolic control, from preconception through pregnancy, can reduce the risk of maternal and fetal complications in women with DM. The risk of fetal congenital abnormalities in pregnant women with DM is intricately related to the level of glycemic control in early pregnancy; thus, strict metabolic targets as close to normal glycosylated hemoglobin (HbA 1c) (ie, 4.0%–6.0%) as possible are recommended. However, these HbA 1c and postprandial plasma glucose targets are challenging for the physician and the patient. The rapid-acting insulin analogues, insulin aspart and insulin lispro, may be useful because they can reduce postprandial hyperglycemia without increasing the risk for hypoglycemia and even provide a small improvement in HbA 1c compared with regular human insulin. In a recent, prospective, randomized controlled study of pregnant women with type 1 DM (N = 322), maternal hypoglycemia, metabolic control, and tolerability, including perinatal outcomes, were compared between those randomized to mealtime insulin aspart or human insulin. The results from this study suggest that insulin aspart is at least as effective and well tolerated as human insulin in basal-bolus therapy with neutral protamine Hagedorn insulin. Overall, 80% of study participants in both groups achieved HbA 1c levels ≤=6.5% in the second trimester. In addition, insulin aspart was associated with lowered postprandial blood glucose levels, as well as reduced risk of hypoglycemia, suggesting that it may offer clinical advantages in this population. Conclusions: Women with DM who are of reproductive age should be identified as members of a high-risk group. Access to specialized prepregnancy clinics should be made available where their DM can be intensively managed throughout pregnancy by a combined obstetrical/endocrine multidisciplinary team. Use of multiple insulin injection regimens, including use of insulin aspart during pregnancy, is both well tolerated and effective and may offer some benefits with respect to postprandial glycemic control.

Accuracy of serum uric acid in predicting complications of pre‐eclampsia: a systematic review

Pre-eclampsia is one of the largest causes of maternal and fetal mortality and morbidity. Hyperuricemia is often associated with pre-eclampsia. To determine the accuracy with which serum uric acid predicts maternal and fetal complications in women with pre-eclampsia. Systematic quantitative review of test accuracy studies. We conducted electronic searches in MEDLINE (1951-2004), EMBASE (1980-2004), the Cochrane Library (2004:4) and the MEDION database to identify relevant articles. A hand-search of selected specialist journals and reference lists of articles obtained was then carried out. There were no language restrictions for any of these searches. Two reviewers independently selected the articles in which the accuracy of serum uric acid was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 x 2 tables with maternal and fetal complications as reference standard. Summary likelihood ratios for positive (LR+) and negative LR(-) test results are generated for various threshold levels of uric acid. There were 18 primary articles that met the selection criteria, including a total of 3913 women and forty-one 2 x 2 tables. In women with pre-eclampsia, a positive test result of uric acid greater than or equal to a 350-micromol/l threshold predicted eclampsia with a pooled likelihood ratio (LR) of 2.1 (95% CI 1.4-3.5), while a negative test result had a pooled LR of 0.38 (95% CI 0.18-0.81). For severe hypertension as the outcome measure, the LRs were 1.7 (95% CI 1.3-2.2) and 0.49 (95% CI 0.38-0.64) for positive and negative test results, respectively, and for caesarean section the LRs were 2.4 (95% CI 1.3-4.7) and 0.39 (95% CI 0.20-0.76). For stillbirths and neonatal deaths the respective LRs were 1.5 (95% CI 0.91-2.6) and 0.51 (95% CI 0.20-1.3). For the prediction of small-for-gestational-age fetus, the pooled LRs were 1.3 (95% CI 1.1-1.7) and 0.60 (95% CI 0.43-0.83) for positive and negative results, respectively. AUTHOR'S CONCLUSION: Serum uric acid is a poor predictor of maternal and fetal complications in women with pre-eclampsia.