Fetal Indications Research Articles

Late termination of pregnancy at a major Queensland tertiary hospital, 2010–2020

To review rates of and indications for late pregnancy feticide at a major Queensland tertiary perinatal centre over the past decade. Retrospective cohort study. The Centre for Advanced Prenatal Care at the Royal Brisbane and Women's Hospital, a tertiary perinatal centre; feticides of singleton pregnancies of at least 22 weeks' gestation, 1 January 2010 - 31 December 2020. Indications for feticide; median gestational age at feticide; referral source; time between referral, maternal-fetal medicine review, and feticide. During 2010-2020, 305 feticides were undertaken at 22 weeks' gestation or later. The annual number of feticides increased from 20 in 2010 to 54 in 2020. The median gestational age at feticide was consistent across the decade (24+6 weeks; range, 17+0 to 37+1 weeks). The most frequent fetal indications for feticide were neurological abnormalities (110 of 305, 36%), aneuploidy or genetic syndromes (67, 22%), and cardiac malformations (59, 19%). Most women were seen for review within seven days of referral for feticide (154 of 197 for whom this information was available, 78%; median, five days; range, 0-34 days), and 136 of 197 feticides (69%) were undertaken within seven days of the initial maternal-fetal medicine review. Most late pregnancy feticides were performed because of fetal indications, primarily structural malformations or genetic abnormalities. Despite advances in prenatal imaging and diagnosis, late termination of pregnancy remains a necessary option in some pregnancies with maternal or fetal indications, and equitable access to late termination of pregnancy services is a vital component of reproductive health care.

Delivery Timing and Associated Outcomes in Pregnancies With Maternal Congenital Heart Disease at Term.

BackgroundCurrent recommendations for delivery timing of pregnant persons with congenital heart disease (CHD) are based on expert opinion. Justification for early‐term birth is based on the theoretical concern of increased cardiovascular stress. The objective was to evaluate whether early‐term birth with maternal CHD is associated with lower adverse maternal or neonatal outcomes.Methods and ResultsThis is a retrospective cohort study of pregnant persons with CHD who delivered a singleton after 37 0/7 weeks gestation at a quaternary care center with a multidisciplinary cardio‐obstetrics care team between 2013 and 2021. Patients were categorized as early‐term (37 0/7 to 38 6/7 weeks) or full‐term (≥39 0/7) births and compared. Multivariable logistic regression was conducted to calculate the adjusted odds ratio for the primary outcomes. The primary outcomes were composite adverse cardiovascular, maternal obstetric, and adverse neonatal outcome. Of 110 pregnancies delivering at term, 55 delivered early‐term and 55 delivered full‐term. Development of adverse cardiovascular and maternal obstetric outcome was not significantly different by delivery timing. The rate of composite adverse neonatal outcomes was significantly higher in early‐term births (36% versus 5%, P<0.01). After adjusting for confounding variables, early‐term birth remained associated with a significantly increased risk of adverse neonatal outcomes (adjusted odds ratio 11.55 [95% CI, 2.59–51.58]).ConclusionsEarly‐term birth for pregnancies with maternal CHD was associated with an increased risk of adverse neonatal outcomes, without an accompanying decreased rate in adverse cardiovascular or obstetric outcomes. In the absence of maternal or fetal indications for early birth, induction of labor before 39 weeks for pregnancies with maternal CHD should be reserved for routine obstetrical indications.

Prospective randomized comparative study between Sustained release vaginal insert and intracervical gel in women with unfavourable cervix at term pregnancy

Background-Induction of Labour (artificially initiated labour) is a common obstetric practice in pregnant women throughout the world, accounting for 20% of all births. Induction of Labour should be performed only when there is a clear medical indication for it and the expected benefits overweigh its potential harms. Objectives- to compare between the two formulations of dinoprostone and study the better option among the two, in cervical ripening and labour induction in women with unfavourable cervix. Methods- It was a Prospective randomized comparative study done in total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient. SPSS (Version 22.0) was used for analysis. Results- Statistically significant increase in final Bishop’s score (p=0.01) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.

Tadalafil treatment for fetuses with early-onset growth restriction: a protocol for a multicentre, randomised, placebo-controlled, double-blind phase II trial (TADAFER IIb)

IntroductionTheTADAlafil treatment for Fetuses with early-onset growth Restriction: multicentrer, randomizsed, phase II trial (TADAFER II) study showed the possibility of prolonging the pregnancy period in cases of early-onset fetal growth...

Onset and outcomes of spontaneous labour in low risk nulliparous women

ObjectivesThe objective of this study was to: 1. Establish the median gestational age of spontaneous labour for low-risk nulliparas. 2. Examine the variation in mode of delivery and short-term neonatal outcomes with gestation at onset of spontaneous labour. Study designThis is a retrospective observational cohort study conducted at a tertiary obstetric unit. The study population was 12, 323 low risk nulliparous women with singleton pregnancies who experienced spontaneous onset of labour. The study period was over seven years, from Jan 1st 2011 to 31st Dec 2017. Exclusion criteria were multiparity, multi-fetal pregnancy, booking after 14 weeks gestation, antepartum or intrapartum death, or any obstetric or fetal indication for delivery with the exception of post-maturity. Gestation of onset of spontaneous labour, demographic variables and maternal and neonatal outcomes were collected.The primary outcome was median gestational age at onset of spontaneous labour and its distribution at term. Secondary outcomes were mode of delivery and neonatal outcomes including low-apgar score and NICU admission. Results12, 323 patients were eligible for inclusion. Median gestation for onset of labour was 40.1 weeks gestation, with 80.5% of spontaneous labour occurs by 41 + 0 weeks gestation. The risk of assisted delivery (RR 1.32, 95% CI 1.23 – 1.42), caesarean section (RR 2.17, 95% CI 1.88–2.51) and low-apgar scores (RR 3.13 95% CI 1.50–6.55) increased significantly with spontaneous labour after 41 weeks’ gestation. ConclusionsNulliparous women with low-risk pregnancies are most likely to experience spontaneous labour between 40 + 0 and 40 + 6. 80.5% of spontaneous labour occurred by 41 + 0 weeks gestation. Assisted vaginal delivery, caesarean section and low-apgar scores were significantly more likely with spontaneous labour after 41 weeks’ gestation.

Utility of blood cultures in preterm infants born by cesarean delivery due to non-infectious maternal or fetal indications.

Utility of blood cultures in preterm infants born by cesarean delivery due to non-infectious maternal or fetal indications.

The impact of neonatologist performed echocardiography in an Italian neonatal unit.

The main goal of neonatologist performed echocardiography is to timely assess hemodynamic changes in order to properly manage unsteady neonates. Detailed structural heart assessment remains the domain of pediatric cardiologists. Nonetheless, many neonatologists take on an additional role in diagnosis of congenital heart defects, mostly compelled by the lack of in-house pediatric cardiology services. The experience of neonatologist performed echocardiography in an Italian neonatal unit was reported and the risk benefit profile of this practice was discussed. We retrospectively reviewed the echocardiograms undertaken by the neonatologist on infants admitted to the neonatal unit and postnatal ward of the Hospital San Pio in Benevento, over a 2-year period. Details of scans and concordance between neonatologist and cardiologist were analyzed. A total of 160 echocardiographic studies were done by the neonatologist on 136 infants. The ECG was requested in a minority of infants. The most common reason for performing the echocardiogram was admission to the neonatal care unit. Around half of the echocardiograms were normal. The remaining scans resulted in functional and structural abnormalities, transitional changes, and doubtful findings. Cardiac anomalies were significantly more likely found in cases of echocardiograms performed for fetal indications. Only 28 patients were eventually referred to the cardiology services. The inter-rater agreement was satisfactory. The hemodynamic assessment of sick infants, as well as triaging and referral of neonates with structural heart diseases are valuable advantages of the echocardiography run by neonatologists.Collaboration with pediatric cardiologists and robust training and accreditation programs are essential to ensure safety and quality service.

Impact of COVID-19 on termination of pregnancy

Objective: To evaluate the impact of COVID-19 pandemic on termination of pregnancy. Methods: This was a retrospective study aimed to assess the impact of COVID-19 pandemic on termination of pregnancy in a single center in Italy. Consecutive data on pregnant women who requested induced termination of pregnancy (I-TOP) from February 2018 to December 2021 were included in a dedicated database. The data were divided into two groups according to the COVID-19 outbreak. Women who requested I-TOP from February 2018 to January 2020 were included into the group ‘before COVID-19 pandemic’. Women who requested I-TOP from February 2020 to January 2022 were included into the group ‘during COVID-19 pandemic’. Indications for I-TOP included elective abortion and therapeutic for fetal or maternal indication. Results: A total of 2578 women were included in the study. Of them, 1637 had I-TOP before COVID-19, and 941 had I-TOP during COVID-19. During the pandemic, the request for elective abortion decreased from 76.2% to 67.7% (p&lt;0.01). Therapeutic abortion were performed in 141/693 cases in the first trimester, and in 552/693 cases in the second trimester. Overall, 91 were for maternal indications and 602 for fetal indications. No differences were noticed between before and during pandemic (p=0.99). Follow-up visits two weeks after abortions were offered to all women. However, only 35.5% women visited for follow-up during pandemic vs. 65.0% before COVID-19 (p&lt;0.01). Conclusion: The COVID-19 pandemic had impact on access to abortion services, reducing request for elective abortion and post-abortion follow-up visits.

Need for Further Medical Attention to Nonreassuring Cardiotocography Near Delivery in High-Risk Pregnancies

Background: Fetal cardiac monitoring indications during labor and near delivery in high- and low-risk pregnancies and their effects on neonatal outcomes have been investigated in previous studies; however, the data of nonreassuring cardiotocography (CTG) near delivery on neonates are insufficient. Objectives: This study aimed to compare fetal distress with nonreassuring CTG in high- and low-risk pregnancies to see if high-risk pregnancies need different or more care or not. Methods: This retrospective cohort study was conducted on pregnant women candidates for vaginal delivery in an academic hospital within 2017 - 2020. The participants were divided according to maternal and fetal risk factors into two groups of low-risk and high-risk pregnancies (including preeclampsia/eclampsia, diabetes, placenta abruption, and intrauterine growth restriction). Three obstetricians, blinded to the participants and neonatal outcomes, reviewed the CTG tracing near delivery individually. The features of nonreassuring CTG 30 minutes before delivery, including variable deceleration, late deceleration, slow return to base, tachycardia, and shoulder and overshoot patterns, were detected in the traces. Then, the neonatal outcomes, including umbilical artery pH at birth, Apgar scores at the 1st and 5th minutes, and admission to the neonatal intensive care unit (NICU), were compared between the groups. Results: A total of 622 participants, including 322 high-risk and 300 low-risk pregnancies, with nonreassuring CTG, were recruited into the study. The adverse neonatal outcomes, such as NICU admission, low Apgar scores in the 1st and the 5th minutes, and pH &lt; 7.1, were significantly different between high-risk and low-risk pregnancies with variable deceleration, tachycardia, and overshoot patterns. High- and low-risk pregnancies with late deceleration had only significantly different Apgar scores in the 5th minute. In the slow return to base features, the Apgar scores in the 1st and 5th minutes and NICU admission were significantly different in high- and low-risk groups. Additionally, NICU admission and low Apgar score in the 1st minute were higher in high-risk women in shoulder patterns. Conclusions: Nonreassuring CTG near delivery might be accompanied by more fetal distress in high-risk pregnancies. Therefore, the nonreassuring features of CTG in high-risk pregnancies should be considered more important and might need prompt and timely action to decrease the adverse outcomes.

Preserving women’s reproductive autonomy while promoting the rights of people with disabilities?: the case of Heidi Crowter and Maire Lea-Wilson in the light of NIPT debates in England, France and Germany

On July 2021, the UK High Court of Justice heard the Case CO/2066/2020 on the application of Heidi Crowter who lives with Down’s syndrome, and Máire Lea-Wilson whose son Aidan...

Predisposing Factors and Outcome of Preterm Birth in a Tertiary Hospital

Preterm birth is a challenging issue for both mother and baby, and pose major threat to newborn survival. The purpose of this study was to find out the magnitude of preterm birth, factors predisposing to preterm birth and its outcome during perinatal period. This was a cross sectional study, conducted among mothers admitted with a gestational age &gt; 28 weeks to &lt; 37 weeks in Obstetrics and Gynae department of Institute of Child and Maternal Health (ICMH). During March-June, 2013, data was collected through face to face interview using structured questionnaire and review of hospital records. Data analysis done using SPSS version 20. Among enrolled 103 women mean age was 23.3±4 years, 64% were multigravida, about 78% were late preterm (35-37 weeks). Commonest associated factor was premature rupture of membrane (53.7%). Other factors were Preeclampsia (16%), UTI (12%) and moderate anaemia (75%). Neutrophilia was found in 7.6%, urinary pus cell raised in 37% and vaginal infection was found in 7.6%. Corticosteroids was given for lung maturity to 55% and Tocolytics used in 11 % mothers. About 50% born by CS, 24% by Obstetric Forceps and 26% by spontaneous vaginal delivery. Puerperal Pyrexia was the most common postpartum complication. Delayed cry was in 66%, , 56% required admission to neonatal ward, of them 91% and 45% belong to gestation age 28-34 weeks and 35-37 weeks respectively. Perinatal death was in 2%, 24.3% had neonatal jaundice and 29 % developed septicemia Preterm birth is associated with several risk factors like paternal smoking, high parity, infection and premature rupture of membrane. Change in obstetric practices in favor of early termination by caesarean section for maternal or fetal indication is also an important determining factor for preterm birth. Awareness among health professionals and public should be made for avoidance of risk factors and adoption of risk specific strategies may contribute to reduction of preterm births and its complications.&#x0D; Bangladesh J Obstet Gynaecol, 2020; Vol. 35(2): 74-80

Caesarean Myomectomy: Safety and Feasibility of The Procedure

Introduction: Frequency of uterine myomas has increased these days with factors like delayed child bearing and IVF conception in elderly pregnant women. The vascularity of uterus increased and thus myomectomy during caesarean was considered a risk. With advanced surgical techniques the risk has become minimal these days. Case Report: 42 year G4P3L3 presented with 36 weeks gestation with USG s/o 3 large uterine fibroid, 2 subserosal fibroids with largest of size 7.1 x 6.3 x 7.2 cms, and 1 intramural fibroid. Emergency LSCS was done for her due to fetal indication. Due to emergency nature of surgery the option of preoperative uterine artery embolisation was not feasible and hence decision of stepwise de-vascularisation was taken. The de-vascularisation was done at the level of B/L uterine arteries, utero ovarian anastomosis bilaterally followed by removal of the three myomas. Discussion: Majority of myomas do not require surgical intervention during pregnancy or delivery. It has been repeatedly stated in the literature that routine myomectomy during cesarean section should be avoided and should only be carried out in carefully selected patients. In our case, stepwise devascularisation was required to control the bleeding. Proper devascularization and experienced obstetricians can reduce the incidence of haemorrhage and hysterectomy. The approximate blood loss was only 400 ml signifying the importance of this approach to myomectomy during caesarean section.

Placental growth factor level is correlated with intrapartum fetal heart rate findings

ObjectiveHere, we tested the correlation between maternal placental growth factor (PlGF) and fetal heart rate (FHR) monitoring findings.MethodsWe included 35 women with single pregnancies from 35 to 42 weeks of gestation who were hospitalized owing to onset of labor. Blood samples were collected at the start of labor. Intrapartum FHR monitoring parameters included total deceleration area, average deceleration area (mean deceleration area per 10 min), and five-tier classification level.ResultsOf the 35 women, 26 (74%) had vaginal delivery and 9 (26%) had cesarean section. After excluding 2 women who had cesarean section for arrest of labor, we analyzed 26 women who had vaginal delivery (VD group) and 7 who had cesarean section for fetal indications (CSF group). PlGF level was significantly higher in the VD group (157 ± 106 pg/ml) than in the CSF group (74 ± 62 pg/ml) (P = 0.03). There were no significant correlations between PlGF and total (r = -0.07) or average (r = -0.08) deceleration area. There was a significant negative correlation (r = -0.42, P = 0.01) between PlGF and the percentage of level 3 or higher in the five-level classification.ConclusionPlGF was correlated with FHR monitoring findings and might be a promising biomarker of intrapartum fetal function.

How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy?

Pregnancy is a delicate state, during which timely investigation of possible physiological anomalies is essential to reduce the risk of maternal and fetal complications. Medical imaging encompasses different technologies to image the human body for the diagnosis, course of treatment management, and follow-up of diseases. Ultrasound (US) is currently the imaging system of choice for pregnant patients. However, sonographic evaluations can be non-effective or give ambiguous results. Therefore, magnetic resonance imaging (MRI), due to its excellent tissue penetration, the possibility of acquisition of three-dimensional anatomical information, and its high spatial resolution, is considered a valid diagnostical alternative. Nevertheless, currently employed contrast agents to improve the MRI image quality are harmful to the fetus. Because of their ability to cross the placenta, their use on pregnant patients is avoided. This review will firstly recapitulate the most common non-obstetrical, obstetrical, and fetal indications for magnetic resonance imaging on pregnant women. Fetal safety risks, due to the use of strong magnetic fields and exogenous contrast agents, will be presented. Then, possible advantages of nanostructured contrast agents compared to current molecular ones are explored. Nanosystems’ characteristics affecting contrast efficiency, and their potential for improving contrast-enhanced MRI’s safety in pregnant women, are discussed. Lastly, promising examples of nanoparticles as safer alternatives to current MRI contrast agents in pregnancy are discussed.

Pregnancy Complications, Correlation With Placental Pathology and Neonatal Outcomes.

We aimed to clarify and contribute to a better comprehension of associations and correlations between placental histological findings, pregnancy evolution, and neonatal outcomes. This is a longitudinal and prospective observational study, performed between May 2015 and May 2019, on 506 pregnant women. Clinical data related to pregnancy outcome, neonatal health status, and placental histology were primarily collected. Twin pregnancies or malformed newborns were excluded and therefore the study was conducted on 439 cases. These cases have been then subdivided into the following study groups: (a) 282 placentas from pathological pregnancies; and, (b) a control group of 157 pregnancies over 33 weeks of gestational age, defined as physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies, most of which had undergone elective cesarean section for maternal or fetal indication. A normal placenta was present in 57.5% of normal pregnancies and in 42.5% of pathological pregnancies. In contrast, placental pathology was present in 26.2% of normal pregnancies and 73.8% of pathological pregnancies. Comparison of the neonatal health status with the pregnancy outcome showed that, among the 191 newborns classified as normal, 98 (51.3%) were born from a normal pregnancy, while 93 (48.7%) were born from mothers with a pathological pregnancy. Among the 248 pathological infants, 59 (23.8%) were born from a mother with a normal pregnancy, while 189 (76.2%) were born from pregnancies defined as pathological. Placental histology must be better understood in the context of natural history of disease. Retrospective awareness of placental damage is useful in prevention in successive pregnancy, but their early identification in the evolving pregnancy could help in association with biological markers or more sophisticated instruments for early diagnosis.

Uptake of prenatal genetic diagnosis and termination of pregnancy by Omani Muslim families at risk of genetic disorders: experience over a 9-year period.

Studies on the acceptance of prenatal diagnosis and termination of pregnancy for single gene disorders within Islamic societies in the Middle East are limited. A few have examined the attitudes toward pregnancy termination for fetal indications, but a dearth of published data exists on actual behavior and uptake. This study reports on all prenatal diagnosis requests for single gene disorders, from the Sultanate of Oman, over 9 years. A retrospective study was conducted during which the medical records of all women who performed prenatal diagnoses for single gene disorders were reviewed. A total of 148 invasive procedures were performed for 114 families. The total number of yearly requests for prenatal diagnosis increased exponentially from three in 2012 to 21 in 2020. Sixty-four different diagnoses were tested for with the majority being autosomal recessive in nature. Seventy-one percent (28/39) of cases where an affected pregnancy was identified were terminated. Fifty-two of the 114 women (45.6%) repeated prenatal diagnosis in a future pregnancy. Seventy-two couples (63%) were consanguineous parents related as second cousins or closer. The majority of tests performed were for couples from Muscat (27%), Albatinah (27%), and Alsharqiya (20.3%) governorates in Oman. The findings of this study provide evidence that prenatal diagnosis is an acceptable reproductive option to prevent the occurrence of genetic disorders that meet termination eligibility criteria as outlined by the Islamic Jurisprudence (Fiqh) Council Fatwa, among Omani Muslim couples.

Repeat Cesarean Section among Pregnant Women in a Tertiary Center of Nepal: A Descriptive Cross-sectional Study.

Cesarean Section is the most common obstetrics surgery done for both maternal and fetal indications. There is a rising trend of cesarean section rates which is associated with increased maternal morbidities. This study aims to find out the prevalence of repeat Cesarean Section among women with previous cesarean sections done in a tertiary centre. This was a descriptive cross-sectional study conducted in a tertiary care hospital of Nepal from August 2020 to January 2021. Pregnant women with previous Cesarean Section status without other pelvic surgery and medical comorbidities were included and data were collected regarding intraoperative findings. Ethical approval was taken from the Institutional Review Committee (Reference Number: 14). A convenience sampling technique was used. Data were analysed using Statistical Package for the Social Sciences version 22. Point estimate at 95% Confidence Interval was calculated, with frequency and percentage. Out of 1315 patients undergoing Cesarean Section, the prevalence of Repeat Cesarean Section was found to be 184 (13.99%) (12.11-15.86 at 95% Confidence Interval). The prevalence of Repeat Cesarean Cection from our study was similar to other studies done in similar settings. Repeat Cesarean Cection confers peri-operative morbidities which adversely affect postoperative recovery. Repeat Cesarean Cection continues to contribute to morbidity over subsequent pregnancies and serious maternal morbidity.

ON PATIENT SAFETY: IMPLEMENTATION OF THE M. ROBSON CLASSIFICATION AS A POSSIBILITY TO CONTROL THE FREQUENCY OF CESAREAN SECTION

Purpose. Delivery by caesarean section (CS) is now becoming an “epidemic” — in some countries it reaches 50% or more; often the operation is carried out at the request or the slightest doubt of the woman. An increase in CS frequency is not always accompanied by a predicted improvement in perinatal mortality. Objective: To develop a strategy for women to gain a positive pregnancy experience based on the analysis of the frequency of caesarean section in the database of a linear maternity hospital using the Robson classification. Materials and methods. Retrospective analysis of childbirth histories of an urban maternity hospital with a specialization in preterm birth management in 2015–2019. Research results. When analyzing 10,345 births, it was found that 3598 or 34.78% of women were delivered by CS surgery. The frequency of CS in group 1 averages (15.71±2.34)% (12.93–20.03)%. Most often, primary CS is performed in the 2nd (84.45±1.62)%, 4th (68.97±4.93)% and 6th (97.08±1.7)% groups, and these groups are subsequently the largest in terms of repeated CS. Traditionally, a high frequency of CS is noted in the 7th (96.69±2.05)%, 8th (86.66±7.02)% and 10 groups (40.02±5.14)%. The most common indications for primary CS were fetal distress, breech presentation, multiple pregnancies, obstructive labor, and extragenital indications. It is necessary to note the socio-ethical indications as an urgent requirement of the patient. Conclusions. The use of Robson’s classification made it possible to determine the main directions for improving the organization of medical care for women in labor in order to ensure safe childbirth: the development of uniform standards and their active implementation in the group of pregnant women in need of pre-induction and induction of labor, training and active use of simulation methods of training medical personnel in the management of childbirth. in breech presentation and multiple pregnancies, prevention of premature birth, psychoprophylactic work with women and family members. Key words: cesarean section, Robson’s classification.

Platelet Changes in Pregnancies with Severe Early Fetal Intrauterine Growth Restriction.

Background and Objectives: In this study, we investigated the changes of platelet count and other platelet indices, such as mean platelet volume (MPV), in cases with severe early intrauterine fetal growth restriction (IUGR). Materials and Methods: We retrospectively analyzed all pregnancies diagnosed with severe early onset IUGR, that were followed up in our hospital between 2010 and 2015 (before implementation of screening and prophylaxis with aspirin). Pregnancies which resulted in birth of a newborn with a birthweight less than 5th percentile for gestational age, that required delivery for fetal or maternal indication before 32 weeks, were selected for the IUGR group. The IUGR cases were divided into two groups according to preeclampsia (PE) association. All cases with a complete blood count (CBC) performed within 7 days prior to delivery were included in the study, as the IUGR group. The control group included normal singleton pregnancies, delivered at term, with birthweight above 10th centile and a CBC taken at 30–32 weeks. Results: There was a significant difference in platelet count and MPV values between the IUGR group and control. Cases with IUGR presented lower platelet count and higher MPV values; there was no significant difference of these parameters when PE was associated with IUGR. Conclusions: Our results suggest that in cases of severe early IUGR, even in the absence of clinically diagnosed PE, there may be maternal endothelial damage and platelet consumption in the systemic and uteroplacental circulation. Platelet count and MPV values are simple and widely available laboratory tests that might be used as indicator of placental insufficiency; however, prospective data are required to establish the mechanistic link and to which extent these parameters are good predictors of severity or adverse perinatal outcomes.

Pregnancy outcomes in women with hyponatraemia and preeclampsia: Case series and literature review.

To determine the prevalence, clinical course, complications and management of preeclampsia complicated by hyponatraemia. A ten year retrospective audit of women delivering at a tertiary referral hospital with preeclampsia complicated by hyponatraemia (defined as serum sodium<130mmol/L). The prevalence, time to delivery, complications, treatment and time to recovery of hyponatraemia in women with preeclampsia associated with hyponatraemia. There were 129 cases of preeclampsia associated with hyponatraemia, representing 9% of women with preeclampsia, and 0.27% of deliveries overall. Hyponatraemia was associated with a significant rate of complications of preeclampsia; acute kidney injury in 34.1%, HELLP syndrome in 17.1%, fetal growth restriction in 36.4%, stillbirth in 2.3%, the use of magnesium sulphate in 44.2%, and postpartum maternal admission to an intensive care unit in 28.7%. Moderate/severe hyponatraemia was associated with greater risk of acute kidney injury, fetal growth restriction and post-partum maternal admission to an intensive care unit than mild hyponatraemia. Urgent delivery was required in 71% of women for either obstetric or fetal indications within 24h of diagnosis of moderate/severe hyponatraemia. In almost all cases, hyponatraemia rapidly resolved postpartum without requirement for fluid restriction or intravenous saline. Hyponatraemia should be regarded as a marker of severity in the setting of preeclampsia, and in the absence of an alternative cause may be an indication for expedited delivery. Hyponatraemia typically recovers rapidly following delivery without the need for specific therapy.