Fetal Outcomes In Women Research Articles

Clinical characteristics and fetal outcomes in women with epilepsy with planned and unplanned pregnancy: A retrospective study

PurposeTo compare the antiepileptic drug (AED) treatment patterns, seizure control, and folic acid supplementation between planned and unplanned pregnancy in women with epilepsy (WWE) and to investigate the effects of planned pregnancy on fetal outcomes. MethodsA prospectively collected database including WWE with pregnancy from Feb 2010 to Dec 2018 was retrospectively analyzed. Planned pregnancy was defined as WWE being regularly supervised by epileptologists from the time of intended pregnancy until delivery. Clinical characteristics and fetal outcomes were compared between the planned and unplanned pregnancy groups. Logistic regression was used to identify modifiable factors associated with adverse fetal outcomes. ResultsA total of 188 planned pregnancies and 289 unplanned pregnancies were enrolled in our study. Among planned pregnancies, 66.0 % took AED monotherapy, and 32.4 % received polytherapy. Among unplanned pregnancies, 58.1 % didn’t take AEDs, 28.0 % took monotherapy, and 12.8 % received polytherapy. The planned pregnancies had less generalized tonic-clonic seizures (P = 0.002) and higher proportion of being seizure-free (41.0 % vs. 22.8 %; P <0.001). All planned pregnancies took folic acid while 39.8 % of unplanned pregnancies never took it (P <0.001). The planned pregnancies had less rates of induced abortions (2.7 % vs. 13.5 %; P <0.001), preterm births (3.3 % vs. 20.4 %; P <0.001), and major congenital malformations (1.6 % vs. 7.5 %; P = 0.016). Pregnancy planning was independently associated with adverse fetal outcomes (adjusted OR, 0.14; 95 % CI, 0.08−0.27; P <0.001). ConclusionPlanned pregnancy in WWE contributes to more optimized AED pattern, better seizure control, more appropriate folic acid supplementation, and less adverse fetal outcomes.

Treatment outcome of different antiretroviral drug regimens in HIV-positive pregnant women.

Objective:The objective of the study was to compare the maternal and fetal outcomes of currently preferred tenofovir-based regimen with previous zidovudine-based regimen and also to determine whether the time of starting antiretroviral therapy (ART), whether it can affect the pregnancy and fetal outcome.Materials and Methods:Pregnant patients prescribed any of the above regimens were followed up every month till delivery and newborns for initial 6 months. Maternal endpoints were body weight, hemoglobin, and CD4 count, whereas fetal endpoints were birth weight, Apgar score, body weight, and HIV status at 6 months. Data were analyzed using ANOVA and unpaired t-test. P <0.05 was considered statistically significant.Results:A significant increase in CD4 count was observed in patients treated with both the regimens at 12 months as compared to baseline (P < 0.001 and 0.05). Moreover, a significant increase in CD4 count was observed at 12 months as compared to baseline, whether treatment was started before or after the diagnosis of pregnancy (P < 0.05 and 0.001). A significant difference in mean body weight at the end of 9 months was observed in patients wherein ART was started before or after the diagnosis of pregnancy (P < 0.005). Majority of patients had a favorable maternal outcome, while fetal birth weight, Apgar score, body weight, and HIV status were comparable at 6 months irrespective of treatment and time of starting ART.Conclusion:All ART regimens are equally effective in terms of increase in CD4 count, gestational gain in body weight, and pregnancy and fetal outcome. Furthermore, there is no significant difference in efficacy, pregnancy, and fetal outcome in women who were already on ART when diagnosed pregnancy or who were started ART later in antenatal period.

Effect of low dose aspirin on fetal outcome in women at risk for developing pregnancy induced hypertension

Background: Though pregnancy induced hypertension is a worldwide problem, it is more prevalent in developing countries particularly south east Asian and African countries. It contributes to 20% of perinatal death and 40-50% of low birth weight babies in India. Fetal salvage is also an important consideration in providing quality care. Low dose aspirin given between 12 weeks to 28 weeks of gestational age in high-risk women at Developing Pregnancy Induced Hypertension (PIH) is anticipated to prevent the development of PIH and complications that arises especially those regarding maternal and fetal mortality due to PIH.Methods: This prospective randomized controlled trial was conducted in the dept of O and G, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13 to 28 week were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group taking placebo.Results: Incidence of IUGR babies in low dose aspirin treated mothers was as low as 1%. Incidence of LBW babies is lower in low dose aspirin treated mothers than with those who were not treated. Mean birth weight in cases was 2780 gm±352 gm vs control 2592 gm±483 gm. There is increased incidence of still birth in high risk group not treated with aspirin. No significant difference in reducing incidence premature deliveries between case and control.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy and its complication like IUGR and low birth weight. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

Hypothyroidism and pregnancy: still a controversial issue

Subclinical hypothyroidism (SCH) in pregnancy is common, according to literature, affecting up to 15% of pregnancies. It still represents a controversy weather levothyroxine has beneficial effects on pregnancy outcomes. In this retrospective and prospective cohort study, we assessed fetal and maternal outcomes in women with known thyroid status pre-pregnancy, and hypothyroidism during pregnancy. We included 393 pregnant women, 90 (22.9%) diagnosed with overt and 303 with SCH (77.1%). A total of 94 (56%) had positive anti-TPO antibodies. Levothyroxine substitution across all observational periods was suboptimal, mostly during first trimester in both groups of patients (85.4%). There was a difference in the number of live births in favor of group with SCH (p = .004). Women with overt hypothyroidism were more likely to develop complications during pregnancy (RR = 1.153, 95%CI = 0.775 − 1.714) and had positive TPO-antibodies more often (p = .022). The only significant association was found between fetal outcomes in women with SCH and positive TPO-antibodies (p = .018), while positive Tg-antibodies did not affect the pregnancy outcomes of women with SCH. Moreover, no correlation was observed between outcomes and adequacy of levothyroxine substitution. These results indicate that TPO-antibody positivity could be the most important factor of pregnancy outcomes independent of the TSH levels or adequacy of levothyroxine therapy.

Risk of pregnancy-related venous thromboembolism and obstetrical complications in women with inherited type I antithrombin deficiency: a retrospective, single-centre, cohort study

Inherited quantitative (type I) deficiency of plasma antithrombin is associated with a high risk of venous thromboembolism, which further increases in pregnancy. Inherited thrombophilia also increases the risk of obstetrical complications, but data on maternal and fetal outcomes in women with antithrombin deficiency are scarce. The aim of this study was to evaluate the risk of pregnancy-associated venous thromboembolism and obstetrical complications in women with type I antithrombin deficiency. In this single-centre, retrospective cohort study, women who had been referred to our Hemophilia and Thrombosis Centre, Milan, Italy for a thrombophilia work-up from Jan 1, 1980, to Jan 1, 2018, with type I antithrombin deficiency and who had had at least one pregnancy were included. Women with type II anthithrombin deficiency were excluded from the study. Data on pregnancy-associated venous thromboembolism, pregnancy outcomes, and the use of low-molecular-weight heparin (LMWH) were collected to evaluate the risk of pregnancy-associated venous thromboembolism and obstetrical complications with or without use of LMWH. 126 women had been referred to the hospital, of whom 88 (70%) had had at least one pregnancy. Eight were excluded because of referral for venous thromboembolism during pregnancy or the puerperium, resulting in 80 (63%)women evaluated for the risk of venous thromboembolism. One woman was excluded because of referral for obstetrical complications, resulting in 87 (69%) evaluated for risk of obstetrical complications. We observed three events of venous thromboembolism in 43 pregnancies in women treated with LMWH (7·0%, 95% CI 1·8-17·8), and 17 events in 146 pregnancies in women who did not receive LMWH (11·6%, 7·2-17·6; relative risk [RR] 0·6, 95% CI 0·2-1·9; p=0·57). The risk of venous thromboembolism without LMWH was 5·4% (95% CI 0·9-16·7) in women with a negative family history of venous thromboembolism, and 11·8% (6·4-19·6) in those with a positive family history of venous thromboembolism. Of the 87 women evaluated for the risk of obstetrical complications, miscarriages occurred in 6 (13%) of 45 pregnant women treated with LMWH and 32 (20%) of 161 women who did not receive LMWH (terminations excluded). Late obstetrical complications occurred in 11 (24%) of women treated with LMWH and nine (6%) in those who did not receive LMWH (RR 4·4, 95% CI 1·9-9·9; p=0·0006). Our results confirm that women with type I antithrombin deficiency have a high risk of first or recurrent venous thromboembolism during pregnancy. The risk of venous thromboembolism is highest in women with a positive family history of the condition, but still relevant in those with a negative family history, suggesting that LMWH prophylaxis should also be considered in these patients. None.

368: Neonatal morbidity and mortality in women with successful external cephalic version and naturally cephalic presentation

External cephalic version (ECV) is an option for women with fetal malpresentation desiring to have a trial of vaginal birth. For those with successful version to cephalic presentation, the associated risks for adverse delivery outcomes compared to naturally cephalic presenting women are unclear. The purpose of our study was to compare maternal and neonatal outcomes between women with successful ECVs and women with naturally cephalic presentations. We conducted a retrospective, population-based cohort study on singleton, term pregnancies using vital statistics data from the United States’ National Center for Disease Control and Prevention (CDC) during the years 2015-2016. Multivariate logistic regression was used to compare the maternal and fetal outcomes of women who underwent successful ECVs with women who had naturally cephalic presentations. During the study period, 9,847 successful ECVs were performed and 6, 330,128 women had cephalic presentations. Women who had successful ECVs were more frequently older in age and multiparous. After adjustment for baseline maternal characteristics, women who underwent a successful ECV were more likely to deliver by cesarean section (OR 1.06, 95% CI 1.01-1.13), to have an instrumental vaginal birth (forceps 2.14, 1.78-2.58; vacuum 1.73, 1.57-1.90), to be induced (2.10, 1.59-1.73), to require a transfusion (2.10, 1.57-2.79), to have an unplanned hysterectomy (3.72,1.93-7.16), and to be admitted to the ICU (2.22, 1.40-3.53). Perinatal death was more common among neonates of women who underwent a successful ECV (1.60, 1.13-2.26), as was the need for assisted ventilation (1.35, 1.20-1.52), the occurrence of seizures (2.72, 1.36-5.45), and admissions to the NICU (1.19, 1.08-1.30). Relative to subjects with a naturally cephalic presentation, women who underwent a successful ECV were at greater risk for maternal and neonatal morbidity and neonatal mortality. These patients should be more closely monitored during the postpartum period.

493: The effect of fetal sex on maternal and fetal outcomes in women with gestational diabetes

493: The effect of fetal sex on maternal and fetal outcomes in women with gestational diabetes

Maternal and Fetal Outcomes in Pregnancies Complicated by Intrahepatic Cholestasis.

This study aimed to report the maternal and fetal outcomes in women with intrahepatic cholestasis of pregnancy (ICP). The maternal and fetal outcomes in 70 consecutive women who gave birth at Ataturk University Hospital between January 2012 and December 2017 were assessed. The clinical diagnosis of ICP and diagnosis confirmed post-delivery when all the symptoms regressed and laboratory parameters returned to normal was utilized. Liver transaminases were elevated in 61 (87%) women. The median week of delivery was 37 (range, 26-42) and the preterm delivery rate was 40% (28 women delivered spontaneously at ≤36 weeks of gestation). Preeclampsia was noted in 8 (11%) women. There were no cases of stillbirth or neonatal death. The rate of stillbirth does not increase in women with ICP. However, further investigations are needed to determine if this result is related to preterm birth.

Correlation of Serum Uric Acid Level to Perinatal Outcome in Preeclamptic Women

Background: Hypertensive disorders are common in pregnancy. Several studies showed a positive correlation between elevated maternal serum creatinine and adverse maternal and fetal outcomes in pre eclamptic women, but only a few studies are available on serum creatinine and maternal and fetal outcomes. The present study was under taken to study the association of maternal serum uric acid with fetal outcomes in pre eclamptic women. Aim and objective: To Study correlation of serum uric acid level to perinatal outcome in preeclamptic women: Material and Methods : The Study was performed on two groups of women with hypertensive disorders of pregnancy; the first group (n=50) with a serum uric acid level of ≥6mg/dl was compared to the second group (n=50) with a serum uric acid level of &lt;6mg/dl. Perinatal complications like IUFD (Intra-Uterine Fetal Death), low APGAR score, IUGR (Intra-Uterine Growth Retardation) NICU admissions, prematurity and perinatal death were studied. Results: In the present study perinatal outcome was studied among 100 pre eclamptic women. In group A, there were 22 pre-term babies , 20 IUGR and 41 babies had low APGAR (&lt;7) In group B, 9 preterm babies, 12 IUGR, 28 babies with low APGAR (&lt; 7). So these entire abnormal fetal outcomes were higher in Group A (uric acid ≥6mg/dl) .In group A, there were 29 babies required NICU admission, 11 perinatal deaths. In group B, 17 babies required NICU admission and 5 perinatal deaths. Conclusion: Maternal serum uric acid concentration is a good predictor of foetal outcome in women with preeclampsia/ eclampsia. Key words: Uric acid, Creatinine, Pre eclampsia, Gestational age , Birth weight

Pregnant Women With Uncorrected Congenital Heart Disease: Heart Failure and Mortality

ObjectivesThe purpose of this work was to study maternal and fetal outcomes of women with uncorrected congenital heart disease (CHD). BackgroundGlobally, CHD is an important cause of maternal morbidity and mortality in women reaching reproductive stage. Data are lacking from larger cohorts of women with uncorrected CHD. MethodsThe 10-year data from the European Society of Cardiology EORP ROPAC (EURObservational Research Programme Registry of Pregnancy and Cardiac disease) registry of women with uncorrected CHD were analyzed. ResultsOf 5,739 pregnancies in 53 countries, 3,295 women had CHD, 1,059 of which were uncorrected cases. Of these, 41.4% were from emerging countries. There were marked differences between the cardiac defects in uncorrected cases versus those in corrected CHD cases with primary shunt lesions (44.7% vs. 32.4%, respectively), valvular abnormalities (33.5% vs. 12.6%, respectively), and Tetralogy of Fallot and pulmonary atresia (0.8% vs. 20.3%, respectively; p < 0.001). In patients with uncorrected CHD, 6.8% were in modified World Health Organization risk class IV, approximately 10% had pulmonary hypertension (PH), and 3% were cyanotic prior to pregnancy. Maternal mortality and heart failure (HF) in the women with uncorrected CHD were 0.7% and 8.7%, respectively. Eisenmenger syndrome was associated with a very high risk of cardiac events (65.5%), maternal mortality (10.3%), and HF (48.3%). Coming from an emerging country was associated with higher pre-pregnancy signs of HF, PH, and cyanosis (p < 0.001) and worse maternal and fetal outcomes, with a 3-fold higher rate of hospital admissions for cardiac events and intrauterine growth retardation (p < 0.001). ConclusionsMarked differences between cardiac conditions in pregnant women with uncorrected CHD and those in corrected CHD were found, with a markedly worse outcome, particularly in women with Eisenmenger syndrome and from emerging countries.

1406-P: Associations between Indices of Glycemic Variability (GV) and Gestational Outcomes among Pregnant Women with Type 1 Diabetes (T1D)

Pregnancies associated with diabetes are at high risk of adverse health outcomes. We examined associations between indices of glycemia and GV, assessed by continuous glucose monitoring, and maternal and fetal outcomes in women with T1D. Women with T1D were stratified to groups during preconception or the 1st trimester: (1) CGM Alone (n=13): women without Apple devices, or (2) CGM Share (n=15, DexCom, San Diego, CA): women with iPhone and followers with data viewing devices. Association between change in GV indices over time and gestational outcomes were measured with linear mixed models. Preeclampsia developed in 28.6% (8/28) of women. Preeclampsia was significantly associated with higher estimated A1C, mean sensor glucose, and time spent &amp;gt;140 mg/dL, and with lower time spent &amp;lt;65 mg/dL and 65-140 mg/dL (Table 1). Gestational age at delivery was 36.7 ± 1.7 weeks (mean ± SD). Gestational age at delivery was associated with lower estimated A1C (0.11% decrease A1C per 1 week increased gestational age, p=0.02), mean sensor glucose, and time spent &amp;gt;140 mg/dL, and with higher time in range (Table 2). There were no associations found between GV indices and cesarean delivery, delivery &amp;lt;37 weeks, large-for-gestational age infants, birth weight, and neonatal hypoxemia. Preeclampsia and gestational age at delivery were associated with worse A1C and CGM metrics, but not with GV indices. Disclosure S. Polsky: Consultant; Self; Jaeb Center for Health Research. Research Support; Self; Barbara Davis Center for Diabetes, Children's Diabetes Foundation, Dexcom, Inc., Eli Lilly and Company, JDRF, Leona &amp; Harry Helmsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US. L. Pyle: None. R. Garcetti: None. P. Joshee: None. J.K. Demmitt: None. T.B. Vigers: None. J.K. Snell-Bergeon: None. Funding Dexcom, Inc.; National Center for Research Resources/Colorado Clinical and Translational Science Institute (UL1RR025780)

Role Of Uterine Artery Doppler For Prediction Of Fetal Outcome In Preeclamptic Patients

Objective: The aim of this prospective observational study is to assess the accuracy of Doppler indices of uterine artery during the third trimester in predicting poor fetal outcome in women with preeclampsia. Methods: Study design: Cohort observational study among women with preeclampsia. Study setting: One hundred cases who were at 32 to 40 weeks of gestation with preeclampsia(from March 2017 to March 2018) attended antenatal clinic and emergency room at obstetrics and gynecology department, faculty of medicine, Sohag University Hospital. Ultrasound was performed at the fetal care unit at Sohag University Hospital. Results: This observational cross-sectional study was designed to assess Doppler indices of uterine artery as predictor of neonatal outcomes among women with preeclampsia.A total of 100 pregnant women with preeclampsia were recruited in the study Conclusion: We recommend adding mean uterine artery Doppler indices to routine antepartum fetal surveillance from 32 weeks gestation for women with preeclampsia as there is a strong correlation between it and poor neonatal outcomes.

Fasting and post-prandial plasma glucose screening for gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy. The purpose of this study was to investigate the prevalence of pregnant women who were not screened for gestational diabetes mellitus and compare the maternal and fetal outcomes of women who had undergone GDM screening. Women who refused to attend the gestational diabetes screening test (n = 162) at a maternity hospital in Ankara, Turkey, between October 2014 and January 2015 were included in this prospective cohort study. The control group (matched for age and body mass index) was recruited from women who agreed to have the gestational diabetes screening test (n = 194). Just 12% of pregnant women did not attend gestational diabetes screening test; these women were at higher risk for idiopathic polyhydramnios (P = 0.026). Prevalence of GDM was 8.8% (n = 17) in the control group and 30.9% (n = 50) in those who refused GDM screening. The maternal and fetal outcomes of GDM patients were similar in both groups. Women who did not attend GDM screening test had increased risk for mild idiopathic polyhydramnios in late gestation. Fasting and postprandial plasma glucose screening can replace gestational diabetes mellitus screening in women who refuse to have the glucose load test.

Comparison of placenta accreta spectrum disorders diagnosed in intrapartum and antepartum period— A three year experience in a tertiary referral unit of India

ObjectiveTo determine the frequency of placenta accreta spectrum (PAS) disorders and to study the demographic profile, risk factors and maternal and fetal outcomes in women with antepartum diagnosis of PAS as compared to women with diagnosis made in the intrapartum period. Study designRetrospective analysis over a 3-year period of all patients who delivered with PAS. The cases were divided into 2 groups. Group 1 consisted of the patients who were diagnosed during the intra partum period and Group 2 was those diagnosed as PAS by ultrasound in the antepartum period. Maternal and fetal outcomes were compared between the 2 groups. The cases that underwent conservative management were also analyzed for need of secondary hysterectomy/placental resolution ResultsThere were 81,480 deliveries conducted during the study period of which 74 were identified as PAS. Hence PAS was seen in 1:1101 deliveries (0.09%). The estimated blood loss and number of units of blood products required were significantly higher in Group 1 (2.36 ± 0.77 l vs 1.8 ± 0.91 L, p = 0.002; and 10.17 ± 5.12 vs 6.77 ± 4.22, p = 0.005) compared to Group 2. The ICU stay was also more common in Group 1 (p = 0.01). The perinatal mortality was significantly higher in Group 1(45.71% vs 23.08%, p = 0.040). 79.7% women underwent primary cesarean hysterectomy while others were managed conservatively. In conservatively managed group, placental resolution took place in 60% and 40% required secondary hysterectomy. ConclusionAntenatal diagnosis of placenta accreta spectrum disorders decreases the maternal morbidity and perinatal mortality.

Relationship between inflammatory markers, glycated hemoglobin and placental weight on fetal outcomes in women with gestational diabetes.

The aim of this study was to evaluate the relationship between inflammatory cytokines, placental weight, glycated hemoglobin and adverse perinatal outcomes (APOs) in women with gestational diabetes mellitus (GDM). This was a prospective, longitudinal and observational study conducted from April 2004 to November 2005 in Bauru, Brazil. Included patients had singleton pregnancies and performed a 100 g OGTT and had the levels of C-reactive protein (CRP), interleukin (IL)-6, TNF alfa and glycated hemoglobin (HbA1c) determined at 24-28th gestation weeks. A total of 176 patients were included, of whom 78 had the diagnosis of GDM (44.3%). Multivariate analysis demonstrated that HbA1c, age, body mass index (BMI) and previous history of GDM were independent predictors for GDM diagnosis. ROC curve indicated that HbA1C levels ≥ 5.1% at 24-28 weeks gestation were associated with GDM. No difference was found in IL-6, tumor necrosis factor alpha (TNF-alpha) and CRP serum levels in women with and without GDM. Multivariate analysis showed that placental weight was significantly associated with APOs (p < 0.005), with a cut-off value of 610 grams as demonstrated by the ROC curve. Placental weight ≥ 610 grams and HbA1C ≥ 5.1% were found to be associated with APOs and GDM, respectively, and their evaluation should be part of prenatal care routine.

Abstract TP581: Maternal and Fetal Outcomes in Women With Brain Arteriovenous Malformation Rupture During Pregnancy

Background: Intracranial hemorrhage (ICH) is often the initial presenting symptom for patients with brain arteriovenous malformations (bAVM), which is further complicated in the setting of pregnancy. There are no standard guidelines for management of pregnant women with bAVM, and few studies have reported on maternal and fetal outcomes in those with bAVM ICH. The purpose of this descriptive study was to review our case series for maternal and fetal outcomes in women with bAVM ICH during pregnancy. Methods: We conducted a retrospective review of our database for women between the ages of 15-50 years who presented with a bAVM ICH during pregnancy between 2000-2017. Demographics, angiographic characteristics, gestational age/trimester at ICH, mode and timing of AVM treatment, and maternal (e.g. modified Rankin Scale, mRS) and fetal outcomes (e.g. healthy or intrauterine fetal death) were recorded from the medical records. Results: We identified 16 bAVM cases who were pregnant at the time of ICH. Mean age of cases was 27±6.7 years, 56% were non-Caucasian, and 81% presented with an ICH during the second or third trimester. Of 16 patients, 2 terminated pregnancies in the 1 st trimester, 1 miscarried immediately after ICH, and 13 patients carried to term (69% delivered cesarean and 23% vaginal). Of 13 patients with live births, 77% received emergent AVM treatment (embolization+resection or resection only) at time of ICH, while 3 deferred treatment until after birth. The majority of bAVMs were Spetzler-Martin grade 2 or 3 (87%), 56% had deep venous drainage, and mean AVM size was 2.5±1.2cm. At 2-year follow-up, 85% of women had good outcomes (mRS 0-2). Only one patient did worse after AVM treatment due to a permanent neurological deficit. All cases had healthy fetal outcomes at time of delivery and at 2-yr follow-up. Conclusion: Our case series suggest good fetal and maternal outcomes in ruptured bAVM patients presenting during pregnancy, the majority of which were treated before delivery. Treatment of ruptured AVMs during pregnancy should be tailored to the needs of each specific patient in close consultation with the obstetrics and neurosurgery teams.

Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis

The desire for pregnancy in sickle cell disease (SCD) women has become a true challenge for hematologists, requiring a multidisciplinary approach. Erythrocytapheresis (ECP) is an important therapeutic tool in SCD, but only limited data on starting time and the effects of ECP during pregnancy are available. This is a double-center retrospective cross-sectional study on a total of 46 single pregnancies in SCD women from January 2008 to June 2017. ECP was started at 10.7 ± 5.2 weeks of gestation, and prophylactic enoxaparin (4,000 U daily) was introduced due to the reported high prevalence of thromboembolic events in pregnant SCD women. The alloimmunization ratio was 2.1 per 1,000 and the alloimmunization rate was 5.6%. In early ECP-treated SCD women, no severe vaso-occlusive crisis, sepsis or severe infection, or preeclampsia or eclampsia were observed. We found normal umbilical arterial impedance during pregnancy, suggesting an optimal uteroplacental function in early ECP-treated SCD women. This was also supported by the improvement in newborn birthweights compared to previous studies. In our cohort, three SCD women were started later on ECP (20-25 weeks), and gestation ended with late fetal loss. Placenta pathology documented SCD-related damage and erythroblasts in placental vessels, indicating fetal hypoxia. Collectively, our data generate a rationale to support a larger clinical trial of early ECP program in SCD pregnancy.

Maternal and fetal outcomes in women undergoing caesarean section under general and spinal anesthesia

Background: Both spinal and general anaesthesia used for caesarean section have certain advantages and disadvantages and there is no method which is completely ideal. The most important factors for choice of anaesthesia are; pregnant systemic problems and wishes, the urgency of the operation, and the surgeon and the anesthetists experience. Aim of the Work: These studies aimed at comparing maternal and fetal outcomes in women undergoing elective caesarean section and have spinal anaesthesia with those having general anaesthesia. Subjects and Methods: This study was carried out at Ain Shams University Maternity Hospital during the period from December 2017 to August 2018 after approval of the hospital health ethical committee. It included 186 patients who had C.S and were subdivided into 2 groups according to a randomization scale. On the day of the operation, each randomly received a closed opaque envelope for the selection of the procedure (spinal versus general). Results: We noted that the mean haemoglobin and haematocrit values at the 24th hour were higher in the spinal anaesthesia group. The estimated blood loss volume was significantly higher in the general anaesthesia group. The median apgar score at the first and the fifth minutes were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer in the spinal anaesthesia group. Conclusion and Recommendations: General anaesthesia could be thought the quickest anaesthesia method in an emergency since it avoids the possibility of a failed regional block. Meanwhile, it is associated with higher possibility of blood loss and low Apgar score. Thus, using spinal anaesthesia for elective caesarean section is recommended provided that adequate maternal hydration is established and sparing general anaesthesia for emergency caesarean sections or whenever spinal anaesthesia is contraindicated (e.g. coagulopathy, sever thrombocytopenia, anticoagulation or sever degree of malformation of spine).

Maternal and fetal outcomes in women undergoing caesarean section under general and spinal anesthesia

Background: Both spinal and general anaesthesia used for caesarean section have certain advantages and disadvantages and there is no method which is completely ideal. The most important factors for choice of anaesthesia are; pregnant systemic problems and wishes, the urgency of the operation, and the surgeon and the anesthetists experience. Aim of the Work: These studies aimed at comparing maternal and fetal outcomes in women undergoing elective caesarean section and have spinal anaesthesia with those having general anaesthesia. Subjects and Methods: This study was carried out at Ain Shams University Maternity Hospital during the period from December 2017 to August 2018 after approval of the hospital health ethical committee. It included 186 patients who had C.S and were subdivided into 2 groups according to a randomization scale. On the day of the operation, each randomly received a closed opaque envelope for the selection of the procedure (spinal versus general). Results: We noted that the mean haemoglobin and haematocrit values at the 24th hour were higher in the spinal anaesthesia group. The estimated blood loss volume was significantly higher in the general anaesthesia group. The median apgar score at the first and the fifth minutes were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer in the spinal anaesthesia group. Conclusion and Recommendations: General anaesthesia could be thought the quickest anaesthesia method in an emergency since it avoids the possibility of a failed regional block. Meanwhile, it is associated with higher possibility of blood loss and low Apgar score. Thus, using spinal anaesthesia for elective caesarean section is recommended provided that adequate maternal hydration is established and sparing general anaesthesia for emergency caesarean sections or whenever spinal anaesthesia is contraindicated (e.g. coagulopathy, sever thrombocytopenia, anticoagulation or sever degree of malformation of spine).

Maternal and Fetal Outcomes in a Cohort of Patients Exposed to Tumor Necrosis Factor Inhibitors throughout Pregnancy.

Tumor necrosis factor inhibitors (TNFi) are increasingly used in pregnancy but are frequently withheld in the second or third trimesters. We evaluated the maternal and fetal outcomes of women who continued their TNFi throughout pregnancy compared to women who interrupted TNFi during pregnancy. We retrospectively analyzed the outcomes of women seen in clinic with rheumatoid arthritis (RA), psoriatic arthritis, juvenile idiopathic arthritis (JIA), or ankylosing spondylitis, who were exposed to TNFi during pregnancy. We separated pregnancies into 2 groups based on the level of TNFi exposure and compared outcomes. In Group 1 (TNFi exposure in first trimester only), 11 women had 14 pregnancies and 12 live births. There were 2 first-trimester losses (2/14, 14%), one in the setting of active RA. Five pregnancies (5/14, 35.7%) were complicated by a disease flare. Eight patients (8/12, 66%) flared postpartum. In Group 2 (TNFi exposure throughout pregnancy), 29 women had 32 pregnancies and 34 live births. Three (3/28, 10.7%) adverse pregnancy outcomes were reported in 2 patients. One patient had a twin pregnancy and delivered at 33 weeks after developing preterm premature rupture of membranes at 32 weeks in the setting of a JIA flare. Her second pregnancy was complicated by active JIA before and throughout gestation, and hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome at 39 weeks. Another patient with comorbid antiphospholipid syndrome underwent a cesarean birth at 36 weeks for suspicion of HELLP syndrome. Six (6/32, 18.7%) postpartum flares occurred. Women who discontinued their TNFi during pregnancy had a higher risk of peri- or postpartum flare compared to those who continued their TNFi throughout pregnancy.