Frequency Of Maternal Complications Research Articles

Prevalence of Maternal Complications after Caesarean Section in Women with Abnormal BODY MASS INDEX (BMI)

Objective: To determine the frequency and maternal complications of cesarean section in women with BMI >25 kg/m2.
 Methodology: This descriptive Case series was done at the Gynaecology and Obstetric Unit III, Civil Hospital Karachi for 6 months i.e. May - Nov 2013. Total 164 obese pregnant women who presentedat gestational age >37 weeks, singleton pregnancy with cephalic presentation were included. Data consists of information on demographic items, gestational age, and parity. BMI was calculated by taking weight in kg divided by height in m2. Patients were monitored for progress of labour and mode of delivery was recorded. Maternal complications were identified and noted in pre design proforma.
 Results: Frequency of maternal complications in women with BMI >25 kg/m2 was found in 57.14%women.Induced labour was the commonest i.e. 35.1% women followed by primary post-partum hemorrhage (PPH) 13% and shoulder dystocia was observed in 9.1%.
 Conclusion: The burden of overweight and obesity in pregnant females belong to local population is high. So it is concluded that pre pregnancy normal body weight females with high BMI during pregnancy require special follow-ups and counselling sessions during pregnancy and delivery.

Prognosis of Patients with Pregnancy Hypertensive Disorders Followed in University Hospital to Parzakou in 2020

Introduction: Hypertensive disorders of pregnancy (HDP) are often accompanied by cardiovascular sequelae. The objective of this study was to describe the prognosis in the postpartum period of patients with HDP in Departmental University Hospital of Borgou CHUD-B from Parakou in 2020. Methods: The study was prospective with a descriptive and analytical design and was conducted from January 2020 to September 2020. Patients with HDP were recruited from the gynecology-obstetrics department and each followed for 3 months in the cardiology department. HDP was classified according to the International Society for the Study of Hypertension in Pregnancy, and blood pressure (BP) was taken according to WHO recommendations. Self-measurement of BP at home was performed to assess blood pressure control outside the hospital. Epidata 3.1 and SPSS 21 software were used for data processing and analysis. P values Results: During the study period, the hospital frequency of HDP was 15.6%. The frequency of maternal complications in the postpartum period was 28% (severe hypertension: 23.2%; eclampsia: 3.6%; puerperal psychosis: 1.2%). At the end of the three-month follow-up, blood pressure returned to normal in 73.2% of cases; it persisted in 26.8% of women. Factors associated with persistence of hypertension after multivariate analysis were, overweight/obesity RRa 8.664 [1.566 - 47.941], (p = 0.013); family history of hypertension RRa 6.499 [1.493 - 28.289], (p = 0.013); history of hypertension in previous pregnancies RRa 7.764 [1.561 - 38.601], (p Conclusion: The frequency of HDP is not negligible at CHUD-B/A. The evolution of these HDP was marked in more than a quarter of cases by complications in the postpartum period followed by a persistence of hypertension 3 months after childbirth predicted by cardiovascular risk factors.

Comparative Evaluation of Stroke in Diabetic and Non-Diabetic Patients

Introduction: Obesity has been recognized by the World Health Organization as ‘a pandemic nutritional disorder which represents a rapidly growing threat to the health of populations of an increasing number of countries worldwide. Objectives: The objective was to determine the obesity as a risk factor for Gestational Diabetes Mellitus and Gestational Hypertension when compared with nonobese patients. Material & methods: A cohort study in which comparison of obese patients versus non-obese patients for developing gestational Diabetes Mellitus and gestational hypertension was done during November 2019 to October 2020 in DHQ teaching hospital, Sargodha. Results: The results of the current study reveals mean and SD was as 27.86 ± 4.21 in Group-1 and 26.33 ± 3.87 years in Group-2, mean and SD of body mass index in both groups was 33.47 ± 2.87 in Group-1 and 22.53 ± 3.21 in Group-2. Conclusion: The frequency of maternal complications is higher among obese pregnant females as compare to normal weight females.

The short-term mortality and morbidity of very low birth weight infants with trisomy 18 or trisomy 13 in Japan.

Trisomy 18 (T18) and trisomy 13 (T13) are major concerns in prenatal genetic testing due to their poor prognosis; very low birth weight (VLBW) is also a concern in neonatology. The aim of this study was to investigate the mortality and morbidity of VLBW infants diagnosed with T18/T13 in Japan, compared with those with no birth defects (BD-). Maternal and neonatal data were collected prospectively from infants weighing <1501 g and were admitted to centers of the Neonatal Research Network of Japan during 2003 to 2016. Among 60,136 infants, 563 and 60 was diagnosed with T18 and T13, respectively. Although the age of mothers of infants with T18/T13 was higher, the frequency of maternal complications was lower than those with BD-. With maternal and neonatal characteristic adjustments, T18/T13 had a higher incidence of each morbidity when compared with BD-. Mortality rates in the NICU were 70, 77, and 5.8% for T18, T13, and BD-, respectively, while the survival discharge rates of T18 and T13 were 29.5 and 23.3%, respectively, which was significantly higher than previous reports. This was the first nationwide survey for VLBW infants with T18/T13 in Japan; this novel data will be relevant and useful for prenatal genetic counseling and perinatal management. Although T18/T13 were considered to be fatal in the past, with proper epidemiological information, discussions with affected families, and compassionate patient care, the mortality rate of T18/T13 can be improved.

743: Maternal complications associated with low birthweight delivery

Delivery of an infant at the extremes of birthweight (bwg) is associated with high neonatal morbidity however there is a paucity of literature regarding maternal complications associated with delivery of an infant the cusp of viability. We sought to quantify the rate of maternal complications by neonatal bwg. Population-based retrospective cohort study of all live births in Ohio (2006-2015) using birth certificate data. Frequency of maternal complications were stratified by neonatal bwg in increments of 250g (0-249g to ≥ 5,550g). Obstetric characteristics were compared between women who delivered in the cumulative “highest risk” bwg group (<1500g) to the referent lowest risk bwg group (2500-4000g). Multivariate logistic regression estimated the relative influence of low bwg (<1500g) on the outcome of maternal complications at delivery. Of the 1,462,995 live births in Ohio during the 10-year study period, the highest rates of each complication per associated bwg group were; cesarean delivery (CD), (76.7%; 1250-1499g), blood transfusion (3.9%; <250g), unplanned operation (6.6%; <250g), unplanned hysterectomy (0.26%; 250-499g), uterine rupture (1.5%; 1000-1249g), maternal ICU admission (1.5%; 750-999g), maternal hospital transfer (17.5%; 500-749g), chorioamnionitis (12.3%; 250-499g), cerclage (6.1%; 250-499g), and higher-degree perineal laceration (2.4%; 4750-4999g). The cumulative complication rate for transfusion, unplanned operation, maternal ICU admission, and chorioamnionitis was highest in the <250g bwg group at 23.0%. Birth of an infant <1500g was associated with an increased risk of CD (aOR 2.5, 95% CI 2.4-2.6). Even after exclusion of women who had a CD, delivery of a singleton infant with bwg <1500g was associated with chorioamnionitis (aOR 10.2, 95% CI 9.1-11.5), ICU admission (aOR 4.7, 95% CI 2.2-9.9), and blood product transfusion (aOR 2.1, 95% CI 1.3-3.5). Birth of an infant < 1500g (low birthweight) is not only associated with complications of prematurity but also high rates of maternal morbidity secondary to CD and other operative complications. Counseling and discussions regarding maternal risks should be considered for a mother at risk of preterm birth. Additionally, these risks should be reflected when determining the societal cost of a preterm birth on the population and support further perinatal efforts on primary prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors affecting pregnancy weight gain and relationships with maternal/fetal outcomes in Turkey.

Objectives:To determine the effects of pre-pregnancy body mass index (BMI) and gestational weight gain on maternal and fetal complications, and to examine whether Turkish women achieve the recommended gestational weight gain. We also investigated the relationship between pregnancy weight gain and mode of delivery, with an examination of maternal anthropometry.Methods:A retrospective cross-sectional study was conducted on a population of 986 pregnant women between November 2011 and November 2015 at Atatürk Education and Research Hospital, Ankara, Turkey. Maternal age, BMI, monthly weight gain during pregnancy, infant birth weight, gender, and maternal and fetal adverse outcomes were evaluated.Results:The frequency of maternal complications was positively associated with elevated pre-pregnancy BMI (p<0.05), and weight gain during pregnancy was associated with parity and increased infant birth weight (p<0.05). However, no correlations were observed between mean pregnancy weight gain and maternal complications (p>0.05). The percentage of women who gained the Institute of Medicine (IOM)-recommended amount of weight was the highest in the underweight BMI group (54.1%) and the lowest in the obese BMI group (24.3%). Pregnancy weight gain exceeded IOM recommendations in the overweight (56.3%) and obese (52.5%) groups.Conclusions:While maternal weight gain during pregnancy affects neonatal body weight, higher pre-pregnancy BMI has an adverse effect on recommended weight gain during pregnancy, with increased maternal complications.

Terminating pregnancy for severe hypertension when the fetus is considered non-viable: a retrospective cohort study

ObjectiveTo investigate frequency and practise of termination of pregnancy for early-onset hypertensive disorders where the fetus is considered to be non-viable. Study designRetrospective cohort study in all Dutch tertiary perinatal care centres (n=10), between January 2000 and January 2014. All women who underwent termination of pregnancy, without fetal surveillance or intention to intervene for fetal reasons, for early-onset hypertensive disorders in pregnancy, were analyzed. Women eligible for this study were identified in the local delivery databases. Medical records were used to collect relevant data. ResultsBetween January 2000 and January 2014, 2,456,584 women delivered in The Netherlands, of which 238,448 (9.7%) in a tertiary care centre. A total of 161 pregnancy terminations (11–12 per year) for severe early-onset preeclampsia were identified, including 6 women with a twin pregnancy. Mean gestational age at termination was 172 days (GA 244/7)±9.4 days. In 70% of cases termination was performed at or shortly after 24 weeks’ gestation. 74.5% of women developed HELLP syndrome (n=96), eclampsia (n=10) or needed admission to an ICU (n=14). Birth weight was below 500g in 64% of cases. In 69% of the cases the estimated fetal weight was within a 10% margin of the actual birth weight. ConclusionTermination of pregnancy for early-onset hypertensive disorders without intervention for fetal indication occurs approximately 12 times per year in The Netherlands. More data are needed to investigate contemporary best practice regarding termination of pregnancy for early-onset hypertensive indications at the limits of fetal viability. Considering the frequency of maternal complications, termination of pregnancy and not expectant management should be considered for all women presenting with severe early onset hypertensive disorders at the limits of fetal viability.

Maternal and Perinatal Outcomes Among Adolescents and Mature Women: A Hospital-Based Study in the North of Mexico

Study ObjectiveTo compare maternal and newborn pregnancy outcomes from adolescents and mature women. Design, Setting, and ParticipantsA cross-sectional study was carried out in a public hospital, including women with singleton pregnancies, who were classified according to their age, as follows: group 1: younger than 16 years old (n = 37), group 2: 16-19 years old (n = 288), and group 3: 20-34 years old (n = 632). Interventions and Main Outcome MeasuresInformation on clinical characteristics, gynecological and obstetric history, pregnancy complications, and perinatal outcomes was obtained through interviews and from clinical records. ResultsThirty-four percent of deliveries were from adolescents. Mature women were more likely to have prepregnancy overweight or obesity than adolescents (odds ratio [OR] = 2.4, 95% confidence interval [CI], 1.7-3.4). The frequency of maternal complications during pregnancy or delivery was not different between groups. Birth asphyxia was more frequent in group 2 (P = .02). Women with inadequate prenatal care had an increased risk of preterm deliveries (OR = 1.64; 95% CI, 1.06-2.54) and of having newborns with low birth weight (OR = 2.02; 95% CI, 1.22-3.35). Weight of newborns from noncomplicated pregnancies was lower in group 1 (P = .02), after adjustment for prepregnancy body mass index, gestational weight gain, preterm delivery, and newborn sex. ConclusionThe frequency of maternal and perinatal complications was similar in adolescents and mature women. Birth weight was decreased in noncomplicated pregnancies of adolescents younger than 16 years of age. Adequate prenatal care might be helpful in prevention of some adverse perinatal outcomes.

Pre-pregnancy Body Mass Index and the Risk of Adverse Pregnancy Outcome in Two Thousand Type 2 Diabetes Mellitus Bangladeshi Women

Background: The aim of the present study were to evaluate the frequency of maternal complications and adverse fetal outcomes in a group of singleton pregnant women with type 2 diabetes mellitus to compare the outcome in three groups (lean, normal and overweight). Materials and Methods: The women were categorized into three groups: lean 25.0-29.9 kg/m2. The effect of pre-pregnancy BMI was analyzed by comparing the frequencies of various outcomes in three BMI groups. The results were expressed as odds ratio (ORs) and the corresponding 95% confidence intervals (CIs) & p values. Results: The risk of late fetal death was consistently increasing with BMI (ORs were 1.2 (0.9-1.7), 1.6 (1.1-2.3) & 2.6 (1.7-3.8) for lean, normal & overweight respectively). The risk of early neonatal death was also higher among women with higher BMI (ORs was 1.6 (1.1-2.3) for overweight). The rate of preeclampsia is higher among women with lean and overweight BMI in compares to normal BMI (the values were 2.5%, 1.8%, & 7.0% for lean, normal & overweight respectively). Hypertensive disorders was also more common among lean (3.8%) and overweight (3.6%) compared to normal (1.6%). The risk of preterm delivery was significantly increased for overweight group (4.2%) and lean (2.4%), as compare to normal. The risk of SGA was significantly more in lean (2.7%) compared to normal weight (1.5%) & overweight group (1.9%). Conclusion: Pre-pregnancy overweight increases the risk of late fetal death and perinatal mortality.

A Study of Association of Obesity with Maternal Complications

Abstract: OBJECTIVE: To determine the association of obesity with maternal complications . METHODOLOGY: A prospective cohort study was conducted at Gynae Unit lll Jinnah Hospital Lahore, from 21 st May 2011 to 20 th Nov.2011 All women fulfilling the inclusion were included in this study .Two groups were made, Group l was allotted to obese pregnant women and Group ll was allotted to non-obese pregnant women. Demographic data included age, parity, duration of pregnancy and maternal complications i-e urinary tract infection , instrumental vaginal delivery and post-partum haemorrhage were recorded and analyzed by SPSS -version 13. RESULTS: The results of this study revealed that demographics like age parity and duration of pregnancy were almost similar in both groups , common age was 25.21 ± 2.73 in group-A and 26.34 ± 3.56 years in group -B . Comparison of maternal complications revealed that 22.23 % in group-A and 10.70% in group -B had urinary tract infection, relative risk was 2.087, instrumental delivery in group -A was 14.42% and in group-B was 4.19% relative risk was 3.44 while post-partum haemorrhage was 9.77% in group -A and 3.26% in group -B , relative risk was 3.00. CONCLUSIONS : The frequency of maternal complications is higher among obese pregnant women so it is recommended that every pregnant woman who presents with increased BMI should be sort out for maternal complications. KEY WORDS: Obese and non- obese pregnant women, maternal complications

Fetomaternal outcome in triplet pregnancy.

To determine maternal outcome as antenatal and postnatal complications and neonatal outcome as birth weight, morbidity and mortality in triplet gestation. Observational study. Mother and Child Health (MCH) Centre, Pakistan Institute of Medical Sciences, Islamabad from May 2000 to April 2006. All the patients with triplet pregnancy beyond 28 weeks gestation, who delivered at the study place during above period were included in the study. The primary outcome measures were frequency of maternal complications and neonatal birth, weight and morbidity. Secondary outcome measures included the frequency of assisted conception in the studied cohort. Eighteen women had triplet pregnancy beyond 28 weeks. Nine were booked, 6 non-booked and 3 of them were referred. Mean duration of gestation was 237.8 days (33.8 weeks). The antenatal complications were preterm delivery in 50%, hypertension in 50%, anemia in 44.4% and obstetric cholestasis in 5.6%. Eight patients (44.4%) suffered postpartum hemorrhage. One patient had peripartum hysterectomy and later expired in intensive care unit after three weeks. Maternal mortality ratio was 5.6%. Fifty five percent women had induction of ovulation with Clomiphene, while none had In Vitro Fertilization (IVF) or Intracytoplasmic Insemination (ICSI) or received gonadotrophins. Fifteen sets of triplets were delivered abdominally. Mean birth weights of 1st, 2nd and 3rd triplet were 1651, 1640 and 1443 grams respectively. Five sets of triplets (27.8%) had more than 25% discordance for birth weight. The mean Apgar scores of the babies at 1 and 10 minutes after birth were 6.0 and 8.0, 5.6 and 7.5; and 5.2 and 7.0 respectively. Of the 54 infants, 18 required Neonatal Intensive Care Unit (NICU) admission and 14 were admitted in nursery. Two died shortly after birth. Total perinatal mortalities were 13 including 4 cases of intra-uterine demise. Three babies suffered from jaundice, 7 had sepsis and 8 had respiratory distress syndrome. Triplet gestation had a high rate of fetomaternal complications. Majority had history of assisted conception.

Endoscopic third ventriculostomy during pregnancy

ology (CVUE), was observed. The frequency of maternal complications in scleroderma patients is not increased compared with healthy controls, except for renal crisis [1]. Prematurity and preterm births are amajor problem. In a recent study, pretermbirths occurred in 29% of scleroderma pregnancies [3]. Detailed descriptions of placental findings in scleroderma are limited and include chronic villitis associated with decidual vasculopathy, placental infarcts, abruption, as well as normal placentas [2]. In a recent study of 13 placentas from 8 women with scleroderma, decidual vasculopathy was observed in 5 placentas and was associated with poor perinatal outcome [4]. Decidual vasculopathy reflects pathological deviations from normal placentation, such as fibrinoid necrosis of vessel walls, with or without foamy macrophages (atherosis), vasculitis, and presence of small muscularized thick-walled blood vessels [5]. In the present case PMD, and not decidual vasculopathy, was the most prominent placental finding. PMD is associated with IUGR. The typical features of PMD, that were also observed in this case, are stem villi with excessive proliferation of mesenchymatous tissue, with foci of myxoid degeneration, and large stromalmacrophages and vessels with fibromuscular sclerosis and thrombosis [6]. In conclusion, PMD, decidual vasculopathy, and other placental lesions associated with compromised uteroplacental perfusion may appear in scleroderma and are correlated with poor perinatal outcome.

Poor Pregnancy Outcome in Women With Type 2 Diabetes

To evaluate the perinatal outcome and the frequency of maternal complications in pregnancies of women with type 2 diabetes during 1996-2001. Medical records of 61 consecutive singleton pregnancies in women with type 2 diabetes from 1996 to 2001 were studied. Pregnancy outcome was compared with that of pregnant women with type 1 diabetes during 1996-2000, the background population, and pregnant women with type 2 diabetes during 1980-1992 from the same department. The perinatal mortality in pregnancies complicated by type 2 diabetes (4/61, 6.6%) was increased four- and ninefold, respectively, and the rate of major congenital malformations (4/60, 6.7%) was more than doubled, although not statistically significant, compared with type 1 diabetic pregnancies and the background population. The glycemic control was similar or better in women with type 2 diabetes compared with women with type 1 diabetes. Multivariate logistic regression analysis in the pooled group of pregnancies with pregestational diabetes from 1996 to 2001 showed that high HbA(1c) at admission and type 2 diabetes were independently associated with a serious adverse fetal outcome (perinatal mortality and/or major congenital malformations). The perinatal mortality and the rate of major congenital malformations in type 2 diabetic pregnancies have increased during the last decade. The perinatal outcome of pregnancies in women with type 2 diabetes during 1996-2001 is poor. It is worse than the outcome of pregnancies in women with type 1 diabetes and the background population in the same period, as well as in women with type 2 diabetes studied during 1982-1990.

Complications of midtrimester pregnancy termination: The effect of prior cesarean delivery

OBJECTIVE: Our purpose was to determine whether a prior cesarean delivery affects the incidence of complications in women having an indicated midtrimester medical pregnancy termination. STUDY DESIGN: A retrospective review of women who underwent a midtrimester medical termination of pregnancy from January 1980 to July 1995 ascertained obstetric history, uterotonic agent(s), and the occurrence of uterine rupture, blood transfusion, or curettage. The frequencies of maternal complications were compared in women with and without a prior cesarean section. RESULTS: Our study population included 606 women with a mean gestational age of 21.1 ± 3.1 weeks and a mean maternal age of 26.3 ± 7 years. Seventy-nine (13%) had undergone a prior cesarean section. There was no significant difference in the need for curettage between women with and without a prior cesarean section. However, there was an increased need for blood transfusions in women with a prior cesarean delivery (11.4% vs 5.3%, odds ratio 2.3, 95% confidence interval 1.1 to 5.0, p = 0.04). The incidence of uterine rupture was significantly higher among women with a prior cesarean (3.8% vs 0.2%, odds ratio 20.8, 95% confidence interval 14.1 to 104, p = 0.008). CONCLUSION: Our data suggest that a prior cesarean section is a risk factor for uterine rupture and blood transfusion in women having a midtrimester pregnancy termination. (Am J Obstet Gynecol 1996;175:889-92.)

Religious Affiliation and Obstetric Outcome

The purpose of this study was to explore the relationship between religious affiliation and obstetric outcome. We reviewed 1,919 records of patients whose infants were born at a university medical center. Data obtained from maternal and newborn records included demographic information, prenatal history, labor and delivery records, and religious affiliation. Maternal complications and neonatal intensive care unit (NICU) admissions were lowest for mainline Christians (11%, 11%), intermediate for evangelical Christians (17%, 12%), and highest for patients with no religious preferences (21%, 18%). After controlling for possible confounders, the association of religious affiliation and lower NICU admission rates remained. Mainline Christians had a lower frequency of maternal complications. Patients with a religious affiliation had better obstetric outcome than those without. Most of the association seems to be due to a lower risk social profile, but a small positive influence of religion persisted.

Pregnancy outcome in maturity onset diabetes at young age (MODY).

Diabetes mellitus is not a single disease, but rather a syndrome comprised of a variety of diseases characterized by hyperglycaemia. Indeed it has a heterogeneous nature. Maturity Onset Diabetes of the Young or MODY is an unusual, mild type of hyperglycaemia, which develops in young women, (below the age of 25), who do not require insulin. This study describes 10 pregnancies in MODY women, who are compared to a group of patients with insulin-dependent diabetes mellitus (IDDM), a group with gestational diabetes, and a control group of normal, healthy pregnant women. Our group of pregnant MODY patients proved to have an intermediate form of diabetes, more severe than gestational diabetes and yet not as severe as insulin-dependent diabetes mellitus. Mean duration of diabetes was shorter and mean daily insulin requirement (during pregnancy) was lower among MODY patients in comparison to IDDM gestants. Moreover the frequency of maternal complications and Caesarean deliveries in MODY patients were lower than in the IDDM group, but higher when compared to the gestational diabetes group.