Good Perinatal Outcome Research Articles

Good Perinatal Outcome of Rhesus Incompatibility in Multigravida without Anti-D Injection Therapy: A Rare Case Report

Good Perinatal Outcome of Rhesus Incompatibility in Multigravida without Anti-D Injection Therapy: A Rare Case Report

Mild obesity does not affect perinatal outcome in gestational carrier cycles.

Does BMI of gestational carriers (GCs) affect perinatal outcomes after embryo transfer? Overweight and class I obesity in GCs does not affect the rate of good perinatal outcomes. The use of GCs is increasing, but uniform guidance regarding optimal BMI for GCs is lacking. Women with obesity who conceive without fertility treatment or through autologous or donor in vitro fertilization are at higher risk of adverse maternal and fetal outcomes, but data on obesity in GCs are very limited. We performed a retrospective cohort study of 1121 GC cycles from January 2015 to December 2020 at US Fertility, the largest national partnership of fertility practices in the USA. All GC cycles performed at a large network of fertility practices were reviewed. Same-sex partners undergoing co-IVF were excluded. The primary outcome was good perinatal outcome from the first embryo transfer, defined as a singleton live birth at ≥37 weeks of gestation with birth weight between 2500 and 4000 g. Secondary outcome measures included frequencies of live birth, clinical pregnancy, miscarriage, full-term birth, low birth weight, large for gestational age, and cesarean delivery. A generalized linear model (log-binomial) was used for each to compare outcomes across BMI groups using normal BMI (20-24.9 kg/m2) as the reference group. Risk ratios and 95% CIs were estimated for each category group relative to normal BMI. We identified 1121 cycles in which GCs underwent first embryo transfer, of which 263 (23.5%) were in GCs with BMI >30. Demographics and reproductive history for GCs did not differ by BMI groups. The age of intended parents, use of frozen eggs, and fresh embryo transfers were higher with increasing BMI group. There were no statistically significant associations between BMI and good perinatal outcomes, live birth, clinical pregnancy, biochemical, spontaneous abortion, or low birth weight. However, among live births, higher BMI was significantly associated with birth by cesarean (P = 0.015) and large for gestational age infants (P = 0.023). This was a retrospective study, and there may be unmeasured confounders. The number of patients with BMI <20 or ≥35 was small, limiting the power for these groups. We were not able to assess all maternal and fetal outcomes. In this study, we did not identify any significant impact of BMI on the chances of having a good perinatal outcome. Prior research studies have been inconsistent and this is the largest study to date. No external funding was received for this work. The authors do not have any conflicts of interest to declare. N/A.

Scrub typhus in pregnancy - A threat to maternal and fetal outcome.

Scrub typhus is an acute febrile illness transmitted by the bite of trombiculid mite in the larval stage. Scrub typhus is rare in pregnancy and there is paucity of data on the clinical outcome of scrub typhus during pregnancy. We present five cases of scrub typhus complicating pregnancy who were admitted in the obstetric ward at AIIMS Rishikesh, India during the antenatal period for management. The first patient presented at term pregnancy in semiconscious state while the rest were preterm between 31 and 34 weeks period of gestation. The age at presentation was 21-31 years. All five had febrile illness of >5 days' duration along with cough. Fever investigations like blood culture, peripheral smear for malarial parasite, dengue serology, widal test, and urine culture were negative. Serology for scrub typhus was positive in all. Once diagnosis was confirmed for scrub typhus, patients were given the drug of choice azithromycin 500 mg twice daily for five days. Scrub typhus complicating pregnancy led to maternal mortality in one patient. It resulted in one preterm delivery, one intrauterine fetal death, and rest three were delivered at term with good perinatal outcome. Scrub typhus is common in endemic areas like Uttarakhand, India. It has a poor fetal outcome. If diagnosed early and treatment started, maternal and fetal prognosis can be favorable. As large case series are unavailable in literature, it is difficult to predict the course of disease which at times may be fulminant.

PERINATAL AND MATERNAL OUTCOME OF PREECLAMPSIA WITH SEVERITY FEATURE MANAGED EXPECTANTLY AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC), 2021, ADDIS ABABA, ETHIOPIA. A CROSS SECTIONAL STUDY

ABSTRACT Background Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is labeled as Preeclampsia with severe features when one of the severity signs occurs. Worldwide, Preeclampsia occurs in up to 7.5 percent of pregnancies and 10 - 15 % of direct maternal deaths are associated with preeclampsia and eclampsia. Majority of adverse maternal and perinatal outcome occur in Preeclampsia with severe features and when Preeclampsia occurs remote from term ( ). Objective The main objective of this study was to determine the maternal and perinatal outcome of Preeclampsia with severe features managed expectantly at SPHMMC in one year period. Materials and Methods: Facility based cross-sectional study was conducted. The study participants were selected consecutively by including all mothers admitted during the study period (January 2021 to December 2021 G.C.) with the diagnosis of Preeclampsia with severe features to SPHMMC that fulfill the inclusion criteria. Data taken was, the patients chart and a direct patient interview using pre-tested &amp; structured questionnaire. Collected data was entered in to Epi info version 7 &amp; analysis was made through SPSS version 25. Descriptive statistics, tables &amp; figures was used to describe the study finding. Result –the mean days of prolongation of pregnancy was 11.5 days with slight increment of maternal complication from expected proportion that completely resolved postpartum. The most common maternal complications were HELLP syndrome (15.1%) and abruptio placenta (7.2%). There were 21 perinatal deaths (08 still births and 13 neonatal deaths) that give perinatal mortality rates of 276 per 1000 live births. The rate of NICU admission was 66.7% and the neonatal survival to seventh day was 71.7%. Only 66(90.4%) of the women were a good candidate for expectant management. Magnesium sulphate and steroid (dexamethasone) at admission was given 100% but 8.2% of the mothers didn’t get magnesium sulphate during intra partum and post partum period. Conclusion / Recommendation - Proper selection of pregnant mothers with pre-eclampsia with severity feature and Close and frequent maternal and fetal surveillance during expectant management is associated with a good perinatal outcome without significant difference in maternal complication. Key Words: pre-eclampsia ,Perinatal outcome, maternal complication.

Obstetric Outcome of Induction of Labour in a Tertiary Hospital in Nigeria: A Five-Year Retrospective Cross-Sectional Study.

Induction of labour has remained one of the most valuable interventions in obstetric practice. Over the years, the proportion of women undergoing induction of labour (IOL) has been on a steady increase. The significance to obstetrics practice as well as its maternal and perinatal outcomes are sacrosanct, hence the need for its periodic review. To determine the obstetric outcomes of induction of labour. A five-year retrospective study of all cases of induction of labour at the maternity unit of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria between January 1st 2017 and 31st December 2021. The labour ward's records were assessed to determine the total number of women who had induction of labour during the study period. Women whose case files could be not retrieved were excluded. The folder numbers of the patients were extracted and their case files retrieved from the medical records department of the hospital. The primary outcomes measures were the indications and the methods of induction of labour, while the secondary outcome measures were the mode of delivery, cause of failed induction, and the perinatal outcome. Data were obtained using proformas and analysed using statistical packages for social sciences (SPSS) version 26.0 IBM corporation. A total of 3,638 deliveries were taken during the period under review and 168 patients had induction of labour giving an overall prevalence of 4.6% (46/1000 deliveries). Induction of labour was successful in 71.2% of cases. Misoprostol was used in 90.4% of cases as an induction agent. The commonest indication for induction of labour was postdate pregnancy (53.8%). Failed induction was due to fetal distress, poor progress of labour from cephalopelvic disproportion/malposition and failed cervical ripening. In about 72% of deliveries, there was good perinatal outcome, 10.3% of babies had moderate to severe asphyxia while 1.3% had neonatal death. Induction of labour is a safe and beneficial procedure in obstetrics. However, it can be associated with adverse obstetric outcomes.

Acculturation Experiences and Preterm Birth in Berlin: Does Acculturative Stress Contribute to Preterm Birth?

Acculturation and acculturative stress are potential risk factors for adverse perinatal outcomes. This study investigates whether and how acculturative stress affects preterm birth (PTB) in a sample of migrant women in Berlin. We interviewed 955 women who recently gave birth using standardized questionnaires (Frankfurt Acculturation Scale and Acculturative Stress Index). Multivariable logistic regression analyses assessed the effects of acculturation and acculturative stress on PTB. Women with migrant backgrounds did not have significantly higher PTB rates than German natives. First-generation migrants experienced higher acculturative stress levels than second-generation migrants, 38.8% vs. 13.2%. Acculturative stress could not be identified as a risk factor for PTB in our sample. These results need to be considered in the context of an international city and the wide use of antenatal care services in our population, which could be responsible for similarly good perinatal outcomes and highlights the potential of good access to perinatal care for vulnerable groups.

Body mass index is negatively associated with a good perinatal outcome after in vitro fertilization among patients with polycystic ovary syndrome: a national study

To evaluate the association between body mass index (BMI) and good perinatal outcomes after invitro fertilization (IVF) among women with polycystic ovary syndrome (PCOS). Retrospective cohort study using 2012-2015 Society for Assisted Reproductive Technology Clinic Outcomes Reporting System data. Fertility clinics. To identify patients most likely to have PCOS, we included women with a diagnosis of ovulation disorder and serum antimüllerian hormone >4.45 ng/mL. Exclusion criteria included age ≥ 41 years, secondary diagnosis of diminished ovarian reserve, preimplantation genetic testing, and missing BMI or primary outcome data. None. Good perinatal outcome, defined as a singleton live birth at ≥ 37 weeks with birth weight ≥ 2,500 g and ≤ 4,000 g. The analysis included 9,521 fresh, autologous IVF cycles from 8,351 women. Among women with PCOS, the proportion of cycles with a good perinatal outcome was inversely associated with BMI: underweight 25.1%, normal weight 22.7%, overweight 18.9%, class I 18.4%, class II 14.9%, and class III or super obesity 12.2%. After adjusting for confounders, women in the highest BMI category had 51% reduced odds of a good perinatal outcome compared with normal weight women (adjusted odds ratio 0.49, 95% confidence interval 0.36-0.67). Among women with PCOS undergoing fresh, autologous IVF, the odds of a good perinatal outcome decline with increasing BMI. Women with PCOS should be counseled that the odds of achieving a good perinatal outcome decrease as their weight increases.

Embryo donation: national trends and outcomes, 2004–2019

In 2016, the Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding characteristics and outcomes of embryo donation cycles could benefit patients and providers during counseling and decision making. To examine trends in utilization of embryo donation, pregnancy rates and live birth rates per transfer between 2004-2019; to describe recipients of donated embryos and outcomes of frozen donated embryo transfer cycles during the most recent time period: 2016-2019 STUDY DESIGN: We conducted a retrospective population-based cohort study of frozen donated embryo transfer cycles in United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2004-2019. Trends in the annual number and proportion of frozen donated embryo transfers, pregnancy rates and live birth rates from 2004-2019 were described. During 2016-2019, rate of cycle cancellation, pregnancy, miscarriage, live birth, singleton birth, and good perinatal outcome (delivery ≥37 weeks, birthweight ≥2500 grams) of frozen donated embryo transfers were also calculated. Transfer and pregnancy outcomes stratified by oocyte source age at the time of oocyte retrieval were also described. From 2004-2019, there were 21,060 frozen donated embryo transfers in the United States resulting in 8,457 live births. During this period, the annual number and proportion of frozen donated embryo transfers of all transfers increased, as did the pregnancy rate and live birth rate. Among all initiated cycles during 2016-2019, the cancellation rate was 8.2%. Among 8,773 transfers with known outcomes, 4,685 (53.4%) resulted in pregnancy and 3,820 (43.5%) in live birth. Among all pregnancies, 814 (17.4%) resulted in miscarriage. Among all live births, 3,223 (84.4%) delivered a singleton of which 2,474 (76.8%) had a good perinatal outcome. The clinical pregnancy rate and live birth rate per frozen donated embryo transfer decreased with increasing age of oocyte source. The outcomes of embryo donation cycles reported in this national cohort may aid patients and providers when considering use of donated embryos.

Knowledge of oral health during pregnancy and associated factors among pregnant mothers attending antenatal care at South Omo Zone public hospitals, Southern Ethiopia, 2021.

BackgroundThe awareness of women towards oral health during pregnancy is an important aspect of her general health. It can compromise pregnancy outcomes, as well as it may affect the newborn’s overall health. Every pregnant woman plays a critical role in shaping the oral hygiene habits adopted by her if she is aware of pregnancy-related oral health and result in good perinatal outcomes. This study aimed to assess knowledge of oral health during pregnancy and associated factors among pregnant mothers who attend antenatal care at South Omo Zone public hospitals, Southern Ethiopia, 2021.MethodsAn institution-based cross-sectional study was conducted among pregnant women attending routine antenatal care from October 01 to November 30. A systematic random sampling method was conducted to select study participants. Data had been collected through face-to-face interviews using semi-structured questionnaires. Data were entered using epi data version 3.1 and exported to Statistical Package for the Social Sciences version 25 for data analysis. Descriptive statistics had calculated for each variable, and binary logistic regression analysis with 95% confidence intervals was carried out to assess the factors associated with the outcome variables. Variables with P-value less than 0.05 were used to declare statistical significance.ResultOverall good knowledge of pregnant mothers regarding oral health was 34.1% with 95% CI, (32.76, 35.44). Having access to health facility (AOR = 2.60, 95% CI, 1.44, 4.70), having the educational status of secondary and above (AOR 1.37, 95% CI, 1.44, 4.31), having the educational status of primary education (AOR = 0.43, 95% CI, 0.20, 0.92), having a median income of > = 1500 Ethiopian birr (AOR = 0.41, 95% CI, 0.23, 0.72), being governmental employee (AOR = 0.11, 95% CI, 0.03, 0.41), received oral health hygiene counseling during pregnancy (AOR = 1.33, 95% CI, 1.62, 2.84) were significantly associated with good knowledge of oral health of pregnant mothers.ConclusionThis study showed that the knowledge of pregnant mothers about oral health was 34.1%. Educational status, monthly income, occupation, access to health services, and receiving counseling on oral hygiene at antenatal care were some factors associated with good knowledge of oral health during pregnancy. Therefore strengthening counseling during antenatal care, improving access to a health facility, improving educational status, monthly income, and being government employee are crucial to enhance knowledge of women towards oral health during pregnancy.

How should we interpret lactate in labour? A reference study.

To investigate maternal lactate concentrations in labour and the puerperium. Reference study. Tertiary obstetric unit. 1279 pregnant women with good perinatal outcomes at term. Electronic patient records were searched for women who had lactate measured on the day of delivery or in the following 24 hours, but who were subsequently found to have a very low likelihood of sepsis, based on their outcomes. The normative distribution of lactate and C-reactive protein (CRP), differences according to the mode of birth, and the proportion of results above the commonly used cut-offs (≥2 and ≥4 mmol/l). Lactate varied between 0.4-5.4 mmol/l (median 1.8 mmol/l, interquartile range [IQR] 1.3-2.5). It was higher in women who had vaginal deliveries than caesarean sections (median 1.9 vs. 1.6 mmol/l, pdiff < 0.001), demonstrating the association with labour (particularly active pushing in the second stage). In contrast, CRP was more elevated in women who had caesarean sections (median 71.8mg/l) than those who had vaginal deliveries (33.4mg/l, pdiff < 0.001). In total, 40.8% had a lactate ≥2 mmol/l, but 95.3% were <4 mmol/l. Lactate in labour and the puerperium is commonly elevated above the levels expected in healthy pregnant or non-pregnant women. There is a paucity of evidence to support using lactate or CRP to make decisions about antibiotics around the time of delivery but, as lactate is rarely higher than 4 mmol/l, this upper limit may still represent a useful severity marker for the investigation and management of sepsis in labour.

Diagnosis and Management of Twin Reversed Arterial Perfusion Sequence at the Korle Bu Teaching Hospital, Ghana

Twin Reversed Arterial Perfusion (TRAP) sequence is a rare complication of twin gestation unique to monochorionic twins, reported to occur in about 1% of all monochorionic pregnancies. In this condition, an acardiac twin, with an absent or non-functioning heart, is perfused by its co-twin (referred to as the “pump” twin) via placental anastomoses. It is associated with a high mortality for the pump twin without intervention. We report two cases of TRAP sequence diagnosed prenatally by ultrasound at the Korle Bu Teaching Hospital. We describe how this rare anomaly can be diagnosed and managed successfully even in a low resource setting to yield good perinatal outcomes.

Assessment of High-Risk Pregnancies using Biophysical Profile

The purpose of the current study was to know the importance of using BPP for primary fetal surveillance in predicting fetal outcome. Methods: A total of 70 individuals with high risk pregnancies were included from 16-45 years examined through ultrasound and Doppler (Toshiba Xario 100 colour Doppler (C5-2 convex probe) having a real-time frequency range of 3.0 to 5.0 MHZ) at a private hospital in Gujranwala from October 2021 to March 2022. A Convenient sampling approach was used to collect data through informed consent forms. Data was collected using SPSS 21. Results: The current study included 70 patients who were examined using Doppler for fetal well-being. Study concluded to have correlation between age groups and development of fetal anomalies of age group 16-25years 44(62.9%), 26-35 years 21(30.0%), 36-45 years (7.1%). Most of the females in gestational weeks 34-37 weeks. Frequency of high-risk pregnancy most common is hypertension 25(35.7%) followed by other such as low fetal movement 10(14.3%), oligohydramnios 8(11.4%) and the least common is diabetes mellitus. Reactive 50(71.4%), and non-reactive 20(28.6%). Result shows the frequency of biophysical profile score in total number of patients included. Biophysical profile score 0-2 in 16(22.9%), 4-6 BPP score in 42(66%) and 8-10 BPP in 12(17.1%) patients. The frequency of IUGR in relation to biophysical profile score showing 18(72.0%), in 0-2 BPP score and 7(28%) in 4-6 BPP score. Conclusions: Normal BPP assures good fetal status and perinatal outcome. Abnormal BPP indicates that the fetus may be compromised. The study concluded that BPP has significant role in predicting fetal outcome.

A STUDY OF ASSOCIATION OF GESTATIONAL WEIGHT GAIN WITH PERINATAL OUTCOME OF PREGNANCY IN PRIMIGRAVIDA WOMEN DELIVERING SINGLE LIVE BABY

BACKGROUND: Gestational weight gain and the body mass index (BMI) of the woman are two important factors for a good perinatal outcome. Maternal nutrition during pregnancy may also have a lifelong consequence on the baby. AIM:1) To study gestational weight gain in primigravida women delivering a single live baby.2) To study the association of gestational weight gain with morbidity during pregnancy and perinatal outcome in primigravida women delivering a single live baby. MATERIALAND METHODS: 500 patients were included in the study. All primigravida in between 37 to 42 weeks of gestational age were included GWG, BMI and associations with the risks. RESULTS:Women with &lt;18.5, 25- 29.9, &gt;30 BMI had 65.3% of inadequate weight gain, 57.5% of excessive weight gain, 94.9% of excessive weight gain respectively.9.3 %, 3.7% of women with excessive weight gain showed preeclampsia, GDM respectively. 15.9%,17.4% of women with inadequate weight gain had oligohydramnios and BNNW admission respectively. 51% of women with excessive weight gain ended up in caesarean section. CONCLUSION: After analysing all the computed data in the present study, we can conclude that from the beginning of pregnancy, by keeping pre-pregnancy body weight under control and monitoring increase in gestational body weight within prescribed limits, few adverse outcomes of pregnancy can be prevented. CLINICAL SIGNIFICANCE: GWG is usually neglected. But increase or decrease in GWG can convert a normal pregnancy to high-risk pregnancy.

MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% delivered vaginally. 23.53% patients had postpartum haemorrhage whereas only 2.98% had undergone Postpartum Hysterectomy. The most common fetal complication in Abruptio Placenta was prematurity (35.71%). 5.89% patients of Abruptio Placentas died during Peripartum period. Perinatal mortality was high 48.58%. Conclusions: Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcomes.

Frozen eggs: national autologous oocyte thaw outcomes

To characterize national outcomes of oocyte thaw (OT) cycles. Retrospective descriptive study. All autologous OT cycles reported to the Society of Assisted Reproductive Technology Clinic Outcome Reporting System from 2012 to 2018. All women undergoing OT cycles in the United States. None. Absolute numbers of oocyte cryopreservation (OC) and OT cycles over time. Among OT cycles, patient and cycle characteristics, the ratio of the total number of oocytes thawed to the number of live births by maternal age at the time of cryopreservation (ATOC), and outcomes including pregnancy, miscarriage, live birth, and good perinatal outcome (GPO) by age ATOC. From 2012 to 2018, 54,675 OC and 6,413 OT cycles were performed; the absolute numbers increased from 2,719 to 13,824 and from 348 to 1,810, respectively. The ratio of the total number of oocytes thawed to the number of live births increased significantly with increasing age ATOC, from 41.4 (age <35 years) to 122.4 (age >41 years). Among OT cycles resulting in embryo transfer, the live birth rate decreased with increasing age ATOC from 42.8% (age <35 years) to 10.8% (age >42 years). The live birth rate was higher when calculated per transfer (42.8% in women aged <35 years ATOC) rather than per thaw cycle (31.5% in women aged <35 years ATOC) because of the number of patients with no transfer. Among 1,124 cycles resulting in pregnancy, the chance of a GPO was highest among women aged <35 years ATOC (65.8%) and decreased as age at ATOC increased. Among reported OT cycles, the rates of pregnancy and live birth decreased as age ATOC increased. The number of oocytes thawed to achieve one live birth increased significantly with increasing age ATOC. In addition, among the resulting pregnancies, the rate of GPO decreased as age ATOC increased.

Antenatal follow-up, anesthesia management and perinatal outcomes in pregnancy with renal transplant

Objective:Due to the recent increase in the successful pregnancies after renal transplant, the number of renal transplant recipients having vaginal or cesarean delivery possibly associated with high maternal, fetal and/or neonatal risk requiring team approach increased. We aimed to evaluate antenatal follow-up, perinatal outcomes, and anesthesia management in pregnancies with renal transplantation and to compare them with the current literature.Materials and Methods:After ethics committee approval, renal transplant recipients who gave birth in our hospital between January 2010 and December 2019 were documented in this retrospective study. Demographic characteristics, comorbidities, antenatal follow-up, anesthesia management, and maternal, fetal, and neonatal outcomes were presented.Results:A total of 20 pregnant women who underwent renal transplant were identified. The mean age of the parturients was 31±5 years. The median interval from transplantation to conception was 8.15±4.8 years. Antenatal mean serum creatinine level and proteinuria were 1.48±1.39 mg/dL and 1.397±1.316 mg/dL, respectively. No allograft rejection was recorded. Comorbidities including hypertension (n=12), preeclampsia (n=6), and preterm delivery (n=10) were noted. The median gestational age was 35±3 weeks and the median newborn weight was 2.520±832 gram. There was one abortion, two pregnancy terminations, and 17 deliveries (3 vaginal and 14 cesareans). Cesarean sections (11/14; 78.6%) were mostly performed under spinal block and general anesthesia was performed in three (21.4%) women. Epidural analgesia for vaginal delivery was recorded in one parturient.Conclusion:Despite the presence of preterm delivery and comorbidities, antenatal/peripartum follow-up and analgesia/anesthesia management of renal transplant recipients revealed good perinatal outcomes.

The efficacy and safety of non-fluoroscopic catheter ablation of arrhythmias in pregnancy after mid-long-term follow-up: a single- center experience

Abstract Funding Acknowledgements Type of funding sources: None. Background Despite the incidence of arrhythmias in pregnancy data on non-fluoroscopic catheter ablation in pregnant women and perinatal outcomes is limited. Purpose the aim of this study is to prospectively assess the efficacy and safety of non-fluoroscopic catheter ablation in pregnant women with arrhythmias. Methods 44 pregnant women (mean age of 28,2 ± 4,2 years, mean gestation age 24,4 ±3,8 weeks) indicated for catheter ablation were enrolled. The ablation was performed under the guidance of CARTO (n = 20; 45%) and Ensite Precision systems (n = 24; 55%) without fluoroscopy. Ablation characteristics, procedure-related complications and clinical outcomes were evaluated during 18 months follow-up. Results all 44 cases of ablation were successful. There were 14 (31,8%) ablation of accessory pathways - in left free wall (n = 8), in right free wall (n = 5), posteroseptal (n = 1). 19 patients (43,2%) underwent ablation for atrioventricular nodal reentrant tachycardia. In 3 cases (6,8%) were combination of accessory pathways with slow conduction ways. Ablation of the right ventricular outflow tract was performed in 8 cases (18,2%) of frequent premature ventricular contractions and idiopathic ventricular tachycardia. The median procedural time was 71 minutes (interquartile range 54-97). Procedural complication was documented in 1 patient (2,3%), who developed an ileofemoral thrombosis. Perinatal outcomes: spontaneus vaginal (n = 35; 79.5%) or vaginal-assisted (n = 4; 9.1%) delivery were in the majority. Five pregnancies (11.4%) were delivered by cesarean section. Mean median gestational age at delivery was 39 ± 1,12 weeks. In one case was placental abruption (2,3%). Maternal cardiac events was none declared. There were 44 live births (in all pregnancies). Fetal birth weight was 3324,39 ± 625,1 grams, 5 minute Apgar was 8,81 ± 1,9. There were no maternal and fetal mortality. During follow-up there were no arrhythmia recurrence. Conclusions non-fluoroscopic catheter ablation of arrhythmias is feasible and can be safety performed in pregnancy. Our data suggests that these pregnancies were with good perinatal and neonatal outcomes.

Perinatal Outcomes After Undergoing External Cephalic Version

: The external cephalic version (ECV) represents the standard for pregnancies at term with a non-cephalic presentation as it avoids planned caesareans. The aim of this study was to assess the caesarean rate and prognostic factors at birth after undergoing ECV, which was compared with scheduled caesareans for a non-cephalic presentation (SCG) and spontaneous cephalic presentations at birth (GG). No difference was observed between the caesarean rate of the ECV (n=65) and the GG (n=3711) groups (9.84% and 14.47%, respectively, p-value=0.30), and neither was found between the ECV group and both the GG and SCG (n=76) groups in the Apgar scores and postpartum pH, but for the five-minute Apgar score (9.98 and 9.84 in the ECV and SCG groups, respectively, p-value=0.04). This study provides further evidence for clinical practice regarding good perinatal outcomes after undergoing ECV. Further research is required to consistently prove the increase in the intrapartum caesarean rate after ECV that has been previously described in the literature, which has not been found in the present study. Keywords: External Cephalic Version, Breech Presentation, Caesarean Rate, Perinatal Outcomes, Apgar Score, Postpartum Ph.

Fetoscopic urethral meatotomy in fetuses with lower urinary tract obstruction by congenital megalourethra.

To describe the perinatal outcomes of fetoscopic urethral meatotomy (FUM) in fetuses with lower urinary tract obstruction (LUTO) by congenital megalourethra. Between 2012 and 2020, 226 cases with LUTO were referred to our fetal surgery center in Queretaro, Mexico. We report the perinatal outcome of cases with LUTO by congenital megalourethra that were selected for FUM in an attempt to release the penile urethral obstruction. Congenital megalourethra was diagnosed in 10 cases (4.4%) but only 3 cases (30%) with obstructive megalourethra and megacystis were selected for fetal surgery. Fetoscopic urethral metatotomy was successfully performed in all three cases at a median gestational age (GA) of 21.4 (18.0-26.7) weeks and with a median surgical time of 27 (12-43) min. A resolution of urethral dilatation and subsequent reduction of the penile length and normalization of both the bladder size and amniotic fluid were observed in all cases. The median GA at delivery was 35.2 (range: 30.6-38.0) weeks. There were no fetal deaths but one neonatal death (33%) secondary to renal failure and preterm delivery. In fetuses with LUTO by congenital obstructive megalourethra, FUM is feasible and is associated with good perinatal outcomes.

More than the oocyte source, egg donors as patients: a national picture of United States egg donors.

To characterize national oocyte donation practice patterns from the perspective of individual donors rather than of recipients. Retrospective cohort including all donor oocyte retrievals and transfers reported to SARTCORS in 2016 and 2017 in the USA. Primary outcomes include characteristics of oocyte donors and of donor oocyte cycles. Secondary outcomes include overall pregnancy rates, elective single embryo transfer (eSET) rates, and perinatal outcomes among donor oocyte recipient transfers. During the study period, 49,193 donor oocyte retrievals were performed, of which the largest proportion were in the Western US. For all reported retrievals, there were 17,099 unique donors, each of whom underwent an average of 2.4 retrievals (range 1-22). Average donor age was 26.3 years (range 18-48). On average, 24.6 oocytes (SD 12.4) were retrieved each cycle, ranging from 0 to 102. Among 37,657 donor oocyte recipient transfers, 20,159 (53.5%) involved eSET, and 17,725 (47.1%) resulted in live birth. Miscarriage rates were 17.5%, and good perinatal outcome (GPO), defined as full-term normal birthweight delivery, was more likely among singleton (75.7%) than multiple (23.8%) pregnancies. The average number of retrievals that donors underwent and oocyte yield mirrored national guidelines; however outliers, exist that may unnecessarily increase donor risk. Additionally, among resultant donor transfers, 46.5% transferred more than one embryo despite national recommendations for eSET. The significantly higher likelihood of GPO among singleton pregnancies points to the need to further increase donor recipient eSET rates.