Higher Rates Of Maternal Complications Research Articles

Assessment of Marijuana Use During Pregnancy and its Effects on Neonatal Outcomes

Background: According to the American College of Obstetricians and Gynecologists (ACOG), marijuana is the most used drug during pregnancy, and its self-reported prevalence ranges from ~2% to 7%. ACOG currently recommends against marijuana use during pregnancy due to inconclusive data regarding its safety and health effects. However, we know that THC readily crosses the placenta and can reach high fetal concentrations on repeated exposures. Several reports have linked adverse infant outcomes, such as low birth weight and abnormal neurological development, to marijuana use in pregnancy. Yet, many pregnant women continue to use marijuana throughout gestation as they believe it is safe, highlighting the role that education on marijuana use in pregnancy may aid in decreasing its usage. Furthermore, the growing legalization of marijuana may lead to further increase in marijuana use during pregnancy. Purpose: We aimed to identify the reported use of marijuana during pregnancy in our patient population, prior to legalization, and examine its effects on maternal and neonatal outcomes. We hypothesized that those who reported using marijuana during pregnancy would have higher rates of maternal complications and adverse neonatal outcomes. Methods: A retrospective chart review (IRB #21-823) was conducted which included pregnant women and their neonates who were admitted and delivered in 2019 at HSHS St. John’s Hospital in Springfield, Illinois to assess marijuana use prior to legalization and to investigate neonatal outcomes of infants who were exposed to marijuana, including the need for respiratory support or assisted ventilation after delivery. Other data extracted included demographic characteristics, the mother’s medical and obstetrical history, intrapartum and postpartum events and all documented substance use during pregnancy including tobacco, marijuana and illicit drugs. A logistic regression was used to assess marijuana use as a predictor of respiratory outcomes in infants. Odds ratios with 95% confidence intervals (CI) are reported. Results: In our study, 599 charts were reviewed. Of those, 69 reported marijuana use during pregnancy, or 11.5%, which importantly, is higher than the reported national average of 2-7%. Previous studies have shown a high correlation between marijuana, tobacco and illicit drug use. Additionally, studies have demonstrated that tobacco and illicit drug use result in poor neonatal outcomes. Therefore, we focused on a subpopulation of mothers who only reported marijuana use during pregnancy to remove these confounders. As a result, 112 subjects were removed from the analysis who reportedly used tobacco and/or other illicit drugs in addition to marijuana in order to exclusively focus on the effect of maternal marijuana use on neonatal outcomes. In this subpopulation of 477 subjects, the rate of marijuana use was 5.5% (lower than the overall population), but the effects of marijuana on neonatal outcomes was found to be significant. Demographics were as follows: mean age 28.2 ± 0.25 years; race, ethnicity: 76% White, non-Hispanic and 23% were other (i.e., African American/black, Asian, native Hawaiian/pacific islander, white and Hispanic, non-white and Hispanic or another race). In this subpopulation, admission to the NICU and small for gestational age were not significantly different between marijuana users and non-users. However, marijuana users did have higher odds of preterm birth (OR=3.8, CI: 1.5-9.6; p=0.004). Additionally, marijuana users had increased odds of having an infant that required respiratory support (OR=3.9, CI: 1.4-10.3; p=0.005) and assisted ventilation (OR=4.6, CI: 1.6-13.1; p=0.003). Yet, no adverse maternal outcomes were associated with exclusive marijuana use. Conclusion: Rates of marijuana use during pregnancy in our population is higher than the reported national average. Moreover, infants whose mothers exclusively used marijuana during pregnancy experienced higher rates of neonatal complications. Thorough screening and counseling regarding marijuana use in pregnancy and during breastfeeding is recommended, although there is no uniform process at this time. Implementing a standardized screening methodology and approach to education on the adverse neonatal effects of marijuana use in pregnancy during prenatal visits may be an effective intervention to improve neonatal outcomes in our patient population. This education is of particular importance in light of the recent legalization of marijuana.

Transient ischemic attack and pregnancy, delivery and neonatal outcomes-An evaluation of a population database.

Transient ischemic attack (TIA) is rare in women of reproductive age. We aimed to compare perinatal outcomes between women who suffered from a TIA to those who did not. A retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). All women who delivered or had a maternal death in the US (2004-2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD-9 diagnosis of a TIA to those without. Overall, 9 096 788 women met the inclusion criteria. Of these, 203 women (2.2/100000) had a TIA (either before or during pregnancy). Women with TIA, compared to those without, were more likely to be older than 35 years of age, white, in the highest income quartile, be insured by private insurance and suffer from obesity and chronic hypertension. Patients in the TIA group, compared to those without, had a higher rate of pregnancy-induced hypertension (aOR 2.5, 95% CI: 1.55-4.05, P < 0.001), pre-eclampsia (aOR 3.77, 95% CI: 2.15-6.62, P < 0.001), eclampsia (aOR 28.05, 95% CI: 6.91-113.95, P < 0.001), preterm delivery (aOR 1.78, 95% CI: 1.03-3.07, P = 0.039), and maternal complications such as deep vein thrombosis (aOR 33.3, 95% CI: 8.07-137.42, P < 0.001). Regarding neonatal outcomes, patients with a TIA, compared to those without, had a higher rate of congenital anomalies (aOR 7.04, 95% CI: 2.86-17.32, P < 0.001). Women with a TIA diagnosis before or during pregnancy had a higher rate of maternal complications, including hypertensive disorders of pregnancy and venous thromboembolism, as well as an increased risk of congenital anomalies.

The Effect of SARS-CoV-2 İnfection on Perinatal Outcomes in Hypertensive Disorders of Pregnancy.

To evaluate the fetal and maternal effects of the severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection in women with hypertensive disorders of pregnancy. Patients with hypertensive disorders of pregnancy and SARS-CoV-2 polymerase chain reaction (PCR) positivity (n = 55) were compared with cases with similar characteristics and PCR negativity (n = 53). The study group was further divided into two groups as severe (n = 11) and nonsevere (n = 44) coronavirus disease 2019 (COVID-19). The groups were compared in terms of clinical characteristics and perinatal outcomes. The study and control groups were similar in terms of maternal age, parity, gestational age at diagnosis, type of hypertensive disorders, magnesium sulfate administration rate, gestational age at birth, birth weight, Apgar scores, and maternal complications. However, all cases of fetal loss (n = 6) were observed in the SARS-CoV-2 positive group (p = 0.027). From the 6 cases, there were 5 in the nonsevere group and 1 patient in the severe SARS-CoV-2 positive group. Moreover, higher rates of maternal complications, lower oxygen saturation values, and intensive care unit admissions were observed in the severe COVID-19 group. Physicians should be cautious about the management of hypertensive disorders of pregnancy cases with SARS-CoV-2 positivity. Fetal loss seems to be more common in cases with SARS-CoV-2 positivity and severe COVID-19 seems to be associated with higher rates of maternal complications. Close follow-up for fetal wellbeing and active management of severe cases in terms of maternal complications seem to be favorable.

Patterns of antiseizure medication prescription in pregnancy and maternal complications in women with epilepsy: A retrospective study in Saudi Arabia

AimTo evaluate patterns of antiseizure medication (ASM) prescription in pregnancy and changes over a 16-year period: 2005–2020, and to investigate maternal complications in pregnant women with epilepsy (WWE). MethodData of pregnant WWE was retrospectively reviewed at the King Faisal Specialist Hospital and Research Centre, Riyadh and Jeddah, Saudi Arabia. ResultsOut of 162 pregnancies, 81.5% were prescribed ASMs. During the study period, the prescription rate increased from 68.8% to 93.5%. Between 2005 and 2020, the use of new ASMs increased from 15.4% to 75.5% (p < 0.0001). Furthermore, valproate use markedly decreased from 23.08% to 2.04%. The rate of maternal and delivery complications was 29.6%; the most frequent was gestational diabetes (5.6%), followed by bleeding during pregnancy (4.9%). Furthermore, preeclampsia and eclampsia were documented in 3.7% and 1.8%, respectively. ASMs use and other factors were not found to be associated with maternal complications (p > 0.05). However, first generation ASMs, i.e. carbamazepine (38.71%) and valproate (41.67%), were associated with higher maternal complication rates than new ASMs, i.e. levetiracetam (25%) and lamotrigine (20%), but the difference was not statistically significant (p = 0.4403). ConclusionASM prescription in pregnancy is increasing as is the use of new ASMs. The rate of maternal and delivery complications was relatively low, particularly preeclampsia and eclampsia. ASMs use was not found to associated with these complications. However, exposure to first generation ASMs seemed to be a predictor of adverse pregnancy outcomes.

Pregnancy Outcomes in Young Women With Youth-Onset Type2 Diabetes Followed in the TODAY Study.

To assess pregnancy outcomes in young women with youth-onset type 2 diabetes followed in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Pregnancy information (outcome and any maternal or fetal complications) was obtained from the female participants by self-report. Additionally, medical records for the pregnancy and the child's neonatal course were obtained with data abstracted into standardized forms. Over a maximum of 15 years, 260 pregnancies were reported by 141 women (aged 21.5 ± 3.2 years, BMI 35.6 ± 7.2 kg/m2, and diabetes duration 8.1 ± 3.2 years). Contraception use prior to pregnancy was reported by 13.5% of the women. Complications were reported by 65% of the women during their pregnancy. Pregnancy loss was observed in 25.3% and preterm birth in 32.6% of pregnancies. HbA1c ≥8% was observed in 31.9% of the pregnancies, and 35% of the pregnancies were complicated by chronic hypertension. Nephropathy prior to pregnancy was observed in 25% of the women. In the offspring, 7.8% were classified as small for gestational age, 26.8% large for gestational age, and 17.9% in the macrosomic range. Based on observations from the TODAY cohort, young women with pregestational, youth-onset type 2 diabetes had very high rates of maternal complications stemming from significant socioeconomic disadvantage. The substantial maternal and infant complications seen in these young moms could potentially be avoided with improved contraception rates and reproductive planning.

Obstructive sleep apnea syndrome is associated with maternal complications in pregnant women.

This study was performed to evaluate the relationship between obstructive sleep apnea syndrome and pregnancy complications. A total of 500 women (18-45 years) who had delivered (vaginal delivery or caesarean section) between January 2017 and March 2017 in our clinic were included in the study. Patients at high risk for obstructive sleep apnea syndrome were identified using the Stop Bang questionnaire. Based on the results of the questionnaire, pregnancy complications were compared between high-risk pregnant women (Group 1) and low-risk pregnant women (Group 2). Age, body mass index, smoking rate, and the rate of systemic disease (e.g., diabetes and/or hypertension) were higher in Group 1 than in Group 2 (p < 0.05). Rates of preeclampsia, gestational diabetes, preterm labor, premature rupture of the membranes, and cesarean section were significantly higher in Group 1 than in Group 2 (p < 0.05). Obstructive sleep apnea syndrome is associated with a higher rate of maternal complications among pregnant women. Affected patients should be carefully monitored.

Maternal Short-term Complications After Planned Cesarean Delivery Without Medical Indication: A Registry-based Study

(Acta Obstet Gynecol Scand. 2019;98:905–912) In Denmark, the cesarean delivery rate increased from 12.8% in 1996 to 20.8% in 2006. Since then the rate has stabilized to ∼20%. Many hospitals in Denmark have been striving to reduce cesarean delivery rates, based on the belief that there are higher rates of maternal complications with cesarean delivery compared with vaginal delivery. However, whether the rate of complications for healthy women requesting a planned cesarean delivery (PCD) without medical indication is actually increased has been called into question. This large, retrospective, population-based cohort study used the Danish Medical Birth Registry to compare short-term maternal outcomes between PCD and planned vaginal delivery (PVD) in term, low-risk women.

Unplanned Cesarean Delivery in the Second Stage of Labor Holds Higher Odds of Complications than in the First Stage, while Similar in Primiparas and Multiparas

Background: While endeavors to reduce cesarean delivery (CD) rates are given priority worldwide, it is important to evaluate if these efforts place parturients and neonates at risk. CD performed in the second stage of labor carries higher risks of maternal and fetal complications and is a more challenging surgical procedure than that performed in the first stage or before labor. In a population with a low CD rate, we sought to evaluate the rate of maternal and fetal complications associated with unplanned CD (UCD) performed in the second vs. the first stage of labor, in primiparas and multiparas, as well as the risk factors leading to and the complications associated with UCD in the second stage of labor in this low-CD rate setting. Methods: This was a retrospective, electronic medical record-based study of 7,635 term and preterm singletons born via UCD in the period 2003–2015. Maternal and neonatal background and outcome parameters were compared between groups. Logistic regression modeling was applied to adjust for clinically and statistically significant risk factors. Results: UCD was more likely to be performed in the second stage of labor in mothers delivering larger fetuses (head circumference and body weight ≥90 centile) and those with persistent occiput posterior (POP) presentation. UCD in the second stage was strongly associated with serious maternal complications (excessive hemorrhage and fever) compared to UCD performed in the first stage, in both primiparas and multiparas. Conclusions: UCD performed in the second stage of labor, while less frequent than first-stage UCD, is more likely with larger neonates and POP presentation, and is associated with a higher rate of maternal complications in primiparas and multiparas. Complication rates in our low-CD-rate population did not exceed those reported in the literature from high-CD-rate areas.

Maternal and fetal outcomes in pregnancies complicated by the inherited aortopathy Loeys-Dietz syndrome.

Pregnancies in women with Loeys-Dietz syndrome (LDS) are rare and are typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited. A retrospective cohort study. Eight specialist UK centres. Pregnant women with LDS. Data was collated on cardiac, obstetric, and neonatal outcomes. Maternal and perinatal outcomes in pregnancies complicated by LDS. Twenty pregnancies in 13 women with LDS were identified. There was one miscarriage, one termination of pregnancy, and 18 livebirths. In eight women the diagnosis was known prior to pregnancy but only one woman had preconception counselling. In four women the diagnosis was made during pregnancy through positive genotyping, and the other was diagnosed following delivery. Five women had a family history of aortic dissection. There were no aortic dissections in our cohort during pregnancy or postpartum. Obstetric complications were common, including postpartum haemorrhage (33%) and preterm delivery (50%). In all, 14/18 (78%) of deliveries were by elective caesarean section, at a median gestational age at delivery of 37 weeks. Over half the infants (56%) were admitted to the neonatal unit following delivery. Women with LDS require multidisciplinary specialist management throughout pregnancy. Women should be referred for preconception counselling to make informed decisions around pregnancy risk and outcomes. Early elective preterm delivery needs to be balanced against a high infant admission rate to the neonatal unit. Pregnancy outcomes in women with Loeys-Dietz syndrome.

Twin pregnancies at federal medical centre Katsina: A 5 year review

Background: Multiple gestation is associated with higher risk of maternal complications in the antenatal, intrapartum, and postpartum periods compared with singleton pregnancies, as well as higher risk for perinatal morbidity and mortality. Objective: The objective of this study was to determine the incidence and obstetric outcomes of twin deliveries in Federal Medical Centre Katsina. Methods: It is a retrospective study of twin deliveries over a 5-year period from January 1st 2010 to December 31st 2014 conducted at the Federal Medical Centre Katsina (FMCK), Katsina state. Results: There were 172 cases of twin deliveries out of 9,947 deliveries giving an overall twinning rate of 17.3 per 1,000 deliveries. There were three cases of triplet delivery during this period. The most common complication was preterm delivery which occurred in 40.1% of cases. The mode of delivery was vaginal in 64.5% while 35.5% had caesarean section. Emergency caesarean section for delivery of both babies was carried out in 24.42% while elective caesarean section for both babies accounted for 8.72%. Combined vaginal and abdominal delivery occurred in 2.33% of deliveries. The stillbirth rate was 81.4 per 1,000 births. There were 11 (6.4%) and 17 (9.9%) stillbirths among the first and the second babies respectively. Babies that had normal birth weight constituted 42.2%. The male to female ratio was 1:1.15. Conclusion: The rate of twin deliveries in our centre is high. There is also associated high rate of maternal complications and adverse perinatal outcomes.

MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during pregnancy: solved and unsolved questions.

With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2- to 3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. Apart from gestational hypertension, differential diagnosis includes pheochromocytoma and primary aldosteronism. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare and has poor prognosis. Active CS during pregnancy is associated with a high rate of maternal complications: hypertension or preeclampsia, diabetes, fractures; more rarely, cardiac failure, psychiatric disorders, infection and maternal death. Increased fetal morbidity includes prematurity, intrauterine growth retardation and less prevalently stillbirth, spontaneous abortion, intrauterine death and hypoadrenalism. Therapy is also challenging. Milder cases can be managed conservatively by controlling comorbidities. Pituitary or adrenal surgery should ideally be performed during the second trimester and patients should then be treated for adrenal insufficiency. Experience with anticortisolic drugs is limited. Metyrapone was found to allow control of hypercortisolism, with a risk of worsening hypertension. Cabergoline may be an alternative option. The use of other drugs is not advised because of potential teratogenicity and/or lack of information. Non-hormonal (mechanical) contraception is recommended until sustained biological remission is obtained.

Maternal outcomes associated with early preterm cesarean delivery

Data on complications associated with classic cesarean delivery are conflicting. In extremely preterm cesarean delivery (22 0/7-27 6/7 weeks' gestation), the lower uterine segment is thicker. It is plausible that the rates of maternal complications may not differ between classic and low transverse cesarean. We sought to compare maternal outcomes associated with classic versus low transverse cesarean after stratifying by gestation (23 0/7-27 6/7 and 28 0/7-31 6/7 weeks' gestation). We conducted a multihospital retrospective cohort study of women undergoing cesarean delivery at 23 0/7 to 31 6/7 weeks' gestation from 2005 through 2014. Composite maternal outcome (postpartum hemorrhage, transfusion, endometritis, sepsis, wound infection, deep venous thrombosis/pulmonary embolism, hysterectomy, respiratory complications, and intensive care unit admission) was compared between classic and low transverse cesarean. Outcomes were calculated using multivariable logistic regression models yielding adjusted odds ratios with 95% confidence intervals and adjusted P values controlling for maternal characteristics, emergency cesarean delivery, and comorbidities. Analyses were stratified by gestational age categories (23 0/7-27 6/7 and 28 0/7-31 6/7 weeks' gestation). Of 902 women, 221 (64%) and 91 (16%) underwent classic cesarean between 23 0/7 and 27 6/7 and between 28 0/7 and 31 6/7 weeks' gestation, respectively. There was no increase in maternal complications for classic cesarean versus low transverse cesarean between 23 0/7 and 27 6/7 weeks' gestation. However, between 28 0/7 and 31 6/7 weeks' gestation, classic cesarean was associated with increased risks of the composite maternal outcome (adjusted odds ratio, 1.95; 95% confidence interval, 1.10-3.45), transfusion (adjusted odds ratio, 2.42; 95% confidence interval, 1.06-5.52), endometritis (adjusted odds ratio, 3.23; 95% confidence interval, 1.02-10.21), and intensive care unit admission (adjusted odds ratio, 5.05; 95% confidence interval, 1.37-18.52) compared to low transverse cesarean. Classic cesarean delivery compared with low transverse was associated with higher maternal complication rates between 280/7 and 31 6/7 weeks, but not between 23 0/7 and 27 6/7 weeks' gestation.

109 Pregnancy among kidney transplanted women: Feasibility of pregnancy and effects on the mother and renal graft

Background Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. Methods Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. Results There were 53 pregnancies in 36 patients. Mean age was 28 ± 5 years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p Conclusion Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Pregnancy outcomes in liver transplant patients, a population-based study

Objective: To determine the incidence of pregnancy in liver transplant (LT) patients in a large population-based cohort and to determine the maternal and fetal risks associated with these pregnancies.Methods: We conducted an age-matched cohort study using the US Healthcare and Utilization project–Nationwide Inpatient Sample from 2003–2011. We used unconditional logistic regression, adjusted for baseline characteristics, to estimate the likelihood of common obstetric complications in the LT group compared with age-matched nontransplant patients.Results: There were 7 288 712 deliveries and an estimated incidence of 2.1 LTs/100 000 deliveries over the nine-year study period. LT patients had higher rates of maternal complications including hypertensive disorders (OR 6.5, 95% CI: 4.4–9.5), gestational diabetes (OR 1.9, 95% CI: 1.0–3.5), anemia (OR 3.2, 95% CI: 2.1–4.9), thrombocytopenia (OR 27.5, 95% CI: 12.7–59.8) and genitourinary tract infections (OR 4.2, 95% CI: 1.8–9.8). Deliveries among women with LT had higher risks of cesarean section (OR 2.9, 95% CI: 2.0–4.1), postpartum hemorrhage (OR 3.2, 95% CI: 1.7–6.2) and blood transfusion (OR 18.7, 95% CI: 8.5–41.0). Fetal complications in LT patients included preterm delivery (OR 4.7, 95% CI: 3.2–7.0), intrauterine growth restriction (OR 4.1, 95% CI: 2.1–7.7) and congenital anomalies (OR 6.0, 95% CI: 1.1–32.0).Conclusion: Although pregnancies in LT recipients are feasible, they are associated with a high rate of maternal and fetal morbidities. Close antenatal surveillance is recommended.

Pregnancy after kidney transplantation: high rates of maternal complications

Women regain fertility a few time after renal transplantation. However, viability of pregnancy and maternal complications are still unclear. To describe the outcomes of pregnancies in kidney transplanted patients, focusing on maternal complications. Retrospective study of pregnancies in kidney transplanted patients between 2004 and 2014, followed up 12 months after delivery. Each pregnancy was considered an event. There were 53 pregnancies in 36 patients. Mean age was 28 ± 5years. Pregnancy occurred 4.4 ± 3.0 years post-transplant. Immunosuppression before conception was tacrolimus, azathioprine, and prednisone in 74% of the cases. There were 15% miscarriages in the 1st trimester and 8% in 2nd trimester. In 41% of the cases, it was necessary to induce labor. From all births, 22% were premature and 17% very premature. There were 5% stillbirths and 5% of neonatal deaths. De novo proteinuria occurred in 60%, urinary tract infection in 23%, preeclampsia in 11%, acute rejection in 6%, and graft loss in 2% of the cases. It was observed a significant increase in creatinine at preconception comparing to 3rd trimester and follow-up (1.17 vs. 1.46 vs. 1.59 mg/dL, p < 0.001). Although the sample is limited, the number of miscarriages was higher than in the general population, with high rates of maternal complications. Sustained increase of creatinine suggests increased risk of graft loss in long-term.

Pregnancy Outcomes in Women with Polycystic Ovarian Syndrome

Background: Polycystic ovary syndrome (PCOs) is a common genetic and endocrine disorder affecting 5-10% of women at reproductive age. Aim was to assess pregnancy outcomes of pregnant women with PCOs. Subjects and methods: Comparative descriptive cross-sectional study design was conducted in the labor ward of Obstetrics and Gynecology, Qena University and Qena General Hospital. Convenient sample were 120 pregnant women with PCOs and other 600 pregnant women without PCOs. Data collected by structured interview questionnaire, maternal and neonatal assessment sheet. Results of the study found that pregnancy with PCOs was associated with significantly higher rates of maternal complications as hypertension (14.2%), gestational diabetes mellitus (10.8%), preeclampsia (4.2%), preterm delivery (5%) and cesarean delivery (79.2%) versus (0.7%), (0.7%), (2.3%), (1.7%) and (53.8%) in the non PCOs group. Neonatal complications as APGAR score of less than 7 (19.2%), macrosomia (9.2%), respiratory distress (20.8%) and admission to neonatal intensive care unit (4.3%) versus (2.2%), (3.2%), (6.2%) and (20.8%) in the non PCOs group with highly statistical significant relationship among both groups. Conclusions: This study confirmed higher association of pregnancy complications among PCOs group compared with non PCOs group. Recommendations: women with PCOs should be followed up for complications on pregnancy and neonatal outcomes.

Analysis of Anticoagulant Therapy by Unfractionated Heparin During Pregnancy After Mechanical Valve Replacement

Consensus has not been reached about the anticoagulant therapy to be used during pregnancy after mechanical valve replacement. Warfarin is a fetal toxicant, so we retrospectively examined anticoagulant therapy using unfractionated heparin. Pregnancy after mechanical valve replacement occurred in 25 cases between 1983 and 2011. Targeted therapy using unfractionated heparin was administered in 9 pregnancies, which were divided into 3 groups: Group I received subcutaneous administration of heparin and APTT was measured twice weekly; Group II received heparin by constant rate infusion (CRI) and APTT was measured twice weekly; Group III received CRI of heparin and APTT was measured daily. Maternal complications consisted of valve thrombosis and perinatal bleeding in 1 pregnancy (Group I), intracranial hemorrhage in 2 pregnancies (Group II), and valve thrombosis and perinatal bleeding in 1 pregnancy (Group III). Two infants died in the neonatal period. Each group showed a high rate of maternal complications, so a review of current anticoagulant treatment strategies is necessary.

Is induction of labor risky for twins compare to singleton pregnancies?

Objective: The aim of this study was to investigate whether induction of labor in twin pregnancies is associated with higher rates of maternal complications as compared to singletons.Method: A retrospective population-based study was conducted to compare maternal complications following induction of labor in twin pregnancies and singletons at Soroka University Medical Center, Be'er-Sheva, Israel, between 1988 and 2010. Stratified analysis using a multiple logistic regression model was performed to control for confounders.Results: The study population included 25 913 patients following induction of labor, of these 191 (0.73%) were in twin pregnancies. Induction of labor in twin pregnancies was not associated with adverse maternal outcomes such as cervical tears, third degree perineal tears, uterine rupture, peripartum hysterectomy, post-partum hemorrhage or retained placenta. However, labor induction in twins was significantly associated with cesarean deliveries (31.2% versus 17.1%; p < 0.001).Using a multivariable analysis controlling for confounders, induction at twins was an independent risk factor for cesarean delivery (CD; adjusted OR = 2.2, 95% CI 1.7–2.7, p < 0.001).Conclusion: Induction of labor in twin pregnancies does not increase the risk for maternal complications. However, it is an independent risk factor for CD.

Impact of previous lupus nephritis on maternal and fetal outcomes during pregnancy

Previous reports suggest that renal involvement before pregnancy or active renal disease during pregnancy may be associated with poor fetal and maternal outcomes in systemic lupus erythematosus (SLE) women. We report our experience of fetal and maternal complications in pregnant lupus women with and without previous lupus nephritis. We analyzed the clinical records of pregnant SLE patients attended in a tertiary reference center during a 5-year period. Patients were allocated into two groups according to the presence or absence of previous lupus nephritis. Women were evaluated monthly during pregnancy and at least 1 month postpartum. Maternal and fetal outcomes of pregnancy were abstracted. We included 95 pregnancies in 92 patients. Compared with pregnant women without lupus nephritis (n = 60), pregnancies with previous lupus nephritis (n = 35) were associated with a higher risk of maternal complications (88.5% vs. 43.3%, p = 0.00001), higher rate of lupus flares (54.2% vs. 25%, p = 0.004), and renal flares (45.7% vs. 6.6%, p = 0.00001), but most of which in most instances were reversible. On the other hand, fetal outcome was similar in both groups. Multivariate analysis showed that previous lupus nephritis and active lupus at conception were predictors of adverse maternal outcome. Pregnancies in women with previous lupus nephritis had a higher rate of maternal complications in comparison with those without. However, fetal prognosis was similar in both groups.

Breech presentation at a district level hospital in South Africa

SA Fam Pract 2010;52(1):64-68 Introduction: The Term Breech Trial has led to obstetricians opting for Caesarean section as the mode of delivery for this presentation, even in poor countries. Concerns related to this approach are the resultant increase in Caesarean section rates and their associated complications, particularly in under-resourced countries, which are faced with financial and human-resource expertise constraints. Method: This was a retrospective chart review of women who presented at term with a singleton breech presentation at the antenatal clinic and in labour, from January 2005 to December 2007, at a district level hospital in South Africa. Results: There was a total of 19 197 deliveries, of which 466 were singleton term breech deliveries, giving a rate of 2.4%. Of the 297 women who had antenatal care and had been allocated to planned Caesarean section, 271 had the planned operation. There were no neonatal deaths in the planned Caesarean section group. The emergency Caesarean section group and the group in which no decision was made on the mode of delivery were associated with higher maternal complication rates than in the group that had planned Caesarean sections. The highest neonatal complication rate was in the group that had unplanned vaginal deliveries. Conclusion: In a district hospital in South Africa, the mode of delivery for breech presentations is usually a planned Caesarean section. Unplanned vaginal deliveries are associated with significant perinatal mortality. Peer reviewed. (Submitted: 2009-03-05, Accepted: 2009-08-10). © SAAFP