Higher Incidence Of Preterm Birth Research Articles

P-782 Are pregnancy complications associated with the method of conception in female same-sex couples? Results of a retrospective, matched cohort study comparing ROPA and IUI

Abstract Study question Are pregnancies in female same-sex couples at a higher risk when using reception of oocytes from partner (ROPA) compared to those following intrauterine insemination (IUI)? Summary answer In female same-sex couples, pregnancies following ROPA demonstrated a higher incidence of preterm birth and first-trimester bleeding. What is known already Reception of Oocytes from PArtner (ROPA) enables both partners to contribute biologically to the desired pregnancy. However, oocyte donation, often performed in case of (premature) ovarian failure, is associated with an increased risk of hypertensive disorders of pregnancy/preeclampsia. Female same-sex couples typically comprising healthy, young women without underlying subfertility problems, are a priori at low absolute risk for pregnancy complications. Few studies have investigated the incidence of pregnancy complications and/or obstetrical outcomes in this specific group of women. Further insights and formal data could guide clinicians and patients in making informed decisions regarding the preferred method of conception. Study design, size, duration A retrospective, single-center, matched cohort study was performed including 577 unique female same-sex couples using donor semen who became pregnant after reproductive treatment (88 pregnancies following ROPA and 489 following IUI). None of the patients who opted for ROPA had (failed) IUI before. The study covered the period from January 2015 to January 2023. Participants/materials, setting, methods Pregnancies following ROPA were matched with pregnancies following IUI for age (+/-4 years), BMI (+/-4 kg/m2), parity (nulliparous vs multiparous) and date of embryo transfer/IUI (+/-1year) in a 1:1 ratio. Statistical Package for Social Sciences (SPSS) v26.0 was used for statistical analysis. Kolmogorov-Smirnov test was used to evaluate the normal distribution of continuous variables. Normally distributed data were analyzed with the student t-test and categorical variables were analyzed with the chi-square test. Main results and the role of chance After matching, 154 pregnancies (77 ROPA versus 77 IUI) were eligible for the study. Age (mean age 31.4±4.0 for ROPA versus 31.2±4.3 years for IUI, p = 0.48) and BMI (24.5±3.9 kg/m2 versus 25.2±4.4 kg/m2, for respectively ROPA versus IUI, p = 0.32) were comparable between groups after matching. Two ROPA pregnancies were excluded from further analysis due to elective termination of pregnancy (radiusaplasia and trisomy 21). Both groups experienced two stillbirths (two unexplained mors in utero, one chorioamnionitis and one intrapartum death). No significant difference in hypertensive disorders of pregnancy (HDP) (10.7% (8/75) versus 13.7% (10/73) for ROPA and IUI respectively, p = 0.53) or preeclampsia rates (11.0% (8/73) and 6.7% (5/75) for ROPA and IUI respectively, p = 0.33) was observed. ROPA-associated preeclampsia cases were often preterm (<37weeks’ gestation) compared to IUI (5/8 versus 1/5). ROPA pregnancies had a higher incidence of preterm birth (15.1% vs 1.3%,p<0.002) and first trimester bleeding was significantly more frequent (12.3% vs 0%,p<0.001). No statistically significant differences were observed between groups in neonatal weight, fetal structural malformations and cesarean section delivery rates. Limitations, reasons for caution The study is limited by its retrospective design and inherent bias. Despite reducing the sample size, matching enhanced study robustness. Recognized risk factors for hypertensive disorder of pregnancy, like the use of donor sperm, may mitigate differences associated with conception methods in this population. Wider implications of the findings The study points out potentially increased obstetrical risks following ROPA. These data are crucial to counsel and guide female same-sex couples in their decision regarding the method of conception. The risk of hypertensive disorders of pregnancy, specifically preterm preeclampsia, associated with ROPA warrants further attention, urging larger prospective studies. Trial registration number not applicable

P-126 The impact of ICSI versus IVF on the reproductive outcomes of couples with non-male factor infertility and frozen-thawed embryo transfer cycles

Abstract Study question Does Intracytoplasmic Sperm Injection (ICSI) improve reproductive outcomes in patients with non-male factor infertility undergoing Frozen-Thawed Embryo Transfer (FET) treatment? Summary answer ICSI showed slightly improved clinical outcomes compared to IVF, but was associated with higher preterm birth rates and low birthweight when twins were born. What is known already The use of ICSI has seen a significant surge globally, particularly in Europe and the USA, as a solution for fertilization failure resulting from male factor infertility. FET presents a viable option for those considering additional children. Numerous studies have investigated the effectiveness of ICSI in couples with non-male factor infertility undergoing fresh embryo transfer in ovarian stimulation cycles. However, there is a dearth of evidence demonstrating whether ICSI, compared to conventional IVF (cIVF), could influence reproductive outcomes in couples with non-male factor infertility undergoing FET treatment. Study design, size, duration This retrospective cohort study included 10,143 cycles from 6,206 couples who underwent FET at the Third Affiliated Hospital of Zhengzhou University between January 2016 and September 2022. Participants/materials, setting, methods Patients were categorized into two groups based on the insemination methods used for the transferred embryos. Patients were excluded if : 1) Embryos were biopsied and tested; 2) Oocytes had been vitrified; 3) Embryos were derived from donor oocytes, AOA treatment, or rescue ICSI; 4) Embryos that were not transferred; and 5) They had undergone fresh embryo transfer. PSM at a ratio of 1:1 was utilized to ensure comparability of reproductive outcomes. Main results and the role of chance Post-PSM, the general characteristics were comparable across both groups. The clinical pregnancy rates (37.6% vs 40.0%, P = 0.311), miscarriage rates (21.4% vs 23.1%, P = 0.597), and live birth rates (28.2% vs 30.4%, P = 0.329) exhibited no significant disparity post-PSM between the two groups. Notably, a marginally elevated live birth rate was observed in the ICSI group when blastocysts were transferred to the women (39.8% vs 48.3%, P = 0.050). However, the GEE models indicated that ICSI did not enhance the likelihood of clinical pregnancy, miscarriage, and live birth relative to IVF in women with non-male factor infertility. Following adjustments for variables, ICSI yielded consistent OR values [1.14(0.92-1.42), P = 0.241; 1.08(0.72-1.61), P = 0.703; and 1.16(0.92-1.46), P = 0.220, respectively]. The perinatal outcomes were similar between the two grousps. However, a significantly higher incidence of preterm birth was observed in the ICSI group compared to the cIVF group (20.0% vs 12.5%, P = 0.026). While pregnancy complications were comparable between the two groups, neonates born as twins in the ICSI group exhibited significantly reduced live birth-weight [2520.8(572.9) vs 2691.9(423.7), P = 0.043] and birth length [47.5(2.8) vs 48.5(2.3), P = 0.031]. Correspondingly, the rate of low birthweight was significantly higher in the ICSI group (38.9% vs 21.0%, P = 0.025). Limitations, reasons for caution The retrospective design may lead to selection bias among the included patients. The use of ICSI in ART has been strictly regulated in our country, limiting the sample size and potentially reducing the statistical power. Wider implications of the findings The value of ICSI should be thoroughly discussed with patients with non-male factor infertility before ovarian stimulation. Further research is needed to better understand the impact of ICSI on reproductive and neonatal outcomes in this population. Trial registration number 2021YFC2700602

Fetal Growth Restriction in Patients with Adenomyosis. Incidence and Mechanism

Reports on adenomyosis in pregnancy are few and include a small number of patients. Currently, ultrasound is the first-line imaging diagnostic tool, with a sensitivity of about 84%. Controversies eist regarding the relation of adenomyosis with infertility and pregnancy complications. We analyzed the intrauterine growth restriction (IUGR) cases for a period of one year aiming to determine if adenomyosis impacts negatively the pregnancy outcome. The preterm birth rate in our study population was 20%. From the preterm birth subgroup, the greatest percentage was attributed to late prematurity. The incidence of adenomyosis in this group of pregnancies complicated with IUGR was about 9%. According to our results, there is a higher incidence of preterm birth in cases complicated with fetal growth restriction, as reported by other much larger studies. At this point, there is no established associated risk or method to prevent unfavorable outcomes related to the impact of adenomyosis on pregnancy.

Maternal and neonatal outcomes of twin pregnancies complicated by gestational diabetes mellitus

IntroductionGestational diabetes mellitus (GDM) is associated with a higher risk of adverse maternal outcomes, but its effects on maternal and perinatal outcomes of twin pregnancies remain conflicting.MethodsThis retrospective cohort study included all primipara who delivered twin pregnancies at a single tertiary perinatal center between January 1, 2016 and December 31, 2022. Excluded were those who had a single pregnancy, twin pregnancies with pre-existing diabetes, missing information on GDM screening, a delivery before gestational 28 weeks, complications related to monochorionic placentation, multifetal reduction, fetal anomalies, and monochorionic monoamniotic twins. Maternal outcomes included preterm birth, pre-eclampsia, hypothyroidism, preterm premature rupture of membranes (PROM), placental abruption, severe postpartum hemorrhage, and oligohydramnios. Neonatal outcomes included small-for-gestational-age (SGA), large-for-gestational-age (LGA), birthweight, Apgar score, neonatal intensive care unit (NICU) admission, extrauterine growth restriction (EUGR), and neonatal hypoglycemia.ResultsA total of 3269 twins were delivered, with 897 women (27.4%) diagnosed with GDM during pregnancies; moreover, 72 (8.0%) of these women received insulin treatment. The GDM group showed a significantly higher maternal age at delivery (≥35 years), as well as incidences of overweight and obesity. These factors also elevated the odds of insulin treatment in GDM women with twin pregnancies (OR = 1.881, 95% CI = 1.073–3.295, P = 0.027; OR = 2.450, 95% CI = 1.422–4.223, P < 0.001; OR = 4.056, 95% CI = 1.728–9.522, P < 0.001, respectively). Chronic hypertension prior to pregnancy was identified as a risk factor for GDM during twin pregnancies (OR = 1.896, 95% CI = 1.290–2.785, P < 0.001), although it did not increase the proportion of women requiring insulin treatment (P = 0.808). Aside from a higher incidence of preterm birth before 37 weeks in insulin-treated GDM twins (OR = 2.096, 95% CI = 1.017–4.321, P = 0.045), there were no significant difference in other maternal outcomes (preterm birth before 34 weeks, pre-eclampsia, hypothyroidism, PROM, placental abruption, placenta previa, severe postpartum hemorrhage, and oligohydramnios) between the GDM group and non-GDM group, and between insulin-treated GDM and non-insulin-treated GDM. The rate of newborns with birthweight <1500 g was significantly lower among twins born to GDM women, but the prevalence of EUGR was notably higher. Additionally, the risk of EUGR was elevated in insulin-treated GDM twins (OR = 3.170, 95% CI = 1.639,6.131, P < 0.001). No significant differences were observed between the GDM group and non-GDM group, or between insulin-treated GDM and non-insulin-treated GDM group in terms of mean birthweight, newborn sex ratio, and incidences of other adverse neonatal outcomes, including gestational age at delivery, LGA, birth weight <2500 g, and 1-min and 5-min Apgar scores.ConclusionMaternal age ≥35 years, overweight or obesity, and chronic hypertension are significant risk factors for GDM during twin pregnancies. Women with GDM during twin pregnancies may achieve similar outcomes compared to those without GDM. However, the women with GDM during twin pregnancies receiving insulin therapy may have a higher risk of preterm birth and EUGR.

Rezultatele naşterii la vârste materne foarte avansate – experienţa unui centru de nivel 2

Background. Advanced maternal age has been linked to unfavorable perinatal outcomes. This study aimed to evaluate the perinatal outcomes in patients with very advanced maternal age. Materials and method. We retrospectively reviewed the records of patients admitted to the Obstetrics and Gynecology Clinic of the Mureş County Clinical Hospital, Romania, between 1 September 2016 and 1 September 2023. The study group comprised 17 patients, while the control group consisted of 661 patients, aged 18-44 years old, who gave birth between 1 January 2023 and 30 June 2023. Results. Patients from rural areas with very advanced maternal age had more pregnancies and births than the control group. The majority of pregnancies were achieved naturally, with a significantly higher incidence of preterm birth before 34 weeks. There were no statistically significant differences in the incidence of pregnancy-induced hypertension and intrauterine growth restriction between groups, while obesity and gestational diabetes were significantly associated with very advanced maternal age. Caesarean section was the most common mode of delivery. Newborns of mothers with very advanced age were more frequently male, had low birth weight, and were frequently admitted to the intensive care unit. Conclusions. Advanced maternal age is associated with an increased risks of gestational diabetes, premature birth, caesarean section, and delivering small-for-gestational-age newborns. Therefore, patients with advanced maternal age require careful obstetric surveillance.

Predicting Adverse Pregnancy Outcomes based on Maternal Serum Markers in Quad Test

OBJECTIVE To compare adverse pregnancy outcomes (APOs) between low-risk and high-risk serum quadruple test for aneuploidy screening. METHODS This cohort design study screened pregnant women who had undergone quad test serum screening in Ratchaburi province, Thailand. The sample of 400 women was divided into two groups, low-risk quad test (n=200) and high-risk quad test (n=200) using random allocation software. Participants were followed up for final outcomes and compared for APOs. The data were analyzed using binary logistic regression analysis and risk ratios. RESULTS Of a total of 1,891 pregnant women, 206 (10.8%) had APOs. Of the women with APOs, 92 (46%) had high-risk quad test results and 32 (16%) were in the low-risk quad test group. The incidence of preeclampsia, intrauterine growth restriction (IUGR) and chromosome abnormality in the high-risk quad test group were all statistically significantly higher in the high-risk quad test group than in the low-risk quad test group (p = 0.013, 0.001, 0.043 respectively). The high-risk quad test group also had a higher incidence of preterm birth, abortion, gestational diabetic mellitus in high-risk quad test group, but the differences were non-statistically significant. CONCLUSIONS High-risk serum quad test results can help predict the risk of APOs such as preeclampsia, IUGR and chromosome abnormality. KEYWORDS quad test, maternal serum marker, adverse pregnancy outcome

Vanishing twin syndrome is associated with first-trimester intrauterine hematoma in twin pregnancies after in vitro fertilization.

Is there an association between intrauterine hematoma (IUH), vanishing twin syndrome (VTS), and subsequent complications in twin pregnancies after in vitro fertilization (IVF)? What are the risk factors for these complications? Women who presented with two live gestational sacs following double embryo transfer were included. Patients with systematic diseases, artificial fetal reduction, and incomplete data were excluded. Further stratification of IUH pregnancies was performed according to IUH-related characteristics (i.e., volume, changing pattern, and relationship with fetal cardiac activities). The primary outcome was the incidence of VTS, while adverse outcomes in the surviving singleton and the gestational age of VTS were secondary outcomes. The incidence of IUH was 13.8%. A total of 1,078 twin pregnancies including 539 IUH pregnancies and 539 non-IUH pregnancies were included. IUH pregnancy was associated with higher risks of VTS (26.9% vs. 18.7%, p = 0.001) as well as a higher incidence of preterm birth (p = 0.001, crude OR = 1.98, 95% CI 1.28-3.09, adjusted OR = 1.19, 95% CI 1.09-1.24), threatened abortion (p < 0.001, crude OR = 9.12, 95% CI 2.90-28.69, adjusted OR = 6.63, 95% CI 1.69-14.67), and postpartum hemorrhage (p = 0.024, crude OR = 3.13, 95% CI 1.09-8.99, adjusted OR = 1.16, 95% CI 1.08-1.32) in the surviving singleton. There was no significant difference in risks of other complications. The absence of fetal cardiac activities at the diagnosis of IUH predicted VTS (p < 0.001, crude OR 4.67, 95% CI 3.67-5.78, adjusted OR 3.33, 95% CI 1.56-5.14) and fetal loss at smaller gestational age (7.81 ± 2.10 vs. 11.39 ± 5.60 weeks, p < 0.001), while an IUH with an increasing volume did not increase the risk of VTS but might induce threatened abortion in the surviving fetus (p < 0.001, crude OR 1.84, 95% CI 1.32-2.55, adjusted OR 1.72, 95% CI 1.13-2.13). IUH was a risk factor for VTS in twin pregnancies following double embryo transfer and elevated the risks of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. The absence of fetal cardiac activities at the diagnosis of IUH elevated the risks of VTS, while an IUH with an increasing volume was associated with threatened abortion without elevating the risks of VTS. An IUH diagnosed before the presence of fetal cardiac activities also resulted in an earlier miscarriage. The study suggests that attention be paid to twin pregnancies with first-trimester IUH to prevent VTS and subsequent adverse perinatal outcomes. First-trimester intrauterine hematoma (IUH) following double embryo transfer is associated with a higher incidence of vanishing twin syndrome (VTS) and elevated subsequent risk of threatened abortion, preterm birth, and postpartum hemorrhage in the surviving singleton. Other perinatal outcomes were not associated with the diagnosis of first-trimester IUH. The absence of fetal cardiac activities at the diagnosis of IUH was of predictive value toward VTS, while an IUH with an increasing size was associated with threatened abortion without elevating the risk of VTS. Incomplete fetal cardiac activities and earlier detection of an IUH might also predict miscarriage at smaller gestational age.

Gestational weight gain and neonatal outcomes in different zygosity twins: a cohort study in Wuhan, China

ObjectiveTo evaluate whether twin zygosity influences the association between neonatal outcomes and gestational weight gain (GWG) based on the Chinese guidelines in twin-pregnancy women.DesignA retrospective cohort study. And it is...

Effect of prior spontaneous preterm birth on delivery timing in subsequent twin pregnancy

People pregnant with twins who had a prior, singleton preterm birth are known to be at risk for preterm birth; however, prior data did not distinguish between spontaneous and iatrogenic births in the prior singleton pregnancy. We aimed to investigate the recurrence risk for preterm birth in a subsequent twin pregnancy in those who had prior spontaneous preterm birth (PSPTB) compared to those without PSPTB in a modern obstetric cohort. This is a secondary analysis of data from a retrospective cohort aimed to evaluate cell-free DNA screening performance in patients with twin pregnancies from 12/2011- 2/2020. We included twin pregnancies >20 weeks gestation and excluded those with nulliparity, unknown pregnancy outcome in twin pregnancy and unknown prior pregnancy history. Presence or absence of PSPTB was confirmed by medical record review. Baseline characteristics, gestational age of twin pregnancy and preterm birth in twin pregnancy were compared between those with history of PSPTB versus those without PSPTB. Multivariable logistic regression was used to assess adjusted odds ratio and adjust for confounders. Of the 958 twin pregnancies, 877 had no PSPTB and 81 had PSPTB. Those with twin pregnancies and prior PSPTB had a higher incidence of preterm birth (PTB) overall (77.8% vs 55.2%, OR 2.84 95%CI 1.66-4.87) and lower gestational age at delivery (34.7 vs 36.6 weeks, p< 0.001) than those with twin pregnancies without PSPTB. However, the rate of spontaneous PTB was not significantly different (46.8% vs 41.7%, OR 1.28 95% CI 0.75-2.17). For patients with PSPTB the adjusted odds ratio for PTB was 3.14 (95% CI 1.72,5.72) after controlling for Black race, body mass index, tobacco use, assisted reproductive technology, chronic hypertension and pregestational diabetes. Pregnant persons who have PSPTB are at increased risk for preterm birth in a subsequent twin pregnancy, and this information may be useful for risk counseling.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Thin endometrium is associated with higher risks of preterm birth and low birth weight after frozen single blastocyst transfer.

It has been demonstrated that a thin endometrium is associated with a lower chance of pregnancy, but there is a paucity of research into whether a thin endometrium adversely affects perinatal outcomes. This was a retrospective cohort study on 10098 frozen cycles with single blastocyst transfer, resulting in 5505 singleton clinical pregnancies, and 4314 singleton live births. Patients were divided into a thin endometrium group (<8mm) and a normal endometrium group (≥8 mm). Multivariable logistic regression with restricted cubic splines, receiver operating characteristic curve, and multivariable linear model were used for statistical analysis. The incidences of preterm birth (15.65 vs. 9.80%, aOR=1.69 [1.19-2.42]), low birth weight (8.40 vs. 4.10%, aOR=2.05 [1.27-3.30]) and gestational diabetes (6.87 vs. 4.17%, aOR=1.74 [1.05-2.90]) were all higher in the endometrial thickness (EMT) <8mm group. The miscarriage rate was higher in the EMT <8mm group than the EMT ≥8 mm group (27.91 vs. 20.39%, aOR=1.40 [1.10-1.79]). A thin endometrium may be associated with a higher incidence of preterm birth, low birth weight, and miscarriage. Therefore, embryo transfer should be performed with caution in these patients, and postponing to a later cycle with a thicker endometrium should be considered.

O-058 Obstetric outcomes of twin gestation after In-Vitro Fertilization and Embryo Transfer (IVT-ET) treatment in patients who underwent hysteroscopic septoplasty for subseptate uterus

Abstract Study question Is there an associated increased risk of preterm birth (PTB) in patients who underwent hysteroscopic septoplasty for subseptate uterus (SSU) with twin gestation through IVF-ET? Summary answer This study suggests an increased risk of PTB in patients, who underwent hysteroscopic septoplasty for SSU, and subsequently conceived twins after IVF-ET treatment. What is known already In general, the incidence of PTB is higher after IVF-ET treatment. In addition, Müllerian uterine anomalies, such as unicornuate uterus, are considered risk factors for PTB, even with singleton pregnancy. Furthermore, historical data suggest that some patients with uterine anomaly may have cervical incompetence. Twin gestation is associated with PTB in approximately 50% of cases. It is assumed that the obstetric outcome of twin gestation after successful septoplasty should be no different from those with normal uterine cavity. The impact of previous septoplasty for SSU on the obstetric outcomes of twin gestation after IVF-ET treatment has not been adequately studied. Study design, size, duration This retrospective cohort study included 377 fertility patients who received treatment between 2006-2019. The study group included 162 patients who underwent hysteroscopic septoplasty for SSU and subsequently conceived dichorionic-diamniotic (DI-DI) twins after IVF-ET treatment (Group 1). The control group included 215 patients who had normal endometrial cavity on hysteroscopy (#109) or Transvaginal 3D ultrasound scan with saline sonohysterogram (#106) and subsequently conceived DI-DI twins after IVF-ET treatment (Group 2). Participants/materials, setting, methods This study was conducted at an infertility clinic affiliated with an academic hospital. Demographic, clinical, and obstetric outcome data were collected for both groups and compared using appropriate statistical methods. PTB, severe PTB, extreme PTB, and peri-viable birth were defined as &amp;lt; 37 weeks, &amp;lt;32 weeks, &amp;lt;28 weeks and between 20 weeks-25 weeks 6 days gestation respectively. Main results and the role of chance There was no significant difference in mean age, BMI and infertility duration or in the incidence of smoking, primary infertility, tubal factors and unexplained infertility between the two groups. There was significantly lower mean baseline FSH levels (p &amp;lt; 0.01), lower incidence of male infertility (p &amp;lt; 0.001) and higher incidence of ovulatory disorders (p &amp;lt; 0.001) and endometriosis (p &amp;lt; 0.05) in Group 1 compared to Group 2. As expected, there was past history of lower parity rate (p &amp;lt; 0.01) and higher miscarriage rate (p &amp;lt; 0.001) in Group 1 compared to Group 2 prior to septum division. There was significantly higher incidence of PTB (72.8% vs 56.3%, p &amp;lt; 0.01), severe PTB (20.3% vs 8.2%, p &amp;lt; 0.01), extreme PTB (8.3% vs 3.9%, p &amp;lt; 0.05), and peri-viable birth (6.3% vs 1.9%, p &amp;lt; 0.05) in Group 1 compared to Group 2. There was no significant difference in cesarean section rate (82.8% vs 87.5%, p = 0.349) between Group1 and Group 2 respectively. There was significantly lower gestational age at birth in weeks (34.0 + 4.0 vs 35.6 + 3.0, p &amp;lt; 0.001), birth weight of the first newborn (2180.5 + 717.9 vs 2436.4 + 606.6, p &amp;lt; 0.001), and the second newborn (2235.2 + 674.2 vs 2398.0 + 537.9, p &amp;lt; 0.05) in grams in Group 1 compared to Group 2. Limitations, reasons for caution Our study has limitations being retrospective in nature. Data on cervical length measurements via ultrasound, if performed, was not available. However, recall bias was prevented by retrieving data from that submitted to the Society of Assisted Reproductive Technology. Additionally, procedural variation was reduced as this was a single-center study. Wider implications of the findings Our study suggests that twin gestation after IVF-ET in patients who underwent successful hysteroscopic septoplasty for SSU may increase the likelihood of PTB. Such patients may require increased surveillance with ultrasound cervical length and signs for preterm labor. Future research should focus on measures to reduce PTB in such patients. Trial registration number Not Applicable

The effect of endometriosis on placental histopathology and perinatal outcome in singleton live births resulting from IVF

Research questionDoes endometriosis have an effect on the placental histopathology pattern and perinatal outcome in singleton live births resulting from IVF treatment? DesignRetrospective cohort study evaluating the data on all live births following IVF treatment between 2009 and 2017 at one university-affiliated tertiary hospital. All patients had placentas sent for full gross and histopathology assessment, irrespective of complication status or delivery mode. The primary outcomes of the study included anatomical, inflammation, vascular malperfusion and villous maturation placental disorders. The secondary outcomes included fetal, maternal, perinatal and delivery complications. A multivariate logistic model was used to adjust the results for confounding factors potentially associated with significant placental characteristics. ResultsA total of 1057 live births were included in the final analysis and were allocated to the group of women with endometriosis (n = 75) and those without (n = 982). After adjustment for confounding factors, endometriosis was found to be significantly associated with acute chorioamnionitis with moderate to severe maternal (odds ratio [OR] 2.2, 95% confidence interval [95% CI] 1.1–4.6) and fetal (OR 4.9, 95% CI 1.8–13.1) inflammatory response, placenta previa (OR 3.1, 95% CI 1.2–7.8), subchorionic fibrin deposition (OR 3.4, 95% CI 1.2–9.1), intervillous thrombosis (OR 3.4, 95% CI 1.5–8.1), and fetal vascular malperfusion (OR 5.1, 95% CI 1.4–18.1), as well as with preterm birth (OR 2.5, 95% CI 1.4–4.7). ConclusionsEndometriosis has a significant impact on the placental histopathology and is associated with a higher incidence of preterm birth.

Fertility treatments and the risk of preterm birth among women with subfertility: a linked-data retrospective cohort study

BackgroundIn vitro fertilization (IVF) births contribute to a considerable proportion of preterm birth (PTB) each year. However, there is no formal surveillance of adverse perinatal outcomes for less invasive fertility treatments. The study objective was to describe associations between fertility treatment (in vitro fertilization, intrauterine insemination, usually with ovulation drugs (IUI), or ovulation drugs alone) and preterm birth, compared to no treatment in subfertile women.MethodsThe Fertility Experiences Study (FES) is a retrospective cohort study conducted at the University of Utah between April 2010 and September 2012. Women with a history of primary subfertility self-reported treatment data via survey and interviews. Participant data were linked to birth certificates and fetal death records to asses for perinatal outcomes, particularly preterm birth.ResultsA total 487 birth certificates and 3 fetal death records were linked as first births for study participants who completed questionnaires. Among linked births, 19% had a PTB. After adjustment for maternal age, paternal age, maternal education, annual income, religious affiliation, female or male fertility diagnosis, and duration of subfertility, the odds ratios and 95% confidence intervals (CI) for PTB were 2.17 (CI 0.99, 4.75) for births conceived using ovulation drugs, 3.17 (CI 1.4, 7.19) for neonates conceived using IUI and 4.24 (CI 2.05, 8.77) for neonates conceived by IVF, compared to women with subfertility who used no treatment during the month of conception. A reported diagnosis of female factor infertility increased the adjusted odds of having a PTB 2.99 (CI 1.5, 5.97). Duration of pregnancy attempt was not independently associated with PTB. In restricting analyses to singleton gestation, odds ratios were not significant for any type of treatment.ConclusionIVF, IUI, and ovulation drugs were all associated with a higher incidence of preterm birth and low birth weight, predominantly related to multiple gestation births.

Comparison of maternal and neonatal outcomes between COVID-19 positive and negative parturients who delivered in a tertiary hospital: A retrospective cohort study

INTRODUCTION: The coronavirus disease 2019 (COVID-19) is a respiratory disease caused by novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2. Its growing number of cases with a very limited number of studies in the country is quite alarming, especially to the vulnerable populations, such as pregnant women.OBJECTIVE: To determine and compare the maternal and neonatal outcomes of COVID-19 positive versus negative parturient.MATERIALS AND METHODOLOGY: This is a retrospective cohort study of 131 parturient in a tertiary hospital.RESULTS: We analyzed a total of 131 patients, of whom 65 (49.6%) were COVID positive. At the time of testing, more than half were at their early term of pregnancy (64.89%) and at term (14.5%). Based on disease severity, 45 women (69.2%) exhibited mild disease, 39 were asymptomatic and 6 symptomatic, 19 (29.2%) moderate disease, and 1 (1.5%) severe disease. Among those symptomatic, the most common signs and symptoms were cough (33.85%), myalgia (10.77%), and a radiographic finding of localized or multilobar infiltrates (30.76%). Those who had laboratory examinations, the c-reactive protein (CRP) and D-dimer were found to be elevated. Based on maternal outcomes, there was a higher incidence of preterm birth (21.54%, P = 0.048) and longer length of hospital stay (P = 0.005) in the COVID-19-positive group. While the neonatal outcomes were similar in both groups, except for longer hospital stay, and delayed institution of breastfeeding among the COVID-19-positive group.CONCLUSION: In this study, there was no evidence that the presence of COVID-19 infection during pregnancy causes increased morbidity and mortality in mothers and their neonates. Close surveillance should be done on this population, especially if detected before term, as these patients are predisposed to having preterm labor. Further research is needed to understand the true extent of the risks to improve the management of these special population.

Features of pregnancy, delivery and postpartum on the background of assisted reproductive technologies

The objective: to establish the characteristics of the course of pregnancy and childbirth after the use of assisted reproductive technologies (ART); to stratify the risks in this contingent of pregnant women, to determine the high-risk subgroup among pregnant women after the use of ART and the formation of possible preventive approaches for these categories of patients. Materials and methods. A retrospective analysis of 3450 histories of pregnancy and childbirth that occurred during 2018–2020, was carried out. Inclusion criteria: first singleton delivery in cephalic presentation without critical congenital malformations in the fetus and severe somatic pathologies in pregnant women aged 18–45 years. Two groups were formed: a group with spontaneous pregnancy (3137 histories) and a group with pregnancy after ART (313 histories), which, according to the age factor, were divided into subgroups of active (2686 and 159 histories, respectively) and late reproductive age (451 and 154 histories, respectively).For statistical analysis, odds ratio (OR) and 95% confidence interval (CI) were calculated. The χ-square test was used to assess the significance of the difference in proportions. The level of statistical significance was at p&lt;0.05.Results. The frequency of normal births in the subgroup of late reproductive age with pregnancy after the use of ART was 38.8%, that almost 2 times lower than in the subgroup of spontaneous pregnancy in women of late reproductive age (65.5%; p&lt;0.05). Patients with late reproductive age and pregnancy after using ART (28.5%) had two times higher chances of induction of labor compared with the spontaneous pregnancy subgroup (14.3%; p&lt;0.05). The incidence of cesarean section was 51.1% in the ART subgroup compared to 27% in the spontaneous pregnancy subgroup (p&lt;0.05). In the subgroup of late reproductive age and pregnancy after ART, the probability of cesarean section was in 1.7 times higher than in the subgroup of active reproductive age and pregnancy after ART. The risks of developing massive obstetric bleeding in patients with late reproductive age and pregnancy after ART were in 5.5 times higher than in patients with spontaneous pregnancy (p&lt;0.05) and 2.8 times higher than in patients of active reproductive age and pregnancy after ART. The rate of normal induced labor in the ART group in women under 35 years of age was 51.7%, while in the subgroup of late reproductive age patients with pregnancy after ART, this indicator decreased to 23.5%. The incidence of unsuccessful induction of labor in patients with late reproductive age and pregnancy after ART was 19.6%, the frequency of cesarean section after induced labor in the subgroup of late reproductive age and pregnancy after ART was 70.6%. The likelihood of the massive obstetric bleeding development during induced labor in patients with late reproductive age and pregnancy after ART was in 5 times higher than in spontaneous pregnancy in this age subgroup (OR 5.05; 95% CI: 0.94-27.05) and 6.8 times higher than in the subgroup of active reproductive age after the use of ART (OR 6.84; 95% CI: 2.2-21.24). The newborns conceived after ART and after induced labor had in 2.8 times greater risks of the necessity for primary neonatal resuscitation.Conclusions. The pregnancy and labor after ART were characterized by a higher incidence of preterm birth, caesarean section, assisted vaginal delivery, and massive obstetric bleeding. The rate of complications significantly increased in women of late reproductive age. For patients with pregnancy after the use of ART, it is advisable to conduct labor using continuous cardiotocography monitoring, timely correction of labor abnormalities according to the partogram, the use of modern effective algorithms for the prevention of obstetric bleeding. For the pregnant women of late reproductive age after ART in the absence of spontaneous onset of regular labor, we recommend to consider the possibility of a planned caesarean section at 40–41 weeks of gestation.

Fetal and maternal outcomes in patients with tetralogy of Fallot

Abstract Introduction Women with tetralogy of Fallot (TOF) have an increased risk of adverse cardiac and neonatal events during pregnancy. The aim was to assess fetal and maternal outcomes in patients (pts) with uncorrected and corrected TOF. Methods Retrospective analysis of cardiological and obstetric data in women with TOF followed at our institution. Pregnancy and neonatal outcomes were compared in patients (pts) submitted to corrective surgery vs pts with no previous intervention and in pts with or without cyanosis. Results 51 women (median age 27 years; median number of previous interventions of 2), 22% with cyanosis, who experienced 126 pregnancies resulting in 73 live births A previous corrective surgery was found in 78% (40 pts), while 4% (2 pts) had previous palliative surgery and 18% (9 pts) no previous procedure. We found that women that were not submitted to previous intervention had a significant higher incidence of preterm birth (56% vs 17.5%, p=0.029), spontaneous abortion (56% vs 10%, p=0.006) and stillbirth (22% vs 0%). No difference was found for obstetric complications between groups. Cyanotic pts also demonstrated higher incidence of low birth weight (LBW) (36% vs 7.5%, p=0.031), preterm birth (54% vs 17.5%, p=0.021), spontaneous abortion (55% vs 10%, p=0.004) and stillbirth (18% vs 0%). There were no cardiac complications during pregnancy nor evident deterioration on cardiac status. Congenital heart disease was reported in 2 infants (3% of live births). Conclusions Pregnancy is well tolerated in pts with TOF. In our population, even in uncorrected TOF and in pts with cyanosis, there were no cardiac complications during pregnancy, although those pts had worse fetal outcomes. An explanation for the low incidence of cardiac events may be less severe forms of the disease, allowing survival into adulthood without intervention. Funding Acknowledgement Type of funding sources: None.

Pregnancy outcomes in women with severe congenital heart disease – a specialized centre experience

Abstract Introduction Progress in pediatric cardiology and cardiac surgery has dramatically raised the number of women with severe complex congenital heart disease (SC-CHD) that reach reproductive age. Pregnancy (P) in this group of women has an increased risk of adverse cardiac and neonatal events and its predictive factors are not fully defined. Our purpose was to assess the experience of our center regarding P and neonatal outcomes in women with SC-CHD. Methods Retrospective analysis of obstetric data in women with CHD followed at our institution. P and neonatal outcomes were evaluated regarding patients presenting SC-CHD and mild and moderate complexity CHD (MMC-CHD), according to ESC guidelines CHD complexity classification. Results The study enrolled 680 women with CHD (median age, 27.2 years) who experienced 1262 pregnancies, resulting in 998 live births. A previous corrective procedure was found in 334 women (49.1%). CHD complexity was considered mild, moderate and severe in 263 (38.7%), 359 (52.8%) and 58 (8.5%), respectively. SC-CHD included 38 women with cyanotic CHD and 18 with pulmonary vascular disease. The most common heart defect in SC-CHD pts was cyanotic tetralogy of Fallot (19.0%), followed by dextro-transposition of the great arteries with atrial switch /palliative procedure (13.8%) – Figure 1. Pts with SC-CHD had successful deliveries in 56.1% comparing with 82.1% in MMC-CHD. Women with SC-CHD had significantly higher incidence of preterm birth (24.6% vs 7.4%, p&amp;lt;0.001), spontaneous abortion (26.3% vs 12.3%, p=0.004) and neonatal mortality (10.3% vs 2.3%) comparing with MMC-CHD. Low birth weight was also extremely more frequent in the SC-CHD group (44.7% vs 8.5%, p&amp;lt;0.001). No difference was found relating to the presence of CHD in infants from SC-CHD mothers compared to off-spring from MMC-CHD (8.4 vs 5.3%, p=0.407). Cesarian deliveries had similar rates independently of increased CHD complexity (34.2% vs 32.1%). Overall, pregnancy was quite well tolerated, although cardiac complications were more common in SC-CHD P (0.4% vs 4.3%, p 0.013). Only one maternal death was registered, during 1st trimester, in a woman with a large unrepaired ventricular septal defect and cyanosis. Conclusion Severe complex CHD remains a challenging condition for pregnancy with increased maternal and neonatal morbimortality. This emphasizes the importance of extensive prepregnancy counselling and centralization of care to address specific risks and requirements of the condition. Funding Acknowledgement Type of funding sources: None. Figure 1. Severe CHD

Maternal and Perinatal Outcome in Anemic Pregnancies

Introduction: Anemia in pregnancy is a public health problem of developing countries and has a significant impact on the health of mother and fetus. It is one of the leading cause responsible for maternal and perinatal morbidity and mortality. Aims: To find out the severity of anemia in pregnancy and its maternal and perinatal outcome. Methods: A prospective randomized case control study undertaken in the Department of Obstetrics and Gynecology, Nepalgunj Medical College, Kolhapur from September 2019 to August 2020. Total of 200 study subjects were enrolled, cases and control were 100 each, with cut off for anemia as 11gm/dl. Results: Out of 100 cases of anemia, 58 were mildly anemic (Hemoglobin: 10-10.9), 23 moderately (7-10) and 21 severely anemic (&lt;7gm/dl). Anemic cases were found to have higher incidence of preterm birth (8%), postpartum hemorrhage (5%), and maternal morbidity (19%) than in non-anemic controls. Adverse fetal outcome in the form of preterm birth (8%), Intrauterine Growth Restriction (14%), Still birth (3%), Early neonatal death (4%), Low birth weight babies (22%), neonatal morbidity (17.5%) was more in anemic group than non-anemic controls. Conclusion: Anemia in pregnancy has adverse effects on the mother and fetus. It is important to diagnose and treat anemia in pregnancy to ensure optimal health of mother and newborn.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Endocrine disrupting chemical-associated hair product use during pregnancy and gestational age at delivery: a pilot study

BackgroundPrenatal endocrine disrupting chemical (EDC) exposure has been associated with increased risk of preterm birth. Non-Hispanic Black women have higher incidence of preterm birth compared to other racial/ethnic groups and may be disproportionately exposed to EDCs through EDC-containing hair products. However, research on the use of EDC-associated hair products during pregnancy and risk of preterm birth is lacking. Therefore, the objective of this pilot study was to estimate associations of prenatal hair product use with gestational age at delivery in a Boston, Massachusetts area pregnancy cohort.MethodsThe study population consisted of a subset of participants enrolled in the Environmental Reproductive and Glucose Outcomes (ERGO) Study between 2018 and 2020. We collected self-reported data on demographics and hair product use using a previously validated questionnaire at four prenatal visits (median: 12, 19, 26, 36 weeks’ gestation) and abstracted gestational age at delivery from medical records. We compared gestational age and hair product use by race/ethnicity and used linear regression to estimate covariate-adjusted associations of product use and frequency of use at each study visit with gestational age at delivery. Primary models were adjusted for maternal age at enrollment and delivery method.ResultsOf the 154 study participants, 7% delivered preterm. Non-Hispanic Black participants had lower mean gestational age at delivery compared to non-Hispanic White participants (38.2 vs. 39.2 weeks) and were more likely to report ever and more frequent use of hair products. In regression models, participants reporting daily use of hair oils at visit 4 had lower mean gestational age at delivery compared to non-users (β: -8.3 days; 95% confidence interval: -14.9, -1.6). We did not find evidence of associations at earlier visits or with other products.ConclusionsFrequent use of hair oils during late pregnancy may be associated with shorter gestational duration. As hair oils are more commonly used by non-Hispanic Black women and represent potentially modifiable EDC exposure sources, this may have important implications for the known racial disparity in preterm birth.