Higher Rates Of Preterm Delivery Research Articles

Pregnancy after stillbirth: maternal and neonatal outcomes and health service utilization

Stillbirth occurs in every 3.5 of 1000 pregnancies in Ireland and is a devastating event for a family. Women who have a pregnancy after stillbirth require increased antenatal support. This study aimed to determine maternal and fetal outcomes and to quantify health service utilization in pregnancy after stillbirth. A retrospective cohort study of all pregnancies after stillbirth was conducted from 2011 to 2017 in a large tertiary referral university maternity teaching hospital with approximately 8000 births annually. There were 222 stillbirths from 2011 to 2017. Two-thirds of women (145 of 222 [64.3%]) had a pregnancy after stillbirth. Almost one-fifth of these women (28 of 145 [19.3%]) had a miscarriage, but 16 of 28 women (57.1%) had a subsequent live birth, giving an overall live birth rate of 90.3% (131/145). The average interval from index loss to booking in the next pregnancy was 13 months, with almost half of the women (72 of 145 [49.7%]) booking within 1 year. The average number of antenatal appointments was twice than expected (10; range, 2-27), and the average number of ultrasound scans was 5 times higher than expected (5; range, 0-29). Rates of induction of labor (63 of 131 [48.1%]) and cesarean delivery (53 of 131 [40.5%]) were significantly higher than national rates for multiparous women. Almost two-thirds of women (40 of 63 [63.5%]) cited previous history of stillbirth as the indication for induction. There was a significantly higher rate of preterm delivery (30 of 131 [22.9%]). Moreover, 1 in 4 babies (35 of 137 [25.5%]) required admission to the neonatal intensive care unit, more than twice the number expected (median gestation, 37 0/7 weeks; range, 25 4/7 to 39 2/7 weeks). Pregnancy after stillbirth was associated with increased surveillance and intervention. The women in this study had higher rates of cesarean delivery, induction of labor, and preterm delivery than the general multiparous population. Decision-making for intervention was often based on previous history of stillbirth. Clinicians should be cognizant of additional supports required for this population and focus on evidence-based interventions that improve maternal well-being and perinatal outcomes in pregnancy after stillbirth.

P–579 Pregnancies following preimplantation Genetic Testing have an increased risk for post-partum complications

Abstract Study question Do preimplantation genetic testing (PGT) pregnancies have higher pregnancy and delivery complications compared to naturally conceived (NC) pregnancies? Summary answer PGT pregnancies do not have increase pregnancy complications but do have increased post-partum complications. What is known already There is limited data about the outcome of PGT cycles regarding pregnancy complications. Previous reports show that PGT pregnancies are similar to NC pregnancies regarding birth weight and preterm delivery rate. Patients performing PGT are less likely to have infertility as a background problem, and therefore it is important to evaluate pregnancy complications in this specific population. Study design, size, duration A retrospective cohort study, between 2008–2020 in Shaare Zedek Medical center (SZMC). Demographic, background variables, treatment cycle information, and delivery data were collected from computerized hospital databases and patient files. Participants/materials, setting, methods All patients aged 18–45 that conceived following PGT treatment in the IVF unit and gave birth in SZMC were included in the study. We used two control groups: (1) women with spontaneous pregnancies (SP) who gave birth in SZMC. We used four “neighborhood control” for each PGT patient (two women delivered before and two after the case delivery). (2) pregnancies following ICSI with four neighborhood control for each. Main results and the role of chance 135 deliveries following PGT, 924 ICSI, and 4199 NC. Demographic variables were similar except PGT, and ICSI women were slightly older (30.93 ±4.33 PGT, 31.70±4.98 ICSI, 28.75±5.69 spontaneous, p < 0.01). PGT pregnancies had similar rates of placental complications (hypertensive disorder, preeclampsia (PET), placental abruption) as NC (p = 0.8), while ICSI pregnancies had significantly higher rates of gestational hypertension (p < 0.01) and abruption (p = 0.05). We found a higher rate of preterm delivery <37 weeks in both PGT and ICSI pregnancies (23.7%, 22.7%, 12.1%, p < 0.01 for PGT, ICSI, NC respectively), but only in ICSI was preterm delivery < 34 weeks increased (2.2% vs. 2.1%, p = 0.9, for PGT and NC, 4.3% for ICSI p < 0.01). Post-partum complications were more prevalent in both PGT and ICSI: longer third stage of labor (13.27±12.81, 12.58±10.08, 10.58±8.14, p < 0.05), manual lysis of placenta (6.7%, 2.3%, 1.4% p < 0.05), post-partum hemorrhage (PPH) (5.9%, 4.2%, 2.5% p = 0.02) and need for blood products (3.7%, 4.5%, 1.3% p = 0.02) for PGT, ICSI, NC respectively. The aOR for composite post-partum complications (PPH, hemoglobin drop>3 gram, revision or lysis) was 2.4, 95%CI [1.6–3.7]. We did not find any difference between fresh and frozen cycles in either placental complications, preterm delivery, or post-partum complications in the PGT group. Limitations, reasons for caution A single-center retrospective study. Included only pregnancies both conceived and delivered in SZMC. Wider implications of the findings: Physicians should be aware of PGT pregnancies as risk factors for post-partum placental complications and handle the third stage of the delivery with caution. Trial registration number 0351–18-SZMC

The association between congenital uterine anomalies and perinatal outcomes – does type of defect matters?

Objective To evaluate the association between congenital uterine anomalies (CUA) and adverse perinatal outcomes stratified by type of anomaly. Methods A retrospective cohort study of all women delivered in one university-affiliated medical center between 2010 and 2017 with CUA. Multiple pregnancies and pregnancies complicated by fetal anomalies were excluded. Maternal and short-term neonatal outcomes were evaluated and compared between women with unification defects (unicornuate, bicornuate, or uterus didelphys), and canalization defects represented by septate uterus. Univariate analysis was utilized followed by multivariate analysis to adjust for confounders. p < .05 was considered significant. Results Among 167 pregnancies with CUA, 92 (55.1%) had bicornuate uterus, 32 (19.1%) septate uterus, 26 (15.6%) didelphys uterus, and 17 (10.1%) unicornuate uterus. Maternal demographics and obstetric characteristics were similar between women with unification and canalization defects. The entire cohort had high rates of preterm delivery (PTD), malpresentation, and cesarean delivery (CD) (25.7%, 42.5%, and 63.5%, respectively). In comparison to unification defects, pregnancies in women with canalization defects (septate uterus), had increased risk for PTD <32 weeks (12.5% vs. 2.9%, p = .02), and placental abruption (12.5% vs. 3%, p = .02), however, a lower overall rate of CD (46.9% vs. 67.4%, p = .03). Following adjustment to confounders (age, BMI, nulliparity, chronic hypertension, and smoking) none of the results remained statistically significant. There were no differences in neonatal outcomes between the groups. Conclusions Overall, women with CUA have a high prevalence of adverse pregnancy outcomes. However, outcome does not differ by type of anomaly.

Ultrasound and Doppler findings in pregnant women withSARS-CoV-2 infection.

ABSTRACTObjectivesTo describe and compare ultrasound and Doppler findings in pregnant women who were positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with findings in those who were SARS‐CoV‐2‐negative, evaluated during the pandemic period.MethodsIn this retrospective case–control study, we analyzed data from 106 pregnant women who tested positive for SARS‐CoV‐2 at the time of, or within 1 week of, an ultrasound scan between 1 May and 31 August 2020. Scans were either performed for routine fetal evaluation or indicated due to a positive SARS‐CoV‐2 test. Forty‐nine women were symptomatic and 57 were asymptomatic. For comparison, we analyzed data from 103 pregnant women matched for maternal age, parity, body mass index and gestational age at the time of the ultrasound scan. These control women did not report symptoms of SARS‐CoV‐2 infection at the time of the ultrasound scan or at the time of admission for delivery and had a negative SARS‐CoV‐2 test at admission for delivery. Fetal biometry, fetal anatomy, amniotic fluid volume and Doppler parameters, including umbilical and fetal middle cerebral artery pulsatility indices, cerebroplacental ratio and biophysical profile (BPP), were evaluated as indicated. Biometric and Doppler values were converted to Z‐scores for comparison. Our primary outcome, an adverse prenatal composite outcome (APCO) included any one or more of: small‐for‐gestational‐age (SGA) fetus, oligohydramnios, abnormal BPP, abnormal Doppler velocimetry and fetal death. Comorbidities, delivery information and neonatal outcome were compared between the two groups.ResultsEighty‐seven (82.1%) women who were positive for SARS‐CoV‐2 had a body mass index > 25 kg/m2. SARS‐CoV‐2‐positive women had a higher prevalence of diabetes (26/106 (24.5%) vs 13/103 (12.6%); P = 0.03), but not of pre‐eclampsia (21/106 (19.8%) vs 11/103 (10.7%); P = 0.08), compared with controls. The prevalence of APCO was not significantly different between SARS‐CoV‐2‐positive women (19/106 (17.9%)) and controls (9/103 (8.7%)) (P = 0.06). There were no differences between SARS‐CoV‐2‐positive women and controls in the prevalence of SGA fetuses (12/106 (11.3%) vs 6/103 (5.8%); P = 0.17), fetuses with abnormal Doppler evaluation (8/106 (7.5%) vs 2/103 (1.9%); P = 0.08) and fetuses with abnormal BPP (4/106 (3.8%) vs 0/103 (0%); P = 0.14). There were two fetal deaths in women who were positive for SARS‐CoV‐2 and these women had a higher rate of preterm delivery ≤ 35 weeks of gestation (22/106 (20.8%) vs 9/103 (8.7%); odds ratio, 2.73 (95% CI, 1.19–6.3); P = 0.01) compared with controls.ConclusionsThere were no significant differences in abnormal fetal ultrasound and Doppler findings observed between pregnant women who were positive for SARS‐CoV‐2 and controls. However, preterm delivery ≤ 35 weeks was more frequent among SARS‐CoV‐2‐positive women. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Prospective risk of stillbirth and neonatal complications for monochorionic diamniotic and dichorionic diamniotic twins after 24 weeks of gestation.

Our study compared the prospective risks of intrauterine fetal death (IUFD), neonatal death (NND), perinatal death (PND), and neonatal morbidities in monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin pregnancies. This retrospective cohort study included twin pregnancies who had antenatal care and delivery in a public hospital from 2011 to 2018. Exclusion criteria included monoamnionicity, one/both twin miscarriage, twin-twin transfusion syndrome, or lethal congenital abnormalities. All twins were managed in multiple pregnancy clinic with standardized protocols. Gestational age-specific IUFD, NND, PND, and neonatal morbidity rates were compared according to chorionicity. Three hundred seventy-eight MCDA and 1282 DCDA twins were included. MCDA twins had higher risks of PND (1.9% vs. 0.7% in DCDA twins, p=0.05), composite neonatal morbidity (p=0.01), preterm delivery (p < 0.01), and low birth weight (p < 0.01). The prospective risk of IUFD was 0.6% and 0.4% for MCDA and DCDA twins, respectively after 34 weeks' gestation. No NND occurred among deliveries after 30 weeks. The risk of neonatal morbidity of MCDA twins fell from 22.7% at 34 weeks to 2.7% at 37 weeks (p < 0.01). For DCDA twins, the risk of morbidity fell insignificantly from 36 to 38 weeks (4.0% vs. 3.4%, p=0.60). Logistic regression analysis suggested that the increased risk of perinatal morbidities was related to the higher rate of preterm delivery in MCDA twins rather than chorionicity. With close fetal monitoring, the risk of late IUFD in twin pregnancies without major complications is low. Perinatal morbidity can be minimized by avoiding late preterm deliveries in twin pregnancies.

The interval between births and the risk of recurrent preeclampsia among predominantly high risk women in urban tertiary care center

Women with a history of preeclampsia have a higher risk of recurrent preeclampsia. This study sought to ascertain the relationship between the interbirth interval and the risk of recurrent preeclampsia and difference in angiogenic markers between the two groups. Data was collected from an ongoing cohort study of women with hypertensive disorders of pregnancy (HDP) enrolled at the admission to the labor and delivery floor. From this dataset, multigravida women with a prior diagnosis of preeclampsia were identified and compared to women with no prior history of preeclampsia. Of the 375 women with HDP who were predominantly African American, 245 were multigravida and 44 (18.0%) had a prior history of preeclampsia. Women with prior preeclampsia had an earlier gestational age of delivery, higher rates of preterm delivery and a higher incidence of preeclampsia with severe features (56.8% vs 29.8%) in the index pregnancy (p-values≤0.001) than those without. The median number of years between history of preeclampsia in previous pregnancy and current pregnancy was 6years (IQR 3, 8). Among patients with a prior history of preeclampsia, the interbirth interval was not associated with severe preeclampsia (p=0.60) and there was no difference in angiogenic factors between patients with a prior history of preeclampsia compared to those without. In this study, the duration of the interbirth interval was not identified as a risk factor of developing severe preeclampsia in a subsequent pregnancy and angiogenic factors are not a reflection of maternal predisposition to recurrent preeclampsia.

Use of the angiogenic biomarker profile to risk stratify patients with fetal growth restriction

Novel angiogenic biomarker profiles have demonstrated emerging evidence for predicting preeclampsia onset, severity, and adverse outcomes. Limited data exist in screening patients with fetal growth restriction for preeclampsia development using angiogenic biomarkers. The objective of this study was to risk stratify patients with fetal growth restriction using a soluble fms-like tyrosine kinase-1 to placental growth factor ratio. Previously published cutoff of 38 was used to predict preeclampsia development and severity as well as adverse maternal or neonatal outcomes within a 2-week time period. This was a prospective observational cohort study performed in a single tertiary hospital. Patients with a singleton fetal growth restriction pregnancy between 24 and 37 weeks' gestation were evaluated using serial 2-week encounters from the time of enrollment to delivery. Pregnancies with proven genetic or infectious etiology of fetal growth restriction or congenital anomalies were excluded. Ultrasound growth and Doppler measurements were obtained at the start of every encounter with routine preeclampsia laboratory tests and blood pressure checks when clinically indicated. Maternal serum was collected for all serial encounters and measured for soluble fms-like tyrosine kinase-1 and placental growth factor after delivery in a double-blinded fashion. Maternal charts were reviewed for baseline demographic characteristics, pregnancy diagnoses and outcomes, and neonatal outcomes. A total of 45 patients were enrolled for a total of 77 encounters, with the median (quartile 1, quartile 3) gestational age of the study enrolled at 31.43 (28.14-33.57) weeks. Patients were divided into low-risk (ratio of <38) and high-risk (ratio of ≥38) groups. Baseline characteristics of patients did not show any marked differences, including preeclampsia labs or ultrasound parameters, between the 2 groups. Systolic and diastolic blood pressures upon enrollment were statistically elevated when soluble fms-like tyrosine kinase-1 to placental growth factor ratio was ≥38 (P=.02 and P=.01, respectively). Compared to patients with a low ratio, patients with a high ratio had a greater proportion of preeclampsia diagnosis, higher rates of preterm delivery under 34 and 37 weeks gestation, smaller neonatal birthweight, and a shorter time to delivery from testing to delivery. Among patients with fetal growth restriction, the soluble fms-like tyrosine kinase-1 to placental growth factor ratio may serve as a potential biomarker for identifying at risk patients for developing preeclampsia and subsequently preterm delivery.

Association Between Trimester and Outcomes after Cholecystectomy During Pregnancy

Conventional philosophy promotes the second trimester as the ideal time during pregnancy for cholecystectomy. However, literature supporting this belief is sparse. The purpose of this study is to examine the association of trimester and clinical outcomes after cholecystectomy during pregnancy. The National Inpatient Sample was queried for pregnant women who underwent cholecystectomy between October 2015 and December 2017. Patients were categorized by trimester. Multivariable logistic and continuous outcome regression models were used to evaluate the association of trimester and outcomes, including maternal and fetal complications, length of stay, and hospital charges. The primary outcome was any complication-a composite of specific clinical complications, each of which were designated as secondary outcomes. A total of 819 pregnant women satisfied our inclusion criteria. Of these, 217 (26.5%) were in the first trimester, 381 (47.5%) were in the second trimester, and 221 (27.0%) were in the third trimester. Median age was 27 years (interquartile range: 23-31 years). Compared with the second trimester, cholecystectomy during the first trimester was not associated with higher rates of complications (adjusted odds ratio [AOR] 0.88, 95% confidence interval [CI]: 0.47-1.63, p= 0.68). However, cholecystectomy during the third trimester was associated with a higher rate of preterm delivery (AOR 7.20, 95% CI 3.09-16.77, p < 0.001) and overall maternal and fetal complications (AOR 2.78, 95% CI 1.71-4.53, p < 0.001). Compared with the second trimester, the third trimester was associated with 21.3% higher total hospital charges (p= 0.003). Our results suggest that cholecystectomy can be performed in the first trimester without significantly increased risk of maternal and fetal complications, compared to the second trimester. In contrast, cholecystectomy during pregnancy should not be delayed until the third trimester.

Acute and chronic pancreatitis in pregnancy

Key content Acute pancreatitis can be a life‐threatening condition at any stage of life. It is seen in up to 3 in 10 000 pregnancies, with high rates of preterm delivery and maternal mortality rates of up to 3%. Diagnosis in pregnancy can be more challenging, and its aetiology is distributed differently to that of the nonpregnant population. When managing pregnant patients, consideration of implications for the fetus poses an additional challenge. Pregnant patients with chronic pancreatitis need careful assessment, paying attention to nutritional and exocrine needs, pain management and the development of diabetes mellitus. Learning objectives Know the symptoms, signs and causes of acute pancreatitis in pregnant women, as well as methods of investigation and classification. Understand how to manage acute pancreatitis. Appreciate the challenges faced by women with chronic pancreatitis and how to manage them, including pregnancy outcome.

Interleukin-6 in Amniotic Fluid: A Reliable Marker for Adverse Outcomes in Women in Preterm Labor and Intact Membranes

Introduction: Amniotic fluid (AF) interleukin-6 (IL-6) concentration has been associated to preterm delivery and perinatal morbidity and mortality in women with preterm labor and intact membranes. Nevertheless, the clinical significance of this biomarker of intra-amniotic inflammation (IAI) is still unclear due in part to the paucity of large studies. Methods: AF IL-6 concentrations were determined in 452 consecutive women with preterm labor and intact membranes, categorized into 3 groups: 302 without IAI (IL-6 of <2.6 ng/mL), 64 with mild IAI (IL-6 of 2.6–11.2 ng/mL), and 86 with severe IAI (IL-6 of ≥11.3 ng/mL). Results: The severe IAI group had a short pregnancy duration from amniocentesis to delivery (median 3 days) than in without IAI group (median 45 days); meanwhile, the mild IAI group had a latency that was intermediate to the severe and without IAI groups (median 9.5 days). As compared to women without IAI, women with mild and severe IAI had higher rates of preterm delivery at both <34 and <37 weeks of gestation and perinatal morbidity and mortality. Furthermore, the risk of various individual adverse outcomes (short latency from amniocentesis to delivery [at ≤3 days, ≤7 days, and ≤14 days], preterm delivery at both <34 and <37 weeks of gestation, histologic chorioamnionitis, respiratory distress syndrome, and congenital sepsis) was higher in women with severe IAI (OR ≥ 2.8), compared with women without IAI. Conclusions: AF IL-6 concentrations appear to be suitable marker to assess the degree of IAI and are associated with increased risk of adverse outcomes.

Pregnancy outcomes following gestational exposure to papaverine: An observational comparative study.

Papaverine is indicated for abdominal pain of various aetiologies. However, data on maternal and foetal safety following gestational exposure are lacking. The aim was to examine whether first trimester exposure to papaverine is associated with increased risk for major malformation and whether gestational exposure at any stage is associated with increased risk for preterm delivery, lower birthweight, small for gestational age, caesarean section (CS), lower Apgar score and perinatal death. A retrospective comparative study consisted of pregnant women treated with papaverine between February 2010 and October 2019 at a large tertiary center. The control group comprised of livebirth deliveries randomly selected from the institutional obstetric database. The study group consisted of 498 pregnancies, which resulted in 537/544 (98.7%) live births, of whom 46/537 (8.6%) were exposed during the first trimester. The control group consisted of 498 pregnancies and 514 live births. Rate of major malformations did not differ between study group (2/46, 4.3%) and control (25/315, 4.9%, P =.67). Papaverine exposure was associated with higher rate of preterm delivery (22.3 vs. 10.3%, P <.001), CS (35.9 vs. 24.1%, P <.001) and lower birth weight (3207 vs. 3246 g, P =.02). Adjustment for treatment indication demonstrated that these remained significant only when given for obstetrical/surgical aetiologies. Comparable rates were observed for the remaining outcomes. Short-term gestational exposure to papaverine adjusted for indication was not associated with preterm deliveries, CS, lower birthweight, small for gestational age or perinatal death. Rate of major malformations among 46 first trimester exposures was comparable to controls.

Reproductive and obstetric outcomes in women of racial minorities aged 40 years and older undergoing IVF

Research questionDo women of racial minorities aged 40 years or older have similar reproductive and obstetric outcomes as white women undergoing IVF? DesignA retrospective cohort study conducted at a single academic university-affiliated centre. The study population included women aged 40 years or older undergoing their first IVF cycle with fresh cleavage-stage embryo transfer stratified by racial minority status: minority (black or Asian) versus white. Clinical intrauterine pregnancy and live birth rate were the primary outcomes. Preterm delivery (<37 weeks) and small for gestational age were the secondary outcomes. Odds ratios with 95% confidence intervals were estimated. P < 0.05 was considered to be statistically significant. ResultsA total of 2050 cycles in women over the age of 40 years were analysed, 561 (27.4%) of which were undertaken by minority women and 1489 (72.6%) by white women. Minority women were 30% less likely to achieve a pregnancy compared with their white (non-Hispanic) counterparts (adjusted OR 0.68, CI 0.54 to 0.87). Once pregnant, however, the odds of live birth were similar (adjusted OR 1.23, CI 0.91 to 1.67). Minority women were significantly more likely to have lower gestational ages at time of delivery (38.5 versus 39.2 weeks, P = 0.009) and were more likely to have extreme preterm birth delivery 24–28 weeks (5.5 versus 1.0%, P = 0.021). ConclusionMinority women of advanced reproductive age are less likely to achieve a pregnancy compared with white (non-Hispanic) women. Once pregnancy is achieved, however, live birth rates are similar albeit with minority women experiencing higher rates of preterm delivery.

Diabetic nephropathy in type 1 diabetes and pregnancy. Modern view of the problem

Diabetic nephropathy (DN) is specific kidney damage in patients with diabetes mellitus. DN develops relatively often in pregestational diabetes patients (5,9-26%) and stills one of the main limitations for successful pregnancy in this patients’ group. Advanced DN increases risks of poor pregnancy outcomes for women and fetuses including chronic kidney disease (CKD) progression, high rate of preeclampsia, preterm deliveries, Cesarean sections, perinatal mortality and neonatal morbidity. At the same time there are more and more successful pregnancies with advanced DN in the wold.In our paper we systematize global experience of planning and management pregnancies with type 1 diabetes and DN in different stages of renal impairment. We discuss role of nephroprotective therapy in preconception care, achievement and maintaining blood pressure goals, multidisciplinary team care for improvement pregnancy outcomes in type 1 diabetic women with DN.

Sonographic growth curves versus neonatal birthweight growth curves for the identification of fetal growth restriction

Objective Fetal growth restriction is suspected when the estimated fetal weight is <10th percentile for gestational age. Using a regional sonographic estimated fetal weight growth curve to diagnose fetal growth restriction has no known benefits; however, the traditional approach of using birthweight curves is misleading, since a large proportion of preterm births arise from pathological pregnancies. Our aim was to compare the diagnostic accuracies of sonographic versus birthweight curves in diagnosing fetal growth restriction. Our secondary aim was to compare maternal, fetal and neonatal outcome based on these two approaches. Methods Retrospective study based on computerized medical records. Included were women with a singleton pregnancy, that underwent fetal biometry between 24 and 36.6 weeks' gestation (January 2010–February 2016) and delivered in our center. Each pregnancy was assigned to one of three groups based on the earliest sonographic estimated fetal weight performed: G1—Appropriate for gestational age, G2—fetal growth restriction based on sonographic but not birthweight curves; or G3—fetal growth restriction based on birthweight growth curves. Demographics, obstetric characteristics, ultrasound data, and neonatal data were retrieved and compared between groups. Primary outcome: rate of small for gestational age neonates in each group. Secondary outcomes were various adverse maternal and neonatal outcomes. Results Six thousand and five pregnancies met inclusion criteria. Of these 5386 (89.6%) were categorized as G1, 300 (5%) as G2 and 319 (5.3%) as G3. The rate of small for gestational age neonates differed significantly between groups: G1 9.2%, G2 39.7% and G3 70%. Multivariable logistic regression modeling reiterated these rates: the odds ratios for small for gestational age were 6.47 [95% CI 4.99–8.40] and 23.99 [95% CI 18.26–31.51] for G2 and G3 respectively. Prediction of small for gestational age based on sonographic EFW curves increased the sensitivity for detection of SGA from 26% to 41% with a slight decrease in specificity from 98% to 95%, and a decrease of the positive likelihood ratio from 18.4 to 7.7, however there was no significant change in the overall test accurcy; 88.5% to 87.1%. Secondary outcomes also differed between groups: G2 and G3 had similar rates of maternal and neonatal morbidities and most parameters were higher than G1. G2 and G3 showed lower mean gestational age at delivery (36.2 weeks and 35.9 weeks vs.37.8; p < .0001), and higher rates of preterm delivery (40% and 51.7% vs. 21.5%; p < .001), as well as higher rates of intrauterine fetal demise 3% in G2, 6.9% in G3 and 0.9% in G1, p < .0001. Conclusion Pregnancies that are currently managed as appropriate for gestational age based on birthweight curves, but classified as growth restricted when prenatal sonographic curves are used, are associated with higher rates of small for gestational age and poor perinatal outcomes, at rates comparable to pregnancies that are classified as growth restricted based on birthweight curves. Furthermore, applying sonographic curves increases the sensitivity for detection of small for gestational age neonates. Consequently, consideration should be given to the use of sonographic biometry curves for defining fetal growth restriction.

Gestational Outcomes of Pregnant Women with Unilateral Congenital Renal Agenesis

Objective We evaluated if there were more adverse gestational outcomes of pregnant women with unilateral congenital renal agenesis (UCRA). Study design: This single center retrospective case–control study compared maternal complications and neonatal outcomes from 25 women with UCRA to the outcomes of 125 women with two kidneys. Results: UCRA women had lower gestational weeks at birth and higher rates of preterm delivery (p = 0.004 and <0.001; respectively). Mothers had higher rates of preeclampsia and newborns with congenital anomalies and neonatal intensive care unit (NICU) admission (p = 0.009, 0.042, and 0.039; respectively). Unadjusted odds ratios were significantly higher for preterm delivery and for any APGAR score of <7 at the first 10 min and preeclampsia [OR (95% CI):13.5 (4.66–39.05), 31 (3.44–279.32) and 5.76 (1.33–24.84), respectively]. Conclusion: Maternal UCRA is a risk factor for less optimal obstetric and neonatal outcomes.

Comparison of maternal and foetal outcomes between adolescent and adult pregnancies; a descriptive cross sectional study

Introduction: Adolescent pregnancy is a global issue and the trend is increasing specially in South East Asia. Pregnancies at a younger age have major maternal and fetal health consequences. The aim of this study was to compare selected maternal and fetal outcomes of adolescent pregnancies with its adult counterpart in atertiary care center. Methods: A hospital based descriptive study was conducted at Teaching Hospital Mahamodara (THM), Galle. One hundred adolescent mothers (10-19 years) were compared with 100 adult mothers (20 -35 years) who had singleton uncomplicated pregnancy. Pre-tested interviewer administered questionnaire was used as the tool to collect data on basic demography, perinatal, maternal outcomes and mode of delivery. Chi-squared test and t-test were used to compare data and presented as proportions, mean (SD), with 95% CI. Results: Mean (SD) age at delivery of adolescent and adult mothers were 18 (0.2) and 27 (0.8) years respectively. Of the adolescent mothers 16% were unmarried. More adolescent mothers had anaemia compared to adults (38% vs. 32%), but the difference was not statistically significant (p=0.37). Adolescent mothers had higher pre term delivery rate compared to adult mothers (23% vs.15%) but the difference was not statistically significant (p=0.18). There were no significant differences in birth weight (2.77 vs. 2.82; p=0.5) rate of admissions to premature baby unit (6% vs. 7%; p=0.8) and mean APGAR scores (9.9 vs 9.8; p=0.3) between the two groups. A significantly greater proportion of vaginal deliveries were carried out in adolescents compared to adults (75% vs. 55%; p= 0.003). Conclusions: Adolescent mothers underwent a significantly larger proportion of vaginal deliveries compared to adults. Though not significant, anaemia and preterm deliveries were higher than in their adult counter-parts. There was no significant difference between the two groups for the selected perinatal outcomes.

Association between Anterior Cervical Angle of the Uterus and Preterm Birth

Background Predicting preterm delivery can help obstetricians and midwives for better management of pregnancy care. Therefore, we aimed to investigate the relationship between cervical length and uteroservical angle with the occurrence of preterm delivery. Materials and Methods: The present cohort study was conducted on 100 pregnant women with singleton pregnancy referred for routine control to perinatology ward of Imam Khomeini Hospital in Tehran between Jan 2019-Apr, 2019. All included cases were undergoing transvaginal sonography to measure the anterior cervical angle and length. Maternal demographic and clinical data, as well as delivery data of pregnant women, were obtained from their medical records. Logistic regression was conducted to estimate the predictors of pre-term delivery. All analyses were performed using Stata 14.0. Results: Among 100 pregnant women, 17 had preterm delivery. Pregnant women with bleeding during pregnancy were reported with a higher preterm delivery rate (23.53% vs. 4.82%) (p =0.01). The difference of mean cervical angle between pregnant women with the term and preterm delivery was statistically different (102.12° in women who delivered pre-term vs. 86.15° in term group, p <0.001). Conclusion According to the results, pregnant women with bleeding during pregnancy and those with a higher mean of cervical angle were more prone to pre-term delivery. Therefore, the anterior cervical angle and bleeding during pregnancy can be considered as predictors for preterm birth.

Obstetric Outcomes in Pregnancies Complicated by Prior Renal Transplant or Chronic Kidney Disease [26N

INTRODUCTION: Compare antepartum admissions and outcomes in pregnancies complicated by renal transplant (RT) versus chronic kidney disease (CKD). METHODS: Retrospective cohort study at University of Illinois at Chicago from 2010 to 2019. Electronic medical record queried for women age 18 to 51 with pregnancy, RT or CKD. SPSS used for statistical analysis. IRB approval was obtained. RESULTS: 577 charts reviewed, 57 pregnancies complicated by RT or CKD. Of 33 women with RT, 20 had live births, 11 miscarried, 2 had elective terminations. Of 24 women with CKD, 14 had live births, 6 miscarried, 2 had ectopic pregnancies, 2 had elective terminations. Average time from RT to pregnancy was 7.45 years. Subjects with CKD had higher rates of preterm delivery and hypertensive disorders of pregnancy. No difference in rate of cesarean delivery (CD) between groups. Gestational age (GA) at delivery lower in women with CKD than RT, 31 vs 34 weeks. Rate of antepartum admission not statistically significant between groups. Subjects with RT admitted for obstetric complications compared to women with CKD admitted for worsening medical problems. Pregnancies 1 to 3 years posttransplant had lower rates of preeclampsia and CD, and later GA at delivery (36.3 vs 34.4 weeks) compared to those greater than 3 years posttransplant. CONCLUSION: Women with RT are not admitted antepartum at a higher rate than women with CKD and overall had better obstetrical outcomes. An area of further study is the ideal time between transplant and pregnancy, as we found improved obstetric outcomes in women with pregnancy closer to RT.

Perinatal HCV Transmission Rate in HIV/HCV Coinfected women with access to ART in Madrid, Spain.

BackgroundMaternal HIV coinfection is a key factor for mother-to-child transmission (MTCT) of HCV. However, data about HCV MTCT in HIV/HCV-coinfected pregnant women on combined antiretroviral treatment (ART) are scarce. This study assessed the HCV MTCT rate in the Madrid Cohort of HIV-infected women.MethodsRetrospective study within the Madrid Cohort of HIV-infected pregnant women (2000–2012). Epidemiological, clinical and treatment related variables were analysed for the mother and infant pairs. HCV MTCT rate was determined.ResultsThree hundred thirty-nine HIV/HCV-coinfected women and their exposed infants were recorded. A total of 227 (67%) paired mother-children had available data of HCV follow-up and were included for the analysis. Sixteen children (rate 7.0%, 95%CI 3.7–10.4%) were HCV infected by 18 months of age, none of them coinfected with HIV. HIV/HCV-coinfected pregnant women were mostly of Spanish origin with a background of previous injection drug use. HCV-genotype 1 was predominant. The characteristics of mothers that transmitted HCV were similar to those that did not transmit HCV with respect to sociodemographic and clinical features. A high rate (50%) of preterm deliveries was observed. Infants infected with HCV were similar at birth in weight, length and head circumference than those uninfected.ConclusionMTCT rates of HCV among HIV/HCV-coinfected women on ART within the Madrid cohort were lower than previously described. However, rates are still significant and strategies to eliminate any HCV transmission from mother to child are needed.

A Randomized Trial of Prenatal n-3 Fatty Acid Supplementation and Preterm Delivery

(N Engl J Med. 2019;381(11):1035–1045) Although early preterm deliveries (before 34 wk of gestation) only comprise 20% of all preterm deliveries, they are more likely to result in neonatal death or childhood disability. The rate of preterm deliveries is rising around the world, and previous research has indicated a significant relationship between reduced fish consumption during pregnancy and higher preterm delivery rates. In this study, the investigators examined the connection between n-3 long-chain polyunsaturated fatty acid (PUFA) supplements and the percentage of pregnant women who experienced preterm delivery.