Incidence Of Adverse Perinatal Outcomes Research Articles

Incidence of Adverse Perinatal Outcomes among Women Exposed to Maternal Near-Misses in Arsi Zone in Ethiopia: Prospective Cohort Study in 2022.

Exposure to maternal near-misses has a massive effect on adverse perinatal outcomes. Hence, investigating the effect of maternal near-misses on perinatal outcomes can aid in the reduction of perinatal morbidity and mortality. The study is aimed at assessing the incidence of adverse perinatal outcomes among women exposed to maternal near-misses at Arsi Zone public hospitals in Ethiopia in 2022. The study included a prospective cohort of 335 women at Arsi Zone public hospitals from December 2021 to June 2022. Women who were admitted for management of pregnancy were followed. The exposed group was women with maternal near-misses screened based on disease-validated criteria. The nonexposed group was made up of women who delivered without complications. Trained data collectors used pretested, structured questionnaires to collect data from women. Pertinent data was also extracted from the clients' logbooks. Data was transferred from EpiData version 3.1 to SPSS version 25 for analysis, logistic regression was computed, and 95% confidence intervals were declared at a p value of 5% significance level. The incidence of adverse perinatal outcomes was higher in the exposed women than in the nonexposed women (56% versus 16%). Contrasted with the nonexposed, women exposed to maternal near-misses had a higher incidence of stillbirth (22% vs. 0.5%), low birth weight (13% vs. 3%), and preterm birth (12% vs. 2%). After adjusting for confounders, exposed women had a twofold increased risk of adverse perinatal outcomes compared to nonexposed women. Delivery mode, delay in seeking care, transport mode, and delay in receiving treatment were the risk factors for negative pregnancy outcomes. In exposed women, a higher incidence of adverse perinatal outcomes was linked to aforementioned risk factors. Evidence-based practice intended to decrease delays in providing maternal care services does indeed improve perinatal outcomes.

Radiofrequency thermal ablation of giant placental chorioangioma complicated with fetal hydrops: a case report and successful outcome

Abstract Objectives Chorioangiomas are the most frequently occurring type of benign tumour of the placenta. However, large chorioangiomas greater than 4 cm are rare and can be more frequently associated with serious complications such as: polyhydramnios, hydrops fetalis, fetal anaemia, intrauterine growth restriction, preterm birth, and an increased risk of perinatal mortality. Importantly timely prenatal diagnosis with close surveillance alongside potential intrauterine intervention can prove impactful on pregnancy outcome and fetal survival. Case presentation We present a case of a 36-year-old female referred to our tertiary fetal medicine unit at 28 weeks’ gestation with a large chorioangioma measuring 9.4×8.8×5.5 cm and ultrasonographic evidence of severe fetal anaemia and fetal hydrops. The patient underwent an intrauterine transfusion and in utero surgical therapy with radiofrequency ablation (RFA). Immediately following the procedure, the fetus sustained a period of bradycardia, followed by asystole. Delivery was expedited via emergency caesarean section. Careful planning and rapid delivery after fetal intervention within the most appropriate surgical setting mitigated risks for the baby and resulted in a positive outcome. The baby was discharged from the neonatal unit on day 84 of life. Conclusions Large placental chorioangiomas are a rare occurrence, however, when associated with fetal complications present a high incidence of adverse perinatal outcomes. In utero interventions require careful planning and surgical expertise to ensure improved fetal and neonatal outcomes. To the best of our knowledge this case is the first recorded instance of a successful postnatal outcome following RFA for a large placental chorioangioma, whereby the fetus was complicated by fetal hydrops.

A cohort study of maternal near-miss events and its adverse perinatal outcomes: an obstetrical finding in Northwest Ethiopia

Globally, various studies have reported that most adverse perinatal outcomes were associated with maternal near-misses. In Ethiopia, studies on adverse perinatal outcomes from maternal near-miss are scarce. This study aimed to assess the incidence, determinants, and maternal near-miss effects on perinatal outcomes among women at public hospitals in the South Gondar zone in 2021. A facility-based prospective cohort study was conducted from January 10, 2021, to May 10, 2021. The chi-square test, multivariable logistic regression methods, and SPSS software were used. The strength of associations and significance level were examined using P values and odds ratios with 95% confidence intervals, respectively. In addition, multicollinearity and model fitness were checked. A total of 304 respondents (76 exposed and 228 unexposed) were included in the study with a response rate of 100.0%. The incidence rates of adverse perinatal outcomes among exposed and unexposed groups were 71.1% (95% confidence interval, 60.0-73.8) and 21.1% (95% confidence interval, 15.8-28.8), respectively. Multivariable logistic regression showed that short interbirth interval (adjusted odds ratio, 8.39; 95% confidence interval, 5.36-16.08), lower household income (adjusted odds ratio, 3.61; 95% confidence interval, 1.12-6.54), rural residence (adjusted odds ratio, 2.54; 95% confidence interval, 1.21-4.07), previous stillbirth (adjusted odds ratio, 4.24; 95% confidence interval, 1.04-17.31), absence of antenatal care (adjusted odds ratio, 9.84; 95% confidence interval, 4.89-17.51), and anemia (adjusted odds ratio, 4.19; 95% confidence interval, 1.01-17.46) were significantly associated with increased odds of adverse perinatal outcomes. This study revealed that the incidence of adverse perinatal outcomes was significantly higher among exposed groups than unexposed groups. The result signified the need for improving the health of mothers by all stakeholders to improve perinatal outcomes.

Perinatal outcomes among Indian-born mothers in Australia

ObjectiveTo examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia.Design, setting and participantsThis retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23).ResultsIndian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20–27 weeks), babies with low to very low birth weight, and low Apgar score (0–2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25–34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country.ConclusionIn the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight.

Adverse perinatal outcomes complicated with gestational diabetes mellitus in preterm mothers and preterm infants.

The incidence rate of gestational diabetes mellitus (GDM) in pregnancy is currently on the increase. GDM is associated with short and long-term adverse outcomes for mothers, fetuses and newborns. The aim of the present study was to compare the incidence of adverse perinatal outcomes in women with and without GDM, in addition to comparing the morbidity and mortality rates of preterm infants born to women with and without GDM. A retrospective analysis of 640 preterm infants admitted to the Neonatal Intensive Care Unit of Qilu Hospital of Shandong University (Qingdao, China) between January 2019 and December 2020 was undertaken in the present study. According to mothers with or without GDM, the preterm infants were divided into the GDM group (n=217) and non-GDM group (n=423). Women with GDM were older (P<0.01) and more of advanced maternal age (≥35 years) or multipara (P<0.001), tended to have an increased risk of gestational hypertension (P<0.05), placenta previa (P<0.005) and polycystic ovarian syndrome (P<0.05). In infants born preterm, those born from mothers with GDM were associated with an increased risk of respiratory distress syndrome (P<0.001) and sepsis (P<0.05). In addition, very low birth weight infants born to mothers with GDM were found to have an increased risk of hypoglycemia (P<0.05) and sepsis (P<0.05). In the logistic regression analysis, RDS was the only condition independently associated with GDM [adjusted odds ratio: 1.699 (95% confidence interval: 1.699-1.699)]. However, there was no significant difference in the risk of mortality among the two groups. In conclusion, data from the present study suggested that GDM is associated with a higher risk of adverse perinatal outcomes in pregnant women and a higher risk of adverse neonatal outcomes in infants born preterm.

Establishment method and significance of birthweight curve and reference in single center

Objective: To establish neonatal birthweight percentile curves based on single-center cohort database using different methods, compare them with the current national birthweight curves and discuss the appropriateness and significance of single-center birthweight standard. Methods: Based on a prospective first-trimester screening cohort at Nanjing Drum Tower Hospital from January 2017 to February 2022, the generalized additive models for location, scale and shape (GAMLSS) and semi-customized method were applied to generate local birthweight percentile curves (hereinafter referred to as the local GAMLSS curves, semi-customized curves) for 3 894 cases who were at low risk of small for gestation age (SGA) and large for gestation age (LGA). Infants were categorized as SGA (birth weight<10th centile) by both semi-customized and local GAMLSS curves, semi-customized curves only, or not SGA (met neither criteria). The incidence of adverse perinatal outcome between different groups was compared. The same method was used to compare the semi-customized curves with the Chinese national birthweight curves (established by GAMLSS method as well, hereinafter referred to as the national GAMLSS curves). Results: (1) Among the 7 044 live births, 404 (5.74%, 404/7 044), 774 (10.99%, 774/7 044) and 868 (12.32%, 868/7 044) cases were diagnosed as SGA according to the national GAMLSS curves, the local GAMLSS curves and the semi-customized curves respectively. The birth weight of the 10th percentile of the semi-customized curves was higher than that of the local GAMLSS curves and the national GAMLSS curves at all gestational age. (2) When comparing semi-customized curves and the local GAMLSS curves, the incidence of admission to neonatal intensive care unit (NICU) for more than 24 hours of infants identified as SGA by semi-customized curves only (94 cases) and both semi-customized and local GAMLSS curves (774 cases) was 10.64% (10/94) and 5.68% (44/774) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks of infants identified as SGA by the semi-customized curves only and both semi-customized and local GAMLSS curves was 12.77% (12/94) and 9.43% (73/774), 9.57% (9/94) and 2.71% (21/774), 24.47% (23/94) and 7.24% (56/774) respectively, which were significantly higher than those of the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. (3) When comparing semi-customized curves and the national GAMLSS curves, the incidence of admission to NICU for more than 24 hours of infants identified as SGA by semi-customized curves only (464 cases) and both semi-customized and national GAMLSS curves (404 cases) was 5.60% (26/464) and 6.93% (28/404) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); all P<0.001]. The incidence of emergency cesarean section or forceps delivery for non-reassuring fetal status (NRFS) in infants identified as SGA by semi-customized curves only and both semi-customized and national GAMLSS curves was 4.96% (23/464) and 12.38% (50/404), both significantly higher than that in the non SGA group [2.57% (159/6 176); all P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks in the semi-customized curves only group and both semi-customized and national GAMLSS curves group was 8.84% (41/464) and 10.89% (44/404), 4.31% (20/464) and 2.48% (10/404), 10.56% (49/464) and 7.43% (30/404) respectively, all significantly higher than those in the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. Conclusion: Compared with the national GAMLSS birthweight curves and the local GAMLSS curves, the birth weight curves established by semi-customized method based on our single center database is in line with our center' SGA screening, which is helpful to identify and strengthen the management of high-risk infants.

COVID-19 mRNA vaccination status and concerns among pregnant women in Japan: a multicenter questionnaire survey

BackgroundmRNA vaccination is an effective, safe, and widespread strategy for protecting pregnant women against infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, information on factors such as perinatal outcomes, safety, and coverage of mRNA vaccinations among pregnant women is limited in Japan. Therefore, this study aimed to investigate the perinatal outcomes, coverage, adverse effects, and short-term safety of mRNA vaccination as well as vaccine hesitancy among pregnant women.MethodsWe conducted a multicenter online survey of postpartum women who delivered their offspring at 15 institutions around Tokyo from October 2021 to March 2022. Postpartum women were divided into vaccinated and unvaccinated groups. Perinatal outcomes, COVID-19 prevalence, and disease severity were compared between the two groups. Adverse reactions in the vaccinated group and the reasons for being unvaccinated were also investigated retrospectively.ResultsA total of 1,051 eligible postpartum women were included. Of these, 834 (79.4%) had received an mRNA vaccine, while 217 (20.6%) had not, mainly due to concerns about the effect of vaccination on the fetus. Vaccination did not increase the incidence of adverse perinatal outcomes, including fetal morphological abnormalities. The vaccinated group demonstrated low COVID-19 morbidity and severity. In the vaccinated group, the preterm birth rate, cesarean section rate, and COVID-19 incidence were 7.2%, 33.2%, and 3.3%, respectively, compared with the 13.7%, 42.2%, and 7.8% in the unvaccinated group, respectively. Almost no serious adverse reactions were associated with vaccination.ConclusionsmRNA vaccines did not demonstrate any adverse effects pertaining to short-term perinatal outcomes and might have prevented SARS-CoV-2 infection or reduced COVID-19 severity. Concerns regarding the safety of the vaccine in relation to the fetus and the mother were the main reasons that prevented pregnant women from being vaccinated. To resolve concerns, it is necessary to conduct further research to confirm not only the short-term safety but also the long-term safety of mRNA vaccines.

Placenta and Cord Blood Malaria in Mothers and Neonates Attending Federal University Teaching Hospital, Owerri, Imo State South East Nigeria

Introduction: In Malaria endemic countries, gestational and cord blood malaria prevalence are highly variable. A comprehensive study to determine the prevalence of placental and cord malaria has not been undertaken in Imo state, south eastern Nigeria. Thus, the need to determine prevalence of placenta and chord blood with Plasmodium falciparum infection among pregnant mothers and their neonates in Federal university teaching hospital Owerri, Imo State, Nigeria.&#x0D; Methodology: A hospital based cross sectional study was carried out between the months of July 2021 and June, 2022 in some public and private hospitals in Owerri, south eastern Nigeria. Malaria transmission is stable with a high seasonal transmission from July to October. Placental and umbilical cord blood was collected into an EDTA bottle from mothers who consented and their neonates respectively at delivery. The presence of Plasmodium speciewas assessed microscopically and quantified by WHO Certified Malaria Microscopists. Parasite density was determined using WHO malaria microscopy protocol. Malaria parasite density was grouped as 1-500parasites/µl, 501-5,000parasites/µl (low), 5,001–10,000 parasites/µl (high), and &gt;10,000 parasites/µl (very high) respectively for ease of analysis. Data was analyzed considering the parasite density grouping and parity while placenta and cord malaria prevalence were determined.&#x0D; Results: Placental and congenital malaria prevalence by microscopy was 21.3% vs. 8.2%. The primigravid had the highest infection rate of 33.0%. Considering the relationship between infection prevalence and parity of pregnancy, there was a significant difference P=.001. 4.2% of 119 neonate and 13.6% of 88 neonates from multigravid and primigravid mothers respectively examined had cord malaria. There was significant difference P=.002 comparing cord malaria infection prevalence and parity of pregnancy of matched mothers. The relationship between parasite malaria density and parity of pregnancy both in placental and cord malaria were not significant. Age group 20-25 years (45%) had the highest Prevalence while age groups 26-30 years recorded a prevalence of 33.3% for the primigravid and multigravid groups, respectively (P&lt;0.05). The Geo mean range of 220 (3-8,250) vs. 23(2-6,412) parasite/µl of blood were recorded in primipare vrs multipare group. The result of this study showed moderate placental malaria infection and a low prevalence of cord malaria by microscopy. The presence of malaria parasites in cord blood at delivery and non in maternal placental blood was also demonstrated. There is a significant association between ITN (Insecticide-Treated Net) usage compliance rate and gravidity (primigravid vs. multigravid) among pregnant mothers. There is also a statistically significant relationship between age and gravidity in the occurrence of placenta malaria, as indicated by the chi-square test results.&#x0D; Conclusion: Antenatal exposure to malaria parasites may have profound effects on the fetus therefore prevention of malaria infection during pregnancy which may reduce the incidence of adverse perinatal outcomes should be strongly advocated.

Chronic glomerulonephritis and pregnancy: predictors of preterm birth

Background: Chronic kidney disease (CKD) in pregnant women, with one of its most important causes being chronic glomerulonephritis (CGN), increases the incidence of adverse perinatal outcomes and gestational complications, including preterm birth (PB). Being the main cause of infant morbidity and mortality, PB has serious medical and social significance.&#x0D; Aim: To identify clinical predictors and develop a predictive model of PB in pregnant women with CGN.&#x0D; Materials and methods: A retrospective/prospective study included 122 CGN patients, whose 128 pregnancies resulted in childbirth from January 2009 to November 2022. Eighty-eight pregnancies were in the patients with CKD stage 1, 15 in stage 2, 21 in stage 3a, 3 in stage 3b, and one in stage 4. One hundred and nine (109) patients (115 pregnancies) delivered on term (at least 37 weeks of gestation) and were included into the group of term deliveries, whereas 13 women with 13 pregnancies had PB within the range of 22 weeks to 36 weeks 6 days. In the patients of both groups, we assessed nephrological and obstetric history, proteinuria and arterial hypertension at baseline and during pregnancy, complications of the index pregnancy, such as preeclampsia (PE) and severe PE, anemia, urinary tract infections, acute kidney injury, placental insufficiency, and cervical insufficiency. Binary logistic regression was used for prediction modeling of PB in women with CGN.&#x0D; Results: The proportion of PB in total cohort of the CGN patients was 10.2%. PB was spontaneous only in 2/13 (15.4%) cases, while in the rest of 11 pregnancies (84.6%) the delivery was induced due to maternal and fetal indications. Six independent predictors of PB were identified: body mass index, CKD stage, history of non-developing pregnancies, proteinuria during pregnancy 1 g/day, PE and placental insufficiency. The predictive model had sensitivity of 76.9%, specificity 99.1%, diagnostic efficiency 96.9%, positive predictive value 90.9%, and negative predictive value 97.4%.&#x0D; Conclusion: Predicting PB and targeting modifiable factors associated with PB may improve pregnancy outcomes in patients with CGN.

Fetal growth restriction: ways to the solution of the problem. A literature review

Fetal growth restriction is a condition that is defined as the inability of a fetus to reach its full genetically determined growth potential. The mechanism underlying the pathogenesis is a placental dysfunction in the form of inadequate supply of oxygen and nutrients to the fetus. Clinically, this is reflected by a drop in fetal size percentiles over the course of gestation. Worldwide, fetal growth restriction is a leading cause of stillbirth, neonatal mortality and morbidity in postnatal period. Prenatal identification of fetuses with this pathology significantly reduces the incidence of adverse perinatal outcomes. However, recognizing this pathology is often a hard challenge because fetal growth cannot be assessed using only a few biometric parameters of fetal size and the fetal growth potential is hypothetical. It is also necessary to distinguish between fetal growth restriction and a fetus small for gestational age to determine the correct the management of pregnancy and the timing of delivery. In this article, we present the approaches to the management of pregnancies and deliveries in fetal growth restriction, and we identify directions for further research in this area.

Explore the impact of abnormal coagulation test results on pregnancy complications and perinatal outcomes by establishing the trimester-specific reference intervals of singleton and twin pregnancies

BackgroundDuring pregnancy, complex physiological changes take place in the hemostatic system, resulting in a hypercoagulable state. With the established trimester-specific reference intervals (RIs) of the coagulation tests, we investigated the associations between disturbance of hemostasis and adverse pregnant outcomes in a population-based cohort study. MethodsThe first- and third-trimester coagulation tests results were retrieved from 29,328 singleton and 840 twin pregnant women for regular antenatal check-ups from November 30th, 2017 to January 31st, 2021. The trimester-specific RIs for fibrinogen (FIB), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), d-dimer (DD) were estimated using both the direct observational and the indirect Hoffmann methods. The associations between the coagulation tests and the risks of developing pregnancy complications as well as adverse perinatal outcomes were assessed using the logistic regression analysis. ResultsIncreased FIB, DD and decreased PT, APTT and TT were observed as the gestational age increases in the singleton pregnancy. An enhanced procoagulant state, marked by significant elevation of FIB, DD and reduction of PT, APTT and TT, was observed in the twin pregnancy. The subjects with anormal PT, APTT, TT, DD, tend to have increased risks of developing peri- and postpartum complications such as preterm birth, fetal growth restriction. ConclusionsThe incidence of adverse perinatal outcomes was remarkably associated with the maternal increased levels of FIB, PT, TT, APTT and DD in the third trimester, which may be applied in early identification of women at high risk of adverse outcomes due to coagulopathy.

Secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China (2011–2019)

The increasing trend in the incidence of adverse perinatal outcomes is a public health concern globally as well as in China. However, the causes of the increasing trend are not well understood. The present tertiary-hospital-based retrospective study (2011–2019) aims to determine the secular trends and age-period-cohort effect on adverse perinatal outcomes in Hubei, China. The age-standardized incidence rates of adverse perinatal outcomes significantly decreased such as preterm births by 22% [AAPC − 3.4% (95% CI − 7.8, − 1.2)], low birth weight (LBW) by 28.5% [AAPC − 4.7% (95% CI − 6.0, − 3.3)], and fetal distress by 64.2% [AAPC − 14.0% (95% CI − 17.8, − 10.0)] during 2011–2019. Both extremes of maternal age groups (18–20 years and 42–44 years) had a higher risk ratio for adverse perinatal outcomes including preterm birth, perinatal mortality, LBW, low ponderal index (LPI), low Apgar score, and congenital defect compared to the reference age group (30–32 years). A higher risk ratio for perinatal mortality, intrauterine growth restriction (IUGR), and fetal distress and a lower risk ratio for preterm births and LBW were observed in the period 2017–2019. Both the young cohort (1997–1999) and the old cohort (1976–1969) had a higher risk ratio for preterm birth, perinatal mortality, macrosomia, and congenital defect compared to the reference cohort (1982–1984). In conclusion, some of the adverse perinatal outcomes incidence significantly decreased in the last 9 years in Hubei. However, extremes of maternal age groups and both young and old cohorts were associated with a higher risk of preterm birth, perinatal mortality, and congenital defect.

Perinatal outcomes of pregnancy and childbirth in moderate to severe COVID-19 patients

BACKGROUND: The presence of COVID-19 caused by SARS-CoV-2 during pregnancy increases the incidence of adverse perinatal outcomes, which are manifested in more frequent spontaneous miscarriages, premature births, antenatal fetal deaths, and fetal growth retardation, as well as in the development of intraamniotic infection and respiratory distress syndrome of the newborn. The most likely cause of premature birth can be considered severe respiratory failure of the mother with hypoxemia, which leads to circulatory disorders in the hemodynamic system of the mother-placenta-fetus. Currently, there is no single expert opinion on pregnancy prolongation tactics, as well as the timing and methods of delivery in patients with COVID-19, which is decided individually by an interdisciplinary consultation of the experts, taking into account the severity of the patients condition, gestational age and fetal condition.&#x0D; AIM: The aim of this study was to analyze perinatal outcomes of pregnancy and childbirth in the presence of moderate and severe COVID-19.&#x0D; MATERIALS AND METHODS: We carried out a retrospective analysis of perinatal outcomes in patients with the novel coronavirus infection in a specialized level III infectious hospital in St. Petersburg, Russia in 20202021 (from the first to the fourth wave of COVID-19) based on the birth histories of 50 patients with moderate (n = 31) and severe (n = 19) forms of the disease.&#x0D; RESULTS: Most of the patients suffered from chronic somatic diseases, with the course of pregnancy and childbirth complicated by premature rupture of amniotic fluid and progressive fetal hypoxia (fetal distress). In severe COVID-19, preterm labor prevailed and the proportion of operative abdominal delivery more than doubled that of vaginal delivery. The course of the postpartum period was determined by the COVID-19 positive dynamics. The majority of patients in the study groups showed significant changes in laboratory parameters such as anemia, an increase in the level of neutrophilic leukocytes with a subsequent decrease in their count, lymphopenia followed by lymphocytosis, and an increase in the levels of C-reactive protein and the activities of lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase. The study of the relationship between the most characteristic laboratory parameters in the disease dynamics showed the presence of statistically significant correlations between inflammation markers and metabolic markers, which allowed for assessing the severity of the patients condition.&#x0D; Antenatal diagnosis of the fetal functional status based on cardiotocography, ultrasound and Doppler sonography data revealed a predominantly compensated fetal condition in the study groups. The condition of newborns in all patients with moderate COVID-19 and in most of patients with the severe form of the disease was satisfactory. In severe COVID-19, the birth of children with moderate asphyxia was due to prematurity and antenatal hypoxia resulted from decompensation of chronic placental insufficiency. The histopathological patterns of the afterbirth in the study groups were represented by inflammatory changes and chronic placental insufficiency.&#x0D; CONCLUSIONS: The data obtained suggest that the basis for favorable perinatal outcomes is an adequate assessment of the condition of the pregnant woman and the fetus with timely delivery before the onset of irreversible organ damage.

Microbiological features and perinatal outcomes in patients with preterm premature rupture of membranes and oligohydramnios

BACKGROUND: Oligohydramnios in preterm premature rupture of membranes is the cause of increased perinatal morbidity and mortality among preterm newborns. Microbiological features in women with preterm premature rupture of membranes and oligohydramnios are probably some of the determining factors affecting the implementation of an unfavorable outcome of gestation.&#x0D; AIM: The aim of this study was to determine microbiological features and perinatal outcomes in patients with preterm premature rupture of membranes and oligohydramnios.&#x0D; MATERIALS AND METHODS: This retrospective study conducted from 2018 to 2021 included 161 pregnant women with PPROM at 24 to 33 weeks and 6 days of gestation. Of these, the main group consisted of 83 patients with signs of oligohydramnios, while the control group comprised 78 patients without oligohydramnios. Patient examination upon admission to the hospital included analysis of the amniotic fluid index, the white blood cell differential, plasma ferritin and C-reactive protein levels, and bacteriological tests of vaginal secretions by isolating and growing microbes on optimal culture media.&#x0D; RESULTS: The patients with oligohydramnios had shorter latent period (р = 0.004), but the noted distinctions were a higher frequency of clinical chorioamnionitis (р = 0.025), fetal distress (р = 0.030), and earlier parturition (р = 0.040) with more frequent caesarean sections (р = 0.016) compared to the control group. Vaginal microbiota in the main group showed a higher prevalence of Staphylococcus aureus (р = 0.008), Bacteroides spp. (р = 0.030), Streptococcus spp. (р = 0.002), Micrococcus spp. (p 0.001), Bacillus subtilis (p 0.001), Bacillus megaterium (p = 0.009), Bacillus buchneri (р = 0.008), Klebsiella pneumoniae (р = 0.002), Haemophilus spp. (р = 0.005) and no Candida albicans compared to the control group. In the main group, newborns more often had a lower body weight at birth (р = 0.002) and a lower Apgar score at the fifth minute (р = 0.011). They also showed higher incidences of respiratory distress syndrome (р = 0.006), bronchopulmonary dysplasia (р = 0.036), congenital pneumonia (р = 0.011) and necrotizing enterocolitis (р = 0.022) and more often needed treatment in an intensive care unit (р = 0.034), including surfactant supplementation (р = 0.007), cardiotonic support (р = 0.004) and artificial lung ventilation (р = 0.006) compared to the control group.&#x0D; CONCLUSIONS: Oligohydramnios in preterm premature rupture of membranes is associated with pronounced dysbiotic changes in the vaginal microbiota including the prevalence of Micrococcus spp., Streptococcus spp., Staphylococcus aureus and absence of Candida spp. from the isolates, as well as increased incidence of adverse perinatal outcomes.

Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial.

ObjectiveTo assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy.DesignMulticentre prospective cohort study alongside RCT.Setting90 midwifery practices and 12 hospitals in the Netherlands.Population3642 low-risk women with uncomplicated singleton late-term pregnancy.Main outcome measuresComposite adverse outcome (perinatal death, Apgar score 5′ < 7, NICU admission, meconium aspiration syndrome), composite severe adverse perinatal outcome (all above with Apgar score 5′ < 4 instead of < 7) and caesarean section.ResultsFrom 2012–2016, 3642 women out of 6088 eligible women for the INDEX RCT, participated in the cohort study for observational data collection (induction of labour n = 372; expectant management n = 2174; unknown preference/management strategy n = 1096).Adverse perinatal outcome occurred in 1.1 % (4/372) in the induction group versus 1.9 % (42/2174) in the expectant group (adjRR 0.56; 95 %CI: 0.17–1.79), with severe adverse perinatal outcome occurring in 0.3 % (1/372) versus 1.0 % (22/2174), respectively (adjRR 0.39; 95 % CI: 0.05–2.88). There were no stillbirths among all 3642 women; one neonatal death occurred in the unknown preference/management group. Caesarean section rates were 10.5 % (39/372) after induction and 8.9 % (193/2174) after expectant management (adjRR 1.32; 95 % CI: 0.95–1.84).A higher incidence of adverse perinatal outcome was observed in nulliparous compared to multiparous women. Nulliparous 1.8 % (3/170) in the induction group versus 2.6 % (30/1134) in the expectant management group (adjRR 0.58; 95 % CI 0.14–2.41), multiparous 0.5 % (1/201) versus 1.1 % (11/1039) (adjRR 0.54; 95 % CI 0.07–24.19). One maternal death due to amniotic fluid embolism occurred after elective induction at 41 weeks + 6 days.ConclusionIn this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1 % versus 1.9 %) and severe adverse (0.3 % versus 1.0 %) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3642 women. Caesarean section rates were comparable.

Confirmation of preeclampsia-like syndrome induced by severe COVID-19: an observational study

BACKGROUNDSince the outbreak of the COVID-19 pandemic, some studies have reported an increased preeclampsia incidence in pregnant women with SARS-CoV-2 infection. Several explanations for this association have been proposed, including a preeclampsia-like syndrome induced by severe COVID-19. This syndrome was described in a small case series and has not been confirmed in larger studies, and its effect on perinatal outcomes has not been studied.OBJECTIVEThis study aimed to confirm the preeclampsia-like syndrome because of COVID-19 and to investigate its implications on pregnancy outcomes and prognosis.STUDY DESIGNThis was a prospective, observational study conducted in a tertiary referral hospital. The inclusion criteria were pregnant women admitted to the intensive care unit for severe pneumonia because of COVID-19. They were classified into 3 groups based on clinical and laboratory findings: preeclampsia, preeclampsia-like syndrome, and women without preeclampsia features. The 3 cohorts were analyzed and compared at 3 different times: before, during, and after severe pneumonia. The main outcomes were incidence of adverse perinatal outcomes and signs and symptoms of PE, such as hypertension, proteinuria, thrombocytopenia, elevated liver enzymes, and increased angiogenic factors (soluble fms-like tyrosine kinase 1–to–placental growth factor ratio).RESULTSA total of 106 women were admitted to the intensive care unit because of severe pneumonia, and 68 women were included in the study. Of those, 53 (50.0%) did not meet the diagnostic criteria for preeclampsia and remained pregnant after pneumonia (non-preeclampsia); 7 (6.6%) met the diagnostic criteria for preeclampsia, had abnormal (>38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia), and delivered during severe pneumonia, and 8 (7.5%) met the diagnostic criteria for preeclampsia, had normal (≤38) soluble fms-like tyrosine kinase 1–to–placental growth factor ratio (preeclampsia like), and did not deliver during pneumonia. Despite not having delivered, most preeclampsia-related features improved after severe pneumonia in women with preeclampsia-like syndrome. Women with preeclampsia had significantly poorer outcomes than women with preeclampsia-like syndrome or without preeclampsia.CONCLUSIONMore than 50% of women with severe COVID-19 and diagnostic criteria for preeclampsia may not be preeclampsia but a preeclampsia-like syndrome, which may affect up to 7.5% of women with severe COVID-19. Preeclampsia-like syndrome might have similar perinatal outcomes to those of normotensive women with severe pneumonia because of COVID-19. For these reasons, preeclampsia-like syndrome should be excluded by using soluble fms-like tyrosine kinase 1–to–placental growth factor ratio in future research and before making clinical decisions.

Perinatal outcome of twin pregnancies among mothers who gave birth in Adama Hospital Medical College, Central Ethiopia.

IntroductionTwin pregnancy carries a high risk of pregnancy-related complications including adverse perinatal outcomes. Although evidence from international studies indicated an increased risk of adverse perinatal outcomes in twin pregnancies, little is known about the adverse perinatal outcomes in twin pregnancies and associated factors in Ethiopia. The purpose of this study was, therefore, to estimate the incidence of twin pregnancies and related-adverse perinatal outcomes and identify factors associated with adverse perinatal outcomes in twin pregnancies in Ethiopia.MethodsA hospital-based retrospective cross-sectional study was conducted among 322 mothers who gave twin birth at Adama Hospital Medical College between 08 July 2015 and 07 June 2017. In this study, the adverse perinatal outcome was defined as the presence of any of the following main conditions: low birth weight, preterm birth, stillbirth, low Apgar Scores, mal-presentation, Admission to neonatal Intensive Care Unit (NICU), and early neonatal deaths. The data were analyzed using SPSS version 20.0. Multivariable logistic regression was conducted to identify factors associated with adverse perinatal outcome at 95% CI or P-value of less than 0.05.ResultOf 10,850 births recorded in the hospital, 354 births were twins and 322 of these paired records had complete perinatal information. One hundred ninety-nine (61.8%) of the 322 paired birth records had at least one adverse perinatal outcome on one or both twins. Low birth weight was the most common perinatal outcome followed by preterm birth. After adjusting for confounding factors, younger maternal age (AOR = 4.1, 95% CI; 1.3, 12.5) and not having ultrasound scan during antenatal care (AOR = 2.0, 95% CI: 1.2, 3.1) were significantly associated with adverse perinatal outcomes.ConclusionThe incidence of adverse perinatal outcome in twin pregnancies was high, that is, in 61.8% of twin births, there was at least one adverse perinatal outcome on one or both twins. Moreover, younger maternal age at birth and not having an ultrasound scan during antenatal care were found to be strong predictors for the observed high incidence of adverse perinatal outcomes.

Effect of short inter-pregnancy interval on perinatal outcomes among pregnant women in North-west Ethiopia: A prospective cohort study.

BackgroundInter-pregnancy interval (IPI) is the elapse of time between the end of one pregnancy and the conception of another pregnancy, while birth to pregnancy interval, is the time gap between live birth and the conception of the next pregnancy. Hence, this study assessed the effects of short inter-pregnancy intervals on perinatal outcomes among women who gave birth in public health institutions of Assosa zone, North-west Ethiopia.MethodsAn institution-based prospective cohort study was conducted among 456 mothers who visited health facilities for the fourth antenatal care appointment (152 exposed and 304 non-exposed). Women who gave their recent birth with the pregnancy interval of <24 months or/and had an abortion history of <6 months were considered as exposed otherwise non-exposed. Data was collected through face-to-face interviews by using questionnaires and checklists. The collected data was entered using Epi-data and exported to STATA for analysis. A log-binomial regression model was used to identify the effect of short inter-pregnancy intervals on the perinatal outcomes.ResultsThe overall incidence of adverse perinatal outcomes is 24%. Mothers who had short inter-pregnancy intervals have two times the risk to develop low birth weight (RR: 2.1, 95%CI: 1.16–3.82), and low Apgar score (RR: 2.1, 95%CI: 1.06–2.69). Similarly, the risk to develop small for gestational age (RR: 2.6, 95% CI: 1.19–7.54), and preterm birth (RR: 3.14, 95%CI: 1.05–4.66) was about 3 times among mothers who had short inter-pregnancy interval compared to mothers who had an optimal inter-pregnancy interval.ConclusionShort inter-pregnancy interval increases the risk of low birth weight, preterm birth, small for gestational age, and low Apgar score. Health Policy makers, National health managers and health care providers should work on increasing the awareness of optimal inter-pregnancy intervals and postpartum family planning utilization to reduce the effect of short inter-pregnancy intervals on adverse perinatal outcomes.

Incidence of adverse perinatal outcomes and risk factors among women with pre-eclampsia, southern Ethiopia: a prospective open cohort study

BackgroundIn Ethiopia, in 2021, more than 80% of all newborn deaths were caused by preventable and treatable conditions. This study aimed to measure the incidence of adverse perinatal outcomes and...

Predictive Value of Serum Cholic Acid and Lithocholic Acid for the Diagnosis in an Intrahepatic Cholestasis of Pregnancy Population with High Levels of Total Bile Acids and the Correlation with Placental Hypoxia-Inducible Factor-1α.

ObjectiveThis study aimed to investigate the ability of serum cholic acid (CA) and lithocholic acid (LCA) in the diagnosis and perinatal prognosis assessment of intrahepatic cholestasis of pregnancy (ICP), and the relationship between both indicators and hypoxia-inducible factor-1α (HIF-1α).MethodsBetween March 2020 and March 2021, pregnant women with high levels of total bile acid (TBA) in the late pregnancy with TBA ≥10 μmol/L and TBA <10 μmol/L (control group) were included for the retrospective study. Those with TBA ≥10 μmol/L were divided into the ICP group and the asymptomatic hypercholanaemia of pregnancy (AHP) group based on ICP symptoms. The comparison of the bile acid profiles, the receiver operating characteristic (ROC) curve analysis, and Pearson correlation analysis were conducted successively.ResultsNine types of bile acids were significantly higher in ICP and AHP than in the control group, while CA and LCA serum levels in the AHP group were significantly lower than those in the ICP group (P < 0.05). The ROC curve analysis showed that LCA, CA, and LCA+CA were all diagnostic indicators for ICP, and LCA+CA displayed the greatest diagnostic value (area under the curve (AUC), 0.923). Subgroup analysis using the LCA+CA cut-off point (3.28 μmol/L) as the subgroup indicator proved that the incidence of adverse perinatal outcomes and the placental HIF-1α positivity were significantly higher in the high LCA+CA group than in the low LCA+CA group (P < 0.05). Pearson correlation analysis revealed significant positive correlations of HIF-1α expression levels to LCA, CA and LCA+CA (r = 0.473, 0.537, 0.619, respectively. P < 0.05 in all).ConclusionThis study confirmed that CA and LCA have a predictive diagnostic value for ICP in pregnant women, and the combined evaluation is associated with adverse perinatal outcomes, and LCA+CA positively correlates to placental HIF-1α expression levels.