Maternofetal Complications Research Articles

Recurring Materno-fetal Complications in Late Pregnancy: An Integrative Review

Background: Pregnancies at advanced ages are increasingly common in society, which represents a concern for the health system, since they are associated with complications and different comorbidities during pregnancy, which can negatively impact its course, due to the occurrence of adverse maternal-fetal events. Therefore, this study aims to summarize the main complications of advanced maternal age and their repercussions. Methods: An integrative review was developed, using the LILACS, MEDLINE, and PubMed databases and the search formula: (“complications”) AND (“pregnancy”) AND (“maternal age”), including articles in Portuguese, English, and Spanish from 2018 to 2023, excluding duplicates and review articles. Results: 484 articles were filtered and, after applying the inclusion and exclusion criteria, 28 articles were selected to compose the study. From them, a higher incidence of gestational diabetes mellitus was evidenced in mothers over 35 years of age due to the progressive depletion of pancreatic β-cell function. In addition, pre-eclampsia was found to be seven times more common in pregnant women aged 40 years than in those under 30 years of age, as the gastro-omental arteries reduce compliance, affecting blood pressure regulation. Conclusion: Therefore, advancing age is related to the emergence of metabolic alterations and cardiovascular diseases that can harm maternal and fetal health, since pregnant women over 35 years of age are more prone to comorbidities that can result in adverse maternal and neonatal outcomes.

The Use of End-Tidal CO2 and Integrated Pulmonary Index to Predict Postspinal Hypotension in Cesarean Section.

Early diagnosis and treatment of postspinal hypotension (PSH) in obstetric anaesthesia reduces the risk of maternofetal complications. In this study, the effect of EtCO2 and the integrated pulmonary index (IPI) in predicting PSH was investigated. Patients scheduled for cesarean section under spinal anaesthesia were included. The Capnostream 35 respiratory monitor (Medtronic, Inc., Dublin, Ireland) was used for EtCO2 and IPI. PSH developed in 52 (63.4%) of the 82 patients. EtCO2 and IPI values decreased significantly compared with baseline values in patients who developed PSH. There were statistically significant differences in EtCO2 (p = 0.001) and the IPI change (p = 0.045) in patients who developed PSH compared with those who did not. It was found that the EtCO2 difference had an independent effect on predicting PSH (p < 0.05), whereas the IPI difference did not (p > 0.05). One unit decrease in EtCO2 from the baseline increased the risk of PSH by 3.3 times. ROC curve analysis showed that the magnitude of change in EtCO2 was diagnostic for predicting PSH (AUC: 0.90 (0.83-0.97; p < 0.001)). IPI showed no predictive value for postspinal hypotension in cesarean section. However, EtCO2 monitoring, which is non-invasive and real-time monitoring, can be used to predict postspinal hypotension.

The Effect of High Parity on the Occurrence of Anaemia in Pregnant Women.

To compare high-para and low-para women with respect to haematological findings, determinants, and consequences secondary to anaemia. Descriptive cohort study. Place and Duration of the Study: Maternity and Child Hospital, Hail, Saudi Arabia and Specialist Care Hospital (private), Islamabad, Pakistan, from April 2022 to April 2023. The study population comprised of pregnant women in the last trimester, with the exception of those women who had more than one fetus and history of haematological disease. Purposive non-probability sampling technique was adopted. Hospital data were retrieved retrospectively for the past obstetrical, contraception usage, and supplement history. Blood parameters, type of delivery, and maternofetal complications were noted down. For qualitative-variable and quantitative-variable comparisons, Chi-square test and t-test were applied, respectively. Significance level was kept at p ≤0.05. The frequency of severe anaemia in high-para was 52%. High parity and anaemia had a significant dose-response relationship (p <0.05). There was a significant difference (p <0.05) in blood parameters between high-para and low-para groups. Main determinants identified for anaemia were lack of intake of iron-rich food (36%) followed by inadequate intake of oral iron (25%). Preterm birth (68%) and post-partum haemorrhage (96%) were significantly associated (p <0.05) with high parity. There was a significantly high proportion (83%) of high-para women with more than 3 cesarean deliveries and admissions in ICU. High parity and anaemia had a significant dose-response relationship. High parity was the main determinant of maternal and fetal admissions in ICU. Parity, Comparison, Maternal anaemia, Haematological findings, Diet, Contraception, Cost-effective.

Isolation and Susceptibility of Microorganisms Responsible for Asymptomatic Antenatal Bacteriuria

Aim &amp; Objective: Determination of prevalence, bacterial profile and antibiotic sensitivity of microorganisms responsible for asymptomatic UTI during pregnancy.&#x0D; Methodology: The type of study is cross-sectional, Prospective type, was conducted at the PUMHS for Women Nawabshah (SBA) after approval from the Ethical Review Committee and the duration was 2 years from 1st Jan 2021-31st Dec 2022. Samples were collected by non-probability- convenient method from all pregnant women without any clinical complaints attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah. The midstream urine collected by clean catch method in sterile containers was processed for DR of urine including physical, chemical, and microscopic examination. After the urine detailed report, the samples were sent for, culture by using the following media, blood, Macconkey’s, and CLED agar. Growth-positive samples were proceeding for gram staining, biochemical tests, and antibiotic sensitivity reports according to world standard methods for confirmation.&#x0D; Results: Out of 477 patients 96 (20%) were positive for ASB, with the mean age of the patient being 29.32±5.74 The most common microorganisms found in the study were E.coli 67 (69.7.%), followed by Klebisella in 4(4%), proteus 9(9%), pseudomonas 8(8.3%), staphylococcus aureus 2(2%), staphylococcus saprophyticus in 4(4%), streptococcus pyogen 2(2%).&#x0D; There was 100% sensitivity found for all isolated microorganisms following culture examination to following antibiotics: Ciprofloxacin, Cefuroxime, Imepenem, Ceftriaxone Amikacin, Meropenem, and Piperacillin-tazobactam; however, 52% and 45% sensitivity of E.coli and 100% sensitivity of streptococci were present for amoxicillin-clavulanic acid and ampicillin respectively.&#x0D; Conclusion: A rising number of silent antenatal bacteriuria was observed in younger age women with severe maternal and fetal complications in advanced stages of pregnancy and thereafter. It is therefore suggested to routinely perform urine cultures for every suspected pregnant lady during advanced antenatal visits to diagnose and properly treat the asymptomatic bacteriuria in terms of avoiding antibiotic resistance and materno-fetal complications in the near future.

PREVALENCE OF PRE-ECLAMPSIA AND ECLAMPSIA AND MATERNO-FETAL OUTCOMES AT A HEALTH FACILTY IN DELTA STATE, NIGERIA

BACKGROUND: Globally, pre-eclampsia and eclampsia complicate up to 4.6% and 1.4% of pregnancies respectively but disproportionally account for nearly 18% of all maternal death worldwide, with an estimated 62,000 to 77,000 deaths per year. OBJECTIVE: This study determined the prevalence of pre-eclampsia and eclampsia, and compared outcomes. METHODS: This was a retrospective cross-sectional study utilizing the case files of women admitted to the maternity ward of the obstetrics and gynaecology unit in Central Hospital, Ughelli from 1st August 2020 to 30th July 2022. Socio-demographic characteristics, maternal and fetal complications and outcomes, prevalence rate of preeclampsia and eclampsia, were presented as frequencies and percentages. RESULTS: Of the 6291 mothers which were delivered of their babies in the maternity ward of the obstetrics and gynaecology department, 120(1.9%) were diagnosed of pre-eclampsia and eclampsia; only 108 which had complete documentation were used for the study. Age range of the participants was 16-45years, the majority, 88(81.5%) were married, had secondary education, 70(64.8%) and higher; 42(38.9%) were nulliparous at admission and 67(62%) were unbooked at the antenatal clinic. Fifty –three (49.1%) had preeclampsia while 55(50.9%) had eclampsia. Majority, 107(99.1%) were discharged home alive and 75(69.4%) had no maternal complications. Number of fetuses delivered were 114, 95 (83.3%) were born alive, 68(59.6%) weighed less than 2500g, and 91( 95.8%) neonates had a good APGAR score at the 5th minute. CONCLUSION: The prevalence of pre-eclampsia and eclampsia was low, however there was high rates of perinatal deaths and occurrence of unfavourable materno-fetal complications.

Treatments During Pregnancy Targeting ERBB2 and Outcomes of Pregnant Individuals and Newborns

Targeted therapies directed against ERBB2 are the cornerstone of medical treatment for ERBB2-positive breast cancers but are contraindicated during pregnancy. To describe the association of exposure to anti-ERBB2 agents during pregnancy with pregnancy and fetal or newborn outcomes, and to compare the risk and types of adverse outcomes reported more frequently in this context than after exposure to other anticancer agents. For this case-control study, All reports with a pregnancy-related condition and an antineoplastic agent (Anatomical Therapeutic Chemical classification group L01) registered in the World Health Organization international pharmacovigilance database VigiBase up to June 26, 2022, were extracted. All reports with a pregnancy, an antineoplastic treatment during pregnancy, and a cancer were retained. Reports with anticancer agents prescribed for nononcologic purposes were not included. The exposure group was defined as reports that mention anti-ERBB2 agents compared with exposure to other anticancer agents. The main outcome was the reporting odds ratio (ROR) for maternofetal complications in the group exposed to anti-ERBB2 agents compared with other anticancer agents, as determined using a disproportionality analysis. A total of 3558 reports (anti-ERBB2 agents, 328; other anticancer agents, 3230) were included in the analysis. In the group exposed to anti-ERBB2 agents, most reports were from the US (159 [48.5%]), the mean (SD) age of participants was 30.8 (10.4) years, and 209 patients (97.7%) were treated for breast cancers. The molecules most frequently involved in cases with anti-ERBB2 agents were trastuzumab (n = 302), pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18). The outcomes overreported in these cases included oligohydramnios (ROR, 17.68 [95% CI, 12.26-25.52]; P < .001), congenital respiratory tract disorders (ROR, 9.98 [95% CI, 2.88-34.67]; P < .001), and neonatal kidney failure (ROR, 9.15 [95% CI, 4.62-18.12]; P < .001). Sensitivity and multivariable analyses found similar results. Toxic effects were also significantly overreported for trastuzumab-emtansine (cardiovascular malformation: ROR, 4.46 [95% CI, 1.02-19.52]) and lapatinib (intrauterine growth restriction: ROR, 7.68 [95% CI, 3.01-19.59]). In this case-control study of 328 individuals exposed to anti-ERBB2 agents during pregnancy, exposure was associated with a severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments.

Abstract #1406181: Complications in the Management of Hypercalcemia in a Patient with Systemic Lupus Erythematous and Lupus Nephritis During Pregnancy

Hypercalcemia can present with a multitude of symptoms including anorexia, nausea and vomiting, constipation and neuropsychiatric disturbances. There is an overlap in these symptoms with those experienced during both pregnancy and in systemic lupus erythematosus. This case report highlights the difficulties in the diagnostic evaluation and management of hypercalcemia during pregnancy. A 26-year-old female with history of Systemic lupus erythematosus (SLE) complicated by Class V lupus nephritis and antiphospholipid syndrome presented August 2022 with symptomatic hypercalcemia at 8-weeks gestation. The patient reported fatigue, nausea and vomiting and new onset severe constipation, polydipsia and polyuria. Lab work was notable for hypercalcemia with calcium 13.2 mg/dl (corrected 13.7 mg/dl for Albumin 3.4g/dl) and parathyroid hormone (PTH) 153pg/ml. No parathyroid nodules were seen on ultrasound and 1st trimester ultrasound demonstrated a single live intra-uterine pregnancy. The patient was diagnosed with primary hyperparathyroidism and started on 0.9% normal saline intravenous fluid at 200cc/hr and Furosemide 20mg/Q6H IV to promote diuresis. Despite this, calcium could not be lowered to less than 12.4 mg/dl (13.0 mg/dl albumin corrected). The patient was discharged with instructions to drink 3-4L water per day and take Furosemide 20mg daily. On follow up at 14 weeks, Calcium was still elevated at 11.9 mg/dl and reported intermittent vomiting and constipation. ENT was consulted to consider parathyroidectomy however opted for conservative management of hypercalcemia prior to delivery due to inability to localize an adenoma and exclude ectopic parathyroid on imaging. The patient was followed closely for the remainder of her pregnancy with improvement in her symptoms, however continued to have persistent hypercalcemia posing risk of materno-fetal complications. Treatment for hypercalcemia is based upon the severity and symptoms, but it is important to consider gestational age. Exceeding the upper normal limit of calcium during pregnancy of 9.5 mg/dL increases the risk of fetal complications including spontaneous abortion, still birth and neonatal tetany. There is added difficulty in determining true symptomatic hypercalcemia given the overlap in symptomatology with pregnancy. In pregnant patients undergoing parathyroid surgery, localization can be done with ultrasound rather than Sestamibi but risks missing ectopic parathyroid glands. If surgery is not recommended, there are limited therapeutic options during pregnancy for hypercalcemia. Notably, IV fluids and diuretics provide modest temporary benefit. Total serum calcium is reported to decline across gestation, likely due to plasma volume expansion, and this may temporize the harmful effects of hypercalcemia to defer surgery until after birth. There is inadequate data on the safe use of Cinacalcet during pregnancy with no known risk of teratogenicity reported in case reports. There is however an increased risk of neonatal hypocalcemia due to gestational suppression of the fetal parathyroid glands.

Dietary quality and mindful eating among pregnant women with and without gestational diabetes

Objective: The incidence of gestational diabetes mellitus (GDM) is increasing in parallel with maternal obesity. The main components of treatment are monitoring blood glucose levels with medical nutrition therapy and lifestyle modification in order to prevent short- and long-term materno-fetal complications. This study aimed to compare the diet quality and mindful eating among pregnant women with and without GDM. Methods: This case-control study included 68 pregnant women. Each participant was face-to-face interviewed using a structured questionnaire to obtain socio-demographic information, general health information, nutritional habits, and registered three days of food record. Mindful Eating Questionnaire (MEQ) and Healthy Eating Index (HEI) were applied in order to assess mindful eating and diet quality, respectively. Results: Mean pre-pregnancy body mass index of women was 27.42+5.44 kg/m2, 66.7% of the gestational diabetes group and 29.4% of the control group was obese. Differences in HEI adequacy subgroup scores between the groups were significant. Mean MEQ scores were 2.85±0.34 and 3.13±0.44 in pregnant women with gestational diabetes and control cases, respectively (r=0.61, p=0003, p&lt;0.05). Conclusion: Our results showed that pregnant women with gestational diabetes had lower mindful eating and diet quality scores.

A rare case of obstructed labor due to sever uterine prolapse; a case report and literature review.

IntroductionUterine prolapse in pregnancy is a rare problem reported in literature and might increase problems such as emergency cesarean section, preterm delivery, and other materno-fetal complications. Prolapse becomes a life-threatening condition for both mother and baby when it creates a labor abstraction.Presentation of caseHere, a 37 years old lady (BMI = 26, gestational age = 37 weeks), without any obvious risk factors, with sever uterine prolapse (stage IV) and obstructed labor was presented. Congested and incarcerated cervix along with the onset of uterine contractions led to emergency cesarean section, by incision made in fundal part of uterus, because the lower segment was not accessible or visible at all. Apical and lateral vaginal defect in the patient was corrected at cesarean section time.ConclusionAs a result: with timely action for cesarean delivery, maternal-fetal complications were reduced, however the correction of apical uterovaginal defects during cesarean time is possible and improves the quality of life of women in the reproductive age.

S2181 Jejunostomy Feeding in Refractory Hyperemesis Gravidarum - A Case Report and Review of Literature

Introduction: Hyperemesis gravidarum (HG) is intractable vomiting experienced by < 1% of pregnant women causing dehydration, significant weight loss and electrolyte disturbances requiring hospital admission. HG is distinguished from nausea/vomiting in pregnancy by ketonuria and loss of >5% of prepregnancy weight. Nutritional support in early pregnancy reduces potential complications associated with HG. We present a patient with severe HG who failed all pharmacological treatment and had a jejunostomy (J) tube placed for nutrition. Case Description/Methods: A 31-year-old G3P1 female presented in her 21stweek of pregnancy with intractable vomiting ( >20 episodes/day) and 13-lb weight loss in 2months. Symptoms began in her 6thweek and she failed a trial of scheduled Ondansetron, Promethazine, Vitamin B1/B6 and Famotidine. Patient later agreed to complete a regimen of IV Methylprednisolone followed by Prednisone taper; however, symptoms persisted. She continued to lose weight and developed protein-calorie malnutrition with ketonuria by her 24thweek. Enteral versus parenteral feeding options were reviewed and she agreed to endoscopic nasojejunal (NJ) tube placement. Tube feeds were uptitrated gradually, however her NJ tube dislodged after 2days due to vigorous vomiting. She subsequently had central line placed and was started on parenteral nutrition. To prevent long-term complications, we opted for J-tube placement laparoscopically to avoid puncturing the uterus during the procedure. Tube feeds were restarted and increased as tolerated to reach nutritional goals. The J-tube will remain in place until she delivers. Discussion: Currently, antiemetics are recommended for HG as there are no superior treatments available with proven efficacy based on the latest Cochrane review. Glucocorticoids or Droperidol are tried for refractory cases, while smaller studies have reported benefits with Gabapentin and Mirtazapine. Early enteral or parenteral feeding should be initiated in parallel for better outcomes. Generally, post-pyloric feeding tubes are preferred due to the changing anatomy in pregnancy. Extensive literature review only revealed 1 case series reporting jejunostomy feeding in 5 patients with HG. In 2 patients, the J-tube was removed or dislodged while the remainder kept it until delivery. All patients successfully delivered at term without maternofetal complications. Though J-tubes appear to be well-tolerated, further large-scale studies are required to assess the actual benefits and risks involved.

Dynamic contrast enhanced magnetic resonance imaging: A review of its application in the assessment of placental function.

It is important to develop a better understanding of placental insufficiency given its role in common maternofetal complications such as preeclampsia and fetal growth restriction. Functional magnetic resonance imaging offers unprecedented techniques for exploring the placenta under both normal and pathological physiological conditions. Dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) is an established and very robust method to investigate the microcirculatory parameters of an organ and more specifically its perfusion. It is currently a gold standard in the physiological and circulatory evaluation of an organ. Its application to the human placenta could enable to access many microcirculatory parameters relevant to the placental function such as organ blood flow, fractional blood volume, and permeability surface area, by the acquisition of serial images, before, during, and after administration of an intravenous contrast agent. Widely used in animal models with gadolinium-based contrast agents, its application to the human placenta could be possible if the safety of contrast agents in pregnancy is established or they are confirmed to not cross the placenta.

277-OR: Use of Noncarbohydrate Fuels Is Associated with Materno-Fetal Complications in Type 1 Diabetes Pregnancy: Metabolomics Analysis of the CONCEPTT Trial

Aims: We assessed metabolomic signatures in maternal and cord blood associated with suboptimal outcomes in the continuous glucose monitoring in women with type 1 diabetes in pregnancy trial (CONCEPTT). Methods: Serum samples from 162 mothers (12, 24 and 34 weeks’ gestation) and 93 cord blood samples were analysed for 1049 metabolites and 1041 lipids using ultra-performance liquid chromatography-tandem mass spectroscopy. We used adjusted and unadjusted logistic regression of metabolomic variables using adjudicated outcomes: extremely-large-for-gestational-age (ELGA; &amp;gt;97.5th centile), pre-eclampsia and neonatal hypoglycaemia with modified Bonferroni false discovery rate p≤0.001. Results: All materno-fetal complications studied were associated with reliance on non-carbohydrate sources of fuel. Lipids through beta oxidation were the main fuel source in ELGA (24 and 34 weeks), neonatal hypoglycaemia (12 weeks only) and pre-eclampsia (12 and 24 weeks). Marked protein catabolism was evident in neonatal hypoglycaemia (34 weeks) and pre-eclampsia (24 and 34 weeks). Cord blood in ELGA infants showed evidence of simultaneous beta oxidation and de novo lipogenesis, a biologically futile cycle of creating and destroying lipids, which consumes excess energy and substrate. Cord blood from infants with neonatal hypoglycaemia showed evidence of pronounced protein catabolism providing glucogenic amino acids for gluconeogenesis. Conclusions: Reliance on lipid or protein sources for fuel was associated with ELGA, neonatal hypoglycaemia and pre-eclampsia. Carbohydrate metabolism was insufficient to meet cellular energy demands, possibly due to insufficient insulin, insufficient dietary carbohydrate or both. Improving outcomes in type 1 diabetes pregnancy may require greater focus on normalising carbohydrate metabolism through optimal carbohydrate intake and matched insulin dosing. Disclosure C. L. Meek: None. Z. Stewart: None. S. Furse: None. J. M. Yamamoto: None. D. Feig: Advisory Panel; Self; Novo Nordisk. A. Koulman: None. H. R. Murphy: None. Funding JDRF (17/2011/533, 80/2010/585); Diabetes UK (DUK-HKF 17/0005712, DUK-PG 17/0005633.BBSRC BB/M027252/1)

Male fetal sex is associated with low maternal plasma anti-inflammatory cytokine profile in the first trimester of healthy pregnancies

Male fetal sex associates with higher rates of materno-fetal complications. Inflammation and inadequate vasoactive responses are mechanisms implicated in obstetric complications, and alterations in maternal plasma cytokine profile and nitric oxide (NO) metabolites are potential predictive biomarkers. We aimed to assess if these parameters are influenced by fetal sex. A prospective, observational study was carried out in 85 healthy pregnant women with singleton pregnancies in the first trimester of gestation. A blood sample was extracted at the tenth week of gestation. In plasma, we assessed: 1) cytokines (micro-array): pro-inflammatory (IL1α, IL1 β, IL6, TNFα), anti-inflammatory (IL4, IL10, IL13), and chemoattractant (IL8, MCP1, IFNγ), and 2) NO metabolites (liquid chromatography–tandem mass spectrometry and Griess reaction): L-arginine, ADMA, SDMA, nitrates (NOx). Women with a male fetus (n = 50) exhibited, compared with those with a female (n = 35): higher IL1β (OR = 1.09 with 95% CI: 0.97–1.28), and lower IL13 (OR = 0.93 with 95% CI: 0.87–0.99), and higher plasma NOx (OR = 1.14 with 95% CI: 1.03–1.31). Our data suggest that fetal sex influences maternal plasma cytokine profile and NO in early pregnancy. Women with a male fetus may have a worse capacity to counteract an inflammatory response. They may have better vasodilator capacity, but in the presence of an oxidative environment, a higher nitrosative damage may occur. These data reinforce the need to include sex as variable in predictive models.

Pregnancy in patients on chronic haemodialysis: about 25 cases which occurred in the south of Tunisia

Introductionla survenue de grossesse au cours de l’hémodialyse chronique est rare. Néanmoins, avec l’évolution des techniques de dialyse, une amélioration de la fertilité est possible. Le but de notre travail est de rapporter notre expérience concernant la survenue d'une grossesse chez les patientes dialysées et de dégager les facteurs impliqués dans sa réussite.Méthodesnotre étude rétrospective a porté sur 25 grossesses spontanées survenues chez 19 patientes traitées par hémodialyse périodique dans différents centres d’hémodialyse du sud tunisien sur une période de 34 ans.Résultatsl’âge maternel de survenue de grossesse était en moyenne égal à 35,6 ans [23-44ans] avec une ancienneté moyenne en hémodialyse de 4,22 ans [1-17 ans]. Sept patientes (37%) avaient une diurèse résiduelle (>500 ml/24h). Le volume horaire hebdomadaire de dialyse était ≥16 heures par semaine dans 7 cas et ≥20 heures dans 4 cas. Le succès de la grossesse (nouveau-né survivant au moins 28 jours) était estimé à 56%. L’âge gestationnel médian était de 34 semaines d’aménorrhée [28-38 SA]. Le poids néonatal moyen est égal à 1970g [1500g-2300g]. L’étude analytique a montré une corrélation significative entre l’augmentation des heures de dialyse par semaine et la réussite de la grossesse (R= 0,59; p= 0,002).Conclusionon souligne qu’avec une prise en charge adéquate et notamment la majoration du nombre de séances de dialyse, les complications materno-fœtales peuvent être minimisées et la balance risque-bénéfice vire vers donner la chance à une femme dialysée de devenir maman.

Diagnostic, therapeutic, and prognostic features of gestational diabetes at the Sylvanus Olympio University Hospital Center

IntroductionLes objectifs de cette étude étaient de décrire les aspects diagnostiques, pronostiques et thérapeutiques du diabète gestationnel au CHU Sylvanus Olympio de Lomé.MéthodesIl s'est agi d'une étude descriptive transversale réalisée sur 5 ans allant du 1er janvier 2013 au 31 décembre 2017. Elle a concerné 125 gestantes ayant accouché, suivies en médecine interne et dans le Service de Gynéco-obstétrique.RésultatsLa moyenne d'âge maternelle était de 30,84±4,17 ans. Les facteurs de risque les plus rencontrés étaient le surpoids et l'obésité (57,7%), antécédent de diabète familial (33,3%), antécédent de fausse couche spontanée (26,6%), antécédent de mort fœtale in utero (MFIU) (15,5%) et de l'antécédent du diabète gestationnel (8,8%). Le dépistage du diabète gestationnel a été réalisé par la glycémie à jeun et hyperglycémie provoquée (HGPO) à 75g. Le diagnostic a été posé au premier trimestre dans 55,6% des cas, au deuxième trimestre dans 33,3% et 11,1% au troisième trimestre. Le recours à l'insulinothérapie a été nécessaire dans 24,4% des cas et 66,6% sous régime seul. Soixante-six virgule sept pour cent (66,7%) des femmes ont accouché par césarienne et 33,3% par voie basse. Parmi les complications maternelles à l'accouchement, nous avons retrouvé 22,2% de HTA, 17,7% de pré-éclampsie et 2,2% de RPM. Parmi les complications du nouveau-né, il y avait 48,9% de macrosomie, 11,1% de prématurité, 11,1% d'hypoglycémie, 4,4% de malformation et 4,4% mort-né. Quatre-vingt-huit virgule neuf pour cent (88,9%) des nouveaux nés avaient un score d'APGAR supérieur à 7 et plus de 48% étaient des macrosomes.ConclusionLe diabète gestationnel entraîne des complications materno-fœtales. La nécessité d'un dépistage systématique est obligatoire même en l'absence de facteur de risque afin de programmer une prise en charge optimale.

Practice Variation in the Care of Subclinical Hypothyroidism During Pregnancy: A National Survey of Physicians in the United States.

Evidence regarding the effects of subclinical hypothyroidism (SCH) on adverse pregnancy outcomes and the ability of levothyroxine (LT4) treatment to prevent them is unclear. Available recommendations for the management of SCH during pregnancy are inconsistent. We conducted a nationwide survey among physicians assessing their knowledge of and current practices in the care of SCH in pregnancy and compared these with the most recent American Thyroid Association (ATA) recommendations. In this cross-sectional study, an online survey was sent to active US members of the Endocrine Society. This survey included questions about current practices and clinical scenarios aimed at assessing diagnostic evaluation, initiation of therapy, and follow-up in pregnant women with SCH. In total, 162 physicians completed the survey. ATA guidelines were reviewed by 76%, of whom 53% indicated that these guidelines actually changed their practice. Universal screening was the preferred screening approach (54%), followed by targeted screening (30%). For SCH diagnosis, most respondents (52%) endorsed a TSH level >2.5 mIU/L as a cutoff, whereas 5% endorsed a population-based cutoff as recommended by the ATA. The decision to initiate treatment varied depending on the specific clinical scenario; however, when LT4 was initiated, respondents expected a small/very small reduction in maternofetal complications. In conclusion, despite recently updated guidelines, there is still wide variation in clinical practices regarding the care of women with SCH in pregnancy. Highly reliable randomized trials are required to evaluate the effectiveness of the most uncertain treatment practices on the care of pregnant women with SCH.

Assessment of materno-fetal complications in pregnant women with type 1 diabetes exposed to insulin degludec

Assessment of materno-fetal complications in pregnant women with type 1 diabetes exposed to insulin degludec

MON-586 Practice Variation in the Management of Subclinical Hypothyroidism During Pregnancy: Results From a National Survey of Endocrinologists in the US

Background: Evidence regarding subclinical hypothyroidism (SCH) effects on pregnancy and the benefits of levothyroxine (LT4) treatment is inconsistent. The American Thyroid Association (ATA) Guidelines for the management of thyroid diseases in pregnancy were published in 2017; the impact of these guidelines on clinical practice remains uncertain. Aim: To conduct a national survey among endocrinologists studying knowledge and perception regarding SCH diagnosis, treatment and impact on pregnancy. Methods: An online survey was sent by email invitation to endocrinologists who are active members of the Endocrine Society in the U.S. (n=5914). The questionnaire included demographic data and clinical scenarios with multiple choice questions to assess diagnostic evaluation, initiation of therapy, and follow up in pregnant women with SCH. Results: The survey was completed by 154 endocrinologists (9/5/18-10/31/18). On average each clinician had treated 5 (IQR 3-10) women with SCH in the past 6 months. The 2017 ATA guidelines were reviewed by 75% of whom 52% consider that these guidelines actually changed their clinical practice. Universal screening is done by 53%, 31% screens when there are associated risk factors for thyroid disease (e.g. clinical symptoms, family history, etc.) and 16% never screens. For the diagnosis of SCH, only 25% uses a TSH>4.0 mIU/L and 5.8% a population-based cutoff as recommended by ATA, while the most used cutoff was TSH>2.5 mIU/L (52%). Following ATA guidelines, 87% would immediately treat a woman with a 1st trimester TSH>4.0 mIU/L and TPO-Abs+ (strong recommendation) vs. 50% if TPO-Abs– (weak recommendation), followed by the option of repeating TSH within a month in 12% and 45% respectively. If a woman had TSH between 2.5-4.0 mIU/L, 58% would treat her if TPO-Abs+ (weak recommendation) vs. 17% if TPO-Abs- (no recommendation), followed by the option of repeating TSH within a month in 39% and 55% respectively. We found similar practices for the treatment of women in the 2nd trimester with the same clinical and laboratory characteristics. Clinicians reported considering the following factors for LT4 treatment decision: TSH level, TPO-Abs, history of miscarriages, and guidelines recommendations. Interestingly, 70-80% of the clinicians who would start LT4, consider treatment would have a small impact (10-20% reduction) or very small impact (<10% reduction) on maternofetal complications regardless the clinical scenario. Only 50% of the clinicians take into consideration the patient’s preferences and 19% the side effects related to LT4 use. Conclusions: Despite recently updated guidelines, there is still a wide variation in the clinical practice regarding the diagnosis and management of SCH in pregnancy. Although LT4 is frequently used as the treatment for SCH in pregnancy, the expected risk reduction is small, and patient’s preferences are often disregarded.

Raised neutrophil lymphocyte ratio and serum beta hCG level in early second trimester of pregnancy as predictors for development and severity of preeclampsia.

Early detection and prediction of preeclampsia (PE) may avert serious materno-fetal complications. This prospective nested study was conducted to evaluate the role of serum beta human chorionic gonadotropin (hCG) and the neutrophil-lymphocyte ratio (NLR) in predicting the development and severity of PE. Four hundred and forty primigravidas, between 16 to 18 weeks of gestation, were recruited in the study. Serum beta-hCG and NLR were measured at the time of recruitment and they were followed and monitored for the development of PE and severe PE. Out of these 440 women, 64 (14%) developed PE; of which 25 (39%) developed severe PE. The mean values of NLR and serum beta hCG were significantly higher in patients developing PE and severe PE. NLR, with a cutoff value of 5.6, predicted the development of PE with 73.4% sensitivity and 88.6% specificity and severe PE with sensitivity 93.3% and specificity 86.6% respectively. The sensitivity and specificity of serum beta hCG in predicting the development of PE was 75% each for a cutoff value of 25,415 IU/mL whereas these values were 86.7%, and 79.1% respectively, for a cut-off value of 29,654 IU/mL for predicting the development of severe PE. These findings suggest that NLR and serum beta hCG can be used as excellent biomarkers in predicting both the development of PE and its severity. Multicentric studies involving subjects of multiple ethnicities should be done for establishing its utility as a routine screening test.

The Problem of Traditional African Pharmacopoeia in Obstetrics: Use of Plants for Utero-Tonic Purposes and Materno-Fetal Outcome in Douala (Cameroon)

Introduction: The use of traditional preparations for the induction or acceleration of labor remains a common practice in our country in particular and in Africa in general with sometimes derogatory outcomes for the mother and the fetus. Goal: The objective was to assess immediate maternal and neonatal outcomes in women who reported having used the traditional pharmacopoeia for utero-tonic purposes. Methodology: We conducted a multi-centric cross- sectional study with prospective data collection in the maternities of the Laquintinie Hospital, Bonassama District and Nylon Hospitals. It took place over a period of seven months, from 1st October 2016 to 31st April 2017. This included all women who reported having used the unconventional pharmacopoeia for utero-tonic purposes before or after contractions started. The student and Chi-square tests were interpreted at the statistical threshold of 5% and the 95% confidence intervals. Results: We recruited 168 cases, 68.5% of the 245 women interviewed. The mean age was 27.1 ± 0.41 years; 55% of our respondents had a secondary level of education; 80% of them were admitted at term and 43% were multiparous. Nulliparity predisposed to traditional pharmacopoeia use (RR = 1.55, CI = 0.79 - 3.03) but primiparity reduced this risk (RR = 0.4, CI = 0.24 - 0.926). Stimulation of labor was the first indication in 85% of women, the rectal evacuation enema was the main route used (67%). The majority of plants used were those of the families Asteraceae, Anthericaceae, and Malvaceae. In per partum, 42% had a brilliant dilatation; there was a statistically significant association between the occurrence of dynamic dystocia (CI = 0.28 - 1.54, p = 0.006) and the risk of perineal tear (RR = 3.13, CI = 1.68 - 5.85; p = 0.007). The APGAR score at 5 min of life was less than 7 in 64% of cases (p = 0.027). The caesarean section rate was 69%. Conclusion: Traditional products with uterotonic effects are frequently used and unregulated with its corollary of materno-fetal complications.