Materno-fetal Outcomes Research Articles

Intimate partner violence among postpartum women at a teaching hospital in Nigeria's Federal Capital City: pattern and materno-fetal outcomes.

Background:Intimate partner violence is an important public health and human rights issue. Previous studies have considered intimate partner violence in pregnancy mainly among pregnant women attending antenatal clinics thereby missing out a few who may encounter this problem in late pregnancy or just before delivery. This study had the objective of ascertaining the prevalence, pattern of intimate partner violence, and associated materno-fetal outcomes.Method:This was a cross-sectional study conducted between January 2017 and June 2017 among postpartum mothers at a Nigerian Teaching Hospital just before being discharged home. The abuse assessment score was adapted and used to interview women regarding possible intimate partner violence experiences within the past 1 year and during the pregnancy after obtaining written consent.Results:Out of 349 postpartum women interviewed, 102/349 (29.2%) experienced intimate partner violence in the past 1 year, while 18/349 (5.2%) of intimate partner violence occurred in the index pregnancy. Sexual partners were the main perpetuators of intimate partner violence, 67/102 (65.7%), while 35/102 (34.3%) were by someone else other than their sexual partners. Among those abused in the current pregnancy, 10/18 (55.6%) were abused once and the remaining 8/18 (44.4%) were abused more than once. Intimate partner violence was associated with higher chances of cesarean section (p = 0.001), increased risk of lesser birth weight babies (p = 0.014), and maternal complications in pregnancy (p = 0.030).Conclusion:The prevalence of intimate partner violence in pregnancy in Abuja is high with associated poor materno-fetal outcomes. Enforcing existing legislations and screening for intimate partner violence during routine antenatal care may help reduce its prevalence and ensure a positive pregnancy experience for Nigerian women.

Rescue cervical cerclage of the second twin at 21 weeks with favorable materno-fetal outcomes at the Douala Gyneco-Obstetric and Pediatric Hospital: a case report

Multiple pregnancies are among the high-risk pregnancies. Common complications include threatened abortion, incomplete abortions and prematurity. These abortions may involve only one of the fetuses, resulting in a conservative therapeutic approach to preserve the remaining fetus or fetuses. We report the case of a delayed delivery of the second twin in a 28-year-old patient. She had benefited from a rescue cervical cerclage of the second twin at 21 weeks of amenorrhea (WA), followed by a Caesarean section at 34 WA, with favorable maternal-fetal outcomes. Our aim is to portray its therapeutic and prognostic particularities. From this uncommon clinical case, it is demonstrated that urgent management can improve the prognosis of the patient and of the remaining fetus.

Materno-Fetal Outcomes of COVID-19 Infected Pregnant Women Managed at the Douala Gyneco-Obstetric and Pediatric Hospital—Cameroon

Introduction: The first case of the novel coronavirus (COVID-19) pandemic in Cameroon was confirmed on March 6, 2020. Though widely considered that pregnant women are more susceptible to respiratory tract infections, the available body of literature on the effect of COVID-19 on pregnancy outcomes is shy from being conclusive. In Cameroon, the Douala Gyneco-Obstetric and Pediatric Hospital (DGOPH) was one of the main frontline tertiary health facilities for the management of severe forms of the disease. After four months of managing COVID-19 cases in the general population and especially in pregnant women at the DGOPH, we decided to take a stop, analyze our findings from the patients managed in order to drive future policies and clinical practices via informed decisions. Overall objective: To describe and understand the clinical burden of patients managed for COVID-19 in pregnancy or post-partum at the DGOPH. Methodology: Cross-sectional and descriptive study covering four months—March 24th to July 24th 2020 at DGOPH. Using a pretested questionnaire, we systematically enrolled all patients who fulfilled the inclusion criteria, with analysis done using proportions from an excel spreadsheet. Results: A total of 18 on the 301 pregnant women consulted at the DGOPH, tested positive for COVID-19 giving a prevalence of 6%, and representing 2.3% of all the 800 COVID-19 cases. Of the 44 pregnant women admitted at the DGOPH, 13 of them were due to COVID-19, giving a general admission proportion of 29.5% and a COVID-19 case admission rate of 72.2%. Two-thirds (66.7%) of the patients were aged 30 - 39 years and over 61.1% (n = 11) of the total cases were referred from other health facilities for better management. The most common presenting symptoms were: fever (27.4%), cough (21.5%) and dyspnea (15.7%). Over 72.2% of cases were in their third trimester, and only three had comorbidities. Nasal throat swab PCR was mainstay for confirmatory diagnosis (83.3%). Chest CT scan was realized in 50% (n = 9) of the patients and ground glass opacification (GGO) was observed in all of them. All 18 patients received the standard national recommended regimen therapy for COVID-19. While five of the cases are ongoing gestations, 8 of them were delivered by cesarean section (61.5%), mostly indicated for maternal distress. The neonatal mortality rate was 46%. Four of the 18 patients died giving a case fatality rate of 22.2%. Conclusion: The profile of COVID-19 pregnant women in Douala-Cameroon tends to be similar to what is observed around the world. However, the high ICU admission rate and high case fatality rates recorded differ from what is observed worldwide.

Subclinical hypothyroidism in pregnancy.

Subclinical hypothyroidism (SCH) is a common diagnosis among women of reproductive age. The importance of sufficient maternal thyroid supply during pregnancy is well known. Nevertheless, the effects of SCH during pregnancy and the efficacy of its treatment on maternofetal outcomes are not well established. This review discusses the recent evidence on SCH in pregnancy and how this evidence is reflected in current clinical care. Recent observational studies have found a positive association between SCH during pregnancy and adverse maternal, neonatal and offspring outcomes, mainly in thyroid peroxidase autoantibody positive women. Although interventional studies have shown a benefit of levothyroxine (LT4) treatment on selected pregnancy outcomes, there was no effect on offspring neurodevelopment. Current evidence strengthens the association between SCH with both maternofetal and offspring adverse outcomes. An earlier and more individualized diagnostic assessment taking into consideration predictors of thyroid dysfunction and major risk factors for complications could result in better management of SCH during pregnancy. The effectiveness of LT4 on improving maternofetal and long-term offspring outcomes is still not fully elucidated.

A294 Evaluation of Early Postoperative Pregnancy after Bariatric Surgery and Effects on Long-Term Weight Loss

The American College of Metabolic and Bariatric Surgery (ASMBS) and the American College of Obstetrics and Gynecologists (ACOG) recommend delaying pregnancy for 12-24 months after bariatric surgery. However, weight loss is known to augment fertility and patients may purse bariatric surgery for this benefit. Despite studies evaluating maternofetal outcomes after bariatric surgery, long-term weight loss has rarely been evaluated in patients becoming pregnant before the current guideline recommendations. We sought to determine patient adherence to these recommendations and the effect of early postoperative pregnancy (PoP) on long-term weight loss.

A Pharmacological Approach to Managing Inflammatory Bowel Disease During Conception, Pregnancy and Breastfeeding: Biologic and Oral Small Molecule Therapy.

The inflammatory bowel diseases commonly affect individuals during their peak reproductive years. Patients are often concerned about the impact of medical therapies on their ability to conceive, effect on the fetus, as well as the ability to breastfeed, which has led to poor medical adherence during pregnancy. However, most medications are safe, and discontinuation may lead to active disease, which is associated with adverse materno-fetal outcomes. The anti-TNF biologic therapies, infliximab and adalimumab have been extensively studied in the context of pregnancy. They are actively transferred to the placenta during the second and third trimesters; these have not been associated with an increased rate of congenital abnormalities or fetal death. The minimal amounts of drug that are transferred to breast milk are proteolyzed by the infant's digestive system with no reported short- or long-term adverse effects. There is a paucity of clinical data for the other approved anti-TNF agents or newer anti-integrin (vedolizumab) and anti-interleukin (ustekinumab) therapies used in the management of inflammatory bowel disease; however, no significant safety signals have been documented thus far. The new oral small molecule therapy, tofacitinib is teratogenic in animal models and is contra-indicated in patients attempting pregnancy. It is important that patients, as well as physicians managing patients with these conditions, be aware of the impact of these medical therapies during pregnancy.

Obstetric outcome of induction of labor using prostaglandin gel in patients with previous one cesarean section.

ObjectiveAfter globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains.MethodsAll patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis.ResultsBoth groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2.ConclusionThis study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.

The Effect of Medication Adherence on the Disease Course in Pregnant Women with Inflammatory Bowel Disease

IntroductionMedical therapy to maintain disease remission is important in pregnant women with inflammatory bowel disease (IBD), as disease flares can predispose adverse materno-fetal outcomes. However, women with IBD are more concerned about medication exposure on their newborn during pregnancy, and often discontinue their medications.&#x0D; Objectives and ApproachWe assessed the rate of disease flare on medication adherence pattern during pregnancy for women with IBD. Validated case definition was used to identify women with IBD from the Albertan’s hospitalization, emergency room, and physician claims databases (2010-2016). Pharmaceutical Information Network provided the dispensed medications. Adherence to medication was defined by medical possession ratio (MPR)≥0.8. Women with two consecutive prescriptions and MPR≥0.8 during pre-conception were included. Disease flare was defined by ≥1 hospitalization or emergency visit for IBD, or ≥1 prescription for steroids/rectal therapy. Chi-square tests and log binomial regression were used; covariates included age, drug class, and IBD subtypes.&#x0D; ResultsOf the 370 women identified with IBD, 170 (45.9%) women were adherent to maintenance IBD medications in the one year prior to pregnancy. During pregnancy, 47 (27.6%; 95% CI: 21.4% to 34.9%) women, who demonstrated adherence in the pre-conception period, discontinued or were not adherent to their IBD medications, and 67 (39.4%; 95% CI: 32.3% to 47.0%) women had a disease flare during pregnancy. There was no significant difference between adherence to medication during pregnancy and a disease flare during pregnancy (p=0.38). In comparing women who were not adherent or discontinued their medication to those that were adherent, the adjusted relative risk ratio for a disease flare during pregnancy was 1.22 (95% CI: 0.81 to 2.04).&#x0D; Conclusion/ImplicationsThe rate of disease flare during pregnancy was not significantly different for women with IBD that were adherent or not-adherent to their IBD medications during pregnancy. Future analysis will assess the rate of disease flare on medication adherence pattern prior to pregnancy.

Maternal and fetal outcomes in pregnancies with pulmonary hypertension: Experience of a tertiary center

ObjectivePregnancies complicated with PHT are serious debates for obstetricians due to high maternal and fetal complication potentials. The aim of the study was to present our maternofetal outcomes in pregnant women with pulmonary hypertension. Materials and methodsThis study was performed using data extracted from the medical files of 23 pregnancies of 18 patients with PHT who were followed-up in the obstetrics and gynecology department. ResultsThe average age was 27.09 ± 6.97 (range: 14–38) years. The most frequent maternal cardiac pathologies were cardiac valvular disease (mitral or aortic insufficiency) (n = 4), atrial septal defect (n = 3), mitral stenosis (n = 3), ventricular septal defect (n = 2) and arrhythmia (n = 2). Caesarean section and normal vaginal delivery were performed in 13 and 7 deliveries, respectively. Therapeutic dilatation and curettage was performed in 3 patients. Preterm delivery occurred in 4 pregnancies and there were 2 intrauterine growth retardations, 1 preeclampsia and 2 maternal pulmonary edemas. One patient underwent re-laparotomy 5 days after delivery due to uterine hematoma. Totally, 20 newborns (14 female, 6 male) were delivered. Most of the complications were seen in advanced PHT classes. ConclusionThe care of the pregnant women with PHT necessitates a well-planned, multidisciplinary approach focusing on close monitoring before, during and after delivery. This approach may contribute to reduction of poor maternal and fetal outcomes.

Aplastic anemia during pregnancy: a review of obstetric and anesthetic considerations.

Aplastic anemia is a hematologic condition occasionally presenting during pregnancy. This pathological process is associated with significant maternal and neonatal morbidity and mortality. Obstetric and anesthetic management is challenging, and treatment requires a coordinated effort by an interdisciplinary team, in order to provide safe care to these patients. In this review, we describe the current state of the literature as it applies to the complexity of aplastic anemia in pregnancy, focusing on pathophysiologic aspects of the disease in pregnancy, as well as relevant obstetric and anesthetic considerations necessary to treat this challenging problem. A multidisciplinary-team approach to the management of aplastic anemia in pregnancy is necessary to coordinate prenatal care, optimize maternofetal outcomes, and plan peripartum interventions. Conservative transfusion management is critical to prevent alloimmunization. Although a safe threshold-platelet count for neuraxial anesthesia has not been established, selection of anesthetic technique must be evaluated on a case-to-case basis.

The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria

Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm), but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7th day postpartum. Results: In this study, 39 (61.90%) and 24 (38.10%) were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24%) and 3 (4.7%) were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47%) had only primary and secondary education, while 59 (93.47%) among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05), and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05) in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.

Early pregnancy body mass index and obstetric outcomes in Ibadan

Introduction: Obesity in pregnancy has been associated with adverse pregnancy outcomes. In this study, we estimate the prevalence of early pregnancy obesity and the impact on materno-fetal outcomes. Materials and Methods: A cohort of 176 pregnant women were purposively recruited before 20 weeks. Women Results: Early pregnancy weight of 173 women followed up from booking to delivery showed 41.2%, 24.3%, and 32.2% were normal weight, overweight, and obese, respectively. At recruitment, the mean age, mean BMI, and mean gestational age were 31.7 ± 4.4 years, 27.1 ± 5.3 kg/m2, and 14.4 ± 3.2 weeks, respectively. Compared to normal weight women, the obese were older (31.1 ± 4.0 vs. 32.8 ± 4.1, P = 0.06) and of higher parity >2 (19.2% vs. 36.9%, P = 0.17). Compared to those with normal BMI, occurrence of gestational diabetes mellitus (1.3% vs. 10.53%) and preeclampsia (6.9% vs. 14.0%) were more in obese women whereas overweight women had higher occurrence of pregnancy-induced hypertension (6.9% vs. 16.3%) and preeclampsia (6.9% vs. 13.95%). At delivery, compared to normal weight, obese women had more cesareans (57.5% vs. 69.7%), more deliveries Conclusion: Even in low-resource setting, obesity in pregnancy is not uncommon. Affected women would benefit from prepregnancy interventions.

Determinants and materno-fetal outcomes related to cesarean section delivery in private and public hospitals in low- and middle-income countries: a systematic review and meta-analysis protocol

BackgroundDespite the well-established morbidity, mortality, long-term effects, and unnecessary extra-cost burden associated with cesarean section delivery (CSD) worldwide, its rate has grown exponentially. This has become a great topical challenge for the international healthcare community and individual countries. Estimated at three times the acceptable rate as defined by the World Health Organization in 1985, the continued upward trend has been fuelled by higher income countries. Some low- and middle-income countries (LMICs) have now taken the lead, and the factors contributing to this situation are poorly understood. The expansion of the private healthcare sector may be playing a significant role. Distinguishing between the public and private hospitals’ role is critical in this investigation as it has not yet been approached. This review aims to systematically synthesize knowledge on the determinants of the CSD rate rise in private and public hospitals in LMICs and to investigate materno-fetal and materno-infant outcomes of CSD in perinatal period, between private and public hospitals.Methods/designWe will include studies published in English, French, Spanish, and Portuguese since 2000, using any experimental design, including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, and interrupted time series. Outcomes of interest are the determinants of CSD and materno-fetal and materno-infant outcomes. We will only include studies carried out in private and public hospitals in LMICs. The literature searches will be conducted in the following databases: MEDLINE, Embase, CINAHL, Cochrane database, LILACS, and HINARI. We will also include unpublished studies in the gray literature (theses and technical reports). Using the two-person approach, two independent review authors will screen eligible articles, extract data, and assess risk of bias. Disagreements will be resolved through discussion with a third author. Results will be presented as structured summaries of the included studies. If possible, a meta-analysis will be conducted and, subsequently, an analysis for heterogeneity will be implemented.DiscussionThe proposed systematic review of the CSD rate rise will provide up-to-date evidence in regard to differences in proportions, determinants, and materno-fetal and materno-infant outcomes in perinatal period, between private and public hospitals in LMICs. We believe that this knowledge synthesis will help to shed light on the evidence and support evidence-informed decision-making with a view to addressing the issue in LMICs.Systematic review registrationPROSPERO CRD42016036871

Spectrum of Maternofetal Outcomes during Dengue Infection in Pregnancy: An Insight.

Dengue is a vector transmitted viral infection; tropical and subtropical countries see outbreaks of dengue each year. There is a paucity of literature on effects of dengue infection on pregnancy outcome and this prompted us to undertake a study for better understanding of pregnancy implications with dengue infection. Pregnant women admitted during the seasonal outbreak of dengue between September 2015 and October 2015 were studied and maternal and fetal outcomes in sixteen NS1Ag positive women were analysed. Out of sixteen women diagnosed with dengue fever, three had dengue shock syndrome (DSS) and eight had dengue haemorrhagic fever (DHF). The most common obstetric complication seen in 43% of the cases was oligohydramnios. Bleeding manifestations occurred in seven women and there were three maternal deaths. Perinatal complications included three intrauterine deaths, six nursery admissions, and one neonatal death. Thus dengue infection was associated with high maternal and perinatal mortality. In view of poor obstetric outcomes, this viral infection warrants early admission and prompt management.

Associations between the Grade of Placental Maturity at Third Trimester Ultrasound and Maternofetal Outcomes at the Maternity of the Yaoundé Central Hospital: A Prospective Cohort Study

ABSTRACT Background Placental maturity assessed by ultrasound has been classified into 3 grades by Grannum. Grade 3 before the 36th week of pregnancy is associated with adverse maternofetal morbidity. We sought to determine the prevalence of grade 3 placenta between the 34th and the 36th week of pregnancy and to assess its impact on maternofetal outcomes in Cameroon. Materials and methods This prospective cohort study was conducted from January 2012 to July 2013 in the maternity unit of the Yaoundé Central Hospital. Results One hundred and two women with singleton pregnancies between the 34th and 36th weeks were included. Grade 3 placenta accounted for 5.9% of our sample. Grade 3 was significantly associated with the following: anterior location of the placenta (RR = 5.36; 95% CI: 1.36–9.62; p = 0.03), pre-eclampsia (RR = 12; 95% CI: 3.52–20.8; p = 0,003), meconium-stained amniotic fluid (RR = 4.32; 95% CI: 1.65–11.51; p = 0.04) and intrauterine growth restriction (RR = 2.43; 95% CI: 1.33–15.6; p = 0.007). Conclusion Grade 3 placental maturity before the 36th week of pregnancy is significantly associated with some maternal and fetal morbidities. Therefore, it warrants close monitoring to detect and avoid complications. How to cite this article Hortence FJ, Florent FY, Fouogue JT, Thierry TT. Associations between the Grade of Placental Maturity at Third Trimester Ultrasound and Maternofetal outcomes at the Maternity of the Yaoundé Central Hospital: A Prospective Cohort Study. Donald School J Ultrasound Obstet Gynecol 2015;9(3):230-233.

Pregnancy outcomes in advanced kidney disease.

Maternal and fetal outcomes of pregnant women with advanced chronic kidney disease (CKD stage 4 and 5) are not well chronicled. Since 1980, we could locate only five published case series'studying this population. This study examines nine pregnant women with severe CKD (defined as estimated GFR < 30 mL/min) and compares their materno-fetal outcomes with a cohort of women with an eGFR 45 - 100 mL/min and pre-pregnancy proteinuria (mild CKD). This is a retrospective, single-center study nd statistical analyses include Fisher' exact test, nonparametric Wilcoxon rank sum, and exact logistic regression. Compared to women with mild CKD, women with severe CKD have higher rates of pre-term delivery (89% vs. 41%, p = 0.02) and a higher average eGFR reduction during pregnancy (26.1% vs. 0%, p = 0.04). Both groups had similar rate of caesarean section, pre-eclampsia, and adverse fetal outcomes including perinatal death, oligohydramnios, and intrauterine growth retardation. Compared to published outcomes of pregnant women receiving hemodialysis, our cohort of women with severe CKD and not on dialysis had a higher incidence of pre-eclampsia and premature birth. In conclusion, the incidence of preterm delivery, small for gestational age, and decline of maternal renal function increased with a reduction in eGFR. Women with severe CKD (eGFR < 30 mL/min) may experience a reduced rate of pre-eclampsia and longer gestation with earlier initiation of dialysis.

Materno-Fetal Outcomes with Viral Hepatitis in Pregnancy

To evaluate materno-fetal outcomes in pregnant women with jaundice. A prospective study was conducted over a period of 6months in a tertiary care hospital of Delhi, India. 82 pregnant women with jaundice were included. The serum was screened for viral markers, liver function tests, and coagulation status. The mean age of women was 27.3±4.3years. 43.9% (n=36) women were HEV positive, 36% (n=27) HBsAg positive, 4% (n=3) HAV positive and 1.3% (n=1) HCV positive. Intrahepatic cholestasis was diagnosed in 10.8% (n=8) of women. Maternal morbidity was evaluated in terms of chorioamnionitis (5.4%, n=3), encephalopathy (26.8%, n=15), and coagulopathy (67.9%, n=38). There were five maternal deaths, and all were unbooked with HEV-positive status and a bilirubin >15mg/dl with deranged coagulogram and encephalopathy and IUDs. 79 women delivered vaginally, and three had cesarean section. Of the vaginal deliveries, 59.8% (n=49) went into spontaneous labor, and 25.5% (n=21) were induced for varied reasons (BPS<6/10 (38%, n=8)) and progressive derangement of LFT (38%, n=8). Among the 71 deliveries, 29 (40.8%) were IUD and 42 (59.1%) were live born. On analyzing the morbidity data, it was found that HEV-positive women (deranged coagulogram 71.05%, IUD 75.86%, encephalopathy 80%) had a poorer outcome as compared to their HBsAg positive counterparts (deranged coagulogram 10.52%, IUD 13.79%, encephalopathy 6.66%). Urgent redressal of issues pertaining to sanitation and provision for clean drinking water for citizens of India is the need of the hour as HEV is fecooral in transmission.

Materno-fetal Outcomes in Patients with Abnormally Invasive Placenta: A 14 Year Experience

Objectives: To establish the incidence of abnormally invasive placenta (AIP); determine trends in the diagnosis and management; and assess maternal and neonatal morbidity associated with AIP. Methods: Women were identified from a tertiary care referral hospital perinatal database (2000-2013) and crosschecked with confirmed histopathology. Verification of undetected cases using perinatal ultrasound database was performed. Risk factors, antenatal suspicion, hospital course, intrapartum management, maternal and neonatal outcomes were obtained from medical records. Results: Thirty eight women had AIP confirmed providing an incidence of 1 per 1420 deliveries. The incidence rose by 55% (95% Confidence interval (CI) 37% - 279%) over the 14 year period (Poisson regression). An antenatal diagnosis of AIP was made in 63% (95% CI 46% - 78%). Excluding women with placenta percreta, there was a significantly higher blood loss in women in whom an attempt was made at placental removal compared to women in whom there was no attempt (median 3.5 liters versus 1.5 L, p=0.002). Conclusion: AIP was associated with significant maternal and neonatal morbidity. A significantly higher blood loss ensued in women with AIP in whom an attempt was made at placental separation. A dedicated multidisciplinary team and a standardized pathway can potentially reduce morbidity.

Motor–vehicle injury in pregnancy and subsequent feto-maternal outcomes: of grave concern

Objectives: (1) To evaluate maternal and fetal outcome after motor-vehicle injury during pregnancy. (2) To determine if there was prenatal care provider counseling for seat belt use.Methods: Retrospective chart analysis of materno-fetal outcome following motor vehicle injury in 728 pregnant women between 2009 and 2012. Women attending antenatal clinics over these years were asked if they were counseled regarding correct seat belt use by prenatal health care providers during their antenatal visits.Results: In these pregnant women, 80 (11%) sustained minor injuries/sprains. 648 women (89%) had severe adverse materno-fetal pregnancy outcomes. Important causes being: (1) placental abruption 58.8%; (2) preterm labor (40%); and (3) uterine rupture (1.6%). There were 100 (13.7%) maternal and 78 (10.7%) fetal deaths. 91 (12.5%) perimortem cesarean deliveries were performed and 74 (81%) fetus survived, as did 31 women. Prenatal care provider counseling for seat belt use occurred in 44.8% of prenatal visit. Only 125 (21%) were using seat belt during the accident.Conclusion: Important causes of adverse pregnancy outcome were: abruptio placenta, preterm labor and uterine rupture. There were 100 maternal and 78 fetal deaths with 97 preterm births. Counseling occurred in 44.8% of women. Those using seat belts during the accidents sustained minor injuries.