Mean Newborn Weight Research Articles

OUTCOMES OF NEONATAL SURGERIES WITHOUT NICU IN LMIC

Dealing with neonatal surgery, which nearly invariably entails emergency neonatal surgical scenarios, is the most challenging and complex problem in pediatrics and pediatric surgery. Congenital abnormalities are the most common reason for emergency neonatal surgery. Pakistan and other low and middle-income countries (LMICs) account for over ninety percent of these abnormalities. Objective: Our goal is to examine the factors contributing to the high mortality rate in neonatal surgery among those individuals who didn't have access to the NICU. This will inform our recommendations for the worldwide community and the need for NICU care post-operatively. Method: This prospective research was carried out in PIMS hospital from December 2022 to December 2023. Our center has a 15-bed NICU facility, which is almost negligible compared to the patient load of our center. Two hundred patients who underwent surgery during the study were enrolled in our study. Demographic and clinical data were gathered using a questionnaire, and SPSS 25 was used for analysis. Results: Throughout the study period, 33 of 200 neonates died, resulting in a 16.5% mortality rate. Over 53% of these cases were preterm. The research had a minimum gestation age of 29 weeks and a mean gestational age of 35.54 ± 3.56 weeks. The mean newborn's weight had been 2.41 ± 0.52 kg (range: 1.22–3.5 kg). There were more male babies (67.5%) than females. Anorectal malformation was found in four infants who died following surgery. Gastroschisis was discovered in five infants who died after surgery. Sepsis was the most common cause of death following neonatal surgery, amounting to 84.84% of total deaths. Cardiogenic shock was the reason for expiry in 9.09% of the cases, and 6.06% of the cases had respiratory failure as the cause of death. Gastroschisis and esophageal atresia were associated with the most significant mortality. Conclusions: In underdeveloped nations like Pakistan, surgical infants account for a sizable fraction of the total neonatal death rate, most of which may be avoided with proper perioperative and NICU care. Nevertheless, the national health strategy does not give neonatal surgery the priority it deserves. NICUs should be established countrywide to enhance patient care and decrease the overall mortality rate of pediatric surgery.

Effect of Maternal Hemogloblin on Anthropometric Measurments of Newborns

Objective: To determine the effect of maternal hemoglobin on the anthropometric measurements of newborns. Study design: Prospective cross-sectional study. Place and duration of study: Neonatal and Obstetric Department of Combined Military Hospital, Quetta Pakistan, from Jan 2020 to Jun 2020. Methodology: All newborn babies born during the study period were enrolled in the study. Anthropometric measurement of the newborn such as length, weight, fronto-occipital circumference (FOC), and mid chest circumference (MCC) were recorded. Moreover, latest maternal hemoglobin level in third trimester of pregnancy was observed. Results: Of 357 patients, mean newborn weight, length, FOC, and MCC were 3032.8±409.3 grams, 48.16±4.57 cm, 35.26±3.77 cm, and 32.15±1.94 cm respectively. Anemia was observed in 164(45.9%) mothers [118/164 (72%) had mild whereas 46/164(28%) had moderate anemia]. Amongst 118 mild anemic mothers, mean newborn weight, length, FOC, and MCC were 2994.9±351.9 grams, 48.43±4.45 cm, 35.08±3.64 cm, and 32.01±1.47 cm respectively. While amongst 46 moderate anemic mothers, mean newborn weight, length, FOC, and MCC were 2726.17±347.51 grams, 47.54±3.02 cm, 34.09±1.38 cm, and 31.14±2.36 cm respectively. Mean weight (p<0.001), fronto-occipital circumference (p 0.035), and MCC (p<0.001) was significantly lower among anemic mothers than non-anemic mothers. A positive significant correlation of maternal hemoglobin level was observed with newborn weight (r=0.176, p 0.001) and MCC (r= 0.194, p<0.001). Conclusion: A considerably negative impact of maternal anemia was observed on weight, FOC, and MCC of the newborn.

Pregnancy-related aortic complications in women with bicuspid aortic valve

ObjectivesTo describe the aortic-related risks associated with pregnancy in women with bicuspid aortic valve (BAV) and to evaluate changes in aortic diameter in pregnancy.MethodsProspective observational study of patients with BAV...

Retrospective evaluation of peripartum hysterectomy patients: 8 years' experience of tertiary health care.

Peripartum hysterectomy (PPH), which means surgical removal of the uterus during pregnancy or postpartum period, is a life-saving procedure performed as a last resort to stop obstetric serious bleeding. Evaluation of the prevalence, risk factors, indications, associated complications, and neonatal outcomes of PPH performed in our clinic. A total of 35 patients who underwent PPH in our clinic between 2013 and 2020 were analyzed retrospectively. Clinical and demographic characteristics of patients, age, gestational week, delivery type, type of hysterectomy performed, length of hospital stay, PPH indications, additional procedures and complications during PPH, maternal and fetal mortality, neonatal characteristics, intensive care unit (ICU) need after PPH, and blood transfusion amount and time were recorded. Patients with PPH were subdivided and studied in subgroups: Emergency - elective surgery, total - subtotal hysterectomy. PPH was performed in 35 (3.2/1000) patients who gave birth during the study period. The most common indication for hysterectomy was placental invasion anomaly (57.1%, n = 20), and the most performed operation was total hysterectomy (68.6%, n = 24). Bilateral hypogastric artery ligation (14.3%, n = 5) was the most common alternative procedure performed before hysterectomy, and the most common complication was bladder injury (22.9%, n = 8). Blood transfusion was performed in 94.3% (n = 33) of the patients due to acute blood loss. The mean newborn weight was 2788.79 ± 913.37 g, and the 1st and 5th-minute APGAR scores were 6.71 ± 2.25 and 7.56 ± 2.35, respectively. Before PPH, uterine integrity should be preserved using medical and surgical methods, but if success is not achieved, hysterectomy is the last life-saving step. It should be kept in mind that in patients with anemia and increased gravidity, the risk of bleeding may be high in the first 24 h after birth and therefore PPH may be required. It would be more appropriate for patients with placentation anomalies to be operated in experienced centers due to possible complications, increased blood transfusion, and intensive care requirement.

Evaluation of the factors affecting newborn weight

Purpose: There is a trend that causes an increase in newborn weights and macrosomy rates in many countries around the world. The aim of our study is to compare the mean newborn weights in 2012 and 2016, to investigate whether there is a tendency to increase in the mean newborn weight and macrosomia rates, and to evaluate the effects of neonatal gender, mode of birth, maternal age and the season of birth on newborn weight.
 Materials and Methods: The data of a total of 1573 newborns 2012 (n:687) and 2016 (n=886) between 37-40 weeks of gestation were evaluated retrospectively. The data of the newborns' birth weight, gender, gestationel age, maternal age, mode of birth and season of birth were evaluated statistically.
 Results: It was found that there was an increase in the rate of macrosomia (birth weight ≥4000 g) from 4.9% in 2012 to 8.1% in 2016. There is a weak positive correlation between maternal age and newborn weight for both years. There was a significant increase in terms of birth weight between babies delivered by cesarean section and babies delivered by normal route 2016. It was observed that the season of birth had no effect on birth weight.
 Conclusion: There was an increase macrosomia rates in 2016. It was observed that maternal age and neonatal gender affected the weight of the newborn, but the seasons have no effect on neonatal weight. Maternal age, sex of newborn and gestational age were considered as independent risk factors for macrosomia.

Influence of Placental Metalloproteinase-9 Protein on the Branching Architecture of Chorionic Blood Vessels of Human Placenta

Introduction: In human placenta, two different branching patterns of chorionic blood vessels exist. In the dispersal type, the chorionic blood vessels undergo successive divisions with gradually diminishing caliber as the blood vessels traverse towards the placental margins. In the magistral type, the blood vessels traverse without appreciable decrease in diameter. We hypothesize, that matrix-degrading enzymes secreted by cytotrophoblasts may influence the branching patterns of these chorionic blood vessels. We, therefore, determined if placental expression of matrix metalloproteinase-9 (MMP-9) protein differed between the two vascular patterns of chorionic blood vessels of human placenta. Methods: 26 full-term delivered placentas were collected from normotensive women. Chorionic villi (CV) were isolated. CV MMP-9 protein was analyzed using human MMP-9 monoclonal antibody based ELISA kits. A novel method was used to determine the vascular patterns of the placentas from placental photographs. Independent t test was used for statistical analysis. P< 0.05 was considered significant. Results: The branching pattern of the chorionic blood vessels was 54% dispersal and 46% of the magistral types. In placentas with dispersal type of branching pattern, MMP-9 protein expression was significantly higher (p=0.035). Women who delivered placentas with magistral type of branching pattern, the mean newborn weight was found to be significantly higher (p=0.039). Conclusion: The study introduces a novel method to investigate chorionic vascular network of human placenta. Our findings underscore the importance of CV MMP-9 protein in affecting the placental branching architecture of chorionic blood vessels in humans. In the magistral type, the calibers of the chorionic blood vessels from the point of insertion of the umbilical cord to the placental margins remained more or less unchanged. We suggest, that this unchanged caliber of blood vessels in the magistral type, may have allowed better nourishment and oxygen to be catered to the fetus; resulting in fetal weight gain.

Pregnancy outcomes after kidney transplantation

BackgroundSome complications are frequently seen in pregnancies with kidney transplantation and graft functions may be impaired. In this study, it was aimed to examine the course and results of pregnancies after transplantation, the effect of pregnancy on graft functions and the risk factors in complications in these pregnancies. MethodsA total of 24 pregnancies conceived after kidney transplantation due to end-stage renal disease between January 2013 and December 2020 and followed up in the Obstetrics and Gynecology clinic of our hospital were included in the study. ResultsThe mean age was 31.8±6.4, the mean time between transplantation and pregnancy was 54±36 months, and the mean newborn weight was 1945±529.5 grams.Of the pregnancies, abortion occurred in one (4.2%), preterm delivery in 17 (70.3%), and intrauterine growth retardation (IUGR) in 10 (41.7%). Immunosuppressant treatment was given to all pregnant women due to transplantation, and all women used tacrolimus. No graft rejection was seen.The median serum creatinine level did not show a significant change during pregnancy according to the prenatal value (p>0.05 for each), and it increased significantly in the 6th month (p=0.006) and 3rd year (p=0.007) measurements. Urine protein level increased significantly in the third trimester compared to pre-pregnancy (p=0.009). ConclusionThe findings show that pregnancy does not have a significant effect on maternal and fetal survival, graft rejection and graft function in pregnancies with kidney transplantation, but that complication rates such as hypertension, preterm delivery and low birth weight are high.

Kliniğimizde doğum yapan ikiz gebeliklerin değerlendirilmesi: Üç yıllık deneyim

Objective: Twin pregnancies constitute 1–2% of all pregnancies. With the recent developments in assisted reproductive technologies, the incidence of multiple pregnancy has increased. Preterm labor is held responsible for the poor neonatal outcomes primarily. In our study, we aimed to assess fetal-maternal outcomes of twin pregnancies seen in our clinic. Methods: One hundred and thirty twin pregnancy cases out of 4241 pregnant women who delivered in our clinic between 01.01.2017 and 01.01.2020 were included in the study. The labor records of the patients were reviewed retrospectively and their data for age, week of gestation, delivery type, birth weight, fetal sex, chorionicity characteristics and laboratory parameters were recorded. Definitive statistics and SPSS 21.0 for statistical analyses were used to evaluate the data obtained from the study. The data were presented as mean ± SD (standard deviation). Results: The incidence of twin pregnancy was found 3%. In the ultrasonographic imaging evaluated during diagnosis, 27.7% of the cases were monochorionic and 72% of them were dichorionic. Of the pregnant women, 12.3% were at term and 87.7% were at preterm period. When the preterm fetuses were evaluated, 37.7% of 114 preterm fetuses were delivered at late preterm period, 29.2% of them at mid-preterm period and 20.8% at premature preterm period. The rates of treatment pregnancy (pregnancy provided by ovulation induction and assisted reproductive technologies) and spontaneous twin pregnancy were 20% and 80%, respectively. Mean maternal age was found 31.3. When evaluated in terms of maternal morbidity, preterm labor and premature rupture of membrane were the most common problems. Mean newborn weight was 1832g and 59.3% of the newborns had low birth weight and 21.8% of them had very low birth weight. While one fetus had transverse presentation in 12.5% of the patients, at least one fetus had breech presentation in 53.1% of the cases and 34.4% of the cases had head-head presentation. Conclusion: Twin pregnancies are characterized by the increased feto-maternal risks. Therefore, both antenatal and intrapartum management should be maintained diligently.

Clinical characteristics and outcomes in pregnant women with epilepsy

BackgroundEpilepsy in pregnancy can lead to substantial maternal and neonatal morbidity and mortality. Early intervention in pregnant women with epilepsy (WWE), accurate assessment of the severity of their condition, and effective treatment are required to improve maternal and neonatal prognosis. Many obstetricians lack experience in monitoring and treating pregnant WWE. AimsThe aim of this study was to describe the demographic and clinical characteristics of pregnant WWE and examine maternal and neonatal outcomes. MethodsMedical records of 75 pregnant women with a history of epilepsy who delivered at Beijing Tiantan Hospital, China between January 2006 and December 2019 were retrospectively reviewed. Pregnant women with a history of epilepsy were matched 1:2 with a control group of 150 pregnant women without epilepsy who delivered at Beijing Tiantan Hospital during the same time period. Information including type and frequency of epilepsy and seizures, maternal complications, medication, delivery mode, newborn weight, and newborn Apgar score were recorded. In subgroup analyses, pregnant WWE were stratified according to presence or absence of seizures during pregnancy and generalized seizure vs. nongeneralized seizure. ResultsThe incidence of anemia, hypertensive disorder of pregnancy, premature rupture of membranes (PROM), cesarean section, and postpartum hemorrhage was significantly higher (p < 0.05), and mean newborn weight and newborn Apgar score were significantly lower (p < 0.05) in pregnant WWE compared with pregnant women without epilepsy. The incidence of premature delivery was significantly higher (p < 0.05), and mean newborn weight was significantly lower (p < 0.05) in pregnant WWE with seizures vs. without seizures. Mean newborn weight was significantly lower (p = 0.01) in pregnant WWE with nongeneralized seizures vs. generalized seizures. ConclusionPregnant WWE are at high risk of anemia, gestational hypertension, PROM, cesarean section, postpartum hemorrhage, and low newborn weight and Apgar score. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data emphasize the need to routinely monitor fetal weight on ultrasound and offer appropriate intervention. These findings highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE. SynopsisPregnant WWE are at high risk of obstetric complications. Women with epilepsy who experience seizures during pregnancy are at high risk of preterm birth and having low birth weight infants. Pregnant WWE who experience nongeneralized seizures are at high risk of having low birth weight infants. These data highlight the need for healthcare providers to take a multidisciplinary approach to the management of pregnant WWE.

The safety of early pregnancy exposure to granisetron

ObjectiveCurrent guidelines suggest that granisetron is an optional treatment for nausea and vomiting in pregnancy (NVP) despite lack of evidence to support fetal safety. We aimed to determine the association between early pregnancy exposure to granisetron and fetal/neonatal outcomes. DesignMedical records of patients treated for NVP during the first and second trimester between June 2013 to September 2015 were reviewed. Patients were asked to participate in the study by answering a detailed questionnaire regarding newborn’s health and complementary data. Pregnancy outcomes of patients exposed to granisetron were compared with those of patients who were not exposed to granisetron. Results100 Granisetron exposed pregnancies were compared with 108 granisetron unexposed pregnancies. Exposure to granisetron occurred in the first trimester in 88 patients (94 fetuses). Maternal characteristics, history of anomalies in first degree relatives, co-exposure to other substances and extent of prenatal sonographic surveillance were comparable between both groups. Miscarriage rate was significantly lower among granisetron exposed patients compared to controls (0 vs 5.5 %, respectively, p = 0.03). Three major malformations were identified prenatally or postnatally in each of the groups (2.77 % Vs 2.83 %, p = 1). The rate of major malformations was similar between exposed and unexposed fetuses even after excluding second trimester exposure (3.2 % vs. 2.83 %, respectively p = 1). Mean gestational age at delivery, mean newborn weight and incidence of small for gestation age, were not significantly different between the groups. ConclusionGranisetron exposure was not associated with increased risk for minor or major fetal anomalies. This study provides preliminary reassurance regarding the safety of in-utero exposure to granisetron.

657: Improving the prediction of shoulder dystocia using artificial intelligence – a novel approach

The American College of Obstetricians and Gynecologists (ACOG) recommends consideration of elective cesarean section (CS) to prevent shoulder dystocia (ShD) for women without diabetes carrying fetuses with an estimated fetal weight (EFW) of at least 5,000g and for women with diabetes carrying fetuses with an EFW of at least 4,500g. However, most ShD cases occur in nondiabetic women with normal-sized infants. Our aim was to analyze the potential of artificial intelligence (AI) to predict ShD. A cohort of 53,754 singleton deliveries between 2011 to 2018 from a large tertiary university-affiliated hospital was analyzed. All ShD cases during the study period were identified, and comprehensive prenatal, obstetric and neonatal data from ShD cases were compared with 4:1 controls of singleton vaginal deliveries from the same institution. The AI model incorporated maternal factors (age, height, weight at delivery, smoking, diabetes, insulin treatment), obstetric history (parity, prior CS and prior ShD), fetal sonographic parameters within 2 wks of delivery (BPD, AC, HC, FL, and EFW) and neonatal factors (birth weight and sex). To develop a ShD prediction model, we split the data to training and test sets (80%-20%), and fit a generalized linear model with Lasso regularization on the training set. We repeated the learning with 100 random splits of the data. 239 (0.44%) cases of ShD occurred during the study period. The mean newborn weight among ShD cases was significantly higher than controls (3857g vs 3230g respectively, P < 0.01); however, there was a wide overlap between groups (Fig 1). The AI model identified 12 variables to include in the prediction of ShD with different predictive strengths, some of them protective (Fig 2). Incorporating all factors, the model was able to prevent 41.7% of ShD cases using a 10% elective CS rate cutoff. This CS rate is equivalent to a universal 4000g elective CS recommendation, although doing so would result in prevention of significantly less (35.9%, P<0.01) ShD cases compared with the AI model. We present the first robust study analyzing the potential of AI for prediction of ShD. The model was superior to traditional clinical parameters and therefore we plan to validate the clinical performance of the model using additional datasets with different population characteristics.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia

Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS). We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months. There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT- patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT. The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.

Effect of smoking during pregnancy on birth weight, placental weight, and time of third stage of labor

Background: Cigarette smoking of the mother during pregnancy is a well-known cause associated with adverse reproductive outcomes, including increase in the incidence of placenta previa, abruption-placentae, and double the risk of infant mortality from all causes. Objective: This study aims to demonstrate the effect of smoking, whether active or passive, on the newborn body weight, placental weight, and the time of the third stage of labor. Materials and Methods: This prospective study involves sixty patients, their ages range between 20 and 32 years, all of them underwent vaginal deliveries, and the lowest accepted packed cell volume (PCV) was 32%. The participants were classified into four groups: active smokers, passive smokers, mixed smokers, and the rest who are nonsmokers, representing the control group. The following data were collected from every: age, gravidity and parity, and number of cigarettes per day, and for each female, the newborn body weight, placental weight, the time of the third stage of labor, and PCV of the mother were estimated. Results: Among these sixty patients who involved in the study, 3% were active smokers, 31% were passive smokers, 27% were mixed smokers, and 39% were nonsmokers; the mean newborn body weight of nonsmokers (control group) was 3252 g; active smokers, 2430 g; passive smokers, 2819 g; and mixed smokers, 2407 g. The mean placental weight in nonsmokers was 527 g; active smokers, 640 g; passive smokers, 551 g; and mixed smokers, 599 g. The time of the third stage of labor in nonsmokers was 6.9 min; active smokers, 12 min; passive smokers, 5.8 min; and mixed smokers, 6.6 min. Conclusions: Cigarette smoking by pregnant women leads to a low birth weight and larger placenta and may interfere with the time of the third stage of labor.

Neonatal Outcomes in a Community Hospital in M’Bour, Senegal

BackgroundNeonatal mortality accounts for up to 10% of the global burden of disease. Low-income countries, especially in Sub-Saharan Africa, suffer the highest rates of neonatal mortality. Identifying the causes is necessary to guide community-specific public health efforts. This study aimed to identify the most common neonatal conditions and outcomes in a community hospital in M’Bour, Senegal. MethodsThis retrospective chart analysis was carried out for 0-28 day old infants admitted to the M’Bour Hospital during 2014. Newborn weight, gestational status, maternal age, delivery location, neonatal diagnoses, and outcomes were tabulated. A logistic regression model was applied to examine the relationship between infant death and maternal age, preterm birth, and the most common diagnoses of asphyxia and infection. ResultsDuring 2014, 322 neonates were treated. 78.2% of the infants were discharged, 17.5% died, and 4.3% were transferred. Birth outside of the hospital carried 20.4% mortality compared to 14.0% for internal births. Mean newborn weight was 2452 grams, with 49% of the infants having low birth weight and 14.6% very low birth weight. Low birth weight carried a 24.9% mortality rate. The most common diagnoses at admission were prematurity (26.4% of cases), neonatal asphyxia (23.3%), infection (17.4%), and neonatal respiratory distress (15.8%). The two significant predictors of death were preterm birth (OR 1.93-2.57, p<0.05) and asphyxia (OR 2.34, p<0.05). Conclusion Neonatal asphyxia, preterm birth, and low birth weight were the main contributors to death. Future efforts to improve neonatal mortality in M’Bour, Senegal should address these conditions.

Factors that influence the development of avulsion of the levator ani muscle in eutocic deliveries: 3–4D transperineal ultrasound study

Introduction: Levator ani muscle (LAM) lesions are the most frequent injuries of the pelvic floor during delivery. Ten to 36% of women report this lesion during their first delivery. Many risk factors have been proposed but very few evaluate the aspects that can influence during natural vaginal delivery.Method: A prospective observational trial was conducted involving 74 primiparous women following vaginal delivery. Maternal, fetal and obstetric characteristics were analyzed. A transperineal three or four-dimensional (3D–4D) ultrasound was offered six months after delivery in order to evaluate avulsions and anomalies of the hiatus.Results: Seventy four women were included, three of them did not show up for ultrasound evaluation. Sixty two (87.3%) demonstrated no avulsion in comparison with nine (12.7%) who did. Five of these lesions were unilateral and four bilateral. Mean newborn weight was 3193 g in the “no avulsion group” versus 3470 g in the “avulsion” group (p=0.025).Discussion: According to the results, the most important risk factor established, for avulsion during natural childbirth, was the newborn weight. This contrasts with many other authors who have established that birth weight has no impact on these lesions.Conclusions: The most important factor intervening in the avulsion of LAM during natural vaginal delivery is the newborn weight. Patients with diagnosed avulsions present an enlarged urogenital hiatus during valsalva and maximal contraction.

The Feasibility of a Modified Method of Laparoscopic Transabdominal Cervicoisthmic Cerclage During Pregnancy.

To evaluate a modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) technique after failure of transvaginal cerclage during pregnancy in women with cervical weakness. Eighty women in whom transvaginal cerclage was unsuccessful or who were anatomically unsuitable for the procedure underwent modified LTCC between January 2003 and December 2008 at Keimyung University, Dongsan Medical Center, Daegu, South Korea. The modified LTCC was performed using a polyfilament polyester double-armed needle that was sutured laterally to the uterine vessels at the level of the internal cervical os. Survival of the fetus was used to calculate the successful pregnancy rate of this modified LTCC. The relationship between successful pregnancy rate and clinical variables was evaluated using a chi-squared test and a Mann-Whitney U test. The mean gestational age was 12.1 weeks (range, 11-15 weeks). The operation time was 52 minutes (range, 25-100 minutes). The successful pregnancy rate was 90% (72/80 pregnancies), with a mean gestational age of 36.3±2.7 weeks. The mean newborn weight was 2690 g (range, 1860-3750 g). Eight pregnancies were lost in the first and second trimesters due to spontaneous abortion, premature rupture of the membrane, and termination due to anomaly; no other complications occurred. No statistical difference was found between the successful pregnancy rate and the measured clinical variables. The modified LTCC is feasible and safer than traditional LTCC.

Pregnancy outcomes in women with moyamoya disease: experiences at a single center in Korea.

PurposeMoyamoya disease (MMD) occurs predominantly in Korean and Japanese women. The aim of this study was to investigate clinical features and pregnancy outcomes in women with MMD.Materials and MethodsWe conducted a retrospective chart review of women with MMD who visited our Department of Obstetrics and Gynecology between January 2005 and October 2013. For all study subjects, clinical features, demographic characteristics, and perinatal outcomes were recorded.ResultsWe identified 28 pregnancies in 22 patients who had been diagnosed with MMD. The mean maternal age at delivery was 31.9±3.5 years old. The mean gestational age at delivery was 38.0±0.9 weeks. Among the 28 pregnancies, 25 (92.5%) underwent cesarean section; 19 (76.0%) of them were performed under regional anesthesia and six (24.0%) under general anesthesia. The mean newborn weight was 3233.7±348.2 g. The 5-minute Apgar score in 85% of the newborns was higher than 8, with no other apparent complications. During the puerperal period, transient ischemic attack symptom or seizure occurred in 4 cases, although patients recovered within a few days.ConclusionFor pregnant women with MMD, it is important to control blood pressure and prevent hyperventilation during the intrapartum period, and the best methods of delivery and anesthesia should be considered to avoid unfavorable sequelae. Additionally, a multidisciplinary approach (i.e., neurosurgery) is necessary to constantly manage underlying diseases.

Sickle cell disease and pregnancy: analysis of 34 patients followed at the Regional Blood Center of Ribeirão Preto, Brazil.

ObjectiveThe objective of this study was to verify the evolution of pregnancies in sickle cell patients followed at one institution over a period of 12 years (January 2000 to June 2012).MethodsThe study evaluated 34 pregnant women with sickle cell disease with a mean age of 23.9 ± 5.3 years. The incidence of obstetric complications, non-obstetric complications linked to sickle cell disease and complications in the newborn were analyzed.ResultsA total of 26% of the cases reported previous miscarriages, 20% had preterm labor, 10% had pre-eclampsia, and 5% had gestational diabetes. Forty-one percent of the deliveries were cesarean sections and 29% of patients required blood transfusions. In respect to sickle cell disease, 62% of patients had vaso-occlusive crises, 29% had acute chest syndrome, 23% had urinary tract infection, 15% had impaired cardiac function and 6% developed pulmonary hypertension. Only one patient died in the postnatal period due to acute chest syndrome. The mean gestational age was 37.8 ± 2.63 weeks, and mean newborn weight was 2.809 ± 643.8 g. There were seven fetal losses, including three stillbirths and four miscarriages. The impact of transfusion therapy on the incidence of maternal–fetal complications during pregnancy was evaluated.ConclusionsPregnancy in sickle cell patients is still associated with complications. Although no statistical difference was observed between transfused and non-transfused women, there were no deaths (fetal or maternal) in transfused patients whereas one maternal death and three stillbirths occurred in non-transfused women. A larger study of sickle cell pregnant women will be necessary to elucidate the actual role of transfusion during pregnancy in sickle cell disease.

Treatment by testicular sperm extraction and intracytoplasmic sperm injection of 65 azoospermic patients with non-mosaic Klinefelter syndrome with birth of 17 healthy children.

The aim of this work was to present the clinical and embryological outcomes of 65 azoospermic patients with non-mosaic Klinefelter syndrome (KS), treated by testicular sperm extraction (TESE), followed by intracytoplasmic sperm injection (ICSI), either with fresh or cryopreserved testicular spermatozoa. In total, spermatozoa were recovered in 25/65 (38.5%) of the cases. Of the 48 patients who choose to perform TESE followed by ICSI using fresh testicular spermatozoa (treatment TESE), spermatozoa was recovered in 19 patients (40%), with birth of 12 newborn. Of the 17 patients who choose to perform TESE followed by testicular sperm cryopreservation, spermatozoa were recovered in six patients (35%), with birth of one child. Of the patients who performed treatment TESE, nine went for a new cycle using cryopreserved spermatozoa. Of these, five patients had a previous failed treatment cycle (two patients, three newborn) and four with a previous success went for a new cycle (one patient, one newborn). Overall, the embryological and clinical rates were as follows: 52% of fertilization, 41% of blastocyst, 27% of implantation, 39% of live birth delivery and 47% of newborn. Of the 16 clinical pregnancies, 14 had a successful delivery (12 girls and 5 boys). The 17 newborns had a mean gestation time of 37.2 weeks (35.3% pre-term) and a mean newborn weight of 2781.3 g (37.5% low weight). Comparisons between cycles with fresh and frozen-thaw spermatozoa revealed higher fertilization and clinical pregnancy rates with fresh spermatozoa, with no differences regarding implantation or newborn rates. Of the 17 newborns, no abnormal karyotypes (n = 3) or numerical abnormalities in chromosomes 13, 18, 21, X and Y (n = 14) as evaluated by Multiplex Ligation-dependent Probe Amplification were observed. In conclusion, this study presents further data that reassures that men with KS have no increased risk of transmitting their genetic problem to the offspring.

Grossesse chez les patientes hémodialysées chroniques

Pregnancy in hemodialysis patients is a rare event, with a high risk of maternal and fetal morbidity. The aim of our study is to report our experience in management of pregnancies occurred in hemodialysis patients, and clarify the factors of good prognosis. We identified all pregnancies occurred in patients on hemodialysis between January 2000 and July 2010, and analysed their clinical and biological characteristics. The adjustment parameters of hemodialysis sessions, and treatment adjustments have been specified. The maternal and fetal complications and pregnancy outcome have been reported. Over a period of 10 years and 6 months, among 23 patients of childbearing age, 14 patients were married. We observed 11 pregnancies in eight patients, with an incidence of 7,14% year, and a prevalence of 71,4%. The evolution was marked by intrauterine fetal death in one case, medical pregnancy termination in a second one and four spontaneous abortions. Only five pregnancies were completed. The average age of conception was 34 years. The average duration of dialysis prior to conception was 76 months. Pregnancy diagnosis was made on average after 10,4 weeks. The mean gestational age at delivery was 33,6 weeks, and the mean newborn weight was 2070g. Apgar score was of 10/10 in the first minute in all newborns. No maternal complication was found. One case of intrauterine growth restriction and another case of pyelo-caliceal dilatation with resolving renal insufficiency were reported. In the long term, the fetal psychomotor development was normal. The fertility chronic hemodialysis patients in childbearing age have improved together with the quality of dialysis, with an increased incidence of pregnancy and the proportion of viable children. However, treatment modalities are not clearly established, because of the absence of randomized studies and the small number of pregnancies during the playoffs. Treatment of anemia with erythropoietin and blood transfusions, and the improvement in blood urea by extensive dialysis in women on hemodialysis, may improve outcomes by reducing the incidence of prematurity and increasing gestational age. Pregnancy in hemodilalysis patient is a rare event, but desired and valuable. Its completion requires a multidisciplinary management involving the nephrologist to ensure adequate dialysis and the gynecologist to ensure good obstetrical monitoring.