Neonatal Complications In Women Research Articles

COMPLICAÇÕES NEONATAIS CONCERNENTE A MORBIDADE MATERNA: DIABETES GESTACIONAL

The monitoring of this morbidity brings with it the need at public health level to emphasize regular monitoring through prenatal care, aiming at early diagnosis and treatment for Obstetric Diabetes (OD) or gestational diabetes mellitus (GDM), thus being able to reduce complications for the mother and fetus binomial. The aim of this study is to analyze these results among fetal or neonatal complications in women with GDM, bringing in the outcomes of premature birth, birth weight, neonatal morbidity and mortality, and the synergistic effect of concomitant risk factors and poor obstetric outcomes. A literature review was carried out using the following databases: Online Medical Literature Search and Analysis System (MEDLINE/PUBMED), Nursing Database - Brazilian Bibliography (BDENF), Web of Science and Cochrane Library (SCOPUS), CAPES Journals and Latin American and Caribbean Health Sciences Literature (LILACS). The search was carried out using descriptors combined with the Boolean operator “and”. From the searches, it was possible to see that the authors corroborate each other in relation to the main neonatal outcomes: Complications include fetal macrosomia, birth injuries, increased caesarean section rates, neonatal hospitalizations, neonatal hypoglycemia, neonatal respiratory distress syndrome (RDS), prematurity and fetal death. It can be concluded that for the mother the impacts, such as the risk of urinary system infections, are high, as well as bleeding in the postpartum period and tearing of the vaginal canal. For the child, hypoglycemia, prematurity and fetal macrosomia are some of the complications resulting from diabetes.

Maternal and neonatal outcomes associated with multiple repeat cesarean deliveries: A registry-based study from Qatar.

Cesarean delivery (CD) is associated with increased maternal and neonatal morbidity compared to vaginal delivery, particularly in cases classified as emergency procedures or when there are multiple CDs. This retrospective cohort study aims to examine the incidence of maternal and neonatal complications in women with multiple CDs. This study used data from a national perinatal database obtained from a single tertiary maternity care hospital. Women who delivered a singleton live birth after 24 weeks of gestation by CD were stratified into five groups based on the number of CDs, with the last group having five or more CDs. The women were divided into those with five or more CDs (Group 5) versus those with fewer than five (Groups 1 to 4). The maternal outcomes included intra-operative surgical complications, blood loss, and intensive care unit (ICU) admission. The neonatal outcomes included preterm birth, neonatal ICU (NICU) admission, respiratory distress syndrome (RDS), and perinatal death. Of the 6,316 women in the study, 2,608 (41.3%) had a primary CD. 30.3%, 17.5%, and 7.3% of the cohort had their second, third, and fourth CDs, respectively. Women undergoing the 5th CD and above formed the remaining 3.5% (227). Women in Group 5 had the highest risk of suffering a surgical complication (3.1%, p=0.015) and postpartum hemorrhage (7.5%, p=0.010). 24% of babies in Group 5 were born preterm (p<0.001). They also had a 3.5 times higher risk of having a surgical complication (RR=3.5, 95% CI 1.6-7.6, p=0.002), a 1.8 times higher risk of developing postpartum hemorrhage (RR=1.8, 95% CI 1.1-2.9, p=0.014), a 1.7 times higher risk of delivering between 32-37 weeks of gestation (RR=1.7, 95% CI 1.3-2.2, p<0.001), a higher risk of the baby getting admitted to NICU (RR=1.3, 95% CI 1.0-1.6, p=0.038), and developing RDS (RR=1.5, 95% CI 1.2-2.0, p=0.002) compared to Groups 1-4. The risks of neonatal outcomes such as NICU admission (RR 2.9, 95% CI 2.1-4.0) and RDS (RR 3.5, 95% CI 2.3-5.5) were much higher in elective CDs performed at term compared to preterm births (p<0.001 for both). Maternal morbidity significantly increases with the increasing number of CD. The increased risk of RDS and NICU admissions in the neonate with multiple CDs reflects lower gestational age and birthweight in these groups-consideration of preoperative steroids for lung maturation in these women to reduce neonatal morbidity warrants further discussion.

Comparison of Maternal and Neonatal Complications in Women with and without Gestational Diabetes Mellitus

Background: Gestational Diabetes Mellitus (GDM) is a common pregnancy-related metabolic disorder associated with adverse maternal and neonatal outcomes. Gestational Diabetes Mellitus is characterized by glucose intolerance that develops during pregnancy. It affects approximately 7% of all pregnancies and has been linked to an increased risk of maternal and neonatal complications. Objective: The study was aimed to provide a comprehensive comparison of maternal and neonatal complications in women with and without GDM involving a thorough examination of medical records and clinical data to identify patterns and associations between GDM and various complications. Methods: A retrospective cohort study was conducted, including pregnant women with and without GDM who received prenatal care and underwent hospital delivery at the Department of Obstetrics and Gynecology, Enam Medical College and Hospital, Dhaka, Bangladesh from June 2022 to June 2023. Clinical data, including maternal age, gestational age at diagnosis, parity, and antenatal care were collected. Pregnancy outcomes, such as maternal complications, and live birth complications were also assessed. Result: A total of 60 pregnant women were included in the analysis, 30 were diagnosed with GDM and 30 without GDM. Analysis of pregnancy outcomes revealed a higher incidence of cesarean section deliveries in the GDM group (p&lt;.05). Additionally, infants born to mothers with GDM had a higher risk of neonatal complications. Conclusions: Women diagnosed with GDM demonstrated distinct clinical characteristics and experienced a higher incidence of adverse pregnancy outcomes. These findings underscore the importance of effective management and close monitoring of pregnant women with GDM to optimize maternal and neonatal health. J Rang Med Col. March 2024; Vol. 9, No. 1: 28-32

Vaginal Progesterone to Prevent Spontaneous Preterm Birth in Women With a Sonographic Short Cervix: The Story of the PREGNANT Trial.

The PREGNANT trial was a randomized, placebo-controlled, multicenter trial designed to determine the efficacy and safety of vaginal progesterone (VP) to reduce the risk of birth < 33 weeks and of neonatal complications in women with a sonographic short cervix (10 to 20 mm) in the mid-trimester (19 to 23 6/7 wk). Patients allocated to receive VP had a 45% lower rate of preterm birth (8.9% vs 16.1%; relative risk = 0.55; 95% CI: 0.33-0.92). Neonates born to mothers allocated to VP had a 60% reduction in the rate of respiratory distress syndrome. This article reviews the background, design, execution, interpretation, and impact of the PREGNANT Trial.

Hypertensive disorders of pregnancy in Western Brazilian Amazon: Associated factors and neonatal outcomes.

Hypertensive disorders of pregnancy (HDP) are responsible for several maternal and fetal complications. This study investigated the occurrence of HDP, associated factors, and neonatal complications in women living in the Western Brazilian Amazon. This is a population-based cross-sectional study with 1521 mother-child pairs enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort (MINA-Brazil study). All parturients with HDP (registered in the medical records) were identified. Crude and adjusted prevalence ratios were calculated in Poisson regression models with robust variance. The prevalence of HDP was 11.0% (95% CI: 9.5-12.7). Factors associated with the prevalence of HDP were maternal age ≥ 35 years (PR: 1.9; 95% CI: 1.3-3.0), primigravida status (PR: 2.0; 95% CI: 1.5-2.7), pre-pregnancy obesity (PR: 2.7; 95% CI: 1.9-4.0), higher gestational weight gain (highest quartile RP: 2.5; 95% CI: 1.6-3.8), chronic hypertension (RP: 3.6; 95% CI: 2.7-4.9), and diabetes in pregnancy (RP: 1.9; 95% CI: 1.1-3.2). HDP was associated with risk for caesarean delivery (PR: 1.8; 95% CI: 1.6-2.0) and prematurity (PR: 2.0; 95% CI: 1.3-3.2). Gestational malaria was not associated with HDP in Amazonian pregnant women. Evaluating risk factors before pregnancy and during the prenatal period is essential for reducing adverse maternal and neonatal outcomes.

The presence of polycystic ovary syndrome increases the risk of maternal but not neonatal complications in women with type 2 diabetes in pregnancy.

Our aims were, in the setting of type 2 diabetes mellitus (T2DM) in pregnancy, to investigate the association of polycystic ovary syndrome (PCOS) with perinatal outcomes and to examine whether treatment with metformin had a differential effect in those with and without PCOS. We performed a retrospective cohort study using the metformin in women with type 2 diabetes in pregnancy (MiTy) trial data. We examined differences in maternal and neonatal outcomes among MiTy participants with and without PCOS using linear and logistic regression to adjust for potential confounders. We additionally examined the relative difference in the effect of metformin treatment on pregnancy outcomes among MiTy participants with PCOS versus those without PCOS. Among women with T2DM in pregnancy, PCOS was significantly associated with higher excess gestational weight gain (unadjusted 12.0 vs. 11.4kg, adjusted mean difference 2.1kg [0.3, 3.9], p=0.021) and higher total insulin dose at 34-36weeks (unadjusted 172 vs. 124 units per day, adjusted mean difference 44 units [15, 73], p=0.004), but no difference was seen in neonatal outcomes. Unlike the non-PCOS subgroup, metformin treatment versus placebo in the PCOS subgroup was associated with an increase in extremely large-for-gestational-age infants (28.6 vs. 14.0%, p=0.008 for interaction) and an increase in worsened pre-existing maternal hypertension (16.7 vs. 4.5%, p=0.046 for interaction). Clinicians should be alerted to the potential for high insulin requirements and excess weight gain in pregnant patients with T2DM and comorbid PCOS. Moreover, metformin may not be as beneficial in this population as previously understood.

Correlations between parameters of glycaemic variability and foetal growth, neonatal hypoglycaemia and hyperbilirubinemia in women with gestational diabetes.

The diagnosis of gestational diabetes mellitus (GDM) is important to prevent maternal and neonatal complications. This study aimed to investigate the feasibility of parameters of glycaemic variability to predict neonatal complications in women with GDM. A retrospective study was conducted on pregnant women tested positive at the oral glucose tolerance test (OGTT) during 16-18 or 24-28 weeks of gestation. Glycaemic measures were extracted from patients' glucometers and expanded to obtain parameters of glycaemic variability. Data on pregnancy outcomes were obtained from clinical folders. Descriptive group-level analysis was used to assess trends in glycaemic measures and foetal outcomes. Twelve patients were included and analysed, accounting for 111 weeks of observations. The analysis of trends in parameters of glycaemic variability showed spikes of glycaemic mean, high blood glucose index and J-index at 30-31 weeks of gestation for cases with foetal macrosomia, defined as foetal growth >90° percentile, neonatal hypoglycaemia and hyperbilirubinemia. Specific trends in parameters of glycaemic variability observed at third trimester correlate with foetal outcomes. Further research is awaited to provide evidence that monitoring of glycaemic variability trends could be more clinically informative and useful than standard glycaemic checks to manage women with GDM at delivery.

Trial of Labor after Three or More Previous Cesarean Sections: Systematic Review and Meta-Analysis of Observational Studies.

To assess the success rate and prevalence of maternal or neonatal complications in women undergoing a trial of labor after three or more (≥3) previous cesarean sections (CSs). A systematic literature review and meta-analysis was conducted from inception to May 2022 in Medline, Scopus, ENBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials and Reviews. Items detailing success rate and complications in women with a history of≥3 previous CSs were considered. Selected articles were evaluated for quality, heterogeneity, and publication bias. A pooled prevalence or odds ratio was calculated. Twelve articles were included for a total of 540 women with a history of≥3 CSs, accounting for the 2% (CI 95% 1-4%) of the whole cohort of trial of labor. Our findings show a 0.67 (CI 95% 0.53-0.78) rate of successful vaginal delivery. A higher success rate was observed in women having a history of a prior vaginal delivery (0.90, CI 95% 0.77-0.96) and when prostaglandins, peridural anesthesia or oxytocin were allowed (respectively 0.73, CI 95% 0.62-0.83, 0,73, CI 95% 0.57-0.85 and 0.73, CI 95% 0.64-0.81). Uterine rupture rate was 0.01 (CI 95% 0.00-0.01). No cases of fetal asphyxia or maternal or neonatal death were registered. The success rate and low frequency of severe complications observed seem to support a trial of labor in selected patients desiring a natural birth. However, a potential underestimation of serious maternal and neonatal complications should be considered in the decision-making process.

Gestational Diabetes Mellitus in Pregnant Women with Beta-Thalassemia Minor: A Matched Case-Control Study.

Pregnancy in women with thalassemia minor is considered safe. However, a higher incidence of maternal and neonatal complications in women with the disorder has been reported in the literature. This study aimed to determine whether there is an increased risk of gestational diabetes mellitus (GDM) in pregnant women with beta-thalassemia minor. We conducted a retrospective matched case-control study of 230 pregnant women who delivered at the Department of Obstetrics and Feto-Maternal Medicine at the Medical University of Vienna between the years 2008 and 2020, whereof 115 women had beta-thalassemia minor. We found no significant difference in the occurrence of GDM between the case group and control group of age and BMI-matched healthy women. However, we observed a significantly lower hemoglobin (Hb) and hematocrit (Ht) level during the first, the second, and the third trimesters of pregnancy, and postpartum (all: p < 0.001) among women with beta-thalassemia minor compared to the healthy controls. Neonates of women with beta-thalassemia were more likely to experience post-natal jaundice and excessive weight loss (p < 0.001). We conclude that GDM is not more likely to occur in pregnant women with beta-thalassemia minor. However, clinicians should be made aware of the risk of adverse maternal and neonatal outcomes. Furthermore, women with beta-thalassemia minor should undergo regular laboratory screening and multidisciplinary pregnancy care.

Maternal and neonatal complications in women with medical comorbidities and preeclampsia.

To evaluate how medical comorbidities - chronic hypertension, pre-gestational or gestational diabetes and obesity - influence maternal and neonatal complications from preeclampsia. We undertook a retrospective cohort study of women delivering in Victoria, Australia, between 2009 and 2017. We compared the likelihood of having a maternal complication before delivery or neonatal complication after birth between women with and without comorbidities. We used causal mediation analysis for neonatal outcomes to separate the effects of comorbidities and of prematurity on morbidity. Pregnancy complications (eclampsia; haemolysis, elevated liver enzymes, low platelets syndrome; placental abruption; stillbirth) and neonatal complications (respiratory distress syndrome; neonatal sepsis; a 5-minute APGAR<5; neonatal intensive care unit admission). Women with comorbidities delivered at a median (interquartile range) of 37.0 (36.0-39.0) weeks gestation, earlier than women without comorbidities (38.0 (36.0-39.0) weeks, p<0.001). Women with comorbidities were less likely than those without to suffer any pregnancy complication prior to delivery (adjusted relative risk 0.78, 95% confidence interval 0.72-0.86); however, their neonates suffered more respiratory distress syndrome (aRR 1.43, 95% CI 1.31-1.57), neonatal sepsis (aRR 1.42, 95% CI 1.17-1.72) and NICU admission (aRR 1.37, 95% CI 1.23-1.53). Earlier delivery was a major contributor to worse neonatal outcomes. Medical comorbidities are associated with earlier delivery among women with preeclampsia. This is associated with fewer maternal complications, but worse neonatal outcomes.

Predictors of maternal and neonatal complications in women with severe valvular heart disease during pregnancy in Tunisia: a retrospective cohort study

BackgroundSevere valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease.MethodsThis is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017.ResultsWe included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12–5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26–31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14–41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01–1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15–23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19–23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002–1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98–38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2–84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4–36.1]).ConclusionsRevelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial.

Decreased Endometrial Thickness Is Associated With Higher Risk of Neonatal Complications in Women With Polycystic Ovary Syndrome.

PurposeTo evaluate the association of endometrial thickness (EMT) with obstetric and neonatal outcomes in women with polycystic ovary syndrome (PCOS).MethodsA total of 1755 subfertile PCOS women with singleton livebirths after frozen-thawed embryo transfer were included between January 2009 and September 2019. Main obstetric outcomes were hypertensive disorders in pregnancy and abnormal placentation. Main neonatal outcomes were preterm birth (PTB), low birthweight (LBW) and small-for-gestational age (SGA). Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses.ResultsEach millimeter decrease in EMT was related to a 9% (adjusted OR 1.09, 95% CI 1.00–1.19; P = 0.053), 14% (adjusted OR 1.14, 95% CI 1.02–1.28; P = 0.002) and 22% (adjusted OR 1.22, 95% CI 1.07–1.38; P = 0.003) higher risk of PTB, LBW and SGA, respectively. Compared to women with EMT >13 mm, women with EMT ≤8 mm also had significantly higher risk of PTB (adjusted OR 3.79, 95% CI 1.53–9.39; P = 0.004), LBW (adjusted OR 4.33, 95% CI 1.39–13.50; P = 0.012) and SGA (adjusted OR 6.38, 95% CI 1.78–22.83; P = 0.004). These associations remained consistent in further subgroup analysis by endometrial preparation regimen and in sensitivity analyses among nulligravida women or women without adverse obstetric outcomes. No significant differences were found in the incidence of several pregnancy complications across EMT categories.ConclusionDecreased EMT was independently associated with increased risk of PTB, LBW and SGA in women with PCOS.

Maternal and neonatal complications in women with congenital heart disease: a nationwide analysis

The aim of this study was to provide population-based data on maternal and neonatal complications and outcome in the pregnancies of women with congenital heart disease (CHD). Based on administrative data from one of the largest German Health Insurance Companies (BARMER GEK, ∼9 million members representative for Germany), all pregnancies in women with CHD between 2005 and 2018 were analysed. In addition, an age-matched non-CHD control group was included for comparison and the association between adult CHD (ACHD) and maternal or neonatal outcomes investigated. Overall, 7512 pregnancies occurred in 4015 women with CHD. The matched non-CHD control group included 6502 women with 11 225 pregnancies. Caesarean deliveries were more common in CHD patients (40.5% vs. 31.5% in the control group; P < 0.001). There was no excess mortality. Although the maternal complication rate was low in absolute terms, women with CHD had a significantly higher rate of stroke, heart failure and cardiac arrhythmias during pregnancy (P < 0.001 for all). Neonatal mortality was low but also significantly higher in the ACHD group (0.83% vs. 0.22%; P = 0.001) and neonates to CHD mothers had low/extremely low birth weight or extreme immaturity (<0.001) or required resuscitation and mechanical ventilation more often compared to non-CHD offspring (P < 0.001 for both). On multivariate logistic regression maternal defect complexity, arterial hypertension, heart failure, prior fertility treatment, and anticoagulation with vitamin K antagonists emerged as significant predictors of adverse neonatal outcome (P < 0.05 for all). Recurrence of CHD was 6.1 times higher in infants to ACHD mothers compared to controls (P < 0.0001). This population-based study illustrates a reassuringly low maternal mortality rate in a highly developed healthcare system. Nevertheless, maternal morbidity and neonatal morbidity/mortality were significantly increased in women with ACHD and their offspring compared to non-ACHD controls highlighting the need of specialized care and pre-pregnancy counselling.

Pregnancy, delivery and neonatal complications in women with schizophrenia: a national population-based cohort study.

BackgroundExisting studies evaluating the association between schizophrenia and complications associated with pregnancy, delivery and neonatal outcomes are based on data prior to 2014 and have reported heterogeneous results. The objective of our study was to determine whether pregnant women with schizophrenia were at increased risk of pregnancy, delivery and neonatal complications compared with women without severe mental disorders.MethodsWe performed a population-based cohort study of all singleton deliveries in France between Jan. 1, 2015, and Dec. 31, 2019. We divided this population into cases (i.e., women with schizophrenia) and controls (i.e., women without a diagnosis of severe mental disorder). Cases and controls were matched (1:4) inside the same hospital and the same year by age, social deprivation, parity, smoking, alcohol and substance addictions, malnutrition, obesity, and comorbidities. Univariate and multivariate models with odds ratios and 95% confidence intervals (ORs [95% CIs]) were used to estimate the association between schizophrenia and 24 pregnancy, delivery and neonatal outcomes.FindingsOver 5 years, 3,667,461 singleton deliveries were identified, of which 3,108 occurred in women with schizophrenia. Compared to controls, women with schizophrenia were found to be older; have more frequent smoking, alcohol and substance addictions; suffer from obesity, diabetes and chronic obstructive pulmonary disease; and often be hospitalized in tertiary maternity hospitals. Compared to matched controls, women with schizophrenia had more pregnancy complications (adjusted OR=1.41[95%CI 1.31-1.51]) (i.e., gestational diabetes, gestational hypertension, genito-urinary infection, intrauterine growth retardation and threatened preterm labour). They had more delivery complications (aOR=1.18[95%CI 1.09 1.29]) with more still births/medical abortions (aOR=2.17[95%CI 1.62-2.90]) and caesarean sections (aOR=1.15[95%CI 1.05-1.25]). Newborns of women with schizophrenia had more neonatal complications (aOR=1.38[95%CI 1.27-1.50]) with more born preterm (aOR=1.64[95%CI1.42 -1.90]), small for gestational age (aOR=1.34[95%CI 1.19-1.50]) and low birth weight (aOR=1.75[95%CI 1.53-2.00]).InterpretationOur results highlight the importance of health disparities between pregnant women with and without schizophrenia, as well as in their newborns. Our study calls for health policy interventions during and before pregnancy, including proportionate intensified care to the level of needs, effective case management and preventive and social determinant approaches.FundingNo funding.

The Relationship between Number of Pregnancy Cares with Maternal and Neonatal Complications in Mothers with Gestational Diabetes

Introduction: Gestational diabetes increases maternal and neonatal complications. Therefore, this study was performed with aim to examine the effect of the number of pregnancy cares on the reduction of maternal and neonatal complications in women with gestational diabetes. Methods: This cohort study was performed in 2018-2020 on 119 mothers with gestational diabetes in Omolbanin hospital. The subjects in the two groups of pregnancy visits < 10 times and ≥10 times were compared in terms of neonatal complications such as overweight 90%, dystocia and maternal complications like preeclampsia. Data were analyzed using SPSS statistical software (version 23) and independent t-test and Mann-Whitney, Chi-square and Fisher tests. P< 0.05 was considered statistically significant. Results: In this study, among 119 pregnant women with gestational diabetes, 37 (31.09%) were in the group of pregnancy visits ≥ 10 times and 82 (68.90%) in the group of pregnancy visits < 10 times. The number of infants weighing more than 90 percent was 4 (10.8%) in the group of pregnancy visits ≥ 10 times and was 4 (4.9%) in the group of pregnancy visits < 10 times, which had no statistically significant difference (P=0.2). Mean fasting blood sugar of mothers in third trimester was 91.22 ± 75.14 mg/dl in the group of pregnancy visits ≥ 10 times and was 93.65 ± 30.23 mg/dl in the group of pregnancy visits < 10 times, which was similar in both groups (P=0.2). Also, the incidence of preeclampsia was 3 (6.2%) in the group of pregnancy visits ≥ 10 times and 5 (8.1%) in the group of pregnancy visits < 10 times, which was similar in the two groups (P=0.8). There was no significant difference between the two groups in terms of other maternal and neonatal consequences. Conclusion: Increasing the number of pregnancy visits in women with gestational diabetes does not improve the maternal and neonatal outcomes.

Comparison of azithromycin versus erythromycin on gestation length (prolongation of latency interval) and neonatal outcomes in pregnant women with premature rupture of the membrane: an open-label randomized clinical trial

Background: Premature rupture of membrane (PROM) is an important problem among pregnant women, which leads to maternal and neonatal morbidity.This study was done to compare the efficacy of azithromycin with erythromycin on the pregnancy length and the neonatal adverse effects in mothers with PROM.Materials and Methods: In this open-label randomized clinical trial, 194 pregnant women with PROM who referred to Akbarabadi Hospital were enrolled and randomly assigned to two groups. Group I received oral Azithromycin (1 gr/orally), Abidi Company Iran ) + Ampicillin 2 gram IV )Abidi Company, Iran) every six hours for 48 hours; then, only Amoxicillin 500 mg every eight hours for five days. and group II recived intravenous Erythromycin (Abidi Company, Iran) 400 mg every six hours for seven days + Ampicillin 2 grams IV every six hours for 48 hours, then Amoxicillin 500 mg every six hours for five days Finally the pregnancy length and neonatal adverse effects or neonatal outcomes compared between two groups.Result: There was no significant difference between the groups in mean of pregnancy length (32.5 versus 32.6 weeks, respectively, p=0.757) Also the frequency ofIntraventricular hemorrhage, Necrotizing enterocolitis, Respiratory Distress Syndrome sepsis, icter, oxygen demand, ICU admission, duration of hospitalization in the NICU, and mortality in neonate were same between the groups. The mean of patient satisfaction (by self-report) was 9.8 and 9.5 in group I, II, respectivel (P=0.001).Conclusion: It can be concluded that oral azithromycin and intravenous erythromycin have the same effect on increasing the duration of pregnancy and reducing neonatal complications in women with PROM. But azithromycin was associated with greater satisfaction and its use is recommended.

Maternal and Neonatal Outcomes of Operative Vaginal Deliveries at a Single Tertiary Center.

ObjectivesOur study sought to assess the maternal and neonatal outcomes of operative vaginal deliveries (OVDs) at Sultan Qaboos University Hospital (SQUH). We assessed the proportion of OVDs along with the proportion of maternal and neonatal outcomes of kiwi OmniCup vacuum, metal cup vacuum, and forceps deliveries.MethodsWe conducted a retrospective cohort study in the Obstetrics and Gynecology Department at SQUH from June 2015 to March 2018. The hospital information system was utilized to obtain records of all women who delivered at SQUH by vacuum or forceps during the study period. We collected data on maternal demographics, maternal and neonatal outcomes, and total number of deliveries.ResultsDuring the study period, 3.8% of deliveries were OVDs. The most common instrument used was the Kiwi OmniCup vacuum device. No significant difference was found between the type of tears and instrument used except perineal tears (p = 0.003), which was seen more in the vacuum group, particularly Kiwi OmniCup. Neonatal birth weight (p = 0.046) was significantly higher in the metallic vacuum cup group. Thirty-one neonates (6.6%) were admitted to the neonatal intensive care unit, and most were born using Kiwi OmniCup vacuum (67.7%).ConclusionsOVD is an ideal alternative to cesarean section with fewer maternal and neonatal complications in women who cannot deliver spontaneously if performed by a well-trained obstetrician.

Third trimester HbA1c and the association with large-for-gestational-age neonates in women with gestational diabetes.

To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.

562 Delivery outcomes in women with hypertensive disorders of pregnancy: comparing induction versus immediate cesarean delivery

To compare delivery outcome and associated maternal and neonatal complications in women with hypertensive disorders of pregnancy (HDP) who undergo induction of labor (IOL) versus immediate primary cesarean delivery (CD). This is a retrospective cohort study of nulliparous women with a singleton pregnancy at term delivering at NYU Langone Health and NYU Langone Hospital Brooklyn in 2018 with a diagnosis of HDP. Women who presented in labor (modified Bishop score >5) were excluded. Delivery outcomes and indication for CD were tabulated for the IOL group. A composite of maternal and fetal/neonatal complications occurring after the decision on delivery mode were compared between women who underwent IOL (defined as cervical ripening and/or oxytocin) versus immediate CD after diagnosis. Outcomes were analyzed using Chi-squared and Fischer’s exact test, with p<0.05 considered significant. 261 women met criteria for inclusion, including 241 (93.1%) who underwent IOL of labor and 18 (7.0%) with CD without labor. There was no difference between groups in severity of HDP diagnosis (p=0.66). Of those that underwent IOL, 140 (58.1%) had a vaginal delivery (VD). The most common indication for CD was labor arrest (67.9%), followed by fetal intolerance of labor (20.5%). Worsening HDP accounted for 3.6% of indications for CD. There was no difference between IOL and CD groups in rates of composite maternal complications (34.0% versus 33.3%, p=0.95, Table 1). There was no difference in fetal/neonatal composite complications between IOL and CD groups (21.2% versus 5.6%, p=0.11, Table 1). In nulliparous women with HDP at term, IOL is not associated with additional maternal or fetal/neonatal complications compared to immediate CD and is associated with a high rate of VD success. Understanding how the decision for IOL or CD influence maternal and neonatal complications in the setting of HDP will inform patient and provider counseling. Further studies should investigate how the rate of successful VD with IOL influences the risk/benefit balance for this decision.

Maternal and neonatal complications in women with congenital heart disease: results from a nationwide analysis including 7,231 pregnancies

Abstract Background The number of adult patients with congenital heart disease (ACHD) is increasing. Many ACHD women aim to start a family and require adequate pre-pregnancy counselling and pregnancy care. Limited population-based data on maternal and neonatal outcome and complications are available. Purpose We analysed the association between ACHD and maternal or neonatal outcomes based on data from one of the largest German Health Insurance Companies (approx. 9 million members). All pregnancies in women with ACHD and an age-matched non-congenital control group were included. The data covered all pregnancies and deliveries (in and out of hospital) between 2005 and 2018. Results The study population comprised 25,528 ACHD patients of childbearing age. Overall, 7,231 pregnancies occurred in 3,868 ACHD women (mean age at delivery 30.7±5.4 years). An age matched group of 6,513 women without ACHD (11,247 pregnancies, mean age 30.0±5.6 years) served as controls. Miscarriages/abortions occurred in 2,501 (34.6%) and 3,586 (31.9%) cases in the ACHD and non-ACHD cohort, respectively. Overall, there were 4,551 successful deliveries (99.5% in hospital) and 59 stillbirths in ACHD patients. Cesarean deliveries (CS) were significantly more common in ACHD patients (40.4% vs. 31.5% in the control group; p&amp;lt;0.0001) and the CS rate increased with disease complexity (Bethesda class I/II/III: 39.2/42.3/44.4%; p=0.035). There was one successful maternal resuscitation in each group, but no maternal deaths during pregnancy and up to 90 days postpartum. ACHD patients had a higher rate of maternal cerebral complications (1.0% vs. 0.17%; p&amp;gt;0.0001) compared to the control group. Neonatal mortality was low but significantly higher in the ACHD group (0.76% vs. 0.22% within the first 30 days of life; p&amp;lt;0.0001). Neonates to ACHD mothers were also significantly more often afflicted by low or extremely low birth weight or extreme immaturity (p&amp;lt;0.0001), and required resuscitation (1.04% vs. 0.34%; p&amp;lt;0.0001), mechanical ventilation (8.7% vs. 3.5%; p&amp;lt;0.0001) or blood transfusions (3.11% vs. 1.08%; p&amp;lt;0.0001) significantly more often compared to offspring from non-ACHD mothers. In addition, recurrence of congenital heart disease was 6.1 times higher in infants to ACHD mothers compared to controls (p&amp;lt;0.0001). Overall, 5.87% of all children born to ACHD mothers required cardiac surgical procedures in the first 6 years of life compared to only 0.39% of children to non-ACHD mothers (p&amp;lt;0.0001). Conclusion Our analysis confirms that maternal morbidity and neonatal morbidity and mortality are significantly increased in women with ACHD and their offspring compared to non-ACHD controls. Although, maternal mortality appears limited in high resource health care systems, the elevated maternal complication rate and particularly the high mortality and complication rate in neonates justifies specialized care to address specific risks and requirements of the condition. Funding Acknowledgement Type of funding source: None