Neonatal Outcomes In Pregnancies Research Articles

Maternal and neonatal outcomes of dichorionic twin pregnancies achieved with assisted reproductive technology: meta-analysis of contemporary data.

Assisted reproductive technology (ART) is commonly used to achieve pregnancy and often results in dichorionic diamniotic (DCDA) twin pregnancies. However, the potential risks of ART on maternal and neonatal outcomes in these pregnancies are not well understood. The objective is to compare the maternal and neonatal outcomes in DCDA twin pregnancies between those achieved through ART and those spontaneously conceived (SC). We carried out a systematic comprehensive search of electronic databases; namely, PubMed, Embase, Scopus, and the Cochrane Library, from inception to March 2023 with a study period of recruitment between 2003 and 2023. We included all studies comparing the maternal and neonatal outcomes of DCDA twin pregnancies between those achieved by ART and those SC. We analyzed data from 18 cohort studies involving 10,485 women with DCDA twin pregnancies. The meta-analysis showed that ART-conceived pregnancies had a significantly higher risk of preeclampsia or gestational hypertension (GH), gestational diabetes mellitus (GDM), placenta previa (PP), placental abruption (PA), postpartum hemorrhage (PPH), and elective and emergency cesarean sections than SC twin pregnancies. The absolute risks of these complications remained relatively low. We also found a slightly higher risk of respiratory distress syndrome (RDS) and congenital malformations in ART-conceived infants compared to the risks in SC infants. Finally, the risk of neonatal intensive care unit (NICU) admissions was significantly higher in ART-conceived infants than in SC infants, but with high heterogeneity. We found associations between DCDA twin pregnancies conceived through ART and increased frequencies of adverse maternal outcomes. However, the absolute risks of these complications remained low, and the benefits of ART for achieving successful pregnancies may well outweigh the potential risks. Additionally, ART-conceived DCDA twin pregnancies may pose higher risks of RDS, congenital malformations and NICU, admissions than SC DCDA twin pregnancies.

Improved neonatal outcomes in pregnancies with coexisting gestational diabetes and preeclampsia in normal birthweight neonates- insights from a retrospective cohort study

IntroductionWe aimed to assess neonatal and maternal outcomes in appropriate-for-gestational-weight (AGA) neonates of mothers with both gestational diabetes mellitus (GDM) and preeclampsia (PET). MethodsMedical records of women diagnosed with GDM or PET were reviewed. Women with AGA neonates were divided into three groups- GDM, PET, and GDM + PET and maternal neonatal and placental outcomes were compared. The primary outcome was a composite of adverse neonatal outcomes, including intensive care unit admission (NICU), neurological morbidity, hypoglycemia, ventilation, respiratory distress syndrome (RDS), phototherapy, sepsis, blood transfusion, and neonatal death. Post-hoc analysis was performed to determine between-group significance. ResultsComposite adverse neonatal outcomes are significantly lower in women with multiple morbidities compared to women with confined PET (p = 0.015), and a similar trend is observed when comparing neonatal outcomes between women with GDM to those with GDM + PET, yet these results are underpowered (18.9 % vs. 12.8 % respectively, p = 0.243). Placentas of women with GDM + PET were larger, with a lower rate of placentas below the 10th percentile as compared to placentas of women with isolated PET (p < 0.001), but with similar rates of MVM lesions. DiscussionWhile maternal and placental outcomes in patients of the GDM + PET group resemble the characteristics of the PET group, surprisingly, the neonatal outcomes in this group are significantly better compared to isolated morbidities. The paradoxical benefit attributed to the coexistence of GDM + PET may be explained by a balance of the opposing trends characterizing these morbidities-the reduced blood and nutrient supply characterizing PET vs. chronic overflow and abundance typical of GDM. Clinical trial registrationapproval of local ethics committee WOMC-19-0152.

The effect of chorionicity on maternal and neonatal outcomes in triplet pregnancies

ObjectiveTriplet gestations are associated with increased maternal, fetal, and neonatal complications particularly early and extreme preterm delivery. Identifying and interrupting the preterm delivery cascade could prevent the fetal, neonatal, and long-term childhood complications. The shared circulation and placental vascular anastomosis are responsible for the occurrence of twin-to-twin transfusion syndrome, selective fetal growth restriction as well as the higher risk of morbidity and mortality observed in mono and dichorionic compared to trichorionic triplet gestations.Thus, the aim of this study was to determine the effect of chorionicity on maternal, fetal, and neonatal outcomes of triplet pregnancies as it has not been fully ascertained. Study designA retrospective population-based cohort study of 125 parturient with triplets' pregnancy who delivered at a single tertiary hospital. Results98 trichorionic and 27 dichorionic gestations were included. Maternal demographic and obstetric characteristics as well as pregnancy and postpartum complications were similar in the two study groups. The median gestational age at delivery was lower among dichorionic than trichorionic triplet gestations (median 31 vs 33 weeks, p < 0.046). Early (<32 weeks) and extreme preterm delivery (<28 weeks) were more prevalent in the dichorionic than the trichorionic group (early − 56 % vs 34 %, p < 0.038; extreme − 33.3 % vs 8 %, p < 0.002). We found no difference in fetal or newborns' complications and characteristics between the groups. However, the rate of neonatal death was significantly higher in the dichorionic compared to trichorionic triplet gestations (22 % vs 7 %, p < 0.038).A multivariate logistic regression model to determine the variables that contribute to early preterm delivery in triplet gestations showed that women who experienced a past preterm delivery had an independently higher risk for early preterm delivery in the triplet gestation (adj. OR 5.91, 95 % CI 1.16–30.03). Neither maternal age nor chorionicity were found to be independent risk factors for early preterm delivery. ConclusionsDichorionic triplet gestations exhibit a higher rate of early (<32 weeks) and extreme (<28 weeks) preterm delivery and are more prone to neonatal death compared to trichorionic gestations. Past preterm delivery is an independent risk factor for early preterm delivery in a triplet gestation.

Obstetric and neonatal outcomes of pregnancy in advanced maternal age

Obstetric and neonatal outcomes of pregnancy in advanced maternal age

Neonatal outcomes in pregnancies complicated by placenta accreta- a matched cohort study

PurposePregnancies complicated by placenta accreta spectrum (PAS) are associated with severe maternal morbidities. The aim of this study is to describe the neonatal outcomes in pregnancies complicated with PAS compared with pregnancies not complicated by PAS.MethodsA retrospective cohort study conducted at a single tertiary center between 03/2011 and 01/2022, comparing women with PAS who underwent cesarean delivery (CD) to a matched control group of women without PAS who underwent CD. We evaluated the following adverse neonatal outcomes: umbilical artery pH < 7.0, umbilical artery base excess ≤ − 12, APGAR score < 7 at 5 min, neonatal intensive care unit (NICU) admission, mechanical ventilation, hypoxic ischemic encephalopathy, seizures and neonatal death. We also evaluated a composite adverse neonatal outcome, defined as the occurrence of at least one of the adverse neonatal outcomes described above. Multivariable regression analysis was used to determine which adverse neonatal outcome were independently associated with the presence of PAS.Results265 women with PAS were included in the study group and were matched to 1382 controls. In the PAS group compared with controls, the rate of composite adverse neonatal outcomes was significantly higher (33.6% vs. 18.7%, respectively, p < 0.001). In a multivariable logistic regression analysis, Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.ConclusionNeonates in PAS pregnancies had higher rates of adverse outcomes. Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.

The Impact of Endometriosis on Pregnancy.

Despite the increased frequency of endometriosis, it remains one of the most enigmatic disorders regarding its effects on pregnancy. Endometriosis adversely affects both natural and assisted conception. Impaired folliculogenesis, which causes follicular dysfunction and low egg quality, as well as luteal phase problems, reduced fertilization, and abnormal embryogenesis, are some of the mechanisms advocated to explain reproductive dysfunction. There is a rising need for a comprehensive study of the potential negative consequences of this condition on pregnancy outcomes, including the postpartum period, as more women with a medical history of endometriosis become pregnant. Obstetrical complications (small for gestational age [SGA], cesarean section [CS], miscarriage, hemorrhage, low placental adhesion, and preterm delivery) are statistically elevated in women with endometriosis. Furthermore, ruptured ovarian endometrioma, appendicitis, intestinal perforation, and hemoperitoneum have been described in pregnancy. Obstetricians are largely unfamiliar with these complications, as they have not been thoroughly investigated. The development and pathogenesis of endometriosis is an important field of study and has not yet been fully elucidated. Finding these mechanisms is crucial for the development of new and more effective strategies to treat this condition. Endometriosis can have an impact on obstetric and neonatal outcomes of pregnancy, in addition to its potential effects on conception. To date, no additional monitoring is recommended for pregnancies with a history of endometriosis. However, more studies are urgently needed to assess the need for the tailored pregnancy monitoring of women with endometriosis.

Obstetrical and neonatal outcomes of pregnancies complicated by sarcoidosis

Obstetrical and neonatal outcomes of pregnancies complicated by sarcoidosis

Enhancing Maternal and Neonatal Outcomes in High-Risk Pregnancies: The Efficacy of Staged Nursing and Nutritional Interventions

Considering the escalating prevalence of high-risk pregnancies encountered in clinical settings, the imperative to safeguard the well-being and survival of both high-risk pregnant women and their babies represents a hotspot of clinical research. This study investigated the clinical effects of an innovative care model for high-risk pregnancies, specifically a combination of staged nursing and nutritional interventions, on maternal nutritional status. Initially, 96 pregnant women were assigned randomly into two groups: a control group receiving routine care and a research group benefiting from the combined approach of staged nursing and nutritional interventions. Comparative analysis revealed that the research group experienced a significant reduction in labor duration and a decrease in the incidence of adverse pregnancy outcomes, thereby highlighting the efficacy of this combined approach in enhancing the safety of childbirth for high-risk pregnancies. Additionally, the research group exhibited more significant improvements in nutritional status than the control group, further endorsing the combined approach as a more effective and reliable safeguard for the health of high-risk pregnant women. Therefore, the implementation of staged nursing in conjunction with nutritional interventions is advocated for use during childbirth in high-risk pregnancies.

Umbilical–portal–systemic venous shunt and intrauterine growth restriction: an inquiry from a prospective study

BackgroundThe investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several retrospective small studies have reported a well-established association between umbilical–portal–systemic venous shunts and fetal growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined. ObjectivesThe aims of this study were:1. To determine the prevalence of fetal umbilical–portal–systemic venous shunts in pregnancies complicated by fetal growth restriction.2. To compare the perinatal and neonatal outcome of fetal growth restriction pregnancies with and without umbilical–portal–systemic venous shunts. Study DesignA prospective cross-sectional study of pregnancies diagnosed with fetal growth restriction, as defined by the Society for Maternal-Fetal Medicine fetal growth restriction guidelines. All participants underwent a detailed anomaly scan supplemented with a targeted scan of the fetal portal system. Venous shunts were diagnosed using color Doppler mode. The perinatal outcomes of fetal growth restriction pregnancies with and without umbilical–portal–systemic venous shunts were compared. ResultsOne hundred and fifty cases of fetal growth restriction were recruited. The prevalence of umbilical–portal–systemic venous shunts in our cohort was 9.3% (n=14). Compared to the control group (fetal growth restriction without umbilical–portal–systemic venous shunts, n=136), the study group had a significantly lower mean gestational age at time of fetal growth restriction diagnosis [29.7 (±5.6) vs. 32.47 (±4.6) weeks of gestation, p=0.036] as well as an earlier gestational week at delivery [33.50 (±6.0) vs. 36.13 (±2.8), p=0.005]. The study group had a higher rate of fetal death (21.4% vs. 0.7%, p<0.001) and accordingly a lower rate of live births (71.4% vs. 95.6%, p=0.001). Associated additional fetal vascular anomalies were significantly more prevalent in the study group compared to controls (35.7% vs. 4.4%, respectively, p=<0.001). The rate of other associated anomalies was similar. The study group had a significantly lower rate of abnormal uterine artery Doppler indices (0% vs. 40.4% p=0.011) and a higher rate of abnormal ductus venosus Doppler indices (64.3% vs. 23% p=0.001). There were no cases of hypertensive disorders of pregnancy in the study group compared to 12.5% in the control group (p=0.16). Other perinatal and neonatal outcomes were comparable. ConclusionsUmbilical–portal–systemic venous shunt is a relatively common finding in growth restricted fetuses. Compared to fetal growth restriction pregnancies with a normal portal system, these pregnancies complicated by FGR and umbilical–portal–systemic venous shunt are associated with different Doppler flow pattern, increased risk for fetal death, earlier presentation of fetal growth restriction, lower gestational age at delivery, additional congenital vascular anomalies and a lower rate of pregnancy induced hypertensive disorders. Meticulous sonographic evaluation of the portal system should be considered in the prenatal workup of fetal growth restriction, as umbilical–portal–systemic venous shunts may have implications on perinatal outcome.

Co-existing chronic hypertension and hypertensive disorders of pregnancy and associated adverse pregnancy outcomes

Objective Chronic hypertension (CHTN) causes vascular damage and resistance in the pregnant person and malperfusion in the placenta which may worsen the endothelial dysfunction of hypertensive disorders of pregnancy (HDP). These conditions frequently co-exist. A cumulative effect has been inconsistently demonstrated in prior studies, and it is unclear how co-existing hypertensive conditions affect pregnancy outcomes. We sought to examine maternal and neonatal outcomes in pregnancies affected by co-existing CHTN and HDP and compare these outcomes to those of pregnancies which were unaffected or affected by either condition alone. Methods This is a retrospective cohort study of singleton deliveries at a single institution 1 October 2013 to 1 October 2021. Data were extracted from the electronic medical record using standardized definitions and billing and diagnosis codes. Pregnant people with no evidence of hypertensive condition were compared to those with CHTN only, HDP only, and co-existing CHTN and HDP. Demographics, baseline clinical data, and use of aspirin or antihypertensive medications were assessed. Maternal outcomes included cesarean delivery, critical range blood pressure, intensive care unit (ICU) admission, and death. Neonatal outcomes included preterm birth <37 weeks’ gestation, small for gestational age (SGA) birthweight, ICU admission, and a morbidity composite. Bivariate tests of association were performed using Chi-square test. Crude and adjusted odds ratios (aORs) were calculated using logistic regression for three maternal and four neonatal outcomes. Descriptive statistics and multivariable analyses were performed. Results Of 40,840 eligible people, 1451 (3.6%) had CHTN only; 5213 (12.8%) had HDP only; and 1890 (4.6%) had co-existing CHTN and HDP. Though odds of adverse maternal and neonatal outcomes were significantly increased for all hypertensive groups relative to the unaffected referent group, co-existing CHTN and HDP had the highest odds of cesarean delivery (aOR 1.60; 95% confidence interval (CI) 1.45–1.77), critical blood pressure (OR 41.54; 95% CI 35.96–47.99), maternal ICU admission or death (aOR 3.52; 95% CI 2.65–4.67), preterm birth (aOR 2.76; 95% CI 2.41–3.16), and SGA birthweight (aOR 1.61; 95% CI 1.39–1.87). Conclusions Hypertensive disorders of pregnancy in the setting of CHTN are associated with the highest odds of serious consequences on the pregnant person and neonate independent of maternal comorbidities and prematurity. Antihypertensive medication use lowers the odds of some adverse outcomes. Patients should be informed of heightened risks, but optimal management remains unclear.

996 Maternal and neonatal outcomes of pregnancies with PPROM following expectant management or elective termination

996 Maternal and neonatal outcomes of pregnancies with PPROM following expectant management or elective termination

A Retrospective Study on Maternal and Neonatal Outcomes of Adolescent Pregnancies at a Referral Hospital in Bengaluru

Background and Aim: Adolescent pregnancy has become an important health and social issue in both developing and developed countries. According to the National Family Health Survey-5, the prevalence of adolescent pregnancy in India is 6.8%. Adolescent pregnancy has shown association with preterm birth, low birth weight, perinatal death, miscarriage, puerperal sepsis, mental illness, and maternal death. With this background, this study was taken up with the objective to delineate the maternal and neonatal complications seen in teenage pregnant women. Materials and Methods: This study was a retrospective case record analysis with descriptive study design of all adolescent pregnancies delivered between October 2021 and September 2022 with mother’s age being ≤19 years, at a first referral hospital in Bengaluru were included in the study. Participants who could not be contacted were excluded from the study. Results: Out of the 1005 deliveries during the study period, 55 were adolescent pregnancy with a proportion of 5.47%. The most common maternal complication is pregnancy-induced hypertension (8.5%) and the most common neonatal complication is low birth weight (21.2%). Conclusions: Despite continuous and consistent efforts by the health-care administration and health-care personnel under maternal and child national health program, the expected outcomes in terms of usage of contraception and delaying first pregnancy have not been attained.

Prevalance of impaired glucose tolerance and its association with adverse perinatal outcomes in non-gestational diabetes pregnancies

Objective: Gestational diabetes mellitus (GDM) is characterized by glucose intolerance with onset during pregnancy and is one of the most common metabolic disorders complicating pregnancy. The aim of this study was to evaluate the risk of maternal and neonatal outcomes in non-gestational diabetes pregnancies with abnormal glucose challenge test (GCT) and abnormal glucose tolerance test (GTT) results.&#x0D; &#x0D; Methods: In this retrospective cohort study of 2982 singleton pregnancies, all patients underwent a non-fasting 50 g GCT at 24 to 28 weeks of gestation. A GCT cutoff of ≥ 140 mg/dl was selected. Women with an elevated GCT underwent prompt diagnostic testing with a 3-hour GTT. Subjects were divided into four groups according to GCT and GTT results.&#x0D; &#x0D; Results: There was an impaired glucose tolerance in 19.2 % of patients and 14.7 % of them had mild glucose intolerance and 4.5 % of them had moderate glucose intolerance. As expected, there was statistically significant difference in fetal macrosomia, neonatal hypoglicemia, PE, primary CS, and preterm birth between secreening negative and GDM patients (p &lt; 0.0001). We also observed statistically significant difference in neonatal hypoglicemia (p = 0.0001) and PE (p = 0.0277) between screning negative and mild glucose intolerance group. Moreover, there was a significant difference in fetal macrosomia (p=0.0480) between mild glucose intolerance and moderate glucose intolerance groups.&#x0D; &#x0D; Conclusion: Compared with screening negative group, mild and moderate glucose intolerance are associated with increased adverse maternal and neonatal outcomes even in the absence of GDM.

THE INFLUENCE OF ANEMIA ON MATERNAL AND NEONATAL OUTCOMES IN TEEN AGED PREGNANT WOMEN

This retrospective study, conducted between October 2022 and October 2023 at Maroof International Hospital &amp; Life Care International Hospital in Pakistan, aimed to assess the impact of anemia on neonatal and maternal outcomes in teenage pregnancies. The study included 585 pregnant women aged 13-19 years, with data collected on various parameters such as demographic details, pregnancy-related information, hemoglobin levels during the last trimester, birth weight, gestational age at birth, obstetric complications, neonatal intensive care admissions, and Apgar scores. Among the 585 participants, 212 (36.2%) were identified as having anemia. Further classification revealed that 57.5% experienced mild anemia, 39% had moderate anemia, and 3.5% had severe anemia. Educational status and irregularities in antepartum care showed significant differences between anemic and non-anemic groups (P &lt; 0.05). Anemia was notably higher in women with lower education levels and irregular antenatal care. The study found that anemia significantly increased the risks of postpartum hemorrhage (P=0.005) and postpartum transfusion (P&lt; 0.001). Additionally, infants born to anemic mothers exhibited a significantly higher rate of neonatal intensive care unit (NICU) admission (P&lt;0.001). Maternal anemia was also significantly associated with low birth weight, small for gestational age (SGA), and preterm delivery. However, anemia had no significant impact on Apgar scores. In conclusion, the study underscores the prevalence of anemia in teenage pregnancies and emphasizes its adverse effects on both fetal and maternal outcomes. The findings highlight the urgent need for governmental initiatives to enhance essential healthcare accessibility and improve antenatal care for this vulnerable demographic.

Comprehensive appraisal of pregnancy and neonatal outcomes in singleton pregnancies conceived via invitro fertilization in the USA (2016-2021).

We set out to compare adverse pregnancy and neonatal outcomes in singleton gestations conceived via invitro fertilization (IVF) to those conceived spontaneously. Retrospective, population-based cohort using the CDC Natality Live Birth database (2016-2021). All singleton births were stratified into two groups: those conceived via IVF, and those conceived spontaneously. The incidence of several adverse pregnancy and neonatal outcomes was compared between the two groups using Pearson's chi-square test with Bonferroni adjustments. Multivariate logistic regression was used to adjust outcomes for potential confounders. Singleton live births conceived by IVF comprised 0.86 % of the cohort (179,987 of 20,930,668). Baseline characteristics varied significantly between the groups. After adjusting for confounding variables, pregnancies conceived via IVF were associated with an increased risk of several adverse pregnancy and neonatal outcomes compared to those conceived spontaneously. The maternal adverse outcomes with the highest risk in IVF pregnancies included maternal transfusion, unplanned hysterectomy, and maternal intensive care unit admission. Increased rates of hypertensive disorder of pregnancy, preterm birth (delivery <37weeks of gestation), and cesarean delivery were also noted. The highest risk neonatal adverse outcomes associated with IVF included immediate and prolonged ventilation, neonatal seizures, and neonatal intensive care unit admissions, among others. Based on this large contemporary United States cohort, the risk of several adverse pregnancy and neonatal outcomes is increased in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Obstetricians should be conscious of these associations while caring for and counseling pregnancies conceived via IVF.

How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations

ObjectiveThis study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic. Study designThis is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once. Results and conclusionIVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20–1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04–1.41), preeclampsia (aOR 1.31, 95 % CI 1.19–1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13–1.41) and placenta previa (aOR 1.7, 95 % CI 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10–1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16–1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37–2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26–1.63) and transfusions (aOR 1.48, 95 %CI 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12–1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.

Re-evaluation of umbilical cord coiling index in adverse pregnancy outcome – Does it have role in obstetric management?

IntroductionThe placenta with the umbilical cord is a vital link between the mother and fetus. Umbilical cord supplies water, nutrients and oxygen from the mother to the fetus. The most unique character of the umbilical cord is its coiling, where the contents of the cord course in a coiled helical fashion. The umbilical coiling index(UCI) can be measured antenatally using ultrasonography. In the present study we have attempted to assess the UCI antenatally by ultrasound screening and correlate abnormal antenatal UCI with the adverse maternal and neonatal outcome of pregnancy. AimsTo study umbilical coiling index ultrasonographically and to correlate it with pregnancy outcome. Methodology150 antenatal cases in the second trimester of pregnancy between 22 and 28weeks of gestation attending the outpatient department were included for the study in a continuous manner and subjected to antenatal UCI measurement. The cases were followed up till delivery and various factors were noted. ResultsWe confirmed that maternal medical comorbidities ( gestational hypertension and anemia) have a significant correlation with abnormal umbilical cord coiling index, either hyper-coiling or hypo-coiling or both.Some studies have shown a particular adverse effect being manifested in both hypo and hypercoiling. In the present study significant correlation of abnormal coiling has been found with only anaemia and hypertension in pregnancy. The question, therefore, arises:“Does abnormal UCI have any significant role in prediction of adverse outcome in pregnancy or is it just a random association?” This study does not reflect any significant role of abnormal UCI in the prediction of adverse perinatal outcome. Hence efforts to monitor UCI in the antenatal period may not have any justification in the present scenario. The latest edition of William’s Obstetrics also makes a similar comment. A population based larger study to generate cut offs for hypo and hyper coiling and finding any association between abnormal coiling and perinatal outcome may throw more light on the utility of UCI as a predictor of adverse outcome in pregnancy.

Predicting adverse perinatal outcomes among gestational diabetes complicated pregnancies using neural network algorithm

Objective The primary aim of this study is to utilize a neural network model to predict adverse neonatal outcomes in pregnancies complicated by gestational diabetes (GDM). Design Our model, based on XGBoost, was implemented using Python 3.6 with the Keras framework built on TensorFlow by Google. We sourced data from medical records of GDM-diagnosed individuals who delivered at our tertiary medical center between 2012 and 2016. The model included simple pregnancy parameters, maternal age, body mass index (BMI), parity, gravity, results of oral glucose tests, treatment modality, and glycemic control. The composite neonatal adverse outcomes defined as one of the following: large or small for gestational age, shoulder dystocia, fetal umbilical pH less than 7.2, neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), hyperbilirubinemia, or polycythemia. For the machine training phase, 70% of the cohort was randomly chosen. Each sample in this set consisted of baseline parameters and the composite outcome. The remaining samples were then employed to assess the accuracy of our model. Results The study encompassed a total of 452 participants. The composite adverse outcome occurred in 29% of cases. Our model exhibited prediction accuracies of 82% at the time of GDM diagnosis and 91% at delivery. The factors most contributing to the prediction model were maternal age, pre-pregnancy BMI, and the results of the single 3-h 100 g oral glucose tolerance test. Conclusion Our advanced neural network algorithm has significant potential in predicting adverse neonatal outcomes in GDM-diagnosed individuals.

Intended delivery mode and neonatal outcomes in pregnancies with fetal growth restriction

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode. Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios. Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively (p < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], p = 0.001; aOR 4.85 [95% CI 1.85, 12.66], p = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] p = 0.002; aOR 5.29 [95% CI 2.01, 13.87], p = 0.001) had higher odds of adverse neonatal outcomes. Conclusion: In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.

Obstetric and Neonatal Outcomes of Adolescent Pregnancies Compared with Adult Pregnancies at a Tertiary Care Hospital in Tak Province, Thailand

Objective: To compare obstetric and neonatal outcomes of adolescent pregnancies with adult pregnancies at Somdej Phrachao Taksin Maharat Hospital, a tertiary hospital in Tak Province, Thailand. Materials and Methods: A retrospective cohort study was conducted at Somdej Phrachao Taksin Maharat Hospital in Tak province. Singleton pregnant women aged 12 to 34 years who delivered between January 2020 and December 2022 were recruited. Data on pregnancy and neonatal outcomes were collected and analyzed using descriptive and inferential statistics, including one-way ANOVA, Pearson correlation, Spearman’s rho correlation, and Pearson chi-square tests. Results: One thousand four hundred sixty-one pregnant women data was collected and divided into three groups, 20 to 34 years with 1,029 participants, 16 to 19 years with 358 participants, and 12 to 15 years with 74 participants. Pregnant women aged 19 or below had significantly higher rates of complications, such as anemia, preterm birth, and caesarean delivery, compared to those over 19 years (p&lt;0.05). Conclusion: Adolescent pregnancies showed more obstetric and neonatal complications. To reduce the problems, enhance sex education, birth control methods for teenagers, and appropriate antenatal care. Keywords: Adolescent pregnancy; Pregnancy complications; Tak province; Thailand