Obstetric Complications In Women Research Articles

Domestic Violence During Pregnancy and Risk of Obstetrical Complications

Context: Intimate partner violence is a phenomenon that affects a significant number of women and has an important impact on society. This conjugal violence against women can have important consequences on their health as well as on the health of the unborn child during pregnancy. Objectives and Methods: In order to assess the risk of obstetrical complications in women who are victims of domestic violence, we conducted a descriptive cross-sectional study with an analytical component to determine the association between domestic violence and obstetrical complications on the one hand, and to determine the factors associated with domestic violence on the other. The descriptive part consisted of determining the prevalence of domestic violence and neonatal complications, and describing the different types of violence. A questionnaire was self-administered to pregnant women who came for prenatal consultations at the Dschang District Hospital. Results: Amongst 320 women approached, 300 agreed to participate in the study. The overall prevalence of spousal violence was 37.33%, and the prevalence of spousal violence during pregnancy was 13.33%; the prevalence of neonatal complications was 20.7%, premature deliveries accounted for 7.7%, miscarriages 7%, stillbirths 6.7%, while the prevalence of low birth weight babies was 1.7%. Domestic violence was significantly associated with neonatal complications (OR=4.1 p value=0.000). Regarding the types of violence, verbal and psychological violence had a frequency of (108)36%, physical violence which represented (40) 13.3%, control and financial violence represented (23) 7.7% and (30) 10% respectively; sexual violence was the least represented with (20) 6.7%. Regarding the factors associated with domestic violence, the 25-34 age group of the woman (p value 0.02, OR: 4.2), consumption of alcohol by the partner (p value 0.02, OR: 4.14) and the history of violence before pregnancy (p value 0.001, OR: 92.91) were significantly associated with domestic violence. Conclusion: Early identification of abuse in pregnant women and taking steps to prevent it may reduce the occurrence of these adverse outcomes.

Obstetrical Complications in Women with Chorioamnionitis

Obstetrical Complications in Women with Chorioamnionitis

Obstetric complications in women who underwent conservative myomectomy before pregnancy

The article presents a literature review devoted to the obstetric complications in pregnant women after conservative myomectomy. The attention is paid to such a complication as uterine rupture. The authors consider impractical to evaluate the uterine scar before pregnancy using ultrasound methods and hysteroscopy.Uterine rupture of any type should be documented in the medical history (published), which allows the clinicians and women to better understand factors associated with the risk for rupture and to inform the patient’s decision to deliver by cesarean section or through the vagina.A review and analysis of a case of uterine rupture in a patient after conservative myomectomy is also performed. A 40-weeks pregnant woman was taken to the operating room 12 hours after the start of the acute uterine rupture clinic and decrease of hemodynamic parameters. About 2 liters of blood was found in the abdominal cavity, and a tear up to 7 cm long was determined in the area of the uterine fundus, closer to the left uterine angle. In the female outpatient consultation, during the observation of a pregnant woman who had the laparoscopic intervention – myomectomy, a diagnosis of “scar on the uterus” was not established. Medical documentation providing information on prior surgery was ignored and was not required. During the observation of the pregnant woman, the method of childbirth was not considered by the doctor’s council, and prenatal hospitalization was not performed.By studying the modern scientific sources, there is very little data about factors what increase the risk of uterine rupture, such as penetration into the uterine cavity. Performance of laparoscopic intervention, as a rule, is associated with the implementation of reproductive function in the future. Obstetricians and gynecologists who perform surgical intervention should describe the operation protocol not formally, but taking into account the implementation of the reproductive function. For many women after myomectomy, vaginal delivery can be a safe and feasible option, with patient choice and informed consent regarding the mode of delivery is important. Women should be offered choice and provided with appropriate counseling using all available evidence and monitored during pregnancy and birth in health care institutions that support their choice. This article provides practical recommendations for the management of pregnancy and childbirth in patients who had conservative myomectomy.

PREDICTORS OF THE DEVELOPMENT OF OBSTETRICS COMPLICATIONS AND THE MANAGEMENT ALGORITHM OF PREGNANT WOMEN WITH CONNECTIVE TISSUE DYSPLASIA OF THE HEART

Pregnancy, even under the condition of its physiological course, is accompanied by tension of all functional systems of the body, which occurs already from the first trimester of pregnancy and increases during the period of their functional restructuring. In the presence of undifferentiated connective tissue dysplasia (UCTD), gestational processes may be disrupted and lead to obstetric losses. The purpose of the work is devoted to the optimization of pregnancy management tactics, treatment and prevention of obstetric complications in women with connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia, through the differentiated use of complex drug treatment, which makes it possible to normalize the main pathogenetic factors of the development of pregnancy complications with this comorbid pathology. Material and methods. To solve the goal, 164 pregnant women with signs of UCTD and mitral valve prolaps (MVP) and 26 healthy pregnant women were examined. In addition to a general clinical and obstetric examination, all pregnant women underwent a laboratory-instrumental study of the state of the fetus and fetoplacental complex, the state of the cardiovascular system, vascular endothelium, the activity of lipid peroxidation and antioxidant defense systems, and the determination of blood electrolyte balance. Research results and their discussion. It was established that the course of pregnancy in women with undifferentiated connective tissue dysplasia and mitral valve prolapse, complicated by extrasystolic arrhythmia (EA), is accompanied by a significantly higher frequency of obstetric and perinatal pregnancy complications during the entire gestation period (r=0.756-0.869, p<0.05). In pregnant women with UCTD and MVP syndrome, complicated by EA, the disease is clinically manifested by the development of both arrhythmic symptoms and signs of impaired vegetative status, which significantly shortens the time of blood supply and worsens metabolic processes in the myocardium and placenta, which are the direct causes of placental dysfunction, fetal growth retardation, the development of labor abnormalities and complications in the early postpartum period. The specified disorders in pregnant women with PMC on the background of UCTD are associated with hypo- and dyselectrolytemia of Mg2+, K+ and hypercalcemia, imbalances in the redox system, and the severity of endothelial dysfunction. In pregnant women with UCTD and MVP under the influence of the recommended treatment with arginine-carnitine and vitamin-mineral complex, the level of electrolytes, electrophysiological and functional indicators of the systolic-diastolic function of the myocardium were normalized to the level of healthy pregnant women due to the restoration of metabolic processes and improvement of peripheral hemodynamics, which was accompanied by satisfactory uterine placental-fetal blood flow (according to dopplerometry), a decrease in the frequency of miscarriage, preeclampsia, FGR and complications during childbirth and the postpartum period. Addition of the selective beta-adrenergic blocker nebivolol to the proposed medical support of pregnant women contributed to the elimination of extrasystole, was manifested by a reliable improvement of electrophysiological parameters and systolic-diastolic function of the heart. The obtained hemodynamic, antiarrhythmic and metabolic effects of the proposed complex therapy in pregnant women with UCTD and MVP complicated by extrasystolic arrhythmia were accompanied by a significant decrease in the frequency of pregnancy and childbirth complications. Conclusions. Recommended treatment algorithm have been proposed for the optimal management of pregnant women with UCTD and MVP syndrome, complicated by EA

Obstetric Complications in Women from Sub-Saharan Africa-A Cross-Sectional Study.

Aim: The aim of this study was to identify and compare birthing complications in women originating from countries where they are at risk (may become victims) of FGM with those of Spanish women, all having given birth from 2012 to 2015 at the “Virgen de la Arrixaca” University Clinical Hospital in Murcia, Spain. Methods: A transversal, observational, quantitative study was carried out, retrospectively, comparing 245 sub-Saharan women originating from countries where FGM is practiced with 490 Spanish women, in terms of obstetric complications. Data collection was performed via electronic clinical records. Results: The sub-Saharan women presented higher rates of intrapartum and emergency caesareans, intense postpartum haemorrhages, concurrent episiotomies and tears (2nd and 3rd degree), failed inductions, and non-progressive labours, and a more severe risk of foetal distress when compared with Spanish women. Conclusions: The fact that the sub-Saharan women originating from countries where FGM is practiced presented a greater number of birthing complications than the Spanish women proves the need for Spanish healthcare professionals to receive training towards cultural competency acquisition, in order to provide a multidisciplinary approach, with standardized action protocols focused fundamentally on prevention.

Impact of concomitant intrauterine adhesions on pregnancy outcomes and obstetric complications in women with a septate uterus.

To explore the impact of concomitant intrauterine adhesions (IUAs) on pregnancy outcomes and obstetric complications in women with a septate uterus. This retrospective cohort included women with a septate uterus, with or without IUAs, between 2015 and 2019 in our hospital. The main outcomes were clinical pregnancy rate, live-birth rate, and obstetric complications. A total of 336 women with a septate uterus-105 women (31.3%) with IUAs and 231 (68.7%) women without IUAs-were analyzed. The rates of clinical pregnancy and live birth among women with moderate-to-severe IUAs were significantly decreased compared with those among women without IUAs (69.9% vs. 76.6%, odds ratio [OR] 0.51; 95% confidence interval [CI] 0.27-0.99, P= 0.046, and 57.0% vs. 67.1%, OR 0.53; 95% CI 0.30-0.95, P= 0.032, respectively). However, these rates were similar between women with mild IUAs and women without IUAs. Women with moderate-to-severe IUAs had a higher incidence of abnormal placentation than women with a septum only (13.2% vs. 1.3%, P= 0.001). Concomitant moderate-to-severe IUAs significantly reduce the rates of clinical pregnancy and live birth and increase the risk of abnormal placentation in subsequent pregnancies in women with a septate uterus.

Increased risk of obstetric complications in patients with adenomyosis: A narrative literature review.

BackgroundReproductive‐age women occasionally face the pathological condition of adenomyosis, which is often concurrent with endometriosis. It is believed that endometriosis and adenomyosis increases the risk of obstetric complications. Although new insights into the mechanism of obstetric complications due to endometriosis are emerging, there is little information on the etiology of adverse pregnancy outcomes in pregnant women with adenomyosis.MethodsWe performed a literature review focusing on the pathophysiological pathways of obstetric complications in women with adenomyosis using currently available basic and clinical studies. We used the internet search engines PubMed and Google Scholar to search for studies published between January 2000 and June 2021. We carefully read pertinent sections within each document to ensure relevancy.Main findingsThe prevalence of adverse pregnancy outcomes in women with adenomyosis is increased after adjusting for conceiving by assisted reproductive technology. Thus, adenomyosis emerges as a relevant factor associated with several obstetric complications such as preterm birth, preterm premature rupture of membranes, placental abruption, small for gestational age/fetal growth restriction, and preeclampsia.ConclusionIt is plausible that the impact of adenomyosis on pregnancy outcomes is not always the same; rather it is dependent on the degree of uterine involvement and subtypes.

Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis.

To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. PROSPERO, CRD42021244487.

Challenges Regarding the Management of Gynecological and Obstetric Complications in Women with Inherited Factor XIII Deficiency

Women with rare bleeding disorders (RBDs) can be exposed throughout their life to several complications such as menorrhagia or hemorrhagic complications during pregnancies and deliveries. Among RBDs, factor XIII deficiency leads to life-threatening hemorrhages such as intracranial hemorrhage, and women during their reproductive period may experience gynecological and obstetric complications, and more specifically recurrent miscarriages due to the role of FXIII in placenta attachment. Because of the rarity of the disease, recommendations for the treatment are mainly based on expert consensus, and although the effectiveness of as-early-as-possible FXIII prophylaxis administration is largely recognized to prevent recurrent miscarriages, the dosage of this prophylaxis is still debated.

A Single Institutional Study on Pregnancy Outcomes in Patients with Von Willebrand Disease

Background:Von Willebrand Disease (VWD) is the most common inherited bleeding disorder in the United States. Despite von Willebrand factor (VWF) antigen and activity levels rising during pregnancy particularly in those with type 1 disease, there are several obstetric concerns regarding patients with VWD, including epidural management, mode of delivery, fetal outcome, and postpartum hemorrhage. Current guidelines suggest achieving a VWF activity (RCoF) and factor VIII:C level of at least 50 IU/dL before delivery, with maintenance > 50% of normal for at least 3-5 days.Aim:To investigate the incidence of obstetric complications in women with VWD and correlate maternal and fetal outcomes with VWF levels.Methods:We conducted a single-institution retrospective observational study reviewing the charts of all women diagnosed with VWD at the Hemophilia Treatment Center from January 2000 to June 2017. We included women with single or multiple pregnancies. We assessed the following obstetric outcomes: bleeding episodes during pregnancy, mode of delivery, use of epidural anesthesia, perioperative management of bleeding, prophylactic measures during peripartum period, presence of postpartum hemorrhage or excessive incisional bleeding, rate of spontaneous fetal loss, VWF/VIII:C levels during perioperative period, and transfusions. We excluded women with other diagnosed bleeding disorders. Statistical analyses were performed using the unpaired Student's t test.Results:The charts of 231 females with VWD were reviewed. There were 71 total pregnancies from 46 patients that were evaluable. 93.5% (43/46) patients had Type 1 VWD. 9.9% (7/71) had bleeding prior to delivery which included ecchymoses, mucosal or gingival bleeding, vaginal spotting, or epistaxis. Regional epidural anesthesia was performed in 16.9% (12/71) of cases with no bleeding complications reported. 25.4% had documented C-sections and 60.6% had vaginal deliveries. Postpartum bleeding (defined as immediate or delayed excessive vaginal or incisional bleeding) occurred in 29.6% (21/71) of cases; 38.9% (7/18) who underwent C-section and 25.6% (11/43) in vaginal deliveries. 50% (6/12) developed heavy bleeding despite receiving preoperative desmopressin (DDAVP) or human factor VIII/human VWF complex. 61.9% (13/21) required transfusions of blood products (either packed red blood cells or platelets), surgical dilation and curettage, IV/IN DDAVP or FVIII/VWF concentrates. 7% (5/71) had complications which included two ectopic pregnancies, two miscarriages, and one stillbirth, and one of these resulted in postpartum heavy bleeding (20%).The baseline and third trimester factor VIII:C and RCoF levels of non-bleeders and bleeders are shown in Table 1. The absolute difference in baseline levels of FVIII:C and RCoF compared to third trimester levels in non-bleeders was statistically significant: FVIII:C (p=0.0001; absolute difference of 53.6 IU/dL), RCoF (p=0.0001; absolute difference of 65.7 IU/dL), respectively. There was no statistically significant rise in FVIII:C nor RCoF levels from baseline to third trimester in women who had bleeding events (Table 1).Discussion:A reasonable estimate for the rate of postpartum hemorrhage in the general population is 1-5%. Our study demonstrated a much higher rate of postpartum bleeding in patients with VWD with a higher rate of hemorrhage in C-sections than vaginal deliveries. In those patients selected for epidural administration of regional anesthesia there were no complications. It appears that the rise in factor VIII:C and RCoF levels from baseline predicted the absence of bleeding and a larger absolute increase of VIII:C and RCoF from baseline levels predicted the absence of postpartum bleeding. In patients with postpartum bleeding, there was a smaller absolute increase in factor VIII:C and RCoF. In both groups, there were bleeding events despite prophylactic treatment prior to delivery.Conclusion:Our study suggests that greater increases of factor VIII:C and RCoF from baseline may predict the absence of postpartum hemorrhage in patients with VWD. Larger studies are needed to further elucidate the relationship between factor VIII:C and RCoF levels at baseline and peripartum and the risk of postpartum hemorrhage. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

What are the causes for low birthweight in Japan? A single hospital-based study.

Low-birthweight (LBW; <2,500 g) babies are at a higher risk of poor educational achievement, disability, and metabolic diseases than normal-birthweight babies in the future. However, reliable data on factors that contribute to LBW have not been considered previously. Therefore, we aimed to examine the distribution of the causes for LBW. A retrospective review of cases involving 4,224 babies whose mothers underwent perinatal care at Keio University Hospital between 2013 and 2019 was conducted. The LBW incidence was 24% (1,028 babies). Of the 1,028 LBW babies, 231 babies were from multiple pregnancies. Of the 797 singleton LBW babies, 518 (65%) were born preterm. Obstetric complications in women with preterm LBW babies included premature rupture of membrane or labor onset (31%), hypertensive disorders of pregnancy (HDP, 64%), fetal growth restriction (24%), non-reassuring fetal status (14%), and placental previa/vasa previa (8%). Of the 279 term LBW babies, 109 (39%) were small for gestational age. Multiple logistic regression analyses revealed the following factors as LBW risk factors in term neonates: low pre-pregnancy maternal weight, inadequate gestational weight gain, birth at 37 gestational weeks, HDP, anemia during pregnancy, female sex, and neonatal congenital anomalies. HDP was an LBW risk factor not only in preterm births but also in term births. Our results suggest that both modifiable and non-modifiable factors are causes for LBW. It may be appropriate to consider a heterogeneous rather than a simple classification of LBW and to evaluate future health risks based on contributing factors.

Birth defects of blood clotting factors and obstetric complications

The data about clinical signs, laboratory features and obstetrical complications in women with inherited blood coagulation defects are presented in the survey article. Multidisciplinary approach, including hematologist, obstetrician, laboratory technician, anesthesiologist, neonatologist and midwife, is needed in treatment and patient management. The delivery had to be planned in specialized institutions with clinical experience of managing women with birth defects of blood-coagulation factors.

Angiogenic markers predict kidney injury and obstetric complications in women with preeclampsia and pregnancy-related acute kidney injury.

Pregnancy-related acute kidney injury (PRAKI) particularly on top of preeclampsia (PE) represents a major cause of maternal and fetal morbidity and mortality. Reliable diagnostic tools are needed to further evaluate the diagnosis and prognosis of PRAKI. Our objective was to study the diagnostic and prognostic value of angiogenic markers (e.g., stromal cell-derived factor 1 (SDF-1), vascular endothelial growth factor (VEGF), alarmins as uric acid) in women with PE and PRAKI. This prospective study included three groups; PRAKI, PE patients, and healthy controls that were compared regarding serum levels of the studied markers correlated to renal, maternal, and fetal outcomes. SDF-1, VEGF, and uric acid levels were significantly different between the three included groups and predicted PRAKI diagnosis. Patients with hemolysis, elevated liver enzymes, and low platelet (HELLP) syndrome exhibited the highest titers of SDF-1 and VEGF. A positive correlation was found between SDF-1 and renal recovery. Conclusively, serum assays of SDF-1, VEGF, and uric acid may add a diagnostic value in PRAKI and PE.

Type 2B von Willebrand Disease in Pregnancy: A Systematic Literature Review.

Our objective was to review the maternal characteristics and obstetric complications in women with type 2B von Willebrand disease (VWD). A systematic literature search was conducted using PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov. We included all publications that addressed type 2B VWD in pregnancy. Our primary and secondary outcomes were incidence of postpartum hemorrhage (PPH) and incidence of thrombocytopenia in pregnancy. Two reviewers independently identified eligible studies and abstracted data including maternal characteristics, hematologic characteristics, treatment, and delivery outcomes. Twenty studies met inclusion criteria. There were 27 women (32 pregnancies) with type 2B VWD. Primary PPH was reported in 9/20 women (45%) and secondary PPH was reported in 6/13 women (46%). Thrombocytopenia in pregnancy was present in 27/28 women (96%); 23/27 women (85%) had platelet count <100 × 109/L, mean 33.7 ± 22.7 × 109/L. Factor concentrate treatment was administered before delivery (n = 16) and postpartum (n = 18), some women received both. Seventeen deliveries required blood products postpartum with 13/17 (76%) platelet transfusions and 6/17 (35%) red blood cell transfusions. No maternal mortality was reported. Women with type 2B VWD have significant morbidity in pregnancy related to high incidence of severe thrombocytopenia and primary and secondary PPH.

Pregnancy and obstetric complications in women with a history of childhood maltreatment: Results from a nationally representative sample

IntroductionA history of childhood maltreatment is associated with increased risk of perinatal complications, with research primarily focused on childhood sexual abuse. Limited research has examined the relationship between different types of childhood maltreatment on perinatal complications, particularly in population-based samples. MethodsThis study examined the association between childhood maltreatment and self-reported perinatal complications in a sample of pregnant and postpartum women (n = 1279) drawn from the 2012–2013 NESARC-III, a nationally representative survey of United States adults. ResultsNearly half (45%) of pregnant or postpartum women reported at least one form of childhood maltreatment and a quarter (24.6%) of these women experienced a perinatal complication compared to 13.5% of women without a history of childhood maltreatment. Exposure to any childhood maltreatment, childhood sexual abuse and intimate partner violence (IPV) during childhood were significantly associated with increased odds of perinatal complications after adjusting for sociodemographic characteristics and lifetime psychiatric disorders (AOR ranged from 1.87 to 2.09). Experiencing two or more types of childhood maltreatment (compared to none) was also associated with increased odds of perinatal complications (AOR 2.18 [99% CI = 1.22, 3.90]). ConclusionsThis association may be explained by vulnerability to physical diseases/complications due to persistent changes in biological stress systems, physical injuries from abuse, or as a result of traumatic memories triggered by pregnancy and childbirth. Findings highlight one of many negative sequelae of childhood maltreatment and the importance of promoting healthcare provider awareness of this association so they can provide appropriate interventions when needed.

Осложнения беременности, родов и послеродового периода у женщин с гипоталамическим ожирением в подростковом возрасте

Objective. To study the features of the course of pregnancy and to identify the main risk factors for the development of obstetric complications in women with hypothalamic dysfunction (HD) and obesity in medical history. Patients and methods. In this study, 72 women of reproductive age with HD and metabolic disorders in medical history were examined. Results. For women with hypothalamic dysfunction and metabolic disorders in medical history, the following pregnancy complications were identified: threatened miscarriage in 16.7%, spontaneous abortion in 11.1%, pre-eclampsia in 20.3%, edema with proteinuria, gestational diabetes mellitus, intrauterine hypoxia and anemia – 17.2% each, threatened preterm labor in 9.4%, labor disorders in 23.4%; every second postpartum woman had hypogalactia. Conclusion. The risk group for early pregnancy loss should include women with HD and metabolic disorders in medical history who had secondary amenorrhea. The risk group for the development of gestational diabetes mellitus should include women with HD and metabolic disorders in medical history who plan infertility treatment by means of assisted reproductive technologies. Key words: obstetric complications, pregnancy, hypothalamic dysfunction, obesity, puberty, risk factors

Type 2B Von Willebrand Disease in Pregnancy: A Systematic Literature Review [36K

INTRODUCTION: Type 2B Von Willebrand Disease (VWD) is a rare hereditary bleeding disorder that is associated with thrombocytopenia. Our objective was to review obstetric complications in women with Type 2B VWD. METHODS: A systematic literature search was conducted using PubMed, Scopus, and Cochrane Central Register of Controlled Trials to include all publications that address Type 2B VWD in pregnancy. Our primary and secondary outcomes were incidence of postpartum hemorrhage (PPH) and incidence of thrombocytopenia in pregnancy, respectively. RESULTS: 20 studies met inclusion criteria. There were 32 pregnancies with Type 2B VWD in 27 women. Primary PPH was reported in 9/20 (45%) and secondary PPH was reported in 6/13 (46%) and occurred between 5-32 days. Factor concentrate treatment was administered before delivery and postpartum in 16 and 18 pregnancies, respectively. 17 pregnancies required blood products postpartum. Platelet transfusion was given in 13/17 (76%) pregnancies. Red blood cell transfusion was performed in 6/17 (35%) pregnancies. Thrombocytopenia in pregnancy was reported in 27/28 (96%). 23/27 (85%) were severe thrombocytopenia with mean platelet count of 33.7±22.7 × 103/ul and 4/27 (15%) were mild thrombocytopenia (range, 126-150 × 103/ul). No maternal mortality was reported. CONCLUSION: Type 2B VWD in pregnancy has significant morbidity, with high incidence of primary and secondary PPH. The majority of patients required the use of factor concentrate before and after delivery in addition to postpartum blood products. The incidence of severe thrombocytopenia was also high, indicating that Type 2B VWD should be considered in the differential diagnosis of severe thrombocytopenia in pregnancy.

Painful gynecologic and obstetric complications of female genital mutilation/cutting: A systematic review and meta-analysis.

BackgroundThe health complications experienced by women having undergone female genital mutilation/cutting (FGM/C) are a source of growing concern to healthcare workers globally as forced displacement and migration from countries with high rates of this practice increases. In this systematic review and meta-analysis, we investigate the association between FGM/C and painful gynecologic and obstetric complications in women affected by the practice.Methods and findingsWe performed a comprehensive literature search from inception to December 19, 2019 of Ovid MEDLINE, Ovid EMBASE, The Cochrane Library (Wiley), and POPLINE (prior to its retirement) for studies mentioning FGM/C. Two reviewers independently screened studies reporting prevalences of painful gynecologic and obstetric sequelae resulting from FGM/C. Random effects models were used to estimate pooled odds ratios (ORs) for outcomes obtained from cross-sectional, cohort, and case–control designs. Subgroup analysis was performed to assess and control for effect differences introduced by study design. Validated appraisal tools were utilized to assess quality and risk of bias. Our study was registered with PROSPERO. Two reviewers independently screened 6,666 abstracts. Of 559 full-text studies assessed for eligibility, 116 met eligibility criteria, which included studies describing the incidence or prevalence of painful sequelae associated with FGM/C. Pooled analyses after adjustment for study design found that FGM/C was associated with dyspareunia (6,283 FGM/C and 3,382 non-FGM/C participants; pooled OR: 2.47; 95% confidence interval [CI]: 1.45–4.21; I2: 79%; p-value < 0.01), perineal tears (4,898 FGM/C and 4,229 non-FGM/C participants; pooled OR: 2.63; 95% CI: 1.35–5.11; I2: 67%; p-value = 0.01), dysuria (3,686 FGM/C and 3,482 non-FGM/C participants; pooled OR: 1.43; 95% CI: 1.17–1.75; I2: 0%; p-value = 0.01), episiotomy (29,341 FGM/C and 39,260 non-FGM/C participants; pooled OR: 1.89; 95% CI: 1.26–2.82; I2: 96%; p-value < 0.01), and prolonged labor (7,516 FGM/C and 8,060 non-FGM/C participants; pooled OR: 2.04; 95% CI: 1.27–3.28; I2: 90%; p-value < 0.01). There was insufficient evidence to conclude that there was an association between FGM/C and dysmenorrhea (7,349 FGM/C and 4,411 non-FGM/C participants; pooled OR: 1.66; 95% CI: 0.97–2.84; I2: 86%; p-value = 0.06), urinary tract infection (4,493 FGM/C and 3,776 non-FGM/C participants; pooled OR: 2.11; 95% CI: 0.80–5.54; I2: 90%; p-value = 0.10), instrumental delivery (5,176 FGM/C and 31,923 non-FGM/C participants; pooled OR: 1.18; 95% CI: 0.78–1.79; I2: 63%; p-value = 0.40), or cesarean delivery (34,693 FGM/C and 46,013 non-FGM/C participants; pooled OR: 1.51; 95% CI: 0.99–2.30; I2: 96%; p-value = 0.05). Studies generally met quality assurance criteria. Limitations of this study include the largely suboptimal quality of studies.ConclusionsIn this study, we observed that specific painful outcomes are significantly more common in participants with FGM/C. Women who underwent FGM/C were around twice as likely as non-FGM/C women to experience dyspareunia, perineal tears, prolonged labor, and episiotomy. These data indicate that providers must familiarize themselves with the unique health consequences of FGM/C, including accurate diagnosis, pain management, and obstetric planning.Review protocol registrationThe review protocol registration in PROSPERO is CRD42018115848.

Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review.

Takayasu arteritis (TAK) is a large vessel vasculitis affecting young women of childbearing age. The outcome of pregnancies in TAK patients, factors associated with maternal and foetal complications and adverse outcomes were analysed. All pregnancies in women with a TAK diagnosis were retrospectively included from 20 French hospitals providing care for TAK, until August 2015. The study consisted of 43 pregnancies in 33 women, including 29 with a pre-existing TAK diagnosis and 4 diagnosed during pregnancy. Complications were observed in 20 pregnancies (47%), including 35% with arterial hypertension (n = 15), 9% with pre-eclampsia (n = 4), 2% with HELLP syndrome (n = 1) and 14% with intrauterine growth restriction (IUGR, n = 6, leading in one case to a medically indicated termination of pregnancy). There were 42 live births (98%) at a median term of 38 [27-42] weeks gestation including 9 before 37weeks (21%). The median birth weight was 2940 [610-4310] grams. Five children (12%) required transfer to a neonatal intensive care unit. One premature boy (27weeks gestation) died after 2days. Treatment during pregnancy included steroids (n = 25/43; 58%), azathioprine (n = 9/43; 21%) and infliximab (n = 1/43; 2%). The risk of developing arterial hypertension during pregnancy was associated with previous chronic arterial hypertension and with an infra-diaphragmatic vasculitis injury (P = 0.01 and P = 0.04, respectively). No correlation was reported between TAK activity and any of the obstetrical complications described in the study. This study showed a high rate of adverse obstetrical complications without significant impact on live birth rates. Pregnancy did not appear to influence TAK disease activity. Key Points • We observed a high rate of adverse obstetrical complications in women with Takayasu arteritis; however, the rate of live births was high. Pregnancy did not appear to influence TA disease activity.

Risk of pregnancy-related venous thromboembolism and obstetrical complications in women with inherited type I antithrombin deficiency: a retrospective, single-centre, cohort study

Inherited quantitative (type I) deficiency of plasma antithrombin is associated with a high risk of venous thromboembolism, which further increases in pregnancy. Inherited thrombophilia also increases the risk of obstetrical complications, but data on maternal and fetal outcomes in women with antithrombin deficiency are scarce. The aim of this study was to evaluate the risk of pregnancy-associated venous thromboembolism and obstetrical complications in women with type I antithrombin deficiency. In this single-centre, retrospective cohort study, women who had been referred to our Hemophilia and Thrombosis Centre, Milan, Italy for a thrombophilia work-up from Jan 1, 1980, to Jan 1, 2018, with type I antithrombin deficiency and who had had at least one pregnancy were included. Women with type II anthithrombin deficiency were excluded from the study. Data on pregnancy-associated venous thromboembolism, pregnancy outcomes, and the use of low-molecular-weight heparin (LMWH) were collected to evaluate the risk of pregnancy-associated venous thromboembolism and obstetrical complications with or without use of LMWH. 126 women had been referred to the hospital, of whom 88 (70%) had had at least one pregnancy. Eight were excluded because of referral for venous thromboembolism during pregnancy or the puerperium, resulting in 80 (63%)women evaluated for the risk of venous thromboembolism. One woman was excluded because of referral for obstetrical complications, resulting in 87 (69%) evaluated for risk of obstetrical complications. We observed three events of venous thromboembolism in 43 pregnancies in women treated with LMWH (7·0%, 95% CI 1·8-17·8), and 17 events in 146 pregnancies in women who did not receive LMWH (11·6%, 7·2-17·6; relative risk [RR] 0·6, 95% CI 0·2-1·9; p=0·57). The risk of venous thromboembolism without LMWH was 5·4% (95% CI 0·9-16·7) in women with a negative family history of venous thromboembolism, and 11·8% (6·4-19·6) in those with a positive family history of venous thromboembolism. Of the 87 women evaluated for the risk of obstetrical complications, miscarriages occurred in 6 (13%) of 45 pregnant women treated with LMWH and 32 (20%) of 161 women who did not receive LMWH (terminations excluded). Late obstetrical complications occurred in 11 (24%) of women treated with LMWH and nine (6%) in those who did not receive LMWH (RR 4·4, 95% CI 1·9-9·9; p=0·0006). Our results confirm that women with type I antithrombin deficiency have a high risk of first or recurrent venous thromboembolism during pregnancy. The risk of venous thromboembolism is highest in women with a positive family history of the condition, but still relevant in those with a negative family history, suggesting that LMWH prophylaxis should also be considered in these patients. None.