Obstetric Outcomes In Patients Research Articles

162 - Minimally Invasive Abdominal Cerclage Compared to Laparotomy: a Comparison of Surgical and Obstetric Outcomes

Study Objective The objective of this study is to report surgical and obstetric outcomes of patients following abdominal cerclage placement through either minimally invasive (MIS) or open techniques. We previously published a study comparing eleven MIS and nine open abdominal cerclage recipients, and here we give an updated report on this infrequently performed procedure. Design Retrospective cohort study. Setting Referral centers specializing in high risk pregnancy and minimally invasive gynecologic surgery. Patients or Participants Women who underwent abdominal cerclage placement either during pregnancy or prior to conception via laparoscopy or laparotomy at Yale New Haven or Bridgeport Hospital between December 2011 through December 2019. Interventions One cohort of women had their abdominal cerclage placed using conventional or robotic-assisted laparoscopy. The other cohort consisted of women whose abdominal cerclage was placed through laparotomy. Electronic medical charts were reviewed to collect baseline demographic and pre-procedure obstetric information, as well as surgical and post-procedure obstetric outcomes. Measurements and Main Results Twenty-three minimally invasive and 14 open abdominal cerclages were performed during the study period. Fifteen of the MIS and three open cerclages were performed as interval procedures, when patients were not pregnant. Average operative time was longer in the minimally invasive cohort by 40 minutes. Estimated blood loss was lower in the minimally invasive group (43mL in MIS vs 167mL in open cohorts). Length of hospital stay was shorter in the MIS group (0.2 days vs 2.1 days). Post-procedure obstetric outcomes were similar between the two cohorts, and cerclages placed during pregnancy resulted in live birth or maintenance of pregnancy in 88% of MIS and 82% of open cases. Conclusion Minimally invasive abdominal cerclage is a safe alternative to laparotomy, when performed by a surgeon with appropriate training and technical skills, providing patients with improved surgical outcomes without impairing the obstetric outcomes.

Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study

BackgroundDuring pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF.MethodsIn this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan’s National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF.ResultsFrom 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/105). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29–83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28–16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94–18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27–17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89–6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001).ConclusionMaternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or gestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had a higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.

Minimally invasive abdominal cerclage compared to laparotomy: a comparison of surgical and obstetric outcomes.

The objective of this study is to report surgical and obstetric outcomes of patients following abdominal cerclage placement through either minimally invasive or open techniques. Subjects of this retrospective cohort study were patients at two referral centers specializing in high-risk pregnancy and minimally invasive gynecologic surgery. Electronic medical records of all patients who underwent abdominal cerclage placement between December 2011 and December 2015 at Yale New Haven Hospital and Bridgeport Hospital were reviewed. The patients included were women who underwent abdominal cerclage placement either during pregnancy or prior to conception. One cohort of women had their abdominal cerclage placed using traditional laparoscopy or robotic-assisted laparoscopy. The other cohort consisted of women whose abdominal cerclage was placed through laparotomy. Electronic medical charts were reviewed to collect baseline demographic and pre-procedure obstetric information, as well as surgical and subsequent obstetric outcomes. Eleven minimally invasive and nine open abdominal cerclages were performed during the study period. Seven of the minimally invasive and two open cerclages were done outside of pregnancy. Average operative time was longer in the minimally invasive cohort. Estimated blood loss was typically lower in the minimally invasive group. Length of hospital stay was shorter in the minimally invasive group. Obstetric outcomes were similar between the two cohorts, with a total of nine live births in the minimally invasive group and seven live births in the open group. Minimally invasive abdominal cerclage is a safe alternative when performed by a surgeon with appropriate training and technical skills, and obstetric outcomes are comparable to those after open abdominal cerclage.

Obstetric outcomes of patients undergoing abdominal radical trachelectomy for early-stage cervical cancer: The largest series based on 12 years of experience from China

Obstetric outcomes of patients undergoing abdominal radical trachelectomy for early-stage cervical cancer: The largest series based on 12 years of experience from China

Fetal Anomalies and Labor Complications [36K

INTRODUCTION: The purpose of this study was to evaluate labor complications and obstetric outcomes in patients diagnosed with fetal anomalies. METHODS: Using the Safe Labor Consortium, a retrospective dataset including labor information from 19 United States hospitals collected from 2002-2008, we compared patients diagnosed with a viable infant with a fetal anomaly to low risk singleton pregnancies. The primary outcome was need for operative vaginal delivery or cesarean delivery. Secondary outcomes include: maternal outcomes–bleeding (administration of blood products, abruption, postpartum hemorrhage, uterine rupture, hysterectomy), malpresentation, maternal ICU admission or death, chorioamnionitis/endometritis, lacerations (third- or fourth-degree), shoulder dystocia and birth injury. Chi-Square or Fisher's exact test was used to examine the association between anomaly and secondary outcomes. Odds ratios and confidence intervals were calculated. RESULTS: We evaluated 5360 patients with a fetal anomalies and compared them to 93,129 patients with low risk singleton pregnancies. There was no significant difference in need for operative vaginal delivery between groups (OR 0.98 95% CI 0.88, 1.10). There was a significant increase risk of cesarean delivery in the patients with anomalies (OR 1.5 95% CI 1.39, 1.62), as well as incidence of malpresentation (OR 1.27 CI 1.11,1.45) and breech presentation (OR 1.7 CI 1.41, 2.18), intrapartum fetal distress (OR 1.30 CI 1.15, 1.48) and birth injury (OR 1.88 CI 1.53, 2.30). CONCLUSION: Patients diagnosed with a fetal anomaly are at increased risk of cesarean delivery, malpresentation and birth injury. These increased risks should be taken into consideration in management of these patients.

Cervicographic progress in active Phase and obstetric outcome in Patients undergoing labour under Epidural analgesia

Objective: To analyze the progress of labour and then the obstetric and fetal outcome of the patients who received epidural analgesia in labor and comparing them with those who did not receive epidural analgesia. Study design: Hospital based prospective comparative study. Methodology: The study involved 200 patients who were divided into 2 groups on the basis of whether they received epidural analgesia or not, with 100 patients in each group. The advantages and disadvantages of epidural analgesia were evaluated. Results: When compared with the non-epidural analgesia group (n = 100), the group that received epidural analgesia (n = 100) had significant prolongation in the duration of first and the second stage of labour and higher likelihood of instrumental delivery. 57.4% patients in the epidural group delivered to the left of the progress line whereas 69.6% patients in the control group delivered to the left. There was also an increased incidence of caesarean deliveries in the epidural group as compared to the control group but the difference was not significant statistically (20% Vs 17%, p&gt;0.05). There was no difference in the neonatal outcome of the patients who received epidural analgesia as compared to control group. Moreover, pain relief and maternal satisfaction was excellent in patients who requested epidural analgesia. Conclusion: Compared with other techniques, epidural analgesia is the most effective form of analgesia. Factors contributing to the progress and outcome of labour are multiple and complex. Epidurals do not increase caesarean section rates. However, we must strive to reduce any effect on duration of labour and instrumental vaginal delivery rates by minimizing motor block through the use of low dose local anaesthetic and opioid combinations. The addition of patient- controlled epidural analgesia and innovations using new technologies enhance patient satisfaction

Results of less radical fertility-sparing procedures with omitted parametrectomy for cervical cancer: 5 years of experience

ObjectiveThe aim of our study was to describe oncological and obstetrical outcomes in patients who underwent less radical fertility-sparing surgical (FSS) procedures with omitted parametrectomy for cervical cancer. MethodsIncluded were women with cervical cancer stages IA2–IB2 who were under the age of 40 and desired future pregnancy. Patients underwent pelvic lymphadenectomy and sentinel lymph node biopsy. Node-negative cases underwent subsequent cervical surgery and were further analyzed. Neoadjuvant chemotherapy (NAC) was administered in patients with tumors >2cm and/or involving >2/3 of cervical stroma. Simple vaginal trachelectomy or needle conization were performed according to tumor extent and topography. The follow-up period started once free surgical margins were reached. ResultsOut of 44 women enrolled, 32 women (IA2=7, IB1=23, IB2=2) successfully completed FSS. NAC was administered in 9 (28.1%) cases. A simple trachelectomy was performed in 11 patients and needle conization in 21 patients. During the follow-up, 6 out of 32 women became pregnant. Of these, 1 miscarried and 5 successfully delivered. Disease recurred in 6 patients; 5 recurrences were central and 1 recurrence presented as an ovarian mass. Invasive cervical carcinoma, high-grade squamous intraepithelial (HSIL), and low-grade squamous intraepithelial (LSIL) lesions were detected in 4, 1 and 1 patients, respectively. Three of them received NAC. All events were detected within 16months after surgery. ConclusionsNearly 27% of patients cannot complete FSS due to node positivity, progression during NAC, or involved margins. The total recurrence rate reached 18.8%, with the majority of invasive recurrences detected in patients after NAC followed by FSS. These patients represent cases at a higher risk of recurrence even if adequate free margins are reached by surgery. Nearly half of the cohort did not consider pregnancy in the near future because of personal reasons.

Triplet pregnancy the improving obstetrical outcome

Objective: The aim of this study was to evaluate the obstetrical outcomes in patients with triplet pregnancy, with and without antenatal care. Study Design: Case Series. Place and Duration of Study: The study was conducted at the Department of Obstetrics and Gynaecology, Services Hospital Lahore, from 1st January 1998 to 31st December 2003. Patients and Methods: Twelve women, including 6 booked and 6 unbooked patients, with triplet pregnancies of ?24 weeks of gestation, who presented at the Department of Obstetrics and Gynaecology, during the study period, were selected. Obstetrical history, examination and antenatal records were assessed. Obstetrical outcomes including length of fetal gestational ages at delivery, birth weights, apgar scores and neonatal assessment, admission in neonatal intensive care and stillbirths / neonatal deaths were recorded. Data was tabulated and comparison of obstetrical outcomes between booked and unbooked patients was done. Results:. In analyses that were limited to triplet pregnancies presenting of &gt;=24 weeks of gestation thus excluding those which could have ended in miscarriage. There were 6 unbooked patients who came to Labour ward with preterm labour, premature rupture of membranes or preeclampsia and were delivered in the Department. 6 patients with triplet pregnancy were booked in the first trimester and received antenatal care. The data was retrospectively collected over 6 years period. There were 6 nullipara and 6 multipara women in our study. The average maternal age was 30.3 years (range 24-36 years) and average maternal weight was 63.25 Kg (range 53 - 75 kg). 10 patients had conceived by ovulation induction and 2 patients had conceived spontaneously. The average gestational age at delivery in unbooked patients was 32 weeks (range 29-35 weeks) and was 34.8 weeks (range 33 - 37 weeks) in booked patients. Caesarean section was the preferred mode of delivery. However, two unbooked patients presented in active labour at 29 and 30 weeks delivered vaginally. Among the booked patients 15 babies were live-born with apgar score `, two babies required admission in neonatal nursery and were discharged on recovery, however one baby died of sepsis in nursery after 4 days and there were no intrauterine deaths. Among the unbooked patients only 3 babies were live-born with apgar score &gt;=7, five babies were admitted in neonatal nursery and recovered within a week. 7 babies died in the first week of life, mostly due to complications of prematurity. There were three intrauterine fetal deaths among the unbooked patients. Conclusion: It was concluded from the study that with antenatal management the obstetrical outcomes of triplet pregnancy improves.

Feto-maternal outcomes in obstetric patients with near miss morbidity: an audit of obstetric high dependency unit

Aim: To evaluate and compare the feto-maternal outcomes of pregnant women with potentially life-threatening complications (PLTC) and near miss events admitted to the obstetric high dependency units (OHDU).Methods: Pregnant women with PLTC admitted to the OHDU were enrolled. Feto-maternal outcomes, need for NICU admission and neonatal mortality, were compared between women without near miss events (controls) and those with near miss events.Results: Of the 1505 admissions to the obstetric department during the study period, 1127 delivered at our hospital. Among the deliveries 125 (11%) women were admitted to the OHDU and 19 (15%) of them were referred to the intensive care unit (ICU) of the hospital. The incidence of near miss morbidity (n = 46) was 37% among the mothers admitted to OHDU and 4.1% among the deliveries. The outcomes were similar in both groups for mean birth weight (among live births), neonatal death and still birth or intra-uterine deaths. The mean duration of ICU stay, proportion of ICU admission, and the mean duration of hospital stay were significantly higher for women with near miss events.Conclusion: In the presence of standardized OHDU and an ICU, the feto-maternal outcomes of women with PLTC and near miss event are similar to those without near miss events.

Profile of obstetric patients requiring ICU care

Aims and Objectives of study: The aim was to study incidence, indications and immediate outcome of obstetric patients admitted in ICU, to assess morbidity and mortality of these patients and to assess risk factors leading to ICU admissions. Methods: In this cross sectional study, from January 2009 to July 2010, 102 obstetric patients were analysed for critical illness for ICUs (medical and surgical) admissions the Descriptive analysis study was done considering Total Obstetric Admissions(Antenatal, intra and Postnatal including Abortions) in ICU, residence, Indications of ICU Admission, Mean SOFA scores on various days of ICU stay, requirement of blood components and maternal mortality during ICU stay were studied. Cross tables and frequency tables with percentage, correlation and regression and statistical analysis were performed using statistical package for social sciences (SPSS 16.0). Results: This is a study of 102 obstetric ICU cases out of 2386 antenatal, intranatal and postnatal admissions including abortions from January 2009 to July 2010.the incidence of obstetric ICU admissions was 4.2%. Mean SOFA score on day 1 of survived patients was 9.2% and expired patients was 13.1, on day 3 mean SOFA Score of survived patients was 6.2 and expired patients was 7.7 and on day 5 mean SOFA Score of survived patients was 3.2 and expired patients was 5.3. Conclusion: The severe maternal morbidity: mortality ratio is a possible new indicator of maternal care and more accurate then mortality data alone. Currently, our top priority are mainly two from this study. Early detection and treatment of anemia and control & treatment of hypertension will reduce large number of maternal and fetal deaths. At present, we must concentrate on anemia, hypertension and medical disorders in pregnancy (CCF, Jaundice, R S dysfunction including H1N1, AIDS etc.)

Pregnancy outcomes in patients with Alport syndrome

To analyze the maternal and obstetric outcomes of patients with Alport syndrome. We describe the pregnancy course of 8 pregnancies of three family members with the autosomal dominant (the rarest) form of Alport syndrome. We also analyzed 10 previously reported pregnancies with other Alport mutations in order to explore risk factors for unfavorable obstetric outcomes and maternal renal deterioration. In 13 pregnancies (72 %), renal function did not deteriorate permanently. All of these women had pre-pregnancy mild chronic kidney disease (CKD stage G1). In all of them, only a transient increase in proteinuria was recorded and in one case there was a transient decrease in the estimated glomerular filtration rate. In four other pregnancies (22 %), renal function deteriorated following pregnancy. All of them were complicated with pre-eclampsia. One woman had pre-pregnancy CKD-G2A3 and chronic hypertension. Two women had CKD-G1A3 of whom one had pre-pregnancy proteinuria near the nephrotic range. In the fourth case, renal function deterioration was reported without information on the exact pre-pregnancy renal function. In the last case, CKD-G2 was reported after pregnancy without information on CKD stage prior to pregnancy. Severe proteinuria did not imply a permanent renal function deterioration if it developed during pregnancy. Ten pregnancies ended with preterm birth (56 %). Two stillbirths were reported (11 %); however, only one was attributed to maternal health deterioration. Data regarding pregnancy outcomes in Alport syndrome is limited. The outcome seems favorable when pre-pregnancy kidney function is normal or near normal and when chronic hypertension/pre-eclampsia is absent.

Obstetrical outcomes in patients with early onset gestational diabetes

Objective: The objective of this study was to characterize patients with early onset gestational diabetes and compare outcomes to patients diagnosed with standard gestational diabetes and pregestational diabetes.Methods: This is a retrospective cohort study of patients diagnosed with gestational or pregestational diabetes. All patients received a glucose challenge test at their first prenatal visit to diagnose early onset gestational diabetes and were recommended to have postpartum glucose tolerance tests to detect undiagnosed type 2 diabetes. Outcomes were compared between patients with early onset gestational diabetes and both standard gestational diabetes and pregestational diabetes with p < 0.05 was used for significance.Results: Four hundred and twenty-four patients met the inclusion criteria. Nine percent of the patients with early onset gestational diabetes were found to have undiagnosed type 2 diabetes based on postpartum testing and 91% to have resolution in the postpartum period. No patient with early onset gestational diabetes and resolution in the postpartum period had abnormal screening for renal or ophthalmologic disease, but 5% had abnormal fetal echocardiograms. These patients were more likely to require pharmacotherapy for glycemic control than patients with standard gestational diabetes and less likely than patients with pregestational diabetes (55% versus 39% versus 81%).Conclusion: Most patients diagnosed with early onset gestational diabetes do not have undiagnosed type 2 diabetes but do have unique characteristics and obstetrical outcomes.

Profile of Obstetric Morbidity Among Maternal Intensive Care Unit Patients

Aims: The objective of the study was to determine the outcome of the obstetric admissions to Maternal Intensive Care Unit in the setting of a tertiary care hospital. Methods: This was a cross-sectional study undertaken at Paropakar Maternity and Women’s Hospital from April 1, 2012 to March 31, 2013. Patient characteristics, gestational age, booking status, indication for intensive care unit admission, intervention, length of stay and outcome were analyzed. Results: During the study period, 19,247 deliveries occurred and 247 women were admitted to maternal intensive care unit. This accounts for 1.28% of all deliveries. The most common indication of admission to intensive care unit was hypertensive disorders in pregnancy (45.3%) followed by obstetric hemorrhage (39.27%). Sepsis was the cause in ten (4.04%) cases. Ten cases (4.04%) of postpartum hemorrhage were managed by balloon tamponade, seven (2.83%) by B-Lynch compression sutures and three (1.21%) necessitated cesarean hysterectomy. Among 18 cases of ruptured uterus, 13 (5.26%) were repaired while five (2.02%) required hysterectomy. Maternal mortality occurred in four (1.61%) of the cases. One was a case of severe preeclampsia who died on 4th post-operative day due to pulmonary embolism, another due to anesthetic complication and the other two died of septic shock and multiorgan failure. Conclusions: Hypertensive disorders of pregnancy and obstetric hemorrhage appeared as the major risk factors for admission to an intensive care unit thereby influencing maternal outcomes in obstetric patients. DOI: http://dx.doi.org/10.3126/njog.v9i2.11762

PPO.32 Audit of management and outcomes of obstetric patients with pre-existing renal disease managed in a specialist obstetric clinic

ObjectiveTo audit a specialist antenatal clinic at St Mary’s hospital in managing obstetric patients with renal disease and evaluate pregnancy outcomes in those patients against set standards.MethodsData from patients with...

Obstetric Outcomes in Patients Treated for Deep Pelvic Endometriosis

Purpose The aim of this study was to assess obstetric outcomes and symptoms during and after pregnancy in women submitted to surgical treatment for deep pelvic endometriosis. Methods We evaluated 123 women who underwent surgery for severe deep pelvic endometriosis-related symptoms. Interventions were excision of rectovaginal septum nodule with or without rectal or vaginal resection, or excision of nodule of uterosacral ligaments. On the basis of pregnancy desire, patients were submitted to a telephone interview and asked if there had been a pregnancy and its outcome. They were also asked to describe their pain symptoms before, after and during the pregnancy. Results From the 123 patients, we selected 43 women desiring pregnancy after surgery, who answered the telephone interview. Twenty-four patients (55.8%) got pregnant. We recorded 34 pregnancies a mean 21.8 ± 17.9 months after surgery. In the group of 25 full-term pregnancies, 14 women (56%) had a vaginal delivery without complications, and 11 (44%) underwent a cesarean section. In only 3 cases, was the indication of cesarean section related to previous surgery. Seventy-one percent of women treated without rectal or vaginal resection delivered vaginally. We also registered 1 case of uncomplicated vaginal delivery in a patient with vaginal resection and another 1 in a patient with rectal resection. In the patients who complained of pain before pregnancy, we observed a resolution of pain symptoms during pregnancy, but after delivery these symptoms reappeared. Conclusions In patients submitted to surgery for deep pelvic endometriosis, even in cases of vaginal or rectal resection, a cesarean section is not always mandatory.

Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala

Objectives: To describe the clinical characteristics of obstetric patients requiring mechanical ventilation in a tertiary referral hospital and their maternal and perinatal outcome ,in order to identify their risk factors and clinical outcome and determine adverse prognostic factors in these patients. Study design: A prospective study was conducted in the Department of Obstetrics and Gynaecology,Government Medical College,Kozhikode of all pregnant women upto 6 weeks postpartum from January 1,2011 to December 31,2013 and subsequently required mechanical ventilation.Data was recorded in a predesigned proforma and was analysed and frequency and percentages were calculated. Results: In the three year period 75 obstetric patients required mechanical ventilation.Majority were between 20-35 years(88%)and were primipara(53.3%).80% were admitted in the antepartum period and most were in the gestational age of 30-36 weeks(41.3%).Hypertensive disorder is the important antepartum complication(29.3%). Postpartum hemorrhage was the important cause (45.3%) of ICU admission. 49.3% required mechanical ventilation for less than 24 hours and multiorgan failure was the important complication encountered(13.3%). Conclusions: Providing optimal prenatal care and improving the management of hemorrhagic complications and hypertensive disease can improve the morbidity and mortality of critically ill obstetric patients requiring mechanical ventilation.

Variation of papp-a level in the first trimester of pregnancy and its clinical outcome.

Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11-13weeks of gestation, is associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and pre-eclampsia in chromosomally normal fetuses, while a raised nuchal translucency is associated with specific structural abnormalities and genetic syndromes. We have studied the serum Papp-A level in 560 pregnant patients (11-13weeks gestation) registered at Bharati Hospital and Research Centre, Pune. All patients undergoing testing were followed till the delivery and their neonatal outcome was also taken into consideration. Our aim is to study the pregnancy outcome in relation to the variations of Papp-A level in the first trimester of pregnancy. Every patient visiting the antenatal OPD was counseled for testing of First Trimester Screening to assess fetal well-being. Patients who were registered for delivery at our hospital were taken into the trial. Blood samples were taken at 11-13weeks of pregnancy and sent to the PerkinElmer lab for analysis. Results were expressed in Multiple of Median and patients having MOM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician. 524 patients were included in the trial out of which 452 patients were found to have a normal Papp-A level of >0.5 MOM. All these patients were followed further during the antenatal period where 18 patients developed preterm labor and few patients developed pregnancy-induced hypertension. The obstetric outcome of patients with a normal Papp-A level was fairly uneventful as compared to others with a low Papp-A level. Though Papp-A level in the first trimester of pregnancy (11-13weeks) is an important predictor of future obstetric outcome, it has poor positive predictive value. Patients having a Papp-A level less than 0.5 MOM have a high risk for preterm delivery, fetal growth restriction, and stillbirths along with increased incidence of hypertensive disorders of pregnancy. A low Papp-A level is a useful indicator of risk of preterm delivery and future chance of development of pregnancy-induced hypertension.

Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies

ObjectiveTo report the obstetrical outcomes in patients with twin pregnancies who underwent an emergency/physical exam-indicated cerclage and to compare them to patients with singleton pregnancies undergoing the same procedure. Study designPatients who underwent emergency/physical exam-indicated cerclage in the second trimester in one maternal-fetal medicine practice from July 1997 to March 2012 were reviewed. We defined an emergency/physical exam-indicated cerclage as any cerclage placed in a patient with a dilated cervix on examination or membranes visible at the external cervical os on speculum examination. We compared outcomes between patients with singleton and twin pregnancies using non-parametric testing. ResultsThere were 43 patients (12 twin and 31 singleton pregnancies) who underwent emergency/physical exam-indicated cerclage placement. The median gestational age at cerclage placement, cervical dilation, maternal age, and cerclage type were similar between the groups. Comparing twins to singletons, the median time from cerclage placement to delivery was similar (92 vs. 106 days, p=0.330), as was the median gestational age at delivery (33.5 vs. 35.0 weeks, p=0.244). The likelihood of delivery at >32 weeks (75.0% vs. 71.0%, p>0.999) and the likelihood of neonatal survival to discharge (83.3% vs. 83.9%, p>0.999) were also similar. ConclusionsEmergency/physical exam-indicated cerclage in twin pregnancies can be associated with favorable outcomes, including a high likelihood of delivery at >32 weeks and a high likelihood of survival. Their outcomes appear similar to singleton pregnancies. Cerclage should be considered an option for patients with twin pregnancies and a dilated cervix in the second trimester.

Obstetrical outcomes in patients with recurrent pregnancy loss

Obstetrical outcomes in patients with recurrent pregnancy loss

Obstetrical outcomes in patients with early ovarian hyperstimulation syndrome (OHSS) down regulated by GnRH antagonists

Obstetrical outcomes in patients with early ovarian hyperstimulation syndrome (OHSS) down regulated by GnRH antagonists