Obstetric Outcomes Of Pregnancies Research Articles

Adverse fetal/neonatal and obstetric outcomes in pregnancies with both maternal and fetal heart disease.

To investigate fetal/neonatal and obstetric events in pregnancies with both maternal and fetal heart disease. From the CARPREG database, singleton pregnancies (>24 weeks) in patients with structural heart disease that underwent fetal/neonatal echocardiograms were selected and separated in two groups: maternal heart disease only (M-HD) and maternal and fetal heart disease (MF-HD). Differences in adverse fetal/neonatal (death, preterm birth, and small for gestational age) and obstetric (preeclampsia/eclampsia) outcomes between groups were analyzed. From 1011 pregnancies, 93 had MF-HD. Fetal/neonatal events (38.7% vs 25.3%, p = 0.006) and spontaneous preterm birth (10.8% vs 4.9%, p = 0.021) were more frequent in MF-HD compared to M-HD, with no difference in obstetric events. MF-HD remained as a significant predictor of fetal/neonatal events after adjustment (OR:1.883; 95% CI:1.182-3.000; p = 0.008). Pregnancies with MF-HD are at risk of adverse fetal/neonatal events and spontaneous preterm birth. Larger studies are needed to determine their association with preeclampsia.

Clinical outcomes of screen-positive genome-wide cfDNA cases for trisomy 20: results from the global expanded NIPT Consortium.

Trisomy 20 has been shown to be one of the most frequent rare autosomal trisomies in patients that undergo genome-wide noninvasive prenatal testing. Here, we describe the clinical outcomes of cases that screened positive for trisomy 20 following prenatal genome-wide cell-free (cf.) DNA screening. These cases are part of a larger cohort of previously published cases. Members of the Global Expanded NIPT Consortium were invited to submit details on their cases with a single rare autosomal aneuploidy following genome-wide cfDNA screening for retrospective analysis. Clinical details including patient demographics, test indications, diagnostic testing, and obstetric pregnancy outcomes were collected. Genome-wide cfDNA screening was conducted following site-specific laboratory procedures. Cases which screened positive for trisomy 20 (n = 10) were reviewed. Clinical outcome information was available for 90% (9/10) of our screen-positive trisomy 20 cases; the case without diagnostic testing ended in a fetal demise. Of the nine cases with outcome information, one was found to have a mosaic partial duplication (duplication at 20p13), rather than a full trisomy 20. Only one case in the study cohort had placental testing; therefore, confined placental mosaicism could not be ruled out in most cases. Adverse pregnancy outcomes were seen in half of the cases, which could suggest the presence of underlying confined placental mosaicism or mosaic/full fetal trisomy 20. Based on our limited series, the likelihood of true fetal aneuploidy is low but pregnancies may be at increased risk for adverse obstetric outcomes and may benefit from additional surveillance.

Fertility Trends and Adverse Pregnancy Outcomes in Female Patients With Psoriasis in the UK

Evidence regarding fertility trends and obstetric outcomes among patients with psoriasis is limited by studies of small sample sizes, noninclusion of comparators, and the lack of accurate pregnancy records. To investigate fertility rates and obstetric outcomes of pregnancies in female patients with psoriasis compared with age- and general practice-matched comparators without psoriasis. This population-based cohort study used data from 887 primary care practices that contributed to the UK Clinical Practice Research Datalink GOLD database between 1998 and 2019, linked to a pregnancy register and Hospital Episode Statistics. There were 6 223 298 patients of common childbearing ages (15-44 years), and 63 681 patients with psoriasis had at least 1 year of follow-up data prior to the diagnosis of psoriasis. For each patient with psoriasis, 5 patients were matched by age from the same general practice. The median follow-up duration was 4.1 years. Data analysis was performed in 2021. Patients with psoriasis were identified using clinical diagnostic codes from consultations. Fertility rates were calculated as the number of pregnancies per 100 patient-years. The outcomes of each pregnancy recorded in the pregnancy register or Hospital Episode Statistics were screened to identify obstetric outcomes. A negative binomial model was used to examine the association between psoriasis and the fertility rate. Logistic regression was applied to compare the association between psoriasis and obstetric outcomes. A total of 63 681 patients with psoriasis and 318 405 matched comparators were included in the analysis (median [IQR] age, 30 [22-37] years). Lower fertility rates (rate ratio, 0.75; 95% CI, 0.69-0.83) were found in patients with moderate to severe psoriasis. Compared with matched comparators without psoriasis, pregnancies in patients with psoriasis had a higher risk of loss (odds ratio, 1.06; 95% CI, 1.03-1.10); however, there was no increase in the risks of antenatal hemorrhage, preeclampsia, or gestational diabetes. In this cohort study, patients with moderate to severe psoriasis had a lower fertility rate, and the risk of pregnancy loss was higher than in matched comparators without psoriasis. Future research should identify the mechanism of increased risk of pregnancy loss among patients with psoriasis.

Short Interpregnancy Interval Following a Multifetal Pregnancy: Maternal and Neonatal Outcomes

To evaluate the maternal and neonatal outcomes of women with short interpregnancy intervals (IPI < 6 months) following a multifetal pregnancy. A multicenter retrospective cohort study of women with an index multifetal delivery and a subsequent singleton gestation between 2005 and 2021. The obstetrical outcomes of pregnancies following short IPI (<6 months) were compared to those with an IPI of 18-48 months. Additional analyses were also conducted for the other IPI groups: 7-17 months, and longer than 49 months, while women with an IPI of 18-48 months served as the reference group. The primary outcome was preterm birth (<37 weeks) rate. Secondary outcomes were other adverse maternal and neonatal outcomes. Univariate and multiple logistic regression analyses were performed. Overall, 2514 women had a primary multifetal delivery with a subsequent singleton gestation at our medical centers; 160 (6.4%) had a short IPI, and 1142 (45.4%) had an optimal IPI. Women with a singleton gestation following a short IPI were younger, with lower rates of previous cesarean and fertility treatments. Women in the short IPI group had significantly higher rates of preterm birth <37 weeks, anemia (Hb < 11 gr%) on admission to the delivery room, and placental abruption. Multivariable logistic regression analysis demonstrated that short IPI is associated with an increased risk for preterm birth (aOR 2.39, 95% CI 1.12-5.11, p = 0.03). Short IPI following a multifetal gestation is associated with an increased risk for preterm birth in subsequent singleton pregnancy.

Multi-Fetal Reduction May Be the Better Choice for Multi-Fetal Pregnancies: A Cohort Study

Objective: The rate of multiple pregnancies increases the number of pregnancies conceived using assisted reproductive techniques. Although the studies indicate a positive effect of multi-fetal pregnancy reduction on pregnancy outcomes, procedure-associated miscarriages should be considered. Therefore, our study aimed to evaluate the outcomes of pregnancies that have undergone multi-fetal reduction and compare the pregnancies' outcomes without any intervention. Material and Methods: Patients from the Perinatology Clinic of Şanlıurfa Training and Research Hospital were selected between July 2017 and May 2021. The patients in the study group were divided into two groups: those with or without multi-fetal reduction. Obstetric outcomes of pregnancies were compared between the groups. Results: During this period, 95 gestations with three or more fetuses were applied to our clinic. Eighteen multi-fetal reduction procedures were performed because of multiple pregnancies. Reductions were performed from five to twins in one case, triplets to twins in ten, and quadruplets to twins in seven cases. Patients preferred to continue pregnancies without intervention in 6 quadruplets, one sextile, and 66 triplet pregnancies. Mean gestational age at birth in the intervention group was 34.43±0.40 (32-38) weeks, while in the non-intervened group, that was 30.46±0.48 (24-37) gestational weeks. Gestational age at birth was significantly lower in the non-intervention group. (p: 0.000029). Conclusion: Multi-fetal reduction is beneficial in preventing preterm delivery.

Effectiveness of low-molecular-weight heparin in obstetric outcome of pregnancies having comorbidities with potential thrombotic risk

Effectiveness of low-molecular-weight heparin in obstetric outcome of pregnancies having comorbidities with potential thrombotic risk

VP20.06: Fetal intra‐abdominal umbilical vein varix: retrospective study and review of literature

To investigate the ultrasound characteristics, associations and obstetric outcome in pregnancies with intra-abdominal umbilical vein varix of the fetus. It was a retrospective cohort study conducted over two years i.e., from March 2019- February 2021. Data was collected from ultrasound records, antenatal and intra- partum records. For the neonatal outcome patients and respective consultants were followed up by telephonic calls. The data collected was demographic characteristics, varix characteristics (gestational age at diagnosis, size, progression, turbulence, thrombus formation, associated malformations and genetic), obstetric complications (fetal growth restriction/ IUFD) and neonatal outcome. Descriptive statistics (means, standard deviations, and percentages [%]) were calculated using SPSS, version 21.0 (SPSS Inc, Chicago, USA). Over the period of 2 years six cases of FIUVV were diagnosed making the incidence of FIUVV of 5/10000 pregnancies. Incidence of isolated FIUVV was 4.4/10000 cases. The mean gestational age at diagnosis was 25 weeks 3days with earliest diagnosis at 19w1d. Aneuploidy screening was done in five of cases with low risk for trisomy 21, 18 & 13 as outcome. The mean varix size was 11.85mm±2.28 mm (range 8.9mm-14.8 mm). No incidence of turbulence or thrombus formation within the varix was seen in the current study. One case had absent DV with anomalous connection of umbilical vein with IVC. One Perinatal death after planned LSCS at term & sudden IUFD at 33 weeks were noted in this study. Detailed anatomical scan and counselling should be done after FIUVV diagnosis. The fetal surveillance should be increased to look for major dilatation thombus or FGR. Longer analysis on the large population is needed to study the association of controls with the outcome. Also, long term studies are needed to for any delayed consequences affecting the adult life of these fetuses.

P–692 Are live birth rate and obstetric outcomes different between immediate and delayed embryo transfers following a freeze-all cycle? A retrospective study combined with a meta-analysis

Abstract Study question Do livebirth rate (LBR), obstetric and perinatal outcomes vary between frozen embryo transfers (FET) in the first or subsequent menstrual cycles following a freeze-all approach? Summary answer Immediate FET has a higher LBR and similar perinatal outcomes than delayed FET. Quantitative synthesis of available literature shows an increased LBR with immediate transfer. What is known already Whether FET should be done in the first menstrual cycle following oocyte collection (OC) is controversial and the duration of a possible detrimental effect of supraphysiological sex steroid levels on pregnancy outcome is unknown. A multinational survey centers showed that, 61% of clinicians prefer to wait for a washout period before proceeding to FET, even after a failed fresh embryo transfer. Limited number of studies compared FET in the first menstrual cycle with delayed FET in a subsequent cycle with varying results. There is limited data on obstetric outcomes of pregnancies resulting from FET in the first menstrual cycle. Study design, size, duration 198 women who underwent a freeze-all cycle followed by FET between July 2017 and June 2020 were included. 119 FET in the first menstrual cycle (&amp;lt;30 days from oocyte collection) and 79 FET in subsequent cycles (&amp;gt;30 days from oocyte collection) were retrospectively compared. MEDLINE was searched on 01 January 2021 using relevant keywords. Cohort studies comparing immediate versus delayed transfer following freeze all cycles were included and quantitative summary for LBR was obtained. Participants/materials, setting, methods Freeze-all was undertaken when (i) the woman is deemed to be at high risk for OHSS, (ii)serum progesterone level is &amp;gt; 1.5 ng/ml on the day of trigger, (iii)preimplantation genetic testing is planned, (iv)the woman will undergo surgery prior to ET, (v)couple preference. Main results and the role of chance Baseline characteristics were similar between the groups except for antral follicle count (22 vs 18, MD = 5, 95% CI = 0 to 8), and number of metaphase-two oocytes (13 vs 10, MD = 3, 95% CI = 1 to 6) all of which were significantly higher in the immediate transfer group. Clinical pregnancy rate (CPR) per ET was similar in two groups (50.4% vs 44.3%, RR = 1.14, 95% CI = 0.84 to 1.54). Miscarriage rate per pregnancy was significantly lower (12.3 vs 31.1, RR = 0.40, 95% CI = 0.19 to 0.84) and LBR per ET was significantly higher (42.9 vs 26.6, RR = 1.61, 95% CI = 1.06 to 2.46) in the immediate transfer group. Median gestational age at delivery was similar (267.5 (262.5–273) vs 268 (260–271.5) days, MD = 1.00, 95% CI= –4.00 to 5.00). Median birthweight was significantly higher in the delayed transfer group (3520 vs 3195 grams, MD= –300, 95% CI= –660 to –20 grams). Birthweight percentile, height at birth and head circumference were similar between groups. Literature search revealed 1712 studies from which nine were eligible for quantitative summary. Cumulative risk ratio showed a 10% increase in LBR with immediate transfer compared to delayed transfer (RR = 1.10, 95% CI = 1.01 – 1.20, I2=67%, 17369 embryo transfers). Limitations, reasons for caution Our study is limited by its retrospective design and relatively limited sample size for multivariate analyses. Yet, it is reassuring that the majority of our findings are consistent with previous publications. Wider implications of the findings: The hypotheses generated by our retrospective findings, i.e., FET in the immediate menstrual cycle resembling fresh ETs with strong trends towards lower birthweight and lower incidence of preeclampsia is noteworthy for the design of future studies, and these outcomes should be followed and reported. Trial registration number None

Obstetric outcomes in pregnancies resulting from in vitro fertilization are not different in fertile, sterilized women compared to infertile women: A Society for Assisted Reproductive Technology database analysis

To compare obstetric and neonatal outcomes resulting from assisted reproductive technology in couples with a history of female sterilization to couples with other infertility diagnoses. Retrospective cohort study. Not applicable. Fresh, nondonor cycles excluding gestational surrogacy from 2004 to 2013 in the United States. None. Preterm birth rates and low birth weight rates from invitro fertilization (IVF) pregnancies in couples with infertility and in couples with prior tubal ligation as their sole indication for IVF. The mean ages of fertile women (N = 8,478) and infertile women (N = 371,488) were 35.3 and 34.6 years, respectively. Of the singletons born to parous women (N = 26,463), the incidence of preterm birth was not significantly different in fertile, sterilized couples compared to infertile couples (13.7% vs. 12.0%). The incidence of low birth weight among term singletons was also not significantly different between fertile couples compared to infertile couples (3.5% vs. 3.2%). Fertile couples have similar preterm birth and low birth weight rates after IVF compared to infertile couples. This suggests that differences in perinatal outcomes may be due to assisted reproductive technology procedures rather than infertility itself.

310 Cardiac and obstetric outcomes in pregnancies associated with mitral valve prolapse

Maternal morbidity and mortality are higher in women with cardiac disease and present the leading indirect cause of mortality in pregnancy. The specific risks, however, associated with mitral valve prolapse in pregnancy are minimally studied. We sought to identify the cardiac and obstetric outcomes associated with mitral valve prolapse in pregnancy. A retrospective cohort study using the Healthcare Cost and Utilization Project- National Readmission Sample database was performed. All pregnant women admitted with mitral valve prolapse were identified using the International Classification of Disease-9 and 10 codes from 2010-2017. The maternal cardiac and obstetric outcomes among pregnant women diagnosed with mitral valve prolapse were compared to those of women without mitral valve prolapse using multivariable logistic regression adjusting for baseline demographic characteristics. There were 11,041 pregnancy admissions with a concurrent diagnosis of mitral valve prolapse with an overall incidence of 16.5 cases per 10,000 pregnancy admissions. Pregnant women with mitral valve prolapse were more likely to have a cardiac arrest (OR 2.79, 95% CI 1.27-6.13), arrhythmia (OR 9.85, 95% CI 8.83-10.99), stroke (OR 8.70, 95% CI 4.32-17.57), heart failure (OR 11.7, 95% CI 10.14-13.51), myocardial infarction (OR 3.15, 95% CI 2.13-4.65), thromboembolism (OR 2.25, 95% CI 1.34-3.76) and endocarditis (OR 16.14, 95% CI 8.84-29.46) compared to women without mitral valve prolapse. Pregnancies with mitral valve prolapse were also associated with an increased risk of preterm delivery (OR 1.43, 95% CI 1.31-1.56) and pre-eclampsia/HELLP syndrome (OR 1.34, 95% CI 1.22-1.46) as compared to pregnant women without mitral valve prolapse. Mitral valve prolapse may pose more significantly higher maternal cardiac and obstetric risks than previously assumed, highlighting the need for closer monitoring of these patients in pregnancy with the importance of a thorough baseline cardiac evaluation.

716 Impact of travel time on obstetric outcomes in pregnancies complicated by fetal congenital heart disease

To identify if driving time had an impact on maternal, neonatal, or delivery outcomes in pregnancies affected by fetal congenital heart disease (CHD). We performed an IRB-approved retrospective cohort study at a tertiary care center with a pediatric cardiac service and a large patient catchment area. The study population included 169 pregnant women with ages ranging from 18-49. Each pregnancy was complicated by CHD and included infants delivered between 01/2011 and 05/2017. Chart review was conducted to determine patient demographics and obstetric outcomes. Travel times were approximated using Google Maps and divided into quartiles based upon equally distributed sample sizes. Of the study population, 16% of deliveries occurred unscheduled at other facilities. Of the deliveries occurring via scheduled induction at our hospital, increased driving time was not significantly associated with higher operative delivery rates (cesarean or assisted vaginal), longer stays in the hospital, or longer induction times (Table 1). Driving time was significantly associated with decreased 1-minute APGAR scores (β = -0.225; p = 0.0406) but had no other effects on neonatal outcomes (Table 2). In pregnancies affected by CHD, driving time does not seem to impact delivery or neonatal outcomes. We suggest that scheduling labor inductions should not be altered based on maternal distance from the hospital.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of obstetric outcomes and prognostic factors in pregnancies with chronic kidney disease

ABSTRACT Objective: To evaluate the obstetric outcomes of pregnancies with chronic kidney disease (CKD) and to assess the prognostic factors on adverse obstetric outcomes. Methods: We retrospectively reviewed 101 singleton pregnancies with CKD. Obstetric outcomes were explored according to CKD stages. The composite adverse obstetric outcome was defined as at least one of stillbirth, neonatal death and delivery <34 weeks due to preeclampsia or fetal distress. Results: The incidences of preeclampsia, fetal growth restriction, perinatal mortality and composite adverse obstetric outcome were 40.5%, 26.7%, 14.8% and 37.6% respectively in pregnancies with CKD. Composite obstetric adverse outcome was significantly higher in pregnancies with CKD stage 4–5 than the other stages (p < 0.01). CKD stage 4–5 and baseline proteinuria >3 g/24 h were associated with composite obstetric adverse outcome (OR 43.2, p = 0.005 and OR 6.08, p = 0.01 respectively) comparing to stage 1 and proteinuria <0.5 g/24 h. Conclusion: Incidences of adverse obstetric outcomes are high even in early stages of CKD. CKD stage 4–5 and baseline proteinuria >3 g/24 h are poor prognostic factors.

Obstetric Outcome in Pregnancies Complicated with Fibroids: A Prospective Observational Study

Background: Fibroid is the most frequently recorded benign, monoclonal smooth muscle tumor of the uterus, affecting 20%–60% women of reproductive age. Being remarkably common, fibroids are an important health concern. Fibroids are the most frequent indication for the performance of hysterectomy. The health-care consequences of these tumors are substantial both for the mother as well as the fetus. Objective: The objective is to study the obstetric outcome in pregnancies complicated with uterine fibroids. Materials and Methods: This is an observational study conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Srinagar, from May 2019 to February 2020. A prospective evaluation of a series of 28 antenatal patients presenting with fibroids (>1 cm), who delivered in our hospital was done. Maternal age, parity, size of fibroid, type of fibroid, complications during pregnancy, and mode of delivery were noted. Ultrasonogram was done at booking visit and during subsequent visits to assess the size of the fibroid and degeneration. Obstetric outcome was assessed in terms of abortion, premature delivery, malpresentation, abruption, postpartum hemorrhage (PPH), subinvolution, and puerperal pyrexia. Fetal outcome was assessed in terms of intrauterine growth retardation (IUGR), low-birth weight, and neonatal intensive care unit (NICU) admissions. Results: Majority of the patients belonged to the age group of 25–29 years (35.7%), majority 19 (67.9%) were multigravida, most 17 (60.7%) of the fibroids were >3 cm in size. There were 2 (7.1%) cases of miscarriage, 6 (21.4%) cases of malpresentation, abruption in 2 (7.1%) cases, 3 (10.7%) had PPH and only 1 (3.6%) needed blood transfusion. A total of 18 (69.2%) patients delivered by lower segment caesarean section and 8 (30.7%) had vaginal delivery. Of 26 babies, 6 (23.1%) had low-birthweight, 2 (7.7%) were IUGR and there were 2 (7.7%) NICU admissions. Conclusion: Even though most of the fibroids in pregnancy are asymptomatic but such pregnancies should be considered as high risk pregnancies. Hence, pregnancy has to be cautiously screened in the antenatal period, through regular follow-up, to detect any adverse obstetric complications thereby improving fetomaternal outcome. Our study also suggests that reduction in fibroid size pre-pregnancy may play a vital role in preventing maternal and fetal complications which became inevitable once pregnancy reaches advanced gestation.

Study of obstetric outcomes of pregnancy with uterine fibroids at a tertiary care hospital

Study of obstetric outcomes of pregnancy with uterine fibroids at a tertiary care hospital

Maternal Characteristics and Obstetric Outcomes of Pregnancies Complicated by Preterm Premature Rupture of the Membranes

Maternal Characteristics and Obstetric Outcomes of Pregnancies Complicated by Preterm Premature Rupture of the Membranes

Nationwide population-based cohort study of adverse obstetric outcomes in pregnancies with myoma or following myomectomy: retrospective cohort study

BackgroundOur objective was to evaluate risks of adverse obstetric outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy.MethodsWe analyzed the national health insurance database, which covers almost the entire Korean population, between 2004 and 2015. The risks of adverse pregnancy outcomes in pregnancies with myoma(s) or in pregnancies following myomectomy, compared to those in women without a diagnosed myoma, were analyzed in multivariate logistic regression analysis.ResultsDuring the study period, 38,402 women with diagnosed myoma(s), 9890 women with a history of myomectomy, and 740,675 women without a diagnosed myoma gave birth. Women with a history of diagnosed myoma(s) and women with a history of myomectomy had significantly higher risks of cesarean section (aOR 1.13, 95% CI 1.1–1.16 and aOR 7.46, 95% CI 6.97–7.98, respectively) and placenta previa (aOR 1.41, 95% CI 1.29–1.54 and aOR 1.58, 95% CI 1.35–1.83, respectively), compared to women without a diagnosed myoma. And the risk of uterine rupture was significantly higher in women with previous myomectomy (aOR 12.78, 95% CI 6.5–25.13), compared to women without a diagnosed myoma, which was much increased (aOR 41.35, 95% CI 16.18–105.69) in nulliparous women. The incidence of uterine rupture was the highest at delivery within one year after myomectomy and decreased over time after myomectomy.ConclusionsWomen with a history of myomectomy had significantly higher risks of cesarean section and placenta previa compared to women without a diagnosed myoma.

Disease course and obstetric outcomes of pregnancies in juvenile idiopathic arthritis: are there any differences among disease subtypes? A single-centre retrospective study of prospectively followed pregnancies in a dedicated pregnancy clinic.

To study disease activity during pregnancy and obstetric outcomes in patients with juvenile idiopathic arthritis (JIA) upon different subsets and with focus on medication use. Retrospective observational study of 22 pregnancies in 16 JIA patients (95.5% Caucasian) who were followed between 2010 and 2018. Disease activity, flares and medications were recorded before conception, during each trimester and postpartum period. Pregnancies occurred in 10 (45.5%) oligoarticular extended (OLA-E), 6 (27.3%) in polyarticular (PLA), 4 in (18.2%) systemic (SYS), 1 (4.5%) in oligoarticular persistent (OLA-P) and 1 (4.5%) in enthesitis-related arthritis (ERA) JIA patients. The median age at disease diagnosis and at conception was 5.5 and 28 years (respectively). The median disease duration was 20 years. Nineteen (95%) pregnancies started in a period of stable disease remission. Among the 22 pregnancies, 20 ended with a live birth (90.9%). No spontaneous miscarriages occurred; two voluntary interruption of pregnancy were performed. There were 7 flares in 6/20 pregnancies (35%) and 8 flares (8/22, 36.4%) occurred in postpartum period, all of them in OLA-E and PLA patients. Seven patients (35%) were taking biological disease-modifying anti-rheumatic drugs (bDMARDs) at conception, and 6 of them stopped this treatment at positive pregnancy test. Five patients resumed bDMARDs either during pregnancy (3 exposed during the third trimester) or puerperium due to a flare. Four preterm deliveries (20%) were recorded, all in patients who had a flare during pregnancy. The preconception counselling should include the evaluation of disease subset, as OLA-E and PLA may flare more than other subsets, especially if bDMARDs are discontinued at positive pregnancy test. Continuation of bDMARDs during pregnancy should be considered to minimize the risk of adverse pregnancy outcomes, particularly preterm delivery. Key Points • In our cohort, all the flares during pregnancy and 75% of postpartum flares were observed in patients who withdrew bDMARDs and cDMARDs at the beginning of pregnancy. • Flares were observed only in PLA and OLA-E patients. • Preterm delivery occurred in 20% of the pregnancies; all of these patients had a disease flare during pregnancy.

Obstetric Outcomes in Pregnancies Complicated by Prior Renal Transplant or Chronic Kidney Disease [26N

INTRODUCTION: Compare antepartum admissions and outcomes in pregnancies complicated by renal transplant (RT) versus chronic kidney disease (CKD). METHODS: Retrospective cohort study at University of Illinois at Chicago from 2010 to 2019. Electronic medical record queried for women age 18 to 51 with pregnancy, RT or CKD. SPSS used for statistical analysis. IRB approval was obtained. RESULTS: 577 charts reviewed, 57 pregnancies complicated by RT or CKD. Of 33 women with RT, 20 had live births, 11 miscarried, 2 had elective terminations. Of 24 women with CKD, 14 had live births, 6 miscarried, 2 had ectopic pregnancies, 2 had elective terminations. Average time from RT to pregnancy was 7.45 years. Subjects with CKD had higher rates of preterm delivery and hypertensive disorders of pregnancy. No difference in rate of cesarean delivery (CD) between groups. Gestational age (GA) at delivery lower in women with CKD than RT, 31 vs 34 weeks. Rate of antepartum admission not statistically significant between groups. Subjects with RT admitted for obstetric complications compared to women with CKD admitted for worsening medical problems. Pregnancies 1 to 3 years posttransplant had lower rates of preeclampsia and CD, and later GA at delivery (36.3 vs 34.4 weeks) compared to those greater than 3 years posttransplant. CONCLUSION: Women with RT are not admitted antepartum at a higher rate than women with CKD and overall had better obstetrical outcomes. An area of further study is the ideal time between transplant and pregnancy, as we found improved obstetric outcomes in women with pregnancy closer to RT.

Obstetric Outcomes of Pregnancy After Uterine Artery Embolization.

BackgroundUterine artery embolization (UAE) is used to treat severe postpartum hemorrhage (PPH). According to a few studies, UAE for PPH was associated with preterm birth, fetal growth restriction (FGR), and placenta accreta spectrum (PAS) in subsequent pregnancies. These previous studies, however, lacked controls, and to the best of our knowledge, no systematic literature reviews have been conducted thus far. We report the results of our retrospective case–control study of pregnancies after UAE at a single center and include a literature review to evaluate the risk of PAS in pregnancies after UAE.MethodsWe retrospectively reviewed data from deliveries at our hospital between January 2012 and October 2017. We divided the delivery data into cases with previous UAEs performed for PPH (the post-UAE group) and those without UAEs (the non-UAE group, which included women without previous PPH). We defined PAS as cases in which hysterectomy was performed and pathological examination confirmed the diagnosis. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).ResultsWe used data from 3155 patients in this study, of whom 16 patients had undergone UAE (post-UAE group) and 3139 had not (non-UAE group). We found no differences between the groups in terms of frequency of preterm births (12.5% versus 14.2%, respectively; OR, 0.863; 95% CI, 0.218 to 3.414; P = 0.84) or FGR (6.2% versus 10.0%, respectively; OR, 0.602; 95% CI, 0.104 to 3.584; P = 0.61). However, cases of PAS were significantly more common in the post-UAE group (37.5%) than in the non-UAE group (1.2%; OR, 50.303; 95% CI, 17.38 to 145.592; P < 0.01).ConclusionOur results suggest that previous UAE is a significant risk factor for PAS.

Obstetric outcomes in pregnancies resulting from in vitro fertilization (IVF) are not different in fertile, sterilized patients compared to infertile women: a society for assisted reproductive technology (SART) database analysis

This study aims to compare obstetric outcomes resulting from assisted reproductive technology (ART) in couples with a history of female sterilization compared to those with other infertility diagnoses. Retrospective Cohort Study. All 760,705 fresh, autologous embryo transfer cycles with partner ejaculated sperm from 2004 to 2013 in the SART database were reviewed. Cycles in women with prior female sterilization were compared to cycles with other infertility diagnoses. After excluding cycles with male sterilization, day of transfer >7, prior sterilization with an additional infertility diagnosis, and unknown method of ICSI or IVF, 4,174 cycles in patients with history of female sterilization were compared to 179,605 cycles in patients with other causes of infertility. Multiple linear regression analyses and generalized estimating equations were performed to assess whether gestational length and birthweight were significantly different between groups in singleton and twin pregnancies after controlling for BMI, age, parity, and type of ART procedure (traditional IVF vs ICSI). Previously sterilized women were older with significantly higher parity and body mass indices than women in couples with all other causes of infertility. Number of oocytes retrieved, timing of embryo transfer, pregnancy and live birth rates were not significantly different between the two groups. Women with a history of sterilization had significantly shorter gestations and lower birth weights than women with other causes of infertility. However, there was no significant difference between these groups after controlling for singleton and twin gestations except in birth weight for twins.Tabled 1All Women (N=183779)Women with history of female sterilization (N=4174)Women with all other causes of infertility (N=179605)P-ValueAge (years)35.281 ± 4.05934.507 ± 4.604<0.0001Parity2.425 ± 1.1720.469 ± 0.710<0.0001Body Mass Index (BMI) (kg/m2)27.155 ± 5.50225.414 ± 15.321<0.0001Number of oocytes retrieved12.734 ± 7.48612.817 ± 7.6980.4794Day of Embryo Transfer3.712 ± 1.0483.705 ± 1.0440.6583Clinical Pregnancy Rate Per Cycle, n (%)1864 (44.66%)81689 (45.48%)0.2897Live Birth Rate Per Cycle, n (%)1544 (36.99%)67972 (37.85%)0.2605Lengthof Gestation, days250.479 ± 1.046252.667 ± 1.3780.0364Singletons Twins270.220 ± 1.051270.662 ± 1.3420.6739236.024 ± 1.924239.780 ± 2.7820.0509Live Birth Weight, grams2100.348 ± 37.1292275.679 ± 53.150<0.0001Singletons Twins3027.401 ± 139.1713142.228 ± 177.8790.40931978.822 ± 48.0002140.158 ± 73.5060.0008 Open table in a new tab Evidence has linked pregnancies resulting from ART with increased risk of adverse obstetric outcomes, including low birthweight; however, it is unclear if this is due to the ART procedures or to subfertility itself.1 This study provides a rare opportunity to evaluate the effects of ART in a population without an underlying infertility diagnosis. This analysis demonstrates no significant differences in neonatal birthweight or gestational age among ART births from women with infertility and tubal sterilization. The results suggest that differences in outcomes between ART and natural conceptions may be due to the procedures of ART itself.