Obstetric Outcomes In Pregnant Women Research Articles

The D&T report

The D&T report

Obstetric Outcome in Pregnant Women on Long-term Dialysis: A Case Series

Although still uncommon, pregnancy frequency in women on maintenance hemodialysis therapy has increased in the past 20 years. Most published reports suggest that intensified hemodialysis regimens result in better pregnancy outcomes. The small number of patients investigated in all reported series is the main limitation of the available studies. Retrospective case series. Data for all pregnancies that occurred in 1988-2008 in women undergoing maintenance hemodialysis (52 pregnancies) at the São Paulo University Medical School (São Paulo, Brazil). We analyzed maternal and fetal outcomes of 52 pregnancies, as well as their relationship with various clinical, laboratory, and hemodialysis parameters, such as pre-eclampsia, pregnancy before or after dialysis therapy, hemodialysis dose, polyhydramnios, anemia, and predialysis serum urea level. In addition, logistic regression models for a composite adverse fetal outcome (perinatal death or extremely premature delivery) and linear regression models for birth weight were built. 87% overall rate of successful delivery, with a mean gestational age of 32.7 +/- 3.1 weeks. Pre-eclampsia was associated with a poor prognosis compared with pregnancies without pre-eclampsia: a successful delivery rate of 60% versus 92.9% (P = 0.02), extremely premature delivery rate of 77.8% versus 3.3% (P < 0.001), lower gestational age (P < 0.001), and birth weight (P < 0.001). Patients with an adverse composite fetal outcome had a higher frequency of pre-eclampsia (P < 0.001), lower frequency of polyhydramnios (P = 0.03), lower third-trimester hematocrit (P = 0.03), and higher predialysis serum urea level (P = 0.03). The same results were seen for birth weight. Retrospective data analysis. The absence of creatinine clearance measurements did not allow evaluation of the impact of residual renal function on fetal outcome. Outcomes of pregnancy in women undergoing hemodialysis often are good. Pre-eclampsia, third-trimester hematocrit, polyhydramnios, and predialysis serum urea level are important variables associated with fetal outcome and birth weight.

Obstetric outcomes in pregnant women with congenital heart disease

Predictors of adverse maternal and neonatal outcomes in pregnant women with congenital heart disease (CHD) have been described, but not for obstetrical outcomes. The primary aim of this study was to determine what risk factors predict sustaining adverse obstetric events in pregnant women with CHD. In addition, a secondary aim was to assess the impact of avoiding Valsalva on obstetrical outcomes, an intervention commonly recommended, but never studied. A retrospective cohort study examined outcomes in women with CHD who delivered between 1998 and 2005. We examined baseline cardiac characteristics in a multivariate logistic regression model to assess which were associated with adverse obstetric events. We also compared outcomes of women who avoided Valsalva versus those who were allowed to Valsalva. The study included 65 women with 112 pregnancies. An adverse obstetric event occurred in 32.6% (n=32) of ongoing pregnancies, the most common being preterm delivery (n=19), post-partum hemorrhage (n=13), and preterm premature rupture of membranes (n=9). There were no independent predictors for sustaining an adverse obstetric event. Women who avoided Valsalva had increased rates of post-partum hemorrhage and 3rd/4th degree lacerations. Although one-third of pregnancies were associated with an adverse obstetric outcome, these events could not be predicted by baseline hemodynamic characteristics. The routine practice of avoiding Valsalva may be associated with high rates of post-partum hemorrhage and 3rd/4th degree lacerations.

Diabetes control and pregnancy outcomes in women with type 1 diabetes treated during pregnancy with continuous subcutaneous insulin infusion or multiple daily insulin injections

The aim of the study was to compare diabetes control and obstetrical outcomes in pregnant women with type 1 diabetes treated during pregnancy with either continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injections (MDII). It was a descriptive, retrospective, observational study of 116 Caucasian pregnant women with type 1 diabetes mellitus. Thirty women were treated during pregnancy with continuous subcutaneous insulin infusion (CSII group) and 86 with multiple daily insulin injections (MDII group). Mean age and body mass index did not differ between groups (p >0.05). Duration of diabetes was longer in CSII than in MDII group, 12.7 +/- 7.20 vs. 7.71 +/- 6.13 years, respectively (p = 0.0005). There were no differences between the studied groups in glycated hemoglobin (HbA(1c)) levels in the I, II and III trimesters of pregnancy - in CSII group 7.41 +/- 1.75, 6.57 +/- 1.09 and 6.46 +/- 0.87, respectively, in MDII group - 7.71 +/- 2.37, 6.65 +/- 1.18 and 6.75 +/- 1.21, respectively (p >0.05). There were no severe hypoglycemia and diabetic coma. Mean duration of pregnancy, rate of premature deliveries, newborn birth weight, incidence of SGA and LGA, and the frequency of neonatal hypoglycemia did not differ between groups (p >0.05). The total malformation rate was 5.13%, including 2 terminated pregnancies and the frequency did not differ between groups (p >0.05). The rate of spontaneous abortions was 16.7% in CSII group and 10.3% in MDII (p >0.05). No apparent relationships between mode of insulin therapy and pregnancy outcome were found in type 1 diabetes patients.

PARVOVIRUS B19 INFECTION IN PREGNANCY

Parvoviruses are widespread in nature, with a diversity of virus types affecting many animal species, usually in a species-specific manner. Some members of the parvovirus family give rise to asymptomatic infections but others are highly pathogenic, causing disease not only in adults but also in the young, the newborn and in the fetus. Parvoviruses of animals have for long been regarded as agents of reproductive failure and parvovirus B19 was recognised as a cause of fetal loss in humans in the 1980s. Moreover, following the control of congenital rubella by pre-pubertal and child vaccination, parvovirus B19 infection has emerged as probably the leading cause of viral embryopathy. This review will focus on the laboratory diagnosis of parvovirus B19 infection following exposure in pregnancy. The indications for testing maternal and fetal samples and the interpretation of test results will be discussed and a section is included on clinical management of the infection in pregnancy. The obstetric outcome in pregnant women who seroconvert will be reviewed.

Unexplained elevated maternal serum α-fetoprotein and/or human chorionic gonadotropin and the risk of adverse outcomes

Objective The study was undertaken to determine the risks of adverse obstetric outcomes in pregnant women with unexplained elevations of maternal serum α-fetoprotein (MSAFP) and/or human chorionic gonadotropin (hCG) and to determine whether these risks vary by prepregnancy risk status. Study design All women who underwent double-marker screening (MSAFP + hCG) between 1994 and 2000 and were delivered of an infant in Nova Scotia, Canada, during this period were identified from a hospital serum screening database and a provincial perinatal database. Patients with inaccurate dating, major structural anomalies, or chromosomal abnormalities were excluded. The primary outcomes studied were preeclampsia, abruptio placentae, fetal growth restriction, fetal death, and preterm birth. Women with medical or previous obstetric complications were designated high risk. Logistic regression, controlling for confounding factors, was used to estimate the relative risks (RRs) and 95% CI for elevated levels of MSAFP and/or hCG and each of the outcomes. Results Among the 14,374 women who met the study criteria, 5,789 were designated high risk. Except for abruptio placentae, unexplained elevated MSAFP or elevated hCG levels were independently associated with all the outcomes in both high- and low-risk women. Elevated screening values were associated with increased risk of abruptio placentae among low-risk women only. Particularly large RRs were seen for fetal death in both high- and low-risk women (RR = 4.9, 95% CI 2.7-8.7 for elevated MSAFP or hCG in high- and low-risk women combined). Conclusion Unexplained elevated levels of MSAFP and/or hCG are associated with an increased risk of most pregnancy complications. Increased antenatal surveillance of these patients is important regardless of prepregnancy risk status.

373 A meta-analysis of adverse obstetrical outcomes in pregnant women with factor V Leiden

373 A meta-analysis of adverse obstetrical outcomes in pregnant women with factor V Leiden

Crash injury investigation and injury mechanisms in road traffic accidents

We performed a systematic review and meta-analysis to assess the efficacy and safety of heparin for preventing adverse obstetrical outcomes in pregnant women with antiphospholipid syndrome (APS).We reviewed randomized controlled trials from CENTRAL, EMBASE, MEDLINE, and Web of science (inception to November 5th 2019), and relevant article reference lists. Two reviewers independently screened and extracted data from trials investigating heparin, including Low Molecular Weight Heparin (LMWH) and unfractionated heparin (UFH) at any dose, associated or not with aspirin, compared to any comparator group in pregnant women with APS. Internal validity was assessed in duplicate using the Cochrane Risk of Bias tool. The strength of evidence was assessed in duplicate using the Grading of Recommendations Assessment, Development and Evaluation framework. Our primary outcome was live birth rate. Secondary outcomes included preeclampsia, preterm birth, intra-uterine growth restriction (IUGR) and thromboembolism. Safety outcomes included maternal or neonatal bleedings, heparin-induced thrombocytopenia and allergy. Subgroup analyses were conducted to explore heterogeneity.From 2395 identified citations, 13 trials (1916 patients) met inclusion criteria. Heparin, associated or not with aspirin, significantly increased the rate of live birth compared to any comparator (RR 1.20; 95 % CI 1.09−1.33, I2 = 67 %, 1916 patients, low-certainty evidence). In subgroup analyses, LMWH and UFH were independently associated with greater rates of live birth: RR 1.15 (95 % CI 1.04–1.28, I2 = 71 %, 1684 patients, 9 trials) and RR 1.45 (95 % CI 1.16–1.81, I2 = 19 %, 149 patients, 4 trials) respectively. Heparin associated or not to aspirin, significantly decreased the rate of preeclampsia compared to any comparator (RR 0.32; 95 % CI 0.12−0.87, I2 = 0%, 465 patients, 8 trials) but was not associated with differential rates of preterm birth nor IUGR. Heparin was associated with minor bleeding (bruises, epistaxis): RR 2.58 (95 % CI 1.03−6.43, I2 = 16 %, 653 patients, 9 trials). No serious maternal or neonatal adverse events were reported in the included studies.In pregnant women with APS, heparin, associated or not to aspirin, significantly improved the live birth rate compared to any comparator and decreased the risk of preeclampsia, without increasing maternal and neonatal severe morbidity.