Obstetric Complications Of Pregnancy Research Articles

Utilization of Antenatal Care and Skilled Birth Delivery Services in Sub-Saharan Africa: A Systematic Scoping Review.

Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia (n = 40, 29.2%), followed by Nigeria (n = 30, 21.9%). Most of the studies were published between 2019 and 2023 (n = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.

Association of Maternal Asthma and Total Serum Immunoglobulin E levels with Obstetric Complications: The Japan Environment and Children's Study.

To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels. Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels (< 52.40IU/mL), moderate IgE levels (52.40-331.00IU/mL), and high IgE levels (> 331.00IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders. The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05-1.50) and 1.33 (95% CI, 1.06-1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73-0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04-1.52). MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA.

Pregnancy in kidney transplantation women: perinatal outcomes and impact on kidney function

Objectives This study aimed to evaluate maternal and perinatal outcomes in pregnancies after kidney transplant (KT) and the impact of pregnancy on graft function. Methods A descriptive and retrospective case-control study included 43 pregnancies in women after KT, followed in our institution, from January 1991 to December 2019. The control group included 200 non-transplanted pregnant women. Statistical analysis used SPSS 25.0 (SPSS Inc., Chicago, IL), and a p value of .05 was considered statistically significant. Results We studied 43 pregnancies in 37 KT women. The live birth rate of KT pregnant was 81.4%. The mean interval between transplantation and pregnancy was 4.6 years (range 1–16). We found a higher rate of obstetric complications in pregnancies after KT: miscarriage (14.0%, OR 6.7 (2.0–22.1), p < .001), preeclampsia (31.4%, OR 25.7 (7.7–85.3), p < .001), and fetal growth restriction (37.1%, OR 37.6 (9.9–142.3), p < .001). The rate of urogenital infections and anemia during pregnancy was higher in the KT group (p < .001). The gestational age at delivery was 35.0 ± 2.8 weeks and premature delivery was observed in 24 (68.6%) cases. The cesarean rate was higher in the KT group (p < .001). In the KT group, there were two neonatal deaths due to prematurity complications. Renal function deterioration, measured by serum creatinine levels, was observed in two pregnancies. Immunosuppressive therapy was used in all pregnancies after KT, and dosage escalation of immunosuppressive therapy was necessary for 69.8%. Conclusions A higher rate of adverse obstetric outcomes was found in KT pregnant. Kidney function remained stable in most pregnancies. An antenatal and postpartum multidisciplinary approach is essential to improve outcomes and minimization of complications.

The Effects of Myoma and Uterine Preserving Procedures for Myoma on Pregnancy Outcomes

Uterine myomas are the most common benign tumors in reproductive aged women. There have been concerns about fertility and obstetric complications in pregnant women with myomas. Currently, maternal age for pregnancy is increasing, and uterine-preserving therapeutic procedures of uterine fibroids such as myomectomy, high-intensity focused ultrasound (HIFU), or uterine artery embolization (UAE) have increased. However, it is unclear whether those treatments can improve fertility and pregnancy outcomes. Recent data suggest that pregnancies after uterus-preserving procedures are associated with obstetric complications such as cesarean section, placenta previa, preterm labor, premature birth, and low birth weight. The biggest obstetric concern in pregnancies after uterine-preserving procedures is uterine rupture during pregnancy, which can threaten the survival of fetuses. Moreover, uterine rupture after myomectomy is more likely to occur before labor onset. Most international guidelines suggest that myomectomy be considered for a woman with uterine myomas who has undergone several unsuccessful in vitro fertilization cycles despite appropriate ovarian response and good-quality embryos or for a woman with symptomatic myomas. In addition, HIFU or UAE treatments are relative contraindications in women with a future pregnancy plan, because there are limited data about associated pregnancy outcomes, and UAE can affect fertility after the procedure. The risks of uterine rupture and of obstetric complications in pregnancies after myomectomy should be discussed in affected women with a future pregnancy plan.

High Rate of Obstetric Complications in Patients With Essential Thrombocythemia.

BackgroundEssential thrombocythemia (ET) is a chronic myeloproliferative neoplasm characterized by persistently elevated platelet count without a clear secondary cause. Although most patients with ET are between 55 and 60 years of age, it has been estimated that 20% of women with ET are diagnosed during reproductive ages. Miscarriage is the most frequent complication of ET that has been hypothesized to be caused by microcirculatory disturbances and placental microinfarction. Furthermore, pregnant patients with ET are at increased risk of other pregnancy complications such as preterm delivery and intrauterine growth restriction.MethodsThis study was planned to evaluate pregnancy outcomes and predictors of obstetric complications in pregnant women with essential thrombocythemia (ET). The data of 21 patients with ET were analyzed retrospectively between 2016 and 2020. Age, parity, history of miscarriage, presence of Janus kinase 2 (JAK2) mutation, history of thrombotic events, treatment of thrombocytosis during pregnancy, and obstetrical outcomes including miscarriage were compared.ResultsPatients with ET had a significantly higher rate of history of two or more previous miscarriages. Miscarriage and obstetric complications in pregnant women with ET were found to be significantly higher than in the control group. Patients with ET with obstetric complications or miscarriage more frequently had a platelet count of >1000 × 103/μL. Acetylsalicylic acid (ASA) prevented miscarriages, but not obstetric complications, in patients with ET.ConclusionET increases miscarriage and obstetric complications in pregnancy. Treatment with ASA may reduce pregnancy losses, but not obstetric complications.

Bleeding Events and Obstetric Complications of Pregnancy in Hospitalized Patients with Hemophilia: Results from Nationwide Inpatient Sample Database 2003-2011

Introduction: Hemophilia is a rare disease, even more so among women. Case reports and retrospective studies suggest that women with hemophilia have increased risk of bleeding and obstetric complications however the exact burden of this remains unknown. By analyzing the Nationwide Inpatient sample database (NIS) of Healthcare Cost and Utilization Project(AHRQ), we attempted to identify pregnant women with hemophilia A or B and compared their outcome and Obstetric complications with pregnant women who did not have a diagnosis of hemophilia.Method: By using NIS database 2003-2011, we identified the number of obstetric hospitalization, deliveries and caesarean deliveries in women between the age group 18-50 years. Patients hospitalized with Hemophilia A or B were also identified (ICD-9 286.0, 286.1 respectively). We then compared pregnancy related complications for women with and without Hemophilia. Multivariate logistic regression analysis was used to obtain adjusted odds ratio (OR).Results: The total number of obstetric hospitalizations was 42.31 million of which 2415 were Hemophilia A or B. After adjusting for potential confounding factors, compared with patients without Hemophilia, those with hemophilia had significantly higher caesarian section rate [37.5% vs 28%, OR 1.44(CI 1.31-1.59)], intrauterine growth retardation [3.2% vs 1.8%, OR 1.66(CI 1.26-2.19)], preterm deliveries [7.9% vs 6.6%, OR 1.22(CI 1.03-1.45)], antepartum hemorrhage [4.5% vs 2%, OR 1.92(CI 1.52-2.42)], postpartum hemorrhage [5% vs 2.6%, OR 1.84(CI 1.49-2.29)] and transfusion rate [4.2% vs 1.1%, OR 3.44(CI 2.68-4.41)] . Conversely, the incidence of premature rupture of membranes in the hemophiliac group was less as compared to the control group. Inpatient fetal and maternal mortality was found to be zero. The frequencies of the above outcomes with Odds Ratio are reported in Table 1.Conclusion: The overall risk of cesarean section, intrauterine growth retardation, preterm deliveries, risk of transfusion and antepartum and postpartum hemorrhage was higher in pregnant women who have hemophilia. This cross sectional study would help to understand the magnitude of these complications so that they could be managed optimally during antenatal period. Further studies are needed to examine these findings in relation to severity of disease, medications used and the presence of other comorbidities. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Pattern of Childhood and Adolescent Neuropsychiatry Disorders Associated with Obstetric Complications in University of Port Harcourt Teaching Hospital (UPTH)

Background: Obstetric complications tend to affect the immature brain which may cause or predispose to neurological or psychiatric disorder(s) in childhood or adolescence.&#x0D; Aim: To determine the pattern and prevalence of childhood and adolescent neuropsychiatric disorders associated with obstetric complications in UPTH.&#x0D; Methodology: This is a multi-design study, a descriptive cross sectional for assessing psychiatric illness in childhood and adolescence at the time of presentation in the outpatient clinic and this was followed by a retrospective design for mothers to recall cases associated with obstetric complications. Therefore, all cases of childhood psychiatric disorders with established and reliable history of obstetric complications as volunteered by either or both parents of affected children from January, 2013-December, 2019 were included in the study. Diagnoses were made by consultant neuropsychiatrists using the Diagnostic Statistical Manual version 5 (DSM IV) criteria. All cases with family history of mental illness were excluded from the study. A study questionnaire was also administered to the mothers of affected children. The results were analysed using GraphPad Prism statistical software.&#x0D; Results: In all, 2182 cases of various childhood psychiatric disorders were seen within the period under study. Out of this figure, 408 (18.7%) were associated with history of obstetric complications. The most prevalent neuropsychiatric disorder was substance abuse with 17.3%, followed by depression 16.2% and then anxiety disorder 14.8%.&#x0D; Conclusion: Obstetric complications have become important in childhood and adolescent neuropsychiatric disorders and is therefore important to pay more attention to steps that are necessary to prevent obstetric complications in pregnancy, labour, delivery as well as the immediate post partum.

Obstetric complications in pregnancies with life-limiting malformations.

The implementation of palliative care at birth has led to a significant rise in the number of couples who choose to continue with pregnancies complicated by life-limiting malformations (LLMs). Prenatal counselling and appropriate antenatal/perinatal management in these cases are poorly studied and may pose significant challenges. The purpose of this review is to outline specific obstetric risks and to suggest management for mothers who choose to continue with pregnancies with the most common LLMs. In pregnancies complicated by LLMs where parents opt for expectant management, clinicians should respect parental wishes, whilst openly sharing potential serious maternal medical risks specific for the identified abnormalities. The focus of both antenatal and perinatal care should be maternal wellbeing rather than foetal survival. Follow-up ultrasound examinations and maternal surveillance should be aimed at achieving timely diagnosis and effective management of obstetric complications. A clear perinatal plan, agreed with the couples by a multi-disciplinary team including a foetal medicine specialist, a neonatologist and a geneticist, is crucial to reduce maternal morbidity. This review provides a useful framework for clinicians who face the challenges of counselling and managing cases complicated by LLMs where parents opt for pregnancy continuation.

EP02.10: Evaluation of maternal hemodynamic and obstetric complications in pregnancy after assisted reproductive technology

EP02.10: Evaluation of maternal hemodynamic and obstetric complications in pregnancy after assisted reproductive technology

Management and referral for high-risk conditions and complications during the antenatal period: knowledge, practice and attitude survey of providers in rural public healthcare in two states of India

BackgroundAppropriate antenatal care improves pregnancy outcomes. Routine antenatal care is provided at primary care facilities in rural India and women at-risk of poor outcomes are referred to advanced centres in cities. The primary care facilities include Sub-health centres, Primary health centres, and Community health centres, in ascending order of level of obstetric care provided. The latter two should provide basic and comprehensive obstetric care, respectively, but they provide only partial services. In such scenario, the management and referrals during pregnancy are less understood. This study assessed rural providers’ perspectives on management and referrals of antenatal women with high obstetric risk, or with complications.MethodsWe surveyed 147 health care providers in primary level public health care from poor and better performing districts from two states. We assessed their knowledge, attitudes and practices regarding obstetric care, referral decisions and pre-referral treatments provided for commonly occurring obstetric high-risk conditions and complications.ResultsStaff had sub-optimal knowledge of, and practices for, screening common high-risk conditions and assessing complications in pregnancy. Only 31% (47/147) mentioned screening for at least 10 of the 16 common high-risk conditions and early complications of pregnancy. Only 35% (17/49) of the staff at Primary health centres, and 51% (18/35) at Community health centres, mentioned that they managed these conditions and, the remaining staff referred most of such cases early in pregnancy. The staff mentioned inability to manage childbirth of women with high-risk conditions and complications. Thus in absence of efficient referral systems and communication, it was better for these women to receive antenatal care at the advanced centres (often far) where they should deliver. There were large gaps in knowledge of emergency treatment for obstetric complications in pregnancy and pre-referral first-aid. Staff generally were low on confidence and did not have adequate resources. Nurses had limited roles in decision making. Staff desired skill building, mentoring, moral support, and motivation from senior officers.ConclusionThe Indian health system should improve the provision of obstetric care by standardising services at each level of health care and increasing the focus on emergency treatment for complications, appropriate decision-making for referral, and improving referral communication and staff support.

Obstetric outcomes after fresh versus frozen-thawed embryo transfers: A systematic review and meta-analysis.

ObjectiveTo evaluate if there are differences in the risks of obstetric outcomes in IVF/ICSI singleton pregnancies when compared fresh to frozen-thawed embryo transfers (FET).MethodsThis was a systematic review and meta-analysis evaluating the obstetric outcomes in singleton pregnancies after FET and fresh embryo transfer. The outcomes included in this study were pregnancy-induced hypertension (PIH), pre-eclampsia, placenta previa, and placenta accreta.ResultsThe search yielded 654 papers, 6 of which met the inclusion criteria and reported on obstetric outcomes. When comparing pregnancies that arose from FET or fresh embryo transfer, there was an increase in the risk of obstetric complications in pregnancies resulting from FET when compared to those emerging from fresh embryo transfers in PIH (aOR 1.82; 95% CI 1.24-2.68), pre-eclampsia (aOR 1.32, 95% CI 1.07, 1.63), and placenta accreta (aOR 3.51, 95% CI 2.04-6.05). There were no significant differences in the risk between the FET and fresh embryo transfer groups when evaluating placenta previa (aOR 0.70; 95% CI 0.46-1.08).ConclusionThe obstetric outcomes observed in pregnancies arising from ART may differ among fresh and FET cycles. Thus, when evaluating to perform a fresh embryo transfer or a freeze-all cycle, these differences found in obstetric outcomes between fresh and FET should be taken into account. The adverse obstetric outcomes after FET found in this study emphasize that the freeze-all policy should not be offered to all the patients, but should be offered to those with a clear indication of the benefit of this strategy.

Использование донорских яйцеклеток как дополнительный риск акушерских осложнений при беременности после экстракорпорального оплодотворения

Использование донорских яйцеклеток как дополнительный риск акушерских осложнений при беременности после экстракорпорального оплодотворения

Aplastic anemia associated with pregnancy: maternal and fetal complications

Objective: To analyze obstetric complications associated with aplastic anemia (AA) among pregnant women and analyze the underlying factors.Methods: A retrospective analysis of 60 pregnancies with AA. Thirty four of these patients were grouped as complicated group having obstetric complications and the rest 26 without complications as the control group. Comparative analysis was conducted to access the related risk factors, which may affect the maternal and fetal complications.Results: The major maternal complications in this study were premature labor, gestational diabetes, pre-eclampsia, acute heart failure, postpartum hemorrhage, and severe postpartum infection. Premature birth, fetal growth restriction and stillbirths accounted for 27.3%, 5.0% and 6.7% of prenatal mortality. Twenty six of patients had uncomplicated pregnancies. Patients without complications had higher mean hemoglobin concentration (75.38 ± 16.19 g/L) and platelet counts (23.92 ± 14.82 × 109 cells/L) than did women with complications (mean hemoglobin concentration, 61.47 ± 15.15 g/L, p = 0.001; mean platelet counts, 12.11 ± 7.87 × 109 cells/L, p < 0.001).Conclusion: Pregnancies associated with AA can carry the risk of multiple maternal and fetal complications. Low hemoglobin concentration and platelet counts may be the primary risk factors for obstetric complications in pregnancies associated with AA.

Utilisation of obstetric sonography at a peri-urban health centre in Uganda

Maternal mortality is related to obstetric complications in pregnancy some of which could be revealed by obstetric sonography. Obstetric sonography has become part of routine antenatal care in both urban and rural settings. The objective of the study was to assess the utilization of obstetric sonography in a rural hospital of Uganda, including the frequency and appropriateness of its usage as well as determine whether there was any relation between number of obstetric scans, patient management and obstetric outcomes. It was a retrospective study in which review of all obstetric charts and obstetric scan requisition forms for all deliveries in Ndejje Health Centre (Uganda) was done. During the study period, there were 105 singleton deliveries, and these mothers underwent a total of 232 obstetric scans. More than half (53.4%) of the scans were classified as inappropriate. There were no significant differences in the number of scans between low- and high-risk pregnancies or between uncomplicated deliveries and those in which induction or instrumental or operative delivery occurred, nor was there any relation between number of scans and obstetric outcome. Obstetric sonography has become popular in rural health settings as part of antenatal care. However, it was over-used in the health centre. This overuse was not associated with any identifiable effect on obstetric outcome. Therefore, more appropriate use of obstetric sonography, in accordance with evidence-based guidelines, is recommended.

Obstetric outcomes in nulliparous women aged 35 and over with singleton pregnancies conceived by in vitro fertilization

To investigate obstetric outcomes in singleton pregnancies conceived by in vitro fertilization (IVF) to nulliparous women older than 35 compared to those of their younger counterparts. Nulliparous women 35 years and older at delivery conceived by IVF (n = 89) were compared with nulliparous women 34 years and younger at delivery conceived by IVF (n = 48). Data included antenatal data, gestational age at delivery, maternal and neonatal complications and mode of delivery. The incidence of pregnancy-induced hypertension in the younger group was significantly higher than that in the elderly group (13 vs. 3.4%, P = 0.043). There were no measurable differences in other obstetric outcomes such as placental abnormality, premature delivery or neonatal asphyxia between the two groups. The current results suggest that obstetric complications in pregnancies conceived IVF are attributed to mechanisms other than those depend on advanced maternal age.

Endometriosis is associated with a decreased risk of pre-eclampsia

We postulated that impaired endometrial differentiation in women with pelvic endometriosis predisposes for pre-eclampsia. A retrospective case-control study set at the University of Ghent IVF centre. The incidence of pre-eclampsia and pregnancy-induced hypertension (PIH) following the clinical and/or laparoscopic diagnosis of endometriosis-associated infertility (case group; n = 245 pregnancies) was compared with the incidence of these obstetric complications in pregnancies following treatment for male-factor infertility (control group; n = 274 pregnancies). Pregnancy data were obtained by searching electronic databases and postal questionnaires. The case and control groups were matched for age, parity and multiple pregnancies. The incidence of pre-eclampsia was significantly lower in the case group (0.8%) when compared with control group (5.8%) (P = 0.002; odds ratio (OR) = 7.5, 95% confidence interval (CI): 1.7-33.3). Analysis of obstetric outcome in the subgroup of patients with laparoscopic data confirmed the lower risk of pre-eclampsia in the case (1.2%) versus control (7.4%) groups (P = 0.032; OR = 6.6, 95% CI: 1.2-37). PIH occurred in 3.5% and 8.7% of case and control pregnancies, respectively (P = 0.018; OR = 2.6, 95% CI: 1.2-6.0). The odds of developing pre-eclampsia were 5.67 times higher in the control group than in pregnancies following endometriosis-associated infertility. In multiple pregnancies, the odds of developing pre-eclampsia increased 1.93 times per additional child, with or without endometriosis. We found no evidence that endometriosis predisposes for pre-eclampsia. Instead, the risk of hypertensive disorder in pregnancy is significantly reduced in women with endometriosis-associated infertility.

Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term

We sought to estimate when rates of maternal pregnancy complications increase beyond 37 weeks of gestation. We designed a retrospective cohort study of all low-risk women delivered beyond 37 weeks' gestational age from 1995 to 1999 within a mature managed care organization. Rates of mode of delivery and maternal complications of labor and delivery were examined by gestational age with both bivariate and multivariable analyses. We found that, among the 119,254 women who delivered at 37 completed weeks and beyond, the rates of operative vaginal delivery (OR 1.15, 95% CI 1.09, 1.22), 3rd- or 4th-degree perineal laceration (OR 1.15, 95% CI 1.06, 1.24), and chorioamnionitis (OR 1.32, 95% CI 1.21, 1.44) all increased at 40 weeks as compared to 39 weeks of gestation (P < .001), and rates of postpartum hemorrhage (OR 1.21, 95% CI (1.10, 1.32), endomyometritis (OR 1.46, 95% CI 1.14, 1.87), and primary cesarean delivery (1.28, 95% CI 1.20, 1.36) increased at 41 weeks of gestation (P < .001). The cesarean indications of nonreassuring fetal heart rate (OR 1.81, 95% CI 1.49, 2.19) and cephalo-pelvic disproportion (OR 1.64, 95% CI 1.40, 1.94) increased at 40 weeks of gestation (P < .001). We found that the risk of maternal peripartum complications increase as pregnancy progresses beyond 40 weeks of gestation. Management of pregnancies that progress past their EDC should include counseling regarding the risks of increasing gestational age.

Primigravidae’s knowledge about obstetric complications in an urban health centre in Malawi

Pregnant women in Malawi receive information about pregnancy, labour and delivery during routine antenatal visits. This study aimed to explore knowledge of obstetric complications amongst primigravidae attending an urban health centre in Blantyre, Malawi. A descriptive study design was used. Recognition of obstetric complications in pregnancy, during labour and after delivery and actions that participants would take if they developed any complications in pregnancy and after delivery were explored. Actions that women would take for complications that occur during labour were not probed, as women have little control over actions taken when complications arise during labour. Participants were selected by means of purposive sampling from a population of pregnant women who fitted defined criteria and who were attending antenatal clinic at a health centre. Forty-five primigravidae from the urban setting with a gestation period between 28 and 42 weeks were interviewed. Data were analysed manually. The findings showed that participants were more aware of obstetric complications that could occur in pregnancy than of complications that may occur during and after delivery. Sixty percent of the participants were knowledgeable about obstetric complications in pregnancy. The majority of the participants, 73% and 82.2% did not know of any problems that could occur during and after the birth of the baby respectively. Participants had limited knowledge of complications that may need immediate treatment during all three periods. Fifty-eight percent (95% ci: 43; 73) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with pregnancy complications. However, only 24% (95% ci: 11; 38) of the primigravidae had some knowledge and could make an informed decision to go to a health facility with complications after delivery. These findings suggest a critical need for provision of information on obstetric complications especially those that may occur during and after birth with emphasis on those obstetric complications that require immediate treatment.

Pregnancy in women with psychotic disorders

To review the psychiatric and obstetric complications of pregnancy in women with psychotic disorders and discuss implications for prevention and treatment of these conditions. Narrative review. Many women with psychotic disorders have children but their pregnancies are at an increased risk of obstetric complications, stillbirths and neonatal deaths, and psychiatric complications. Women with a history of mood disorders (affective psychoses) are at high risk of postpartum relapse. A significant proportion of mothers with psychotic disorders have parenting difficulties and lose custody of their infant. Close liaison between all health professionals during pregnancy and postpartum is essential for optimal management of these high-risk pregnancies.

Misoprostol is effective for induction of labor in high risk pregnant women: A randomized controlled trial

WOMEN: A RANDOMIZED CONTROLLED TRIAL MICHAEL SCHNEIDER, RISA RAMSEY, LU KAO, KELLY ANGELA BENNETT, University of Tennessee, Maternal Fetal Medicine, Memphis, Tennessee, University of Tennessee, Obstetrics and Gynecology, Memphis, Tennessee, University of Tennessee Health Science Center, Obstetrics and Gynecology, Memphis, Tennessee, Vanderbilt University, Maternal Fetal Medicine, Nashville, Tennessee OBJECTIVE: To test the null hypothesis that administering misoprostol orally or vaginally to high risk pregnant women undergoing labor induction will result in no difference in cesarean delivery rates. STUDY DESIGN: Three hundred and eleven women with medical and obstetrical complications of pregnancy were randomized to receive either misoprostol orally (50 mg) or vaginally (25 mg) every four hours for labor induction. Sample size was calculated using a two-tailed alpha of 0.05 and power [1-b] of 80%. Student’s t test, c and Fisher’s exact tests were used in analysis. Data were analyzed on an intent-to-treat basis. RESULTS: Analysis involved 134 women in the vaginal and 162 women in the oral misoprostol group. There were 41 cesarean deliveries (30.6%) in the vaginal and 59 (36.4%) in the oral group [P = .30, relative risk [RR] 0.86, confidence interval [CI] 0.6-1.1] Cesarean delivery rates for dystocia [P = .97, RR 0.99, CI 0.7-1.3] or non reassuring fetal heart rate tracing [P = .97, RR 0.99, CI 0.5-1.7] were not different based on route of administration. Significantly more women in the vaginal group required only a single dose of misoprostol. [P = .007, RR 1.4, CI 1.1-1.8]. No neonate in this study met ACOG criteria for birth asphyxia. CONCLUSION: Misoprostol is effective for induction of labor in women with medical and obstetrical complications of pregnancy. Vaginal administration may be the preferred route when time to delivery is an important concern.