Outcome In High Risk Pregnancies Research Articles

Early clindamycin for bacterial vaginosis in pregnancy (PREMEVA): a multicentre, double-blind, randomised controlled trial

Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth. PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980. Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial. Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered. French Ministry of Health.

Umbilical artery Doppler velocimetry and adverse perinatal outcome in high risk pregnancies in a tertiary care center

Umbilical artery Doppler velocimetry and adverse perinatal outcome in high risk pregnancies in a tertiary care center

Neonatal Outcomes in High Risk Pregnancies in an Egyptian Tertiary Health Care Center

AbstractBackground: Early neonatal morbidity and mortality represents a major problem caused by maternal medical and obstetric risk factors complicated by lack of primary antenatal care. High risk pregnancy is known to negatively affect the neonatal outcomes.Aim of the Work: This study aimed to compare low and high risk pregnancy neonatal outcomes and to test individual maternal risk factors for poor neonatal outcomes.Patients and Methods: A retrospective study was conducted at a tertiary referral hospital over 6 months. After applying eligibility criteria, 157 high and 125 low risk patients were identified. The neonatal outcome measures were weight, sex, Apgar score at 1 and 5 minutes, respiratory distress, neonatal intensive care unit admission, endotracheal intubation, me-chanical ventilation, meconium aspiration and neonatal death.Results: Neonatal morbidity was higher in high risk group (p<0.05). The Relative Risk of low birth weight, poor Apgar score at 1 minute, respiratory distress, neonatal intensive care unit admission, endotracheal intubation and mechanical ven-tilation was 8.2, 1.85, 5.13, 6.83, 15.37 and 26.42 respectively emphasizing that prematurity affected early neonatal outcomes.Conclusion: The main determinants of poor neonatal outcomes were preterm delivery, previous section and hyper-tensive disorders.

Transient epigenomic changes during pregnancy and early postpartum in women with and without type 2 diabetes.

To investigate epigenomic changes in pregnancy and early postpartum in women with and without type 2 diabetes. Dimethylation of histones H3K4, H3K9, H3K27, H3K36 and H3K79 was measured in white blood cells of women at 30weeks pregnancy, at 8-10 and 20weeks postpartum and in never-pregnant women. Dimethylation levels of all five histones were different between women in pregnancy and early postpartum compared with never-pregnant women and were different between women with and without type 2 diabetes. Histone methylation changes are transient in pregnancy and early postpartum and may represent normal physiological responses to hormones. Different epigenomic profiles in women with type 2 diabetes mellitus may correlate with hormonal responses, leading to high risk pregnancy outcomes.

Amniotic Fluid and its Co-Relation with Pregnancy Outcome in High Risk Pregnancies

Amniotic Fluid and its Co-Relation with Pregnancy Outcome in High Risk Pregnancies

How does Doppler ultrasound compare with no ultrasound for improving infant outcomes in high-risk pregnancies?

How does Doppler ultrasound compare with no ultrasound for improving infant outcomes in high-risk pregnancies?

How does Doppler ultrasound compare with cardiotocography for improving infant outcomes in high-risk pregnancies?

How does Doppler ultrasound compare with cardiotocography for improving infant outcomes in high-risk pregnancies?

FETAL ECHOCARDIOGRAPHY FOR RISKY PREGNANCIES IN SULAIMANI GOVERNORATE

Background&#x0D; Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiacanomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may alsolead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the post natal outcome.Morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries.&#x0D; Objective&#x0D; The aim of this prospective study is to evaluate our experience and results of fetal echo for high risk pregnancies in sulaimani city.&#x0D; Methods&#x0D; This is prospective descriptive study conducted on 450 pregnant ladies refered for fetal echocardiography from obstetricians , ultrasonographers and (self referral) from the 1st January 2013 to 1st the February 2017. Echocardiography done with Siemens machine with semicurved phased array probe at their first visit at 16-22 weeks in 330 ladies, at 22-28 weeks in 70 cases and at 31 weeks and above in 50 ladies. Also 2nd visit echo done for 60 patients for follow up at 31-33 weeks gestation. All babies checked post labour for accuracy of the diagnoses.&#x0D; Results&#x0D; Among 450 pregnant ladies, 98 cases found to have abnormal findings , of which 27 diagnosed as hypertrophic cardiomyopathy ( just one persist after 6 months post labour), 25 cases as ASD (just 10 left true ASD postlabour), 14 diagnosed as tricuspid atersia and single ventricle physiology, 5 AVSD , 5 arrhythmia with hydropis , 5 with MV and TV abnormalities, 4 AS, 3 hypoplastic left heart syndrome, 3 PS, 2 l-TGA and one Coa . For cases whom classify as low risk populations of defects no action undertaken, for high risk population decision for termination wan one of the options. 2 miss diagnosis observed after labour checking among anomalies observed echo findings and they were of low risk cases, and no miss diagnosis observed in major risk group diagnosed cases. Fetal echocardiography examination specifity was sensitivity as 97.9% and specifity as 99.4% which is within 95% CI, positive predictive value was 97.9%, negative predictive value was 99.4% in which both within 95% CI.&#x0D; Conclusion&#x0D; The present study showed that fetal echo has great value in detection of congenital heart disease, prognosis and outcome in high risk pregnancies. It’s recommended to familiarize our obstetrician about this important diagnostic test. We should train our ultrasonographer and pediatric cardiologist to increase awareness about this diagnostic test (is it screening test,or a diagnostic test). Also as far as we know this the first paper written on this kind of diagnostic technique , so more studies need to be conducted in the future.

Inpatient Prenatal Yoga for Hospitalized High-Risk Antepartum Patients: A Feasibility Study [1Q

INTRODUCTION: Prenatal yoga has been shown to be a safe and effective treatment for depression and pain, while improving high-risk pregnancy outcomes. This study investigated the feasibility of establishing a prenatal yoga program for hospitalized high-risk antepartum patients. METHODS: Patients admitted for at least 72 hours to the antepartum service at a tertiary care center were screened for eligibility and consented. Additional medical clearance was obtained from their primary obstetrician. A 30-minute prenatal yoga session was held once a week by a certified prenatal yoga instructor. Physical activity level was adapted to accommodate patients on modified bed rest. Participants completed a questionnaire following the conclusion of each session addressing class timing, length, and frequency. Antepartum nurses were also surveyed to evaluate their perspective. RESULTS: The majority of antepartum patients hospitalized for pregnancy-related complications were offered participation. Of these, 34 women consented and were eligible to participate; 13 attended at least one session during their hospitalization. Others did not participate due to scheduling conflicts with fetal testing, change in clinical status, lack of interest the day of, and delivery or discharge. Post session patient surveys revealed that all patients enjoyed class length and frequency and viewed them as beneficial for managing stress, musculoskeletal discomfort, and sleep quality. Nursing surveys revealed the class did not affect their ability to provide medical care for the patients. CONCLUSION: Inpatient prenatal yoga is a feasible and acceptable intervention for high risk women admitted for antepartum management. Future study of the effect on maternal and fetal outcomes should be strongly considered.

Impact of Intrapartum Cardiotocographic Monitoring On Neonatal Outcome in High Risk Pregnancies: Our Experience

Impact of Intrapartum Cardiotocographic Monitoring On Neonatal Outcome in High Risk Pregnancies: Our Experience

A Study of Cardiotocography During Active Labour to Assess the Perinatal Outcome in High Risk Pregnancy

&lt;strong&gt;Introduction:&lt;/strong&gt; Cardiotocography is a test performed duringactive labour. It was used to assess the fetal wellbeing. Aim: To evaluate the CTG in high risk pregnancies and assess the perinatal outcome. &lt;strong&gt;Materials and Methods:&lt;/strong&gt; Prospective observational study was conducted on 105 high risk pregnant patients fulfilling the eligibility criteria &amp;amp; written informed consent. Complete clinical &amp;amp; obstetrics examination was done. CTG monitoring was done during active labour. The results of CTG were studied according to NICE guidelines. Perinatal outcome were studied by Apgar score, NICU admission. Results: Out of 105 patients 56.2% were primigravida. Post datism was the most common risk factor present in 35.2% females followed by PIH (31.4%), oligohydramnios (18.1%), Anaemia (17.1%), Prev. LSCS (16.2%) and IUGR (16.2%). Normal CTG pattern was observed in 62.9% while suspicious and abnormal pattern was observed in 13.3% and 23.8% pregnancies respectively. Over one third of females with suspicious and abnormal CTG pattern had Thick Meconium Stained Liquor (MSL) during pregnancy. (p&amp;lt; 0.05) The association of abnormal pattern in CTG and caesarean section was found to be statistically significant (p&amp;lt;0.001). The Sensitivity and Specificity of CTG for predicting neonatal morbidity was 81.25% and 82.2%, while it's PPV and NPV was 66.6% and 90.9%. Conclusion: CTG appears to be a simple non-invasive test that can serve as a screening tool in assessing fetuses of high risk obstetric patients in hospitals/centers with a heavy workload and limited resources.

Doppler screening and predictors of adverse outcomes in high risk pregnancies affected by tobacco

ObjectiveThe purpose of this study was to investigate associations between Doppler measurements and adverse outcomes in an obstetric population with high tobacco use. MethodsThis retrospective study included patients with Doppler data (umbilical systolic/diastolic velocity ratios (S/D), uterine S/D, uterine left/right ratio index (RI)). Receiver operator characteristic curve analysis determined cut-off elevated Doppler indices. Stepwise logistic regression was used to predict adverse outcomes. Results338 of 745 patients (45.4%) had adverse outcomes. Doppler artery indices identified significant associations with IUGR, preeclampsia, low birth weight, pre-term birth and composite adverse outcome variable. An elevated Umbilical S/D was 2.1 (95% Confidence Interval (CI): 1.5–2.9; p<0.001) times was more likely to have an adverse outcome. For left uterine artery S/D and nulliparity, the odds ratios were 1.8 (95% CI: 1.3–2.5) and 1.4 (95% CI: 1.0–1.9), respectively. ConclusionUmbilical and uterine left S/D indices and nulliparity are significant independent predictors of adverse outcomes.

A study to evaluate the perinatal outcome in pregnancy induced hypertension

Introduction: Pregnancy-induced hypertension is the general classification for hypertension diseases during pregnancy, which include pregnancy-induced hypertension usually after 20th week of gestation (without proteinuria), pre-eclampsia (with proteinuria), and eclampsia (pre-eclampsia with convulsions). This disease is responsible for high maternal and perinatal morbidity and mortality rates, and is one of the main public health problems. Material and Methods: It was retrospective study conducted between March 2013 to March 2016 in the department of pediatrics, Chirayu Medical College and hospital Bhopal. A total of 3015 mothers were delivered in department of obstetrics and gynecology. Out of these 180 were identified as having pregnancy induced hypertension. During the same period 100 mothers without any risk factor were included in the study. Results: Out of 180 cases of hypertensive disorders of pregnancy, majority were of preeclampsia (47.22%), then Gestational hypertension 38.88%, percentage of eclampsia (13.88%). Incidence of Pregnancy Induced Hypertension– 5.97%. Incidence of low birth weight in PIH is 57.7%, preterm 44.2% and IUGR 20.4%, Still birth 8(4.4%) , early neonatal death 22(12.2%), Highest incidence of LBW (88%), Preterm (80%), IUGR (12%) is present in eclampsia group. In control group incidence of LBW is 22% (P<.001)**, Prmaturity-18% (P<.001)**, IUGR-6% P(<.05)*. Conclusion: The purpose of this article is to give overview of burden of adverse perinatal outcome in high risk Pregnancy. Thus High risk pregnancy should be identified prospectively and then given special care, perhaps a major impact on overall perinatal loss could be reduced.

Which is Superior, Doppler Velocimetry or Non-stress Test or Both in Predicting the Perinatal Outcome of High-Risk Pregnancies.

To analyze which is superior, Doppler velocimetry or non-stress test or both by means of categorization into four groups and comparing the prediction of perinatal outcome in high-risk pregnancies like anemia, hypertensive disorders of pregnancies. This was a prospective study conducted at the Department of Obstetrics and Gynaecology, ISO KGH, Madras Medical College, Chennai, in the year 2014. Two hundred high-risk pregnancies like anemia, hypertensive disorders of pregnancy were included in the study. They were examined systematically, and Doppler velocimetry and non-stress test were done. The main vessels studied by Doppler were umbilical artery and middle cerebral artery, and the indices were calculated. The results of the non-stress test were interpreted as reactive and non-reactive. Based on the results of Doppler and non-stress test, the 200 cases were categorized into four groups and the results were analyzed. Among the 200 cases of high-risk pregnancies, those with a normal Doppler study and a reactive non-stress test had good perinatal outcome. When both were abnormal, there was a higher percentage of adverse outcome as compared to that of either Doppler alone being abnormal or non-stress test alone being non-reactive. It was also found that abnormal Doppler but with a reactive non-stress test had the advantage of prolonging the pregnancy and bringing a better outcome indicating that non-stress test is surely a good test of well-being. When Doppler was normal, but non-stress test was non-reactive, there was an increase in the rate of cesarean section. Each method of fetal surveillance reflects different aspect of maternal and fetal pathophysiology. Hence, combining these will help to bring out better perinatal outcome.

Neonatal Outcome in High Risk Pregnancies

Neonatal Outcome in High Risk Pregnancies

Outcomes of High-Risk Pregnancies in Northern Iran: Multivariate Logistic Regression Model

Background and Purpose High-risk pregnancy is referred to a situation in which mother, fetus or neonate are in higher risk of morbidity or mortality. Because of adverse outcomes of high-risk pregnancies, this study aims to determine these outcomes in the North of Iran. Materials And Methods We recruited 803 urban and rural pregnant women in this crosssectional study via consensus method. Data were collected by a questionnaire and analyzed using descriptive statistics [mean, standard deviation (SD)], chi-square test and multivariate logistic regression model. All data analyses were performed using SPSS software and P Results Mean ± SD, minimum and maximum age of participants were 27.0 ± 6.2, 14 and44 years, respectively, 26.3% of which were urban residences. The frequency of adverse outcomes of pregnancy (stillbirth, abortion, and weight under 2500 g) was 10.8%. According to the multivariate logistic regression model, preeclampsia was significantly associated with adverse outcomes of high-risk pregnancy (Odds ratio = 2.7, 95% confidence interval: 1.03-7.10). Conclusion Our study showed that preeclampsia during pregnancy is a predictive factor of adverse outcomes of pregnancy such as abortion, stillbirth, and low birth weight.

Comparative Study of Foetal Colour Doppler versus Non-Stress Test as a Predictor of Perinatal Outcome in High Risk Pregnancy

Aim & Objectives: To study the perinatal outcome in high risk pregnancy by comparative analysis of Foetal colour Doppler and non-stress test. Material & Methods: This comparative study carried out on 100 antenatal patients of >34 weeks pregnancy in the Department of Obstetrics & Gynaecology S.N. Medical College Agra. All patients were subjected to colour Doppler and non-stress test after doing routine examination and investigations. Result: In our study it was found that, in high risk group 36% had normal NST while 64% had abnormal. In control group 82% had normal NST while 18% shows abnormal NST. In Doppler study 52% were having abnormal findings suggestive of foetal hypoxia and 48% cases had normal Doppler in high risk group while in control group 96% cases had normal findings. On comparing NST and colour Doppler, it was found that where both NST and Doppler were abnormal, Doppler showed changes earlier than NST giving a significant lead time of up to 8 days with an average of 5 days. This lead time is very important as foetus can be delivered in this period or can be followed up to gain a little more pulmonary maturity or steroid prophylaxis can be administered during this period in preterm foetuses. Conclusion: We concluded that Doppler is useful in recognising foetal compromise earlier than NST, giving a lead time which is important in management of preterm high risk pregnancies, Doppler depicts chronic hypoxic changes while NST can detect acute events in presence or absence of chronic hypoxia. An abnormal NST following an abnormal Doppler is associated with worst perinatal outcome.NST still holds its importance because of its ease of use, low cost and minimal time required. On the other hand Doppler requires sophisticated equipments, operative skills and experience.

Effect of maternal cervical bacterial colonization on neonatal outcome in high-risk pregnancies: results from a tertiary maternity center in Turkey

Purpose: To evaluate and compare the morbidity and mortality of neonates born to pregnant women with positive and negative cervical cultures. Materials and Methods: The demographic and clinical features of mothers included in this study, along with details of the microorganisms isolated on maternal cervical cultures and the number of days between a positive cervical culture and delivery were recorded. Neonates were stratified into two groups based on cervical culture results of their mothers - Group 1, positive cervical culture; Group 2, negative cervical culture. Results: A total of 216 women who delivered 242 infants were included in the study. Group 1 consisted of 90 neonates while Group 2 had 152 newborns. The difference between the groups with demographic characteristics was statistically insignificant. Mean levels of the acute phase reactants, CRP, and IL-6, obtained six hours after delivery were significantly higher in Group 1 compared to Group 2 (p p p p Conclusions: Women diagnosed with a high-risk pregnancy should be treated with antibiotics immediately after a positive cervical culture result, and delivery should be delayed until the success of antibiotic treatment can be evaluated. Early initiation of maternal antibiotic therapy is associated with shorter durations of hospital stay for newborns. Close follow-up of mothers with high-risk pregnancies and extension of treatment duration are critical for determining prognosis in newborn infants.

Aminotic Fluid Index and its Correlation with Fetal Growth and Perinatal Outcome

AbstractThe present study aimed to measure amniotic fluid index (AFI) in high-risk pregnancies at ≥30 weeks of gestation and its correlation with fetal growth and perinatal outcome. The Study was carried out in the Department of Obstetrics and Gynecology Hindu Rao Hospital, Delhi. Ultrasound examination was done on women with high-risk pregnancy (pregnancy-induced hypertension, intrauterine growth restriction, diabetes, and postdated pregnancy etc.) attending the antenatal OPD and maternity ward at ≥30 weeks of gestation. AFI was measured by the four quadrant technique. The study included 48 (48 %) primigravida and 52 (52 %) multigravida. Sixteen patients with a history of previous abortion had mean AFI of 9.97 cm which was lower than patients with no history of previous abortion i.e., 11.87 cm (P ≥ 0.1 insignificant). The mean AFI was maximum between 34–36 weeks, i.e., 13.1 cm, after which, it gradually decreased to 9.08 cm beyond 40 weeks. Mean AFI of patients with &lt;40 weeks of gestation gradually decreased from 12.2 cm to 8.0 cm after 42 weeks (P value &lt;0.05). Patients with IUGR had low mean AFI i.e., 9.8 cm whereas mean AFI in patients without IUGR was 12.1 cm (P value &lt;0.01). Congenital anomalies were found in 4 % patients in the present study. Out of seven cases of perinatal mortality encountered, four (57 %) had abnormal AFI values, of which, two had low AFI (i.e., &lt;8 cm) and two had abnormally-high AFI values i.e., &gt;18 cm. Serious congenital malformations were present in three neonates, which resulted in early neonatal death. Out of these three, one patient had low AFI i.e., &lt;8 cm and one had abnormally-high AFI value i.e., &gt;24 cm. The study supports the view that AFI is a quick, noninvasive, and good indicator of fetal outcome in high-risk pregnancy.

Predictive Value of Cerebroplacental Ratio in Detection of Perinatal Outcome in High-Risk Pregnancies.

To assess the predictive value of cerebroplacental ratio (i.e., S/D ratio of middle cerebral artery to S/D ratio of Umbilical artery) in detection of perinatal outcome in high-risk pregnancies. This retrospective study was conducted on 150 patients between 28 and 40weeks of gestation (25 low risk and 125 high risk) who attended OPD and indoor wards of Teerthanker Mahaveer medical college and research center, Moradabad. All patients had serial color Doppler ultrasounds done after taking informed consent which was repeated at 2weeks interval, and data were collected with regard to perinatal outcome. Cerebroplacental ratio is having higher sensitivity and negative predictive value in detection of IUGR, Meconium aspiration syndrome, operative interference for fetal distress, and NICU admissions in comparison to its components. So, better prediction of neonatal outcome can be done by C/U ratio.