Perinatal Outcome In Patients Research Articles

Perinatal outcomes in patients undergoing repeat cerclage: A retrospective case series study.

This study aimed to describe the pregnancy outcomes of a case series of patients with probable cerclage failure who received repeat cerclage (RC) with potential indications. We retrospectively collected a case series of 55 singleton pregnancies with RC from 2019 to 2022 in Shanghai, China. All included women provided written informed consent, and the study was approved by the ethics committees of the two hospitals. We compared pregnancy outcomes between pregnancies with RC for different indications. Among the case series, nine patients underwent RC for the indication of protruding membranes below the previous suture loop (group A), and the other 46 patients for painless cervix dilation (group B). Gestational age at delivery was shorter in group B than in group A (30.7 vs 37.6 weeks, P = 0.009). Rates of preterm birth <32 weeks (63.0% vs 22.2%, P = 0.033) and < 37 weeks (76.1% vs 33.3%, P = 0.002) were significantly higher in group B than in group A. Of the 46 patients who underwent RC for painless cervical dilation, 28 had cervical dilation of 1 to 2 cm (group C) and the other 18 had cervical dilation of 3 to 6 cm (group D). The gestational age at delivery was shorter in group D than in group C (27.4 vs 31.5 weeks, P = 0.037). However, rates of preterm birth <32 or <37 weeks were similar between the groups. RC may constitute a rescue strategy for patients with probable cerclage failure. Protrusion of membranes below the cerclage loop or cervical dilation <3 cm may be an indicator of better pregnancy outcome.

Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre.

Background One of the leading causes contributing to morbidity and mortality globally is attributed to eclampsia. Hence, it is vital to comprehensively review each female having eclampsia and to evaluate the factors that govern the outcomes in females with eclampsia. Aim To decode the fetal and maternal outcomes in subjects having eclampsia and to evaluate various factors that govern the outcomes. Methods This retrospective cohort and epidemiological study commenced at the Department of Obstetrics and Gynaecology,Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, in January 2016 till April 2017, and included females that either developed eclampsia in hospital stay duration or presented with pre-existing eclampsia. In included females, various fetal and maternal parameters were assessed along with the outcome of pregnancy. The institutional data records and the database were also used to determine the prevalence and incidence of eclampsia. Baseline maternal parameters were recorded from the already-existing institute data. These included the gestational age (in years), socioeconomic status, educational attainment, parity, gravidity, and the number of weeks of gestation present at the time of delivery. Antenatal care data assessed were blood pressure recordings, any proteinuria documented in the data, and the number of antenatal visits by the subjects. Statistical analysis was performed to assess both parameters. Results In the current investigation, there were 0.34% eclampsia cases among females visiting the institution for deliveries. Incidences of stillbirth were seen in 19.04% and 8% of study participants, respectively. We found 9.52% (n=4) of female infants to have perished from eclampsia. Preterm births, a delayed start to the treatment, and insufficient care were all linked to poor foetal and mother outcomes. The longer the period between the beginning of a fit and delivery, the greater the likelihood of unfavourable results.Seizure onset before or after birth, parity, or subject age had no impact on mother or foetal health.The p-value for statistical significance was kept at 0.05. Conclusion Most of the research participant women, had intrapartum eclampsia, postpartum eclampsia, and antepartum eclampsia, based on the time of the convulsions in relation to the labor. It was highlighted that there was no conclusive evidence linking the date of the fit's beginning to unfavourable results or an elevated risk of complications. Neonatal mortality and stillbirth were observed with vaginal delivery in eclampsia cases. Outcomes in eclampsia can be improved byearly treatment initiation, timely and appropriate referral, early disease recognition, and appropriate antenatal care.

Hypertensive disorders of pregnancy in moyamoya disease: A single institution experience

ObjectiveThe characteristics of pregnancy and delivery in patients with moyamoya disease (MMD) remain unclear. We retrospectively investigated perinatal outcomes in patients with MMD to evaluate the risks associated to this condition. Materials and methodsClinical data of women with MMD who delivered at the University of Tokyo Hospital between 2000 and 2021 were collected. Maternal characteristics including genetic data, obstetric complications, method of delivery and anesthesia, neonatal outcomes, neurological events during pregnancy, delivery, and postpartum course, were reviewed. ResultsThirteen pregnancies with MMD were identified. The median maternal age was 30 years. The initial clinical symptoms were identified as transient ischemic attack, infarction, and headache. Eight patients had a history of bypass surgery. The median gestational age at delivery was 37 weeks. DNA samples were collected from five patients, responsible for six pregnancies. Of these six cases, five had the RNF213 c.14429G > A (p.Arg4810Lys) heterozygous variant. Of the 13 pregnancies, seven had hypertensive disorder of pregnancy (HDP). Additionally, three of five pregnancy cases with RNF213 p.Arg4810Lys heterozygous variant presented with HDP. Nine patients underwent cesarean section, and four delivered vaginally with epidural anesthesia. One case of ischemic stroke was confirmed during the postpartum period. Regarding newborns, neither Apgar scores lower than 7 nor neonatal intensive care unit admissions were reported. ConclusionsThis study suggests that the frequency of HDP is higher in patients with MMD compared to those with normal pregnancies. Strict blood pressure control should be performed in patients with MMD during pregnancy and postpartum period.

The influence of air pollution on gestational age at delivery and birthweight in patients with or without respiratory allergy: A nested case-control study.

Air pollution is a current major health issue. The burden of airborne pollutants and aeroallergen levels varies throughout the year, as well as their interaction and consequences. Prenatal exposure during pregnancy has been associated with adverse perinatal outcomes. The aim of this study was to evaluate the impact of air pollutants on perinatal outcomes in patients with or without respiratory allergy. Nested case-control retrospective study on 3006 pregnant women. Correlations between concentrations of common pollutants in each trimester of pregnancy and on average during the whole pregnancy and both gestational age at delivery and birthweight were studied. Pearson's correlation coefficient and binary logistic regression were used. In general, pollutants correlated more strongly with birthweight than with gestational age at delivery. Nine-month NO2 , SO2 , CO, and benzene, and second-trimester CO negatively correlated with birthweight, whereas only first-trimester NO2 showed a very mild correlation with gestational age at delivery. Negative correlations between pollutants and birthweight were much stronger in the respiratory allergy group (n = 43; 1.4%) than in the non-allergic group. After adjustments, the most significant predictive pollutant of birthweight was SO2 in both groups. The best predictive model was much stronger in the allergic group for third-trimester SO2 (R2 = 0.12, p = 0.02) than in the non-allergic group for total SO2 (R2 = 0.002, p = 0.02). For each unit that SO2 increased, birthweight reduced by 3.22% vs. 1.28% in each group, respectively. Air pollutant concentrations, especially SO2 , negatively influenced birthweight. The impact of this association was much stronger and more relevant in the group of women with respiratory allergies.

Effect of preimplantation genetic testing for aneuploidies on pregnancy outcome in patients with unexplained recurrent spontaneous abortion

Objective: To investigate the effect of preimplantation genetic testing for aneuploidies (PGT-A) on pregnancy outcome and perinatal outcome of single live birth in patients with unexplained recurrent spontaneous abortion (URSA). Methods: The clinical data of 351 cycles of the first transfer of a blastocyst through whole embryo freezing in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from 2019 to 2021 were retrospectively analyzed. According to whether PGT-A was performed before the transfer, the patients were divided into two groups: the PGT-A group (160 cycles) and the control group (191 cycles) were treated with in vitro fertilization/intracytoplasmic sperm microinjection (IVF/ICSI). To adjust for confounding factors, propensity score matching (PSM) was carried out in a 1∶1 ratio between the two groups of patients. After matching, 98 patients in the PGT-A group and 98 patients in the control group were compared for pregnancy outcome and perinatal outcome of singleton live births. Results: Before PSM, the female age in the PGT-A group was (33.6±4.0) years, lower than that in the control group (34.5±4.5) years (P=0.049). Male age in the PGT-A group was (33.6±4.1) years, lower than that in the control group (35.3±5.1) years (P<0.001). There were statistically significant differences between the two groups in infertility factors, female body mass index (BMI), years of infertility, number of spontaneous abortions, basal follicle stimulating hormone (FSH), endometrial thickness on the day of transfer and the percentage of high-quality blastocysts (all P values<0.05); After PSM, there was a statistically significant difference in fertilization methods and infertility factors between the two groups (P<0.05), while other differences were not statistically significant (all P values>0.05); There were statistically significant differences between the two groups in implant rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], clinical pregnancy rate [63.3% (62 cycles) vs. 49.0% (48 cycles), P=0.044], and live birth rate [42.9% (42 cycles) vs. 28.6% (28 cycles), P=0.037]. There was no statistically significant difference in perinatal outcomes between the PGT-A group and the control group in obtaining single birth live births (P>0.05). Conclusion: Compared with conventional IVF/ICSI assisted pregnancy, PGT-A assisted pregnancy significantly improves implantation rate, clinical pregnancy rate, and live birth rate in URSA patients. PGT-A improves the pregnancy outcomes in URSA patients but not perinatal outcomes in patients with singleton live births.

Maternal and Fetal Outcome Following Post In vitro Fertilization and Embryo Transfer Pregnancy: A Prospective Observational Study

Abstract Background: While the majority of in vitro fertilization (IVF)-conceived children are healthy, IVF has been associated with an increased risk of adverse obstetric and perinatal outcomes including hypertensive disorders of pregnancy, preterm labor and preterm delivery, and low birth weight (LBW). Objective: The objective of the study is to assess pregnancy, maternal, and perinatal outcomes in patients undergoing IVF embryo transfer (IVF-ET) at tertiary care center in North India. Methodology: It was a prospective observational study carried out for duration of 20 months among women who conceived following an IVF-ET. The sample size was 107 consecutive mothers and data were collected using a predesigned semi-structured study pro forma. Detailed menstrual, obstetric, and medical histories of each patient were noted. Findings of the general, physical, systemic, and obstetrical and gynecological examination were noted for all patients. Results: One hundred and seven mothers who fulfilled the study criteria were included. Of these, 4 had an abortion. Rest of the 103 mothers were included in the final analysis. The mean age of the mothers was 30.39 ± 4.7, ranging from 22 to 50 years. Twin pregnancy rate was 45.7%. All were dichorionic-diamniotic twins. Based on gestational age, 5% were extreme preterm births, 14% were very preterm births, 32% were late preterm births, and 48% were early-term births. Normal vaginal delivery (NVD) occurred in 26.2% of the mothers, elective lower-segment cesarean section (LSCS) in 21.4%, emergency LSCS in 51.4%, and one case had vacuum delivery. Hence, NVD occurred in 27% and 73% had LSCS. With respect to neonates born to study participants, 8% were extremely LBW, 7.3% were very LBW, 46% were LBW, and the rest 38.7% weighed 2.5 kg or more at birth. Conclusion: IVF-ET is a safe and highly successful treatment for infertility. Many of adverse outcomes are largely due to an increased risk of multiple gestations in IVF. Patients with infertility are likely to be older and have preexisting comorbid conditions such as hypertension, diabetes, insulin resistance, or other endocrinopathies which may predispose them to adverse obstetric and perinatal outcomes. It is also recommended that patients should be given adequate preconception counseling regarding increased maternal as well as neonatal risk.

Influence of health system factors on Fetomaternal outcomes among pregnant women presenting with antepartum hemorrhage at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu-Kenya

Background: Globally, maternal mortality is decreasing, but in developing countries, especially Sub-Saharan Africa, maternal death has remained high. Antepartum haemorrhage (APH), which is the per-vaginal bleeding after 28 weeks of gestation and before delivery complicates 2-5% of pregnancies. Although timely access to quality obstetric services, availability of trained health service providers, availability of transfusion products, theatre waiting time are major determinants of both maternal and new-born outcomes after antepartum haemorrhage, the impact of the health system and health provider related factors associated with APH on the neonatal and maternal outcomes remains to be investigated. As such, this study evaluated the influence of health system factors on maternal and neonatal outcomes among women presenting with Antepartum haemorrhage at the Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Kisumu County, Kenya. Methods: The study was a prospective case-control study that recruited mothers (n=63) presenting at the maternity department with antepartum haemorrhage. The control group comprised of mothers (n=63) presenting without antepartum haemorrhage at the same maternity. The study took a period of one year. Data was coded and analysed by SPSS program version 23.0 and STATA version 14.0. Results: Abruptio placentae and placenta Previa were the major causes of APH recorded in 17 (27%) and 39 (61.9%) of APH patients, respectively. A large proportion of patients presenting with antepartum haemorrhage (APH) were younger, aged between 20-29 years (n=37, 58.7%), with an overall mean age of 26.22. Cases with APH had a lower mean parity (1.17), while controls had a higher mean parity (2.97 Caesarean section rate was high among pregnant women who had APH (n=42, 66.7%). (p=0.001). Out of these, 32 (52.4%) were done as emergency. Majority of the emergency caesarean sections were done within 30 minutes from the time the decision to deliver had been made (n=17, 54.8%). Most patients who presented with APH were referred from another facility (n=42 (66.7%) in our study. Risks of perinatal and maternal mortality were higher for patients who came from outside of JOOTRH compared to patients from JOOTRH (OR=3.16, 95%CI=1.34-5.57, P&lt; 0.0001). High risks of perinatal mortality (19.9%) and maternal mortality (3.2%) were observed among APH patients in our study hospital compared to mothers who did not experience APH (8% and 0% respectively). Majority of new-borns of patients who had APH were admitted to NBU (n=42, 66.7%) (p=0.017) and the major reason for admission to NBU was prematurity and low Apgar score. Conclusion of the study is that APH is a major cause of maternal and perinatal morbidity and mortality. This could be prevented by regular and focused antenatal care, early detection of risk factors and prompt referrals. Many facilities for caesarean sections, availability of blood banks and blood transfusion products, facilities with ICU and proper new-born units with adequate staffing can improve maternal and perinatal outcome of patients with APH

Patients with gestational diabetes mellitus may be treated in both early and late pregnancy, especially in patients with pre-pregnancy overweight: A cross-sectional study in Japan.

The significance of diagnosing gestational diabetes mellitus (GDM) in early pregnancy is controversial. We used the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria to investigate whether clinical background and neonatal outcomes differ depending on when GDM is diagnosed in early or late pregnancy. This was a single-center, observational study conducted between November 2012 and March 2020 at St. Marianna University Hospital (Kawasaki, Japan). We compared the background and perinatal outcomes of patients with GDM depending on the time of diagnosis (at < 24 gestational weeks or ≥ 24weeks). Insulin sensitivity index, homeostasis model assessment of insulin resistance, and β-cell function were calculated from a 75-g oral glucose tolerance test. Stratified analysis was performed by pre-pregnancy BMI in patients with early GDM. As a result, in the 507 patients, 89.9% gave birth at our hospital. The pre-pregnancy BMI was significantly higher in patients with early GDM than in those with late GDM (the median [interquartile range], 22.7 [20.3, 26.3] and 21.5 [19.3, 23.8] kg/m2, respectively; p = 0.001). Perinatal outcomes were not different between the two groups. However, in the subgroup analysis of patients with early GDM, the prevalence of large-for-gestational-age infants was significantly higher in the group with overweight (15.4% vs 2.1%, respectively; p = 0.008). In conclusion, patients with GDM using the IADPSG criteria in early pregnancy may be treated, especially in patients with pre-pregnancy overweight.

Rezultatele naşterii la vârste materne foarte avansate – experienţa unui centru de nivel 2

Background. Advanced maternal age has been linked to unfavorable perinatal outcomes. This study aimed to evaluate the perinatal outcomes in patients with very advanced maternal age. Materials and method. We retrospectively reviewed the records of patients admitted to the Obstetrics and Gynecology Clinic of the Mureş County Clinical Hospital, Romania, between 1 September 2016 and 1 September 2023. The study group comprised 17 patients, while the control group consisted of 661 patients, aged 18-44 years old, who gave birth between 1 January 2023 and 30 June 2023. Results. Patients from rural areas with very advanced maternal age had more pregnancies and births than the control group. The majority of pregnancies were achieved naturally, with a significantly higher incidence of preterm birth before 34 weeks. There were no statistically significant differences in the incidence of pregnancy-induced hypertension and intrauterine growth restriction between groups, while obesity and gestational diabetes were significantly associated with very advanced maternal age. Caesarean section was the most common mode of delivery. Newborns of mothers with very advanced age were more frequently male, had low birth weight, and were frequently admitted to the intensive care unit. Conclusions. Advanced maternal age is associated with an increased risks of gestational diabetes, premature birth, caesarean section, and delivering small-for-gestational-age newborns. Therefore, patients with advanced maternal age require careful obstetric surveillance.

P-589 How Does Hypothyroidism Alter Perinatal Outcomes in Patients with Polycystic Ovary Syndrome? - An Evaluation of a Population Database

Abstract Study question Does concomitant hypothyroidism in polycystic ovary syndrome (PCOS) patients have an additive effect on the risk for adverse pregnancy, delivery and neonatal outcomes? Summary answer In patients with PCOS, hypothyroidism significantly increases the risk for preeclampsia, however risks of other adverse perinatal outcomes are unaltered. What is known already PCOS and hypothyroidism are common endocrinopathies during reproductive age, and each has been shown to be associated with pregnancy complications. While PCOS has been associated with gestational diabetes, gestational hypertension, and preeclampsia, overt hypothyroidism has been associated with pregnancy loss, intrauterine growth restriction, preeclampsia, and preterm birth. Furthermore, PCOS and thyroid abnormalities are known to be linked, with a higher prevalence of thyroid dysfunction in pregnant PCOS patients compared to controls. However, information on obstetric and neonatal outcomes in women with both PCOS and hypothyroidism is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. This population-based cohort study included 14,882 women with an International Classification of Diseases (ICD)-9 diagnosis of PCOS in the United States. IN 2015 data was converted to ICD-10 codes which are not comparable to ICD-9 codes. Participants/materials, setting, methods All pregnancy admissions that resulted in delivery or maternal death were included so that patients were counted only once per pregnancy. We compared PCOS women with a concurrent diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Multivariate logistic regression analysis was used to adjust for confounding effects. Main results and the role of chance Overall, 14,882 women met the inclusion criteria. Amongst them, 1,882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥35 years vs. 18%, p &amp;lt; 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery, and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033), when not accounting for confounding effects. In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). Of note when controlling for confounding effects, all other pregnancy, delivery, and neonatal outcomes were comparable between the groups, including pregnancy-induced hypertension; eclampsia; gestational diabetes mellitus; preterm premature rupture of membranes; preterm delivery; placental abruption; cesarean delivery; hysterectomy; post-partum hemorrhage; wound complications; maternal death; blood transfusions; maternal infection; venous thromboembolism; disseminated intravascular coagulation; SGA; intrauterine fetal death; and congenital anomalies. Limitations, reasons for caution Due to our study’s retrospective nature, some data is missing such as TSH levels, TPO antibody status, the time period in which hypothyroidism was diagnosed (pre-gestationally or during the 1st, 2nd or 3rd trimesters), and Levothyroxine treatment dose and compliance. Wider implications of the findings Patients with PCOS and hypothyroidism during pregnancy should be managed with consideration of instituting both preventive measures for preeclampsia development and heightened blood pressure, proteinuria, and symptom monitoring. Interestingly, hypothyroidism did little to affect the already increased rates of pregnancy complications in PCOS. This should be further studied. Trial registration number not applicable

The perinatal outcomes of women treated for Asherman syndrome: a propensity score-matched cohort study.

Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. N/A.

Influence of ovarian reserves on assisted reproductive and perinatal outcomes in patients with endometriosis: a retrospective study.

To investigate the association between different ovarian reserves and reproductive and adverse perinatal outcomes in patients with endometriosis. Retrospective study. Reproductive Medicine Center in a hospital. Patients surgically diagnosed with endometriosis were divided into three groups according to their ovarian reserve: diminished ovarian reserve (DOR) group (n=66), normal ovarian reserve (NOR) group (n=160), and high ovarian reserve (HOR) group (n=141). None. Live birth rate (LBR), cumulative live birth rate (CLBR), and adverse perinatal outcome for singleton live births. There were significantly higher live birth and cumulative live birth rates in endometriosis patients with NOR or HOR than in those with DOR. For adverse perinatal outcomes, patients with NOR or HOR had no significant association with preterm birth, gestational hypertension, placenta previa, fetal malformation, abruptio placentae, macrosomia, or low birth weight, except for a decreased risk of gestational diabetes mellitus. Our study revealed that although patients with endometriosis with NOR and HOR had increased reproductive outcomes, patients with endometriosis with DOR had still an acceptable live birth rate and a similar cumulative live birth rate with available oocytes. Moreover, patients with NOR and HOR might not exhibit a decreased risk of abnormal perinatal outcomes, except for gestational diabetes mellitus. Multicenter prospective studies are needed to further clarify the relationship.

The association between hypothyroidism and perinatal outcomes in patients with polycystic ovary syndrome.

To compare pregnancy, delivery, and neonatal outcomes in patients with polycystic ovary syndrome (PCOS) with and without concomitant hypothyroidism. A retrospective population-based cohort study including all women with an ICD-9 diagnosis of PCOS in the US between 2004 and 2014, who delivered in the third trimester or had a maternal death. We compared women with a concomitant diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Overall, 14,882 women met inclusion criteria. Among them, 1882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥ 35years vs. 18%, p < 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033) (Tables 2 and 3). In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). In patients with PCOS, concomitant hypothyroidism significantly increases the risk for preeclampsia. Unexpectedly, other pregnancy complications commonly increased by hypothyroidism were not increased in women with PCOS, likely due to the inherent elevated baseline pregnancy risks of PCOS.

Adverse obstetric and perinatal outcomes of patients with history of recurrent miscarriage: a retrospective cohort study

To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy that progressed beyond 24 weeks. Retrospective cohort study. A large tertiary maternity hospital. All women who booked for antenatal care and delivery between January 2014 and August 2021 were recorded. The study was limited to women with a singleton pregnancy, and to avoid intraperson correlation, we selected the first record of delivery from each mother in the study, leaving 108,792 deliveries for analysis. Obstetric and perinatal outcomes were compared among 1994 women (1.83%) with a history of ≥2 miscarriages (RM), 11,477 women (10.55%) with a history of 1 miscarriage, and 95,321 women (87.62%) with no history of miscarriage, respectively. Women with a history of ≥2 miscarriages or RM. Obstetric complications included gestational diabetes mellitus, preeclampsia (subclassified as preterm and term preeclampsia), placenta previa, placenta accreta, and fetal distress. Perinatal outcomes included emergency cesarean section, elective cesarean section, induction, postpartum hemorrhage, preterm birth, stillbirth, Apgar score <7 at 5 minutes, neonatal asphyxia, neonatal sex, congenital; malformation, low birth weight, and neonatal death. After adjusting for relevant confounders, there was an increased risk of adverse obstetric and perinatal outcomes in a subsequent pregnancy for women with a history of RM, specifically for placental dysfunction disorders: preterm preeclampsia (risk ratio [RR] = 1.58; 95% confidence interval [CI], 1.03-2.32), preterm birth (RR = 1.34; 95% CI, 1.15-1.54)], and abnormal placentation, that is placenta previa (RR = 1.78; 95% CI, 1.36-2.28), and placenta accreta (RR = 4.19; 95% CI, 2.75-6.13). Significant associations existed between a history of RM and the occurrence of adverse obstetric and perinatal outcomes including placental dysfunction disorders and abnormal placentation. These findings may contribute to the early detection and appropriate intervention for placenta-associated diseases in women with a history of RM, with the goal of avoiding or reducing the associated detrimental effects.

RELATIONSHIP BETWEEN HEMOGLOBIN A1C LEVELS IN EARLY PREGNANCY AND ADVERSE OUTCOMES AMONG NON-DIABETIC PATIENTS

This study was designed to assess the effects of increased hemoglobin A1c in the first trimester on adverse perinatal outcomes in patients without gestational diabetes mellitus. A prospective study was conducted in the Obstetrics and Gynecology Department of Buch International Hospital Multan from January 2022- January 2023. A total of 160 women with singleton pregnancies in their first trimester and elevated hemoglobin A1c were included in the study. The following outcomes were evaluated in patients: miscarriage, shoulder dystocia, preterm delivery &lt;37 weeks, macrosomia, small or large for gestational age, hypertensive disorders of pregnancy, third- or fourth-degree lacerations, operative vaginal delivery, cesarean delivery, neonatal hypoglycemia, neonatal jaundice, NICU admission, and intrauterine fetal demise. The multivariate analysis evaluated the relationship between hemoglobin A1c and adverse outcomes. The Hb1Ac level in patients ranged from 5.7-6.4%. Elevated levels were noted in elderly patients who were multiparous, obese, and diagnosed with chronic hypertension. 5.6% of patients had a preterm delivery, and 31.2% had a c-section delivery. 7.5% had a likelihood of hypertensive pregnancy disorder, and 10.6% were likely to deliver a macrosomic infant. Based on the results, it can be concluded that elevated hemoglobin A1c levels are significantly associated with preterm birth in patients without gestational diabetes.&#x0D;

Pregnancy complicated by iron deficiency anemia: does the problem have a solution?

Introduction. The problem of iron deficiency anemia by pregnant women remains relevant due to the wide spread of this complication (up to 40%) and requires the search for effective drugs with a minimum number of side effects.Aim. To improve perinatal outcomes in patients with iron deficiency anemia.Materials and methods. A retrospective analysis was done for 2020 of the medical records of patients, including an exchange card and birth histories. The patients were selected by a continuous sampling method. The study was conducted at the clinical base of the Department of Obstetrics and Gynecology with the course of perinatology of the Peoples’ Friendship University of Russia (Head of the Department, Corresponding Member of the Russian Academy of Sciences, Professor V.E. Radzinsky). All the patients (n = 114) were divided into three groups: the first group (n = 54) – a study group, which included pregnant women who had iron deficiency anemia in the II or III trimesters and received antianemic treatment; the second group (n = 30) – pregnant women with iron deficiency anemia (diagnosed in the 2nd trimester) who did not take iron supplements, the third group (n = 30) – a control group of women with normal hemoglobin levels during pregnancy and delivery.Results. The use of ferrous sulfate (Sorbifer durules) at a dose of 200 mg per day by pregnant women with IDA led to the fact that the weight-height parameters in newborns did not differ from those of children from healthy puerperas. At the same time, the volume of blood loss was greater in patients with IDA, however, there were no massive bleedings and moderate IDA in the postpartum period. The level of hemoglobin was significantly higher in women in labor who received ferrous sulfate (Sorbifer Durules) from the II trimester compared with pregnant women who had IDA in the III trimester. Thus, further research and the search for optimal dosages are required, as well as determining the most effective period for the use of iron supplements.Conclusions. Good tolerability and high efficacy of Sorbifer Durules in relation to a significant increase in hemoglobin and the absence of severe complications of pregnancy and childbirth associated with anemia allow us to recommend it for the treatment of IDA in pregnant women and puerperas.

Association of Maternal Medical Comorbidities with Duration of Expectant Management in Patients with Severe Preeclampsia.

This study aimed to estimate the association between number of maternal comorbidities and duration of expectant management and perinatal outcomes in patients with preeclampsia with severe features. Retrospective cohort of patients with preeclampsia with severe features delivering live, nonanomalous singletons at 23 to 342/7 weeks' gestation at a single center from 2016 to 2018. Patients delivered for an indication other than severe preeclampsia were excluded. Patients were categorized based on the number (0, 1, or ≥2) of comorbidities present: chronic hypertension, pregestational diabetes, chronic kidney disease, and systemic lupus erythematosus. The primary outcome was proportion of potential expectant management time achieved, that is, days of expectant management achieved divided by total potential expectant management time (days from severe preeclampsia diagnosis to 340/7 weeks). Secondary outcomes included delivery gestational age, days of expectant management, and perinatal outcomes. Outcomes were compared in bivariable and multivariable analyses. Of 337 patients included, 167 (50%) had 0, 151 (45%) had 1, and 19 (5%) had ≥2 comorbidities. Groups differed with respect to age, body mass index, race/ethnicity, insurance, and parity. The median proportion of potential expectant management achieved in this cohort was 1.8% (interquartile range: 0-15.4), and did not differ by number of comorbidities (adjusted β: 5.3 [95% confidence interval [CI]: -2.1 to 12.9] for 1 comorbidity vs. 0 and adjusted β: -2.9 [95% CI: -18.0 to 12.2] for ≥2 comorbidities vs. 0). There was no difference in delivery gestational age or duration of expectant management in days. Patients with ≥2 (vs. 0) comorbidities had higher odds of composite maternal morbidity (adjusted odds ratio: 3.0 [95% CI: 1.1-8.2]). There was no association between number of comorbidities and composite neonatal morbidity. Among patients with preeclampsia with severe features, the number of comorbidities was not associated with duration of expectant management; however, patients with ≥2 comorbidities had higher odds of adverse maternal outcomes. · Greater number of medical comorbidities were not associated with expectant management duration.. · Two or more medical comorbidities were associated with higher odds of adverse maternal outcomes.. · Expectant management should be undertaken cautiously in medically complicated patients..

Maternal and perinatal outcomes in mixed antenatal care modality implementing telemedicine in the southwestern region of Colombia during the COVID-19 pandemic

IntroductionContingency measures due to the COVID-19 pandemic limited access to routine prenatal care for pregnant women, increasing the risk of pregnancy complications due to poor prenatal follow-up, especially in those patients at high obstetric risk. This prompted the implementation and adaptation of telemedicine.ObjectiveWe aim to evaluate the maternal and perinatal outcomes of patients who received prenatal care in-person and by telemedicine.MethodsWe conducted a retrospective observational cohort study of pregnant women who received exclusive in-person and alternate (telemedicine and in-person) care from March to December 20,202, determining each group's maternal and neonatal outcomes.ResultsA total of 1078 patients were included, 156 in the mixed group and 922 in the in-person group. The patients in the mixed group had a higher number of prenatal controls (8 (6–9) vs 6 (4–8) p < 0.001), with an earlier gestational age at onset (7.1 (6–8.5) vs 9.3 (6.6–20.3), p < 0.001), however, they required a longer hospital stay (26 (16,67%) vs 86 (9,33%), p = 0.002) compared to those attended in-person; there were no significant differences in the development of obstetric emergencies, maternal death or neonatal complications.DiscussionIncorporating telemedicine mixed with in-person care could be considered as an alternative for antenatal follow-up of pregnant women in low- and middle-income countries with barriers to timely and quality health care access.

Prospective Observational Study to Determine Perinatal Outcome in Patients with HELLP Syndrome

Background: HELLP syndrome is a serious obstetric complication in pregnancy characterised by hemolysis, elevated liver enzymes and low platelet count. Incidence is 9.7% and prevalence ranges from 0.5-0.9%. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and eclampsia and to analyse the severity, complications, maternal and perinatal outcome. Aim &amp; Objective: To determine perinatal outcome in patients diagnosed with HELLP syndrome. Methodology: The clinical trial was conducted for a period of two years OBGY department of Bharati Vidyapeeth University, Pune. It is an prospective observational study where a total number of 30 cases of HELLP syndrome above 28 weeks of gestational age were admitted in Bharati hospital during the study period of 24 months. Data analysis was done and appropriate statistical tests were used. Results: A total of 30 females with HELLP syndrome visiting tertiary care teaching hospital were included in the study. The mean age of the patients was ranging between 21 to 43 years. The mean gestation age was ranging between 28 to 38 weeks. Majority 13 (43.3%) of women were primigravida, followed by G2A1 7(23.3%), G2P1L1 3(10.0%), G3P1L1 and G3P1L1A1 2(6.7%) each, G3A2, G4P1D1A2 and G2P2L1 1(3.3%)each. There were total 8 (26.6%), 7 (23.4%) of HELLP syndrome patients had pre eclampsia and GDM, respectively, one and 2 of these patients were also having hypothyroidism respectively. 2 (6.7%) each patients had hypothyroidism, anemia and chronic hypertension. While, eclampsia, epilepsy, IVF and gestational hypertension were reported in 1 (3.3%) patient each. Majority of women with HELLP syndrome had brisk (24 (80%) type of deep tendon reflexes, followed by exaggerated 3 (10%) and there were 3 (10%) women with normal reflexes. Majority of women the mode of delivery was emergency LSCS (60%), mean of the APGAR score at 1 minandat 5 minutes was recorded among 25 (83.33%) patients. The NICU admission was require damong 14/30 (46.7%) of new born, while it was not required in 16 (53.3%) of new born. Conclusion: This study was done to intensify our efforts to reduce pre eclampsia with HELLP syndrome by undergoing regular antenatal care, early detection of pre eclampsia and its prompt management and early detection of complications with timely intervention.

Determining the risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes in patients with antenatal lower threshold blood pressure elevations: A retrospective cohort study

BACKGROUND: Diagnosing hypertensive disorders in pregnancy utilizes systolic blood pressure (BP) of &gt;140 mmHg and/or diastolic of &gt;90 mmHg. However, since 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) have been endorsing lower BP thresholds for diagnosing hypertension. OBJECTIVES: This study determines if antenatal lower threshold BP elevations under elevated BP and Stage 1 hypertension from ACC/AHA show an increased risk of gestational hypertension, preeclampsia, and adverse perinatal outcomes. MATERIALS AND METHODS: This retrospective cohort study included service patients with prenatal consultations and deliveries at a private tertiary-level hospital from February 2016 to 2020. Antenatal BP measurements, categorized into “normal,” “elevated BP,” and “Stage 1 hypertension” under ACC/AHA classifications, had crude and adjusted relative risks (aRRs) and 95% confidence intervals (CIs) estimated to determine their associations with hypertensive disorders of pregnancy. RESULTS: Stage 1 hypertension was twice more likely to develop gestational hypertension (aRR: 2.314, 95% CI: 1.08–4.98) and thrice more likely to develop preeclampsia (aRR: 3.673, 95% CI: 2.30–5.86), whether without (aRR: 3.520, 95% CI: 1.33–9.29) or with severe features (aRR: 3.717, 95% CI: 2.16–6.41). There was a slightly increased risk for adverse perinatal outcomes from Stage 1 hypertension, as well as all outcomes from elevated BP, but was not statistically significant. Majority of BP elevations were during the third trimester. CONCLUSION: Lower threshold Stage 1 hypertension showed an increased risk of developing hypertensive disorders of pregnancy, with a three-fold increased risk for preeclampsia. There may be advantages in its application for diagnosing preeclampsia or having increased monitoring for these patients.