Perinatal Outcomes In Pregnancies Research Articles

Maternal and Perinatal Outcomes of Pregnancy in Women With Autoimmune Disorder.

ObjectivePregnancy with an autoimmune disorder is faced with several risks for mother and fetus. The aim of the present study is to analyze the course and outcome of pregnancy in women with autoimmune disorders (AIDs).MethodsA retrospective cohort study was conducted at a tertiary care teaching hospital. The hospital records of 153 pregnancies with autoimmune disorders and 1095 low-risk pregnant women who served as controls were reviewed. An adverse perinatal outcome was defined as the presence of any obstetric complications, including preeclampsia, eclampsia, abruption, antepartum hemorrhage (APH), prematurity, fetal growth restriction (FGR), intrauterine death (IUD), intrapartum event, mode of delivery, birth weight, neonatal intensive care unit (NICU) stay, or disease-specific neonatal complications. For all statistical tests with two-tailed probability, p<0.05 was considered statistically significant.ResultsA high incidence of adverse perinatal outcomes was observed in all women with AIDs when compared with age-matched controls. The highest incidence of adverse perinatal outcomes was observed in women with Takayasu’s arteritis. The incidence of abortions was more in women with antiphospholipid antibody syndrome (APS) and Grave’s disease (22.2% and 33.3%, respectively). The incidence of prematurity, fetal growth restriction (FGR), and low birth weight were highest in women with systemic lupus erythematosus (SLE). Pregnancy with myasthenia gravis and rheumatoid arthritis did not have any significant adverse impact on pregnancy outcomes.ConclusionWe found a strong association between autoimmune disorders and obstetric complications. The multidisciplinary team approach and pre-pregnancy optimization of the disease improve maternal and fetal outcomes.

Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus

AimsIn previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2–30 min) and asphyxia-related neonatal outcomes in GDM pregnancies.MethodsIntrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths. The following CTG changes were evaluated: ZigZag pattern, saltatory pattern, late decelerations, episodes of tachycardia and bradycardia, reduced variability, and uterine tachysystole. The cohort was divided into three groups: women with GDM, women with normal oral glucose tolerance test (OGTT), and women with no OGTT performed. Umbilical artery (UA) blood gases, Apgar scores, neonatal respiratory distress, and neonatal encephalopathy were used as outcome variables.ResultsGDM was diagnosed in 624 (12.1%), OGTT was normal in 4115 (79.9%), and OGTT was not performed in 411 (8.0%) women. Hypoxia-related ZigZag patterns (OR 1.94, 95% CI 1.64–2.34) and late decelerations (OR 1.65, 95% CI 1.27–2.13) of FHR, as well as a greater risk of fetal asphyxia (UA pH < 7.10 and/or UA BE < -12.0 meq/L and/or Apgar scores < 7 at 5-min) (OR 6.64, 95% CI 1.84–12.03) were observed in those with GDM compared with those without GDM.ConclusionsGDM is associated with intrapartal ZigZag pattern and late decelerations, cord blood acidemia and low 5-min Apgar scores at birth indicating increased occurrence of fetal hypoxia in GDM pregnancies.

Maternal and neonatal outcome in pregnancy bbeyond 41 Weeks of Gestation: Observational study

Background: Pregnancy beyond term is associated with adverse maternal and perinatal outcome. The aim of the study the maternal and perinatal outcome in pregnancies at and beyond 41 week of gestation. Methods: This is a prospective study of 140 patients with pregnancy beyond 41 weeks fulfilling the eligibility criteria and admitted and delivered in department of obstetrics and gynaecology at a tertiary care hospital. We examined its association with following outcomes: age, parity, genetic factors, bishop’s score at admission, mode of delivery, induction rate, meconium stained amniotic fluid, oligohydramnios, Perinatal and neonatal morbidity, Perineal tear, postpartum haemorrhage, maternal morbidity and mortality etc. Results: Out of 140 patients, majority in the age group of 21-25 years, 68 (48.6%) patients were primigravida while 72 (51.4%) patients were multigravida. Maximum patients 65% were not in labour whereas 35% were in labour. In 51 (36.4%) patients mode of delivery was caesarean section, in which most common indication being foetal distress in 25.5% followed by meconium stained amniotic fluid in 17.6%. In present study perinatal morbidity like stillbirth, RDS were 2.86% &amp; 25.8% respectively. Maternal morbidity like PPH, tear and wound infection were 4.31%, 6.4%, 0.7%respectively. Conclusions: With Regular antenatal check-up, incidence of post term pregnancy can be decreased and Labour induction should be considered at 41weeks to prevent lot of maternal and perinatal complications.

Comparison between Cerebroplacental Ratio and Umbilicocerebral Ratio in Predicting Adverse Perinatal Outcome in Pregnancies Complicated by Late Fetal Growth Restriction: A Multicenter, Retrospective Study

Introduction: The role of cerebroplacental ratio (CPR) or umbilicocerebral ratio (UCR) to predict adverse intrapartum and perinatal outcomes in pregnancies complicated by late fetal growth restriction (FGR) remains controversial. Methods: This was a multicenter, retrospective cohort study involving 5 referral centers in Italy and Spain, including singleton pregnancies complicated by late FGR, as defined by Delphi consensus criteria, with a scan 1 week prior to delivery. The primary objective was to compare the diagnostic accuracy of the CPR and UCR for the prediction of a composite adverse outcome, defined as the presence of either an adverse intrapartum outcome (need for operative delivery/cesarean section for suspected fetal distress) or an adverse perinatal outcome (intrauterine death, Apgar score <7 at 5 min, arterial pH <7.1, base excess of >−11 mEq/mL, or neonatal intensive care unit admission). Results: Median CPR absolute values (1.11 vs. 1.22, p = 0.018) and centiles (3 vs. 4, p = 0.028) were lower in pregnancies with a composite adverse outcome than in those without it. Median UCR absolute values (0.89 vs. 0.82, p = 0.018) and centiles (97 vs. 96, p = 0.028) were higher. However, the area under the curve, 95% confidence interval for predicting the composite adverse outcome showed a poor predictive value: 0.580 (0.512–0.646) for the raw absolute values of CPR and UCR, and 0.575 (0.507–0.642) for CPR and UCR centiles adjusted for gestational age. The use of dichotomized values (CPR <1, UCR >1 or CPR <5th centile, UCR >95th centile) did not improve the diagnostic accuracy. Conclusion: The CPR and UCR measured in the week prior delivery are of low predictive value to assess adverse intrapartum and perinatal outcomes in pregnancies with late FGR.

To evaluate the tests of antepartum fetal surveillance for predicting adverse perinatal outcome in pregnancy with IUGR

IUGR is one of the most common pregnancy complications which substantially increase risk of adverse neonatal outcome. The sequelae of IUGR include stillbirth, neuro-developmental delay in childhood and high risk of diseases like hypertension, diabetes in adulthood. Therefore, IUGR in pregnancy warrants intensive antepartum fetal surveillance to ensure optimal perinatal outcome.To evaluate the tests of antepartum fetal surveillance like AFI, BPS and Doppler ultrasound, alone and in combination for predicting adverse perinatal outcome in pregnancy with IUGR.This was a prospective observational study done on 100 pregnant IUGR women &amp;#62; 34weeks of gestation, at a tertiary care centre in Karnataka, from June 2017 till December 2018. They were monitored by tests of fetal surveillance like Amniotic Fluid Index (AFI), Bio Physical score (BPS) and Doppler ultrasound. Tests done within 48 hours before labour and its relation to perinatal outcome were assessed. Continuous data such as age, height, weight were described by mean and standard deviation. The sensitivity specificity, positive and negative predictive value were calculated for each test.The statistical difference between the normal and abnormal tests of antepartum fetal surveillance in relation to perinatal outcome was significant. Diagnostic accuracy of Doppler was 67%, BPS and AFI was 69%. In case of combination of findings of BPS and Doppler, the accuracy rose to 75%.Biophysical profile was most reliable diagnostic method than Doppler in predicting adverse outcome. Sensitivity increased when BPS and Doppler was combined which is beneficial in predicting perinatal outcome.

Antenatal follow-up, anesthesia management and perinatal outcomes in pregnancy with renal transplant

Objective:Due to the recent increase in the successful pregnancies after renal transplant, the number of renal transplant recipients having vaginal or cesarean delivery possibly associated with high maternal, fetal and/or neonatal risk requiring team approach increased. We aimed to evaluate antenatal follow-up, perinatal outcomes, and anesthesia management in pregnancies with renal transplantation and to compare them with the current literature.Materials and Methods:After ethics committee approval, renal transplant recipients who gave birth in our hospital between January 2010 and December 2019 were documented in this retrospective study. Demographic characteristics, comorbidities, antenatal follow-up, anesthesia management, and maternal, fetal, and neonatal outcomes were presented.Results:A total of 20 pregnant women who underwent renal transplant were identified. The mean age of the parturients was 31±5 years. The median interval from transplantation to conception was 8.15±4.8 years. Antenatal mean serum creatinine level and proteinuria were 1.48±1.39 mg/dL and 1.397±1.316 mg/dL, respectively. No allograft rejection was recorded. Comorbidities including hypertension (n=12), preeclampsia (n=6), and preterm delivery (n=10) were noted. The median gestational age was 35±3 weeks and the median newborn weight was 2.520±832 gram. There was one abortion, two pregnancy terminations, and 17 deliveries (3 vaginal and 14 cesareans). Cesarean sections (11/14; 78.6%) were mostly performed under spinal block and general anesthesia was performed in three (21.4%) women. Epidural analgesia for vaginal delivery was recorded in one parturient.Conclusion:Despite the presence of preterm delivery and comorbidities, antenatal/peripartum follow-up and analgesia/anesthesia management of renal transplant recipients revealed good perinatal outcomes.

Diabetes type 1 and pregnancy outcome at University Hospital Center Split – a retrospective study

Aim: To evaluate the prevalence, assessment, and perinatal outcome of pregnancies complicated with diabetes mellitus type 1 (DM type 1) at a tertiary perinatal center in the town of Split, Dalmatia County. Materials and methods: The investigation was designed as a retrospective cohort study. All pregnant women with DM type 1 that were supervised and gave birth at Clinical Department of Obstetrics and Gynecology, Split University Hospital Center during a 7-year period (2009-2015), including those diagnosed in 2015 and having delivered in 2016, were included in the study group. Data were collected by the census method from legal protocol books. Control group included DM type 1-free pregnancies entered in the same protocol books just following a particular study woman, if meeting all inclusion and exclusion criteria. Results: There were 70 DM type 1 pregnancies, accounting for 0.2% of all deliveries. DM type 1 group newborns were statistically heavier (3650±605 vs. 3428±591g; p=0.031), more frequent large for gestational age (24.3% vs. 5.7%; p=0.002) and macrosomic (24.3% vs. 10%; p=0.033). Compared to control group, DM type 1 women had a significantly higher delivery rate in the 37th to 39th week of gestation (84.3% vs. 58.6%; p=0.001) and higher cesarean section rate (61.4% vs. 32.9%; p=0.001). Conclusion: DM type 1 significantly influences perinatal outcome. It requires multidisciplinary approach and complete supervision should be provided at specialized centers. Respecting the fetal origin of adult diseases theory, inappropriate protocol(s) and/or individual decision(s) can have many health consequences throughout newborns life, which highlights DM type 1 pregnancies to a public health level issue.

Value of second-trimester uterine artery pulsatility index in pregnancies with systemic lupus erythematosus and/or antiphospholipid syndrome

Objective To assess the value of the second trimester mean pulsatility index of the uterine arteries (MPI-UtA) to predict adverse perinatal outcome (APO) in women with systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS). Methods Pregnancies with either an SLE diagnosis or with primary APS controlled at our Hospital during a 10 years period were included. MPI-UtA was performed between 19–23 weeks' gestation. The MPI-UtA was defined as abnormal when it was >95th centile. APO was defined as the presence of: preeclampsia (PE), small for gestational age (SGA) newborn, preterm delivery, placental abruption and fetal or neonatal death. Results There were 39 ongoing pregnancies, 16 of them with SLE and 23 with primary APS. Nine patients had no previous pregnancy (23%). Globally, 35 live births were recorded, being the mean gestational age at delivery 38.1 ± 2.1 weeks and the mean birth weight 2835 ± 492 g. Abnormal MPI-UtA was found in 6 (15%) pregnancies, all of them (100%) had an APO: there were 4 fetal deaths and 2 further severe PE with live newborn. Normal MPI-UtA was shown in the remaining 33 (84.6%); of them, 6 (18%) had an APO: one late PE with a premature newborn, another one severe preterm baby and 4 SGA term newborns. No cases of perinatal death occurred in this group. Therefore, accuracy of MPI-UtA evaluation for APO was: sensitivity 50%, specificity 100%, PPV 100% and NPV 82%, respectively (p < .001). Conclusion Abnormal second-trimester uterine artery Doppler evaluation is highly predictive for adverse perinatal outcome in pregnancies affected by SLE or APS.

Perinatal outcome of monochorionic diamniotic twin pregnancy complicated by selective intrauterine growth restriction according to umbilical artery Doppler flow pattern: single-center study using strict fetal surveillance protocol.

To determine the perinatal outcome of monochorionic diamniotic (MCDA) twin pregnancies complicated by selective intrauterine growth restriction (sIUGR), which were classified according to the umbilical artery (UA) Doppler flow pattern of the IUGR twin. This was a retrospective cohort study of all MCDA twin pregnancies diagnosed with sIUGR and managed at a single tertiary referral center between 2012 and 2018. Cases were classified according to the UA Doppler flow pattern of the IUGR twin as Type I (positive end-diastolic flow), Type II (persistently absent/reversed end-diastolic flow) or Type III (intermittently absent/reversed end-diastolic flow). Patients with Type-II or -III sIUGR were hospitalized at 26-28 weeks of gestation for increased fetal surveillance. Perinatal and immediate and long-term neurodevelopmental outcomes were stratified according to the UA Doppler flow pattern at the final examination. Intact survival rate was defined as the number of infants surviving without neurological impairment, divided by the total number of fetuses. Composite adverse outcome, defined as any mortality, presence of severe brain lesions on postnatal transcranial ultrasound or severe neurological morbidity, was also assessed. Of 88 MCDA twin pregnancies with sIUGR included in the study, 28 underwent selective termination by cord occlusion using radiofrequency ablation, resulting in a perinatal survival rate of 89.3% and a median gestational age (GA) at delivery of 33.8 (interquartile range (IQR), 28.8-38.2) weeks for the large cotwin. Expectant management was employed in 60 cases. In 26 (43.3%) cases in the expectant-management group, the classification according to the UA Doppler flow pattern changed during gestation, resulting in 26 (43.3%) cases of Type-I, 22 (36.7%) cases of Type-II and 12 (20.0%) cases of Type-III sIUGR at the final examination. The perinatal survival rate of both twins with sIUGR Types I, II and III at the final examination was 100%, 81.8% and 75.0%, respectively (P = 0.04). Two cases of double fetal death and one case of single fetal death occurred 1-4 weeks after the Doppler pattern had changed from Type I or Type II to Type III. The median GA at delivery was 34.8 (IQR, 33.1-35.7) weeks in Type I, 30.3 (IQR, 28.6-32.1) weeks in Type II and 32.0 (IQR, 31.3-32.6) weeks in Type III (P < 0.01). The total intact survival rate was 100% for Type I, 77.3% for Type II and 75.0% for Type III (P < 0.001). Multivariate analysis demonstrated that early GA at diagnosis (odds ratio (OR), 0.83 (95% CI, 0.69-0.99); P = 0.04) and the presence of Type II or III vs Type I at the last examination (OR, 13.16 (95% CI, 1.53-113.32); P = 0.02) were associated with preterm birth < 32 weeks' gestation. Early GA at diagnosis was also associated with the composite adverse outcome (OR, 0.60 (95% CI, 0.36-0.99); P = 0.04). The classification system of MCDA pregnancy complicated by sIUGR, according to the UA Doppler flow pattern of the IUGR twin at final examination, is associated with perinatal outcome. Importantly, the UA Doppler flow pattern can change during gestation, which has an impact on the risk of fetal death. Nevertheless, under strict fetal surveillance, the perinatal outcome of these pregnancies is favorable. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Perinatal outcome of pregnancies with prenatal diagnosis of vasa previa: systematic review and meta-analysis.

To derive accurate estimates of perinatal survival in pregnancies with and without a prenatal diagnosis of vasa previa based on a systematic review of the literature and meta-analysis. A search of MEDLINE, EMBASE and The Cochrane Library was performed to review relevant citations reporting on the perinatal outcomes of pregnancies with vasa previa. We included prospective and retrospective cohort and population studies that provided data on pregnancies with a prenatal diagnosis of vasa previa or cases diagnosed at birth or following postnatal placental examination. Meta-analysis using a random-effects model was performed to derive weighted pooled estimates of perinatal survival (excluding stillbirths and neonatal deaths) and intact perinatal survival (additionally excluding hypoxic morbidity). Incidence rate difference (IRD) meta-analysis was used to estimate the significance of differences in pooled proportions between cases of vasa previa with and those without a prenatal diagnosis. Heterogeneity between studies was estimated using Cochran's Q and the I2 statistic. We included 21 studies reporting on the perinatal outcomes of 683 pregnancies with a prenatal diagnosis of vasa previa. There were three stillbirths (1.01% (95% CI, 0.40-1.87%)), five neonatal deaths (1.19% (95% CI, 0.52-2.12%)) and 675 surviving neonates, resulting in a pooled estimate for perinatal survival of 98.6% (95% CI, 97.6-99.3%). Based on seven studies that included cases of vasa previa with and without a prenatal diagnosis, the pooled perinatal survival in pregnancies without a prenatal diagnosis (61/118) was 72.1% (95% CI, 50.6-89.4%) vs 98.6% (95% CI, 96.7-99.7%) in cases with a prenatal diagnosis (224/226). Therefore, the risk of perinatal death was 25-fold higher when a diagnosis of vasa previa was not made antenatally, compared with when it was (odds ratio (OR), 25.39 (95% CI, 7.93-81.31); P < 0.0001). Similarly, the risk of hypoxic morbidity was increased 50-fold in cases with vasa previa without a prenatal diagnosis compared with those with a prenatal diagnosis (36/61 vs 5/224; OR, 50.09 (95% CI, 17.33-144.79)). The intact perinatal survival rate in cases of vasa previa without a prenatal diagnosis was significantly lower than in those with a prenatal diagnosis (28.1% (95% CI, 14.1-44.7%) vs 96.7% (95% CI, 93.6-98.8%)) (IRD, 73.4% (95% CI, 53.9-92.7%); Z = -7.4066, P < 0.001). Prenatal diagnosis of vasa previa is associated with a high rate of perinatal survival, whereas lack of an antenatal diagnosis significantly increases the risk of perinatal death and hypoxic morbidity. Further research should be undertaken to investigate strategies for incorporating prenatal screening for vasa previa into routine clinical practice. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Foetal cardiac function in third trimester pregnancies with reduced fetal movements

The objective of our study was to investigate the possible relationship between poor perinatal outcome and foetal cardiac functions in pregnant women with reduced foetal movements (RFM). This cross-sectional study included 126 pregnant women with normal foetal movements (Group 1, Controls) and 42 pregnant women over 32 weeks gestation with RFM (Group 2). Group 2 was further divided into two subgroups according to their perinatal outcome: normal perinatal outcome (Group 2a) and poor perinatal outcome (Group 2b). Cardiotocography, the E/A ratio in both atrioventricular valves, myocardial performance index (MPI) and foetal tricuspid annular plane systolic excursion (f-TAPSE) were evaluated. Foetuses with poor perinatal outcome had a higher MPI (p = .003), higher tricuspid and mitral E/A (p < .001), and lower f-TAPSE values (p < .001). In regression analysis, f-TAPSE was the only parameter (p = .04) independently associated with poor perinatal outcome. İn conclusion, examining f-TAPSE may predict adverse perinatal outcome in pregnancies with RFM. IMPACT STATEMENT What is already known on this subject? Reduced foetal movement (RFM) is associated with adverse pregnancy outcome. Cardiotocography, amniotic fluid assessment, estimated birthweight, foetal Doppler and formal foetal movement count (kick chart) are generally used in the clinical assessment of pregnancies with reduced foetal movements. These tests, we currently use to assess foetal wellbeing in women with reduced foetal movements, have limited sensitivity in predicting foetal compromise. What do the results of this study add? Foetal cardiac Doppler may potentially be used as an important adjunct to the conventional management of women with a perception of reduced foetal movements. What are the implications of these findings for clinical practice and/or further research? Foetal echocardiographic evaluation, such as f-TAPSE, may influence clinical practice by enabling improved risk stratification for poor perinatal outcome, thus allowing more timely definitive intervention. This could help to decrease the rate of stillbirth related to reduced foetal movements. The few established echocardiographically derived parameters, which can asses global right ventricle function, are not always easy to obtain, however, f-TAPSE is easily obtainable using ultrasound and it appears to be a clinically useful echocardiographic measurement of right ventricular function.

Perinatal outcomes of pregnancies resulting from assisted reproduction technology in SARS-CoV-2-infected women: a prospective observational study

ObjectiveTo evaluate the perinatal and maternal outcomes of pregnancies in women infected with SARS-CoV-2, comparing spontaneous and in vitro fertilization (IVF) pregnancies (with either own or donor oocytes).DesignMulticenter, prospective, observational study.Setting78 centers participating in the Spanish COVID19 Registry.Patient(s)1,347 pregnant women with SARS-CoV-2 positive results registered consecutively between February 26 and November 5, 2020.Intervention(s)The patients’ information was collected from their medical records, and multivariable regression analyses were performed, controlling for maternal age and the clinical presentation of the infection.Main Outcome Measure(s)Obstetrics and neonatal outcomes, pregnancy comorbidities, intensive care unit admission, mechanical ventilation need, and medical conditions.Result(s)The IVF group included 74 (5.5%) women whereas the spontaneous pregnancy group included 1,275 (94.5%) women. The operative delivery rate was high in all patients, especially in the IVF group, where cesarean section became the most frequent method of delivery (55.4%, compared with 26.1% of the spontaneous pregnancy group). The reason for cesarean section was induction failure in 56.1% of the IVF patients. IVF women had more gestational hypertensive disorders (16.2% vs. 4.5% among spontaneous pregnancy women, adjusted odds ratio [aOR] 5.31, 95% confidence interval [CI] 2.45–10.93) irrespective of oocyte origin. The higher rate of intensive care unit admittance observed in the IVF group (8.1% vs. 2.4% in the spontaneous pregnancy group) was attributed to preeclampsia (aOR 11.82, 95% CI 5.25–25.87), not to the type of conception.Conclusion(s)A high rate of operative delivery was observed in pregnant women infected with SARS-CoV-2, especially in those with IVF pregnancies; method of conception did not affect fetal or maternal outcomes, except for preeclampsia.Clinical Trial Registration NumberNCT04558996.

PlGF (Placental Growth Factor) Testing in Clinical Practice: Evidence From a Canadian Tertiary Maternity Referral Center.

[Figure: see text].

The first Italian COVID-19 lockdown reduced births and voluntary terminations by just under a fifth.

The first Italian COVID-19 lockdown reduced births and voluntary terminations by just under a fifth.

The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

AimTo examine the characteristics of pregnancies at a very advanced age and the effect of parity on adverse obstetric outcomes.MethodsWe retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).ResultsSignificantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher.ConclusionSince primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

Autoimmune Hemolytic Anaemias in Pregnancy: Experience in a Tertiary Care Hospital in South India.

Autoimmune hemolytic anaemia is very rare and there is limited data regarding their pregnancy outcomes. Hence we aimed to study the maternal and perinatal outcomes in pregnancies with autoimmune hemolytic anaemias (AIHA). A retrospective descriptive study of pregnant women with AIHA, who delivered at SJMCH between January 2011 and January 2016 was carried out. Their antenatal and labour records were reviewed and demographic details noted.The primary outcome measures studied were-the prevalence of AIHA, gestational age at delivery, antepartum, intrapartum and postpartum complications, mode of delivery and requirement of transfusion of blood and blood products. The secondary outcome measures studied included neonatal outcomes such as low birth weight, intrauterine growth restriction and need for intensive care. The data is presented as descriptive statistics, including means and percentage. The prevalence of AIHA was (18/12,420) 0.14%. The mean gestational age at delivery was 34weeks; 100%, 77% and 50% had antenatal, intra partum or postpartum complications, respectively. 44% had preeclampsia, 38% intrauterine growth restriction and 16% preterm labour. 83% required additional drugs for treatment of AIHA.72% had vaginal delivery; 28% had caesarean delivery; 33% were transfused antenatally and 22% postnatally; 50% of the babies were preterm and required intensive care, 66% had low birth weight. There was no maternal mortality. Multidisciplinary approach, early diagnosis and detection of autoimmune hemolytic anaemia and complications, good antenatal care, judicious transfusions and delivery at tertiary care centre are the keys to successful outcomes.

Adverse maternal and perinatal pregnancy outcomes related to very advanced maternal age in primigravida and multigravida in the Netherlands: A population‐based cohort

The age at which women give birth is rising steadily in the western world. Advanced maternal age has been associated with adverse pregnancy outcomes. We assessed the association between advanced maternal age and the risk of adverse maternal and perinatal outcome in primigravid and multigravid women. The study was a population-based cohort study and included women giving birth between January 2000 and December 2018 using data from the Dutch perinatal registration of Perined. Women were divided into age groups. We compared outcomes between women of 40-44, 45-49, and over 50years old (the study groups) with women of 25-29years old (reference group), stratified for parity. We employed multivariable regression to correct for possible confounders including methods of conception, multiple pregnancies, ethnicity, and socio-economic status. Our primary outcomes were maternal and perinatal mortality. Secondary outcomes included common maternal and perinatal complications, as well as cesarean section rate. A cohort of 3700326 women gave birth during the study period. Of these women, 3.2% were above 40years of age. Maternal mortality was rare in all groups, but significantly higher in multigravid women over 50years old. Perinatal mortality was significantly higher in all pregnancies of women over 40years old, but not for primigravida over 50years old. The most notable results with the steepest increase were in maternal complications. Both primigravida and multigravida over 40years old were at a two times higher risk of perinatal mortality, cesarean section, gestational diabetes, hypertensive disorders, and a low Apgar score after 5minutes. The risk for women over 45 was almost tripled for perinatal mortality and gestational diabetes and six times higher for cesarean section. Women over 50years old had a seven times higher risk of cesarean section, a four times higher risk of gestational diabetes, postpartum hemorrhage, and neonatal intensive care unit admission, and a 10 times higher risk of hypertensive disorders. The risk of adverse maternal and perinatal outcomes for women over 40years old surges as age increases. A novel aspect was the consistent increased risks not only for primigravid women but also for multigravida.

305 A predictive index for severe adverse perinatal outcomes in pregnancies complicated by fetal growth restriction

Lack of significance of several covariates in a model we recently validated indicated model reconstruction may improve its performance. Our aim was to redevelop the model and then use it to develop an index predictive of severe adverse perinatal outcomes in pregnancies complicated by fetal growth restriction (FGR). Data was derived from a cohort of singleton non-anomalous gestations meeting Delphi procedure-based consensus criteria [Gordijn S et al. Ultrasound Obstet Gynecol 2016;48(3):333-9] for FGR between 2010-2020 at a single tertiary-care institution. The cohort was retrospectively analyzed according to the occurrence of composite adverse perinatal outcome: perinatal demise, 5-minute Apgar < 7, cord pH ≤ 7.1, or cord base excess ≥ 12. Regression analysis incorporated clinical factors widely available at the time of growth restriction diagnosis. The sum of beta coefficient-based weights yielded a severe adverse perinatal outcome index score. Of the 907 pregnancies that met criteria for FGR, 226 (25%) were complicated by severe adverse perinatal outcomes. 278 (31%) were delivered by cesarean for non-reassuring fetal status and 410 (45%) neonates were admitted to the NICU. The derived index included nine clinical factors: maternal age ≥ 30, body mass index ≥ 40, nulliparity, male fetus, gestational age ≤ 28 weeks, hypertensive disorder of pregnancy both with and without chronic hypertension, umbilical artery absent or reversed end diastolic flow, and gestational diabetes. The index’s bootstrapped bias-corrected AUC was 0.78 (95% CI 0.74-0.81). Index sum cut-points were selected to identify “high risk” (≥ 10) and “low risk” (≤ 4) ranges that have positive and negative predictive values of 73% (95% CI 63-81%) and 88% (95% CI 86-90%), respectively. An index incorporating nine clinical factors widely available at time of growth restriction diagnosis was predictive of severe adverse perinatal outcomes. If validated, the index may prove useful in counseling and management of pregnancies meeting consensus-based criteria for fetal growth restriction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

304 Predicting severe adverse perinatal outcomes in pregnancies complicated by fetal growth restriction: a validation study

Validate a model predictive of severe adverse perinatal outcomes in pregnancies complicated by fetal growth restriction using clinical factors widely available at time of diagnosis. We assessed the performance of a 7-item model previously developed from 336 pregnancies (2013-2019) meeting Delphi procedure-based consensus criteria [Gordijn SJ et al. Ultrasound Obstet Gynecol 2016;48(3):333-9] for fetal growth restriction (FGR). The model assesses risk of composite severe adverse perinatal outcome: perinatal demise, 5-minute Apgar < 7, cord pH ≤ 7.1, or cord base excess > 12. It includes factors available at diagnosis: hypertensive disorder of pregnancy (HDP), gestational age ≤ 30 weeks, isolated abdominal circumference < 3rd centile, absent/reversed end diastolic flow (A/REDF), chronic hypertension, maternal height > 160 cm, and pre-gravid weight 68.5 kg. To validate the model, we retrospectively analyzed data from non-anomalous, singleton gestations (2010-2020) not included in model development. Severe adverse perinatal outcomes complicated 22% (127) of 585 pregnancies. In addition, there were 257 (45%) NICU admissions and 169 (29%) cesareans for non-reassuring fetal status. Women with the composite outcome were more likely to have a higher body mass index, hypertensive disorders, and abnormal umbilical artery flow. Model performance in the validation cohort [bias-corrected bootstrapped AUC of 0.76 (95% CI 0.69-0.79)], was similar to the development cohort [AUC of 0.81 (95% CI 0.73-0.84)]; however only HDP, A/REDF, and gestational age ≤ 30 weeks were significant. Performance was better for early-onset [n = 316, AUC 0.76 (95% CI 0.71-0.82)] compared to late-onset (n = 269) growth restriction [AUC 0.69 (95% CI 0.55-0.66)]. Performance of a model predictive of severe adverse perinatal outcome in a larger validation cohort was relatively strong. However, lack of significance of four covariates indicates model redevelopment may improve performance and, in doing so, its utility in counseling and management of pregnancies complicated by growth restriction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

329 Perinatal outcomes of pregnancies with iatrogenic chorioamniotic separation following fetal interventions: systematic review and meta-analysis

This systematic review and meta-analysis aims to compare the perinatal outcomes of pregnancies with and without iatrogenic chorioamniotic separation (iCAS) after fetal interventions and to stratify the outcomes based on the indication for intervention. We performed a search in PubMed, Embase, Scopus, Web of Science and Google Scholar from inception up to August 2020 for studies evaluating perinatal variables among pregnancies developing iCAS after in utero fetal interventions. Inter-study heterogeneity was also assessed using the I2 statistic. Afterward, the random-effects model was used to pool the mean differences (MDs) or odds ratios (OR) and the corresponding 95% confidence intervals (CIs). Nine studies (total of 2,043 pregnancies) were included. Development of iCAS after fetal intervention is associated with significantly lower gestational age (GA) at the time of intervention (MD -0.80, 95% CI -1.58, -0.02), lower GA at delivery (MD -1.53, 95% CI: -2.67, -0.38) and lower neonatal survival (OR 0.48; 95% CI: 0.24, 0.93). In addition, iCAS significantly increased risks for preterm premature rupture of membranes (PPROM) < 37 weeks (OR 9.54; 95% CI: 3.97, 22.89), PPROM < 34 weeks (OR 3.94; 95% CI: 2.15, 7.23), preterm delivery < 32 weeks (OR 1.80; 95% CI: 1.16, 2.80) in this population (Figures A-H). Stratifying the patients based on the indication for intervention showed that development of iCAS is associated with lower GA at delivery (OR -1.74; 95% CI -3.13, -0.34, P 0.01) and lower neonatal survival (OR 0.41; 95% CI 0.24, 0.70) following fetal intervention for twin to twin transfusion syndrome (TTTS) but not for fetal myelomeningocele (fMMC) repair. iCAS is a common complication of fetal intervention that tends to develop more with earlier GA at intervention. iCAS is associated with earlier GA at delivery, higher risk of PPROM, preterm delivery before 32 weeks’ gestation and lower neonatal survival. On subgroup analysis, those risks were observed in patients who developed iCAS following fetal intervention for TTTS but not for fMMC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)