Perinatal Outcome In Patients Research Articles

Prediction of pre-eclampsia complicated by fetal growth restriction and its perinatal outcome based on an artificial neural network model.

Objective: Pre-eclampsia (PE) complicated by fetal growth restriction (FGR) increases both perinatal mortality and the incidence of preterm birth and neonatal asphyxia. Because ultrasound measurements are bone markers, soft tissues, such as fetal fat and muscle, are ignored, and the selection of section surface and the influence of fetal position can lead to estimation errors. The early detection of FGR is not easy, resulting in a relative delay in intervention. It is assumed that FGR complicated with PE can be predicted by laboratory and clinical indicators. The present study adopts an artificial neural network (ANN) to assess the effect and predictive value of changes in maternal peripheral blood parameters and clinical indicators on the perinatal outcomes in patients with PE complicated by FGR. Methods: This study used a retrospective case-control approach. The correlation between maternal peripheral blood parameters and perinatal outcomes in pregnant patients with PE complicated by FGR was retrospectively analyzed, and an ANN was constructed to assess the value of the changes in maternal blood parameters in predicting the occurrence of PE complicated by FGR and adverse perinatal outcomes. Results: A total of 15 factors-maternal age, pre-pregnancy body mass index, inflammatory markers (neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio), coagulation parameters (prothrombin time and thrombin time), lipid parameters (high-density lipoprotein, low-density lipoprotein, and triglyceride counts), platelet parameters (mean platelet volume and plateletcrit), uric acid, lactate dehydrogenase, and total bile acids-were correlated with PE complicated by FGR. A total of six ANNs were constructed with the adoption of these parameters. The accuracy, sensitivity, and specificity of predicting the occurrence of the following diseases and adverse outcomes were respectively as follows: 84.3%, 97.7%, and 78% for PE complicated by FGR; 76.3%, 97.3%, and 68% for provider-initiated preterm births,; 81.9%, 97.2%, and 51% for predicting the severity of FGR; 80.3%, 92.9%, and 79% for premature rupture of membranes; 80.1%, 92.3%, and 79% for postpartum hemorrhage; and 77.6%, 92.3%, and 76% for fetal distress. Conclusion: An ANN model based on maternal peripheral blood parameters has a good predictive value for the occurrence of PE complicated by FGR and its adverse perinatal outcomes, such as the severity of FGR and preterm births in these patients.

The Effects of Vaginal Probiotic Administration on Perinatal Outcomes in Patients with Premature Preterm Rupture of Membrane

Preterm premature rupture of membrane is the rupture of the chorionic-amniotic membrane and leakage of amniotic fluid before the onset of labor pains and prior to the 37th week of pregnancy. Preterm premature rupture of membrane (PPROM) occurs in 3% of pregnancies and is the cause of about 25 to 30% of all preterm births. PPROM is an important contributor to perinatal morbidity.

The impact of in utero transfusions on perinatal outcomes in patients with alpha thalassemia major: the UCSF registry

AbstractAlpha thalassemia major (ATM) is a hemoglobinopathy that usually results in perinatal demise if in utero transfusions (IUTs) are not performed. We established an international registry (NCT04872179) to evaluate the impact of IUTs on survival to discharge (primary outcome) as well as perinatal and neurodevelopmental secondary outcomes. Forty-nine patients were diagnosed prenatally, 11 were diagnosed postnatally, and all 11 spontaneous survivor genotypes had preserved embryonic zeta-globin levels. We compared 3 groups of patients; group 1, prenatally diagnosed and alive at hospital discharge (n = 14), group 2, prenatally diagnosed and deceased perinatally (n = 5), and group 3, postnatally diagnosed and alive at hospital discharge (n = 11). Group 1 had better outcomes than groups 2 and 3 in terms of the resolution of hydrops, delivery closer to term, shorter hospitalizations, and more frequent average or greater neurodevelopmental outcomes. Earlier IUT initiation was correlated with higher neurodevelopmental (Vineland-3) scores (r = −0.72, P = .02). Preterm delivery after IUT was seen in 3/16 (19%) patients who continued their pregnancy. When we combined our data with those from 2 published series, patients who received ≥2 IUTs had better outcomes than those with 0 to 1 IUT, including resolution of hydrops, delivery at ≥34 weeks gestation, and 5-minute appearance, pulse, grimace, activity, and respiration scores ≥7. Neurodevelopmental assessments were normal in 17/18 of the ≥2 IUT vs 5/13 of the 0 to 1 IUT group (OR 2.74; P = .01). Thus, fetal transfusions enable the survival of patients with ATM and normal neurodevelopment, even in those patients presenting with hydrops. Nondirective prenatal counseling for expectant parents should include the option of IUTs.

Perinatal Outcome in Patients with Borderline AFI

Background: During pregnancy, amniotic fluid indicates the normal placental function. It is the most essential element for surveillance of fetal growth and health. Amniotic fluid index (AFI) is the most ideal way to determine the level of amniotic fluid during pregnancy. However, the single deepest pocket is applied to determine the changes in AFI level in pregnancies suspected to oligohydramnios. Borderline AFI is defined as AFI levels > 5 to < 10cm; it is a challenging task in obstetrics to associate it with adverse pregnancy outcomes. Objective: To assess the perinatal outcomes in patients with borderline AFI. Study Design: Cross-sectional. Setting: Department of Obstetrics & Gynaecology, Sharif Medical City Hospital, Lahore. Study Duration: Study was carried out over a period of six months from 10-11-2020 to 11-05-2021. Subjects And Methods: A total of 160 patients having borderline AFI (more than 5 and less than 10cm) were included in the study. Perinatal outcomes were assessed at the time of delivery in the hospital. Data Analysis Method: Stratification of data was carried out with regard to age, gestational age, parity and area of residence. Results: Mean age of the patients was 25.17±4.90 years. Mean gestational age was observed to be 38.44±1.54 weeks. Majority of the patients were between Para 0 to 3. There was no smoker in preset study. Most of the patients belonged to rural area. Perinatal outcomes were as follows: Intrapartum fetal distress was observed in 64 (40%), meconium staining in 56 (35%), Apgar score < 10 at 5 minutes in 37 patients (23.1%) and NICU admission in 38 (23.8%). Conclusion: In conclusion, borderline AFI during pregnancy can lead to severe hazardous consequences. Therefore, pregnancy complicated with borderline AFI must be observed carefully in order to improve the outcome of pregnancy and avoid adverse perinatal outcomes. Keywords: Borderline AFI, Apgar Score, NICU Admission, Intrapartum Fetal Distress, Meconium Staining.

Microbiological features and perinatal outcomes in patients with preterm premature rupture of membranes and oligohydramnios

BACKGROUND: Oligohydramnios in preterm premature rupture of membranes is the cause of increased perinatal morbidity and mortality among preterm newborns. Microbiological features in women with preterm premature rupture of membranes and oligohydramnios are probably some of the determining factors affecting the implementation of an unfavorable outcome of gestation.
 AIM: The aim of this study was to determine microbiological features and perinatal outcomes in patients with preterm premature rupture of membranes and oligohydramnios.
 MATERIALS AND METHODS: This retrospective study conducted from 2018 to 2021 included 161 pregnant women with PPROM at 24 to 33 weeks and 6 days of gestation. Of these, the main group consisted of 83 patients with signs of oligohydramnios, while the control group comprised 78 patients without oligohydramnios. Patient examination upon admission to the hospital included analysis of the amniotic fluid index, the white blood cell differential, plasma ferritin and C-reactive protein levels, and bacteriological tests of vaginal secretions by isolating and growing microbes on optimal culture media.
 RESULTS: The patients with oligohydramnios had shorter latent period (р = 0.004), but the noted distinctions were a higher frequency of clinical chorioamnionitis (р = 0.025), fetal distress (р = 0.030), and earlier parturition (р = 0.040) with more frequent caesarean sections (р = 0.016) compared to the control group. Vaginal microbiota in the main group showed a higher prevalence of Staphylococcus aureus (р = 0.008), Bacteroides spp. (р = 0.030), Streptococcus spp. (р = 0.002), Micrococcus spp. (p 0.001), Bacillus subtilis (p 0.001), Bacillus megaterium (p = 0.009), Bacillus buchneri (р = 0.008), Klebsiella pneumoniae (р = 0.002), Haemophilus spp. (р = 0.005) and no Candida albicans compared to the control group. In the main group, newborns more often had a lower body weight at birth (р = 0.002) and a lower Apgar score at the fifth minute (р = 0.011). They also showed higher incidences of respiratory distress syndrome (р = 0.006), bronchopulmonary dysplasia (р = 0.036), congenital pneumonia (р = 0.011) and necrotizing enterocolitis (р = 0.022) and more often needed treatment in an intensive care unit (р = 0.034), including surfactant supplementation (р = 0.007), cardiotonic support (р = 0.004) and artificial lung ventilation (р = 0.006) compared to the control group.
 CONCLUSIONS: Oligohydramnios in preterm premature rupture of membranes is associated with pronounced dysbiotic changes in the vaginal microbiota including the prevalence of Micrococcus spp., Streptococcus spp., Staphylococcus aureus and absence of Candida spp. from the isolates, as well as increased incidence of adverse perinatal outcomes.

Perinatal outcomes of pregnancy and childbirth in moderate to severe COVID-19 patients

BACKGROUND: The presence of COVID-19 caused by SARS-CoV-2 during pregnancy increases the incidence of adverse perinatal outcomes, which are manifested in more frequent spontaneous miscarriages, premature births, antenatal fetal deaths, and fetal growth retardation, as well as in the development of intraamniotic infection and respiratory distress syndrome of the newborn. The most likely cause of premature birth can be considered severe respiratory failure of the mother with hypoxemia, which leads to circulatory disorders in the hemodynamic system of the mother-placenta-fetus. Currently, there is no single expert opinion on pregnancy prolongation tactics, as well as the timing and methods of delivery in patients with COVID-19, which is decided individually by an interdisciplinary consultation of the experts, taking into account the severity of the patients condition, gestational age and fetal condition.
 AIM: The aim of this study was to analyze perinatal outcomes of pregnancy and childbirth in the presence of moderate and severe COVID-19.
 MATERIALS AND METHODS: We carried out a retrospective analysis of perinatal outcomes in patients with the novel coronavirus infection in a specialized level III infectious hospital in St. Petersburg, Russia in 20202021 (from the first to the fourth wave of COVID-19) based on the birth histories of 50 patients with moderate (n = 31) and severe (n = 19) forms of the disease.
 RESULTS: Most of the patients suffered from chronic somatic diseases, with the course of pregnancy and childbirth complicated by premature rupture of amniotic fluid and progressive fetal hypoxia (fetal distress). In severe COVID-19, preterm labor prevailed and the proportion of operative abdominal delivery more than doubled that of vaginal delivery. The course of the postpartum period was determined by the COVID-19 positive dynamics. The majority of patients in the study groups showed significant changes in laboratory parameters such as anemia, an increase in the level of neutrophilic leukocytes with a subsequent decrease in their count, lymphopenia followed by lymphocytosis, and an increase in the levels of C-reactive protein and the activities of lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase. The study of the relationship between the most characteristic laboratory parameters in the disease dynamics showed the presence of statistically significant correlations between inflammation markers and metabolic markers, which allowed for assessing the severity of the patients condition.
 Antenatal diagnosis of the fetal functional status based on cardiotocography, ultrasound and Doppler sonography data revealed a predominantly compensated fetal condition in the study groups. The condition of newborns in all patients with moderate COVID-19 and in most of patients with the severe form of the disease was satisfactory. In severe COVID-19, the birth of children with moderate asphyxia was due to prematurity and antenatal hypoxia resulted from decompensation of chronic placental insufficiency. The histopathological patterns of the afterbirth in the study groups were represented by inflammatory changes and chronic placental insufficiency.
 CONCLUSIONS: The data obtained suggest that the basis for favorable perinatal outcomes is an adequate assessment of the condition of the pregnant woman and the fetus with timely delivery before the onset of irreversible organ damage.

Blastocyst quality and perinatal outcomes of frozen-thawed single blastocyst transfer cycles.

ObjectiveTo investigate the effects of blastocyst quality and morphological grade on the perinatal outcomes in patients undergoing frozen-thawed single blastocyst transfer cycles.MethodsThis single-center retrospective cohort study included 2648 singleton neonates resulting from frozen-thawed single blastocyst transfers performed between January 2017 and September 2021. Multivariate logistic regression was performed to evaluate perinatal outcomes for their association with blastocyst quality and morphological parameters.ResultTransfer of a good-quality blastocyst in a frozen-thawed cycle was associated with a lower rate of preterm delivery (PTD, adjusted OR =0.7, 95% CI 0.5-0.9; P=0.020) and a higher likelihood of a male neonate (adjusted OR =1.2, 95%CI 1.0-1.5; P=0.048). Compared with grade C inner cell mass (ICM) blastocyst transfer, grade B ICM (adjusted OR =0.5, 95%CI 0.2-0.9; P=0.027) and grade A ICM (adjusted OR =0.6, 95%CI 0.3-1.5; P=0.290) blastocyst transfers were associated with a lower rate of PTD, which was more evident for grade B ICM. After adjusting for confounders, the likelihood of a male neonate (grade B TE, OR =1.2, 95%CI 1.0-1.5, P=0.037; grade A TE OR =1.9, 95%CI 1.3-28, P=0.002) increased with increasing trophectoderm (TE) quality. Compared with expansion stage 4, the likelihood of a male neonate was 1.5 times greater with transfer of a stage 6 blastocyst (OR =1.5, 95%CI 1.0-2.3; P=0.06), and the risk of small for gestational age (SGA) was greater with transfer of a stage 5 blastocyst (adjusted OR =3.5, 95%CI 1.5-8.0; P=0.004). The overall grading of the blastocyst, expansion stage, ICM grade, and TE grade were not associated with length at birth, birthweight, large for gestational age (LGA), or birth defects (all P>0.05).ConclusionsIn frozen-thawed single blastocyst transfer cycles, transfer of a good-quality blastocyst was associated with a lower rate of PTD and a greater likelihood of a male neonate. Transfer of grade B ICM blastocysts decreased the rate of PTD, and TE quality was positively correlated with the likelihood of a male neonate.

Is early-follicular long-acting GnRH agonist protocol an alternative for patients with polycystic ovary syndrome undergoing in vitro fertilization?

BackgroundWe aimed to compare the clinical and perinatal outcomes of patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment with either an early-follicular long-acting gonadotropin-releasing hormone agonist (GnRH-a) long protocol (EFLL) or a midluteal short-acting GnRH-a long protocol (MLSL).MethodsThis single–center, retrospective study, included patients with PCOS who underwent IVF/ICSI from January 2013 to June 2019 at the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China. Patients underwent either MLSL (1179 cycles) or EFLL (2390 cycles). The primary outcomes were pregnancy outcomes, perinatal and maternal complications.ResultsFresh embryo transfer (59.12% vs. 55.47%, P = 0.038), clinical pregnancy (75.23% vs. 53.82%, P = 0.001), and live birth rates (63.27% vs. 42.05%, P = 0.010) were higher in the EFLL group. However, the proportion of patients “freezing all" for high risk of ovarian hyperstimulation syndrome (OHSS) (24.27% vs. 32.06%, P = 0.001) and ectopic pregnancy (1.51% vs. 5.97%, P = 0.002) were lower in the EFLL group than in the MLSL group. The incidence of gestational diabetes was higher in the EFLL group than in the MLSL group (5.08% vs. 1.42%, RR 3.714, 95% confidence interval (CI) 1.474–9.360, P = 0.003). There were no significant differences in the incidence of hypertension, premature rupture of membranes, placenta previa, congenital heart disease, or neonatal weight between the two groups. Logistic regression results showed that age (OR 0.966, 95% CI 0.941–0.993, P = 0.013), treatments (OR 2.380, 95% CI 1.833–3.089, P = 0.001), and endometrial thickness on trigger day (OR 1.115, 95% CI 1.070–1.162, P = 0.001) were correlated with clinical pregnancy. Pre-pregnancy BMI (OR 1.098, 95% CI 1.002–1.204, P = 0.046), fasting plasma glucose (FPG) (OR 3.096, 95% CI 1.900–5.046, P = 0.001), and treatments (OR 3.458, 95% CI 1.359–8.800, P = 0.009) were correlated with gestational diabetes mellitus (GDM). Treatments (OR 0.291, 95% CI 0.148–0.575, P = 0.001) and endometrial thickness on trigger day (OR 0.834, 95% CI 0.722–0.962, P = 0.013) were correlated with ectopic pregnancy.ConclusionThe early-follicular long-acting GnRH agonist long protocol can be used as an ideal assisted reproductive technology (ART) pregnancy assistance program for patients with PCOS, but obese patients should be encouraged to lose weight before ART treatments to reduce the risk of GDM.

Perinatal Outcomes of Patients with Hepatitis B Viral Infection in Pregnancy

Perinatal Outcomes of Patients with Hepatitis B Viral Infection in Pregnancy

Adverse Pregnancy Outcomes in Nondiabetic Patients with an Elevated Early Pregnancy HbA1c.

This study aimed to evaluate the impact of elevated early hemoglobin A1c (HbA1c) values on perinatal outcomes in patients without a diagnosis of diabetes or gestational diabetes. This is a retrospective study of patients with a singleton pregnancy who underwent universal HbA1c screening in early pregnancy at an urban tertiary care center between December 1, 2016, and December 31, 2018. Patients with pregestational diabetes mellitus (DM) and gestational DM (GDM) were excluded from analysis. The exposure of interest was HbA1c of 5.7 to 6.4% as measured on routine prenatal bloodwork at or during 16 weeks' gestation. The following pregnancy outcomes were assessed: preterm delivery <37 weeks, hypertensive disorders of pregnancy, shoulder dystocia, macrosomia (birth weight >4,000 g), small or large for gestational age neonate, operative vaginal delivery, third- or fourth-degree lacerations, cesarean delivery, neonatal intensive care unit (NICU) admission, neonatal hypoglycemia, and neonatal hyperbilirubinemia. Multivariable regression was performed to assess the relationship between HbA1c and selected adverse outcomes while controlling for potential confounders RESULTS: Of the 2,621 patients who met inclusion criteria, 334 (12.7%) had an elevated HbA1c of 5.7 to 6.4%. Patients with an elevated HbA1c were more likely to be older, Black, multiparous, publically insured, obese, or have chronic hypertension than patients with normal HbA1c values. In the unadjusted analysis, patients with an elevated HbA1c were less likely to deliver at term (84.7 vs. 92.4%, p = 0.006), but more likely to undergo cesarean section (32.8 vs. 27.6%, p = 0.038), develop hypertensive disorders of pregnancy (31.9 vs. 23.2%, p = 0.001), or deliver a macrosomic infant (10.5 vs. 6.8%, p = 0.016) than those with a normal A1c. After adjusting for race, body mass index, insurance status, nulliparity, and age, however, only the relationship between HbA1c and spontaneous preterm birth remained significant (adjusted odds ratio [aOR] = 1.76, 95% confidence interval [CI]: 1.01-3.07). In our urban population, an elevated early HbA1c was associated with spontaneous preterm birth in nondiabetic patients KEY POINTS: · In nondiabetic patients, early pregnancy HbA1c was associated with selected adverse outcomes.. · Rates of preterm birth, pregnancy-induced hypertension, cesarean section, and macrosomia were higher in patients with an elevated HbA1c.. · The relationship between early pregnancy HbA1c and spontaneous preterm birth remained significant after adjustment..

Effects of oral glibenclamide versus subcutaneous insulin on perinatal outcome of patients with gestational diabetes mellitus: A randomized clinical trial.

The first-line treatment for gestational diabetes mellitus remains insulin, but oral hypoglycemic agents are easier and cheaper to use. The aim of the current study was to compare the efficacy and safety of oral glibenclamide and subcutaneous insulin on the serum glucose control and perinatal outcome of patients with gestational diabetes mellitus. This randomized clinical trial was conducted during a 2-year period from 2017 to 2019 in two tertiary healthcare centers in Shiraz, Iran. We included 84 singleton pregnancies between 24 and 34 weeks of gestation diagnosed with gestational diabetes mellitus. Patients were randomly assigned to oral glibenclamide (n = 44) or subcutaneous insulin (n = 40) according to a standard protocol and followed until delivery. The primary endpoint was to compare the glycemic level of patients, and the secondary outcomes included pregnancy adverse events and neonatal complications such as preeclampsia, preterm and premature rupture of membranes, preterm labor, placental abruption, maternal hypoglycemia, birth weight, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and neonatal intensive care unit admission. The two study groups had comparable baseline characteristics. After treatment, the two study groups were comparable regarding fasting blood glucose (p = 0.398) and 2 h postprandial glucose (p = 0.085). There was no significant difference between the two groups regarding the rate of preeclampsia (p = 0.250), preterm rupture of membranes (p = 0.998), preterm labor (p = 0.495), hypoglycemia (p = 0.476), and abruption (p = 0.815). There was no significant difference between the two study groups in birth weight (p = 0.863) and the Apgar score at 1 (p = 0.190) and 5 min (p = 0.055). The rates of neonatal adverse events including hypoglycemia (p = 0.999), hyperbilirubinemia (p = 0.160), neonatal intensive care unit admission (p = 0.852), and respiratory distress syndrome (p = 0.665) were comparable between the two groups. The results of the current study demonstrate that oral glibenclamide is as effective and safe as subcutaneous insulin in glycemic control and maternal and neonatal outcomes in women with gestational diabetes mellitus. Thus, it could be used as first-line treatment of gestational diabetes mellitus.

Pregnancy and Perinatal Outcomes of Patients With Prior Cesarean Section After a Single Embryo Transfer in IVF/ICSI: A Retrospective Cohort Study.

ObjectiveTo study the influence of the previous cesarean section on the pregnancy outcomes and perinatal outcomes in single embryo transfer (SET) cycles in an in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) setting compared to those with previous vaginal delivery (VD). In addition, the association between fertility outcomes and different cesarean scar defect (CSD) sizes was studied.MethodThis was a retrospective cohort study conducted in the Reproductive Center of the First Affiliated Hospital of Nanjing Medical University. A total of 4,879 patients with previous delivery history undergoing SET were included between January 2015 and April 2019. Patients were divided into the VD group and cesarean delivery (CD) group according to different modes of previous delivery. The primary outcome was live birth rate. The pregnancy outcomes of CD were analyzed as a subgroup and the relationship between pregnancy outcomes as well as the different sizes of CSD were explored by logistic regression analysis.ResultsThere were no significant differences in live birth rate, clinical pregnancy rate, and miscarriage rate between the CD group and VD group. The incidence rates of pregnancy complications such as pregnancy hypertension, gestational diabetes mellitus, placenta abnormalities, premature rupture of membrane, and postpartum hemorrhage were similar in the two groups. Live birth rate was significantly lower in the CSD group (23.77% vs 37.01%, aOR: 0.609, 95% CI: 0.476-0.778) comparing to patients without CSD. There were also significant differences in clinical pregnancy rate (37.52% vs 47.64%, aOR: 0.779, 95%CI: 0.623-0.973) and miscarriage rate (34.55% vs 20.59%, aOR: 1.407, 95%CI:1.03-1.923). Large size CSD significantly decreased live birth rate (13.33% vs 26.29%, aOR: 0.422, 95%CI: 0.197-0.902) and clinical pregnancy rate (25.33% vs 40.09%, aOR: 0.503, 95%CI: 0.272-0.930) compared with small size CSD.ConclusionFor women with previous cesarean sections, the pregnancy outcomes were similar to those with previous VD without increased perinatal complications following SET. The presence of CSD was associated with a marked reduction in live birth rate, especially in patients with large size CSD.

Arrhythmias in pregnant women without structural heart disease: characteristics and outcomes

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart rhythm disorders are relatively common in pregnant women. There are few data of arrhythmia characteristics and perinatal outcomes in patients without any structural heart disease. Purpose To describe the clinical peculiarities, pregnancy course and characterize outcomes. Methods A total of 99 pregnant without structural heart disease with arrhythmia was included, aged: 29.05±5.37years with a mean gestation age 22.7±7.29 weeks. Clinical characteristics, obstetric and neonatal outcomes were determined. Results The most common reported arrhythmias were supraventricular tachycardia (n=46; 46.5%) and premature contractions (n=36; 36.3%). Advanced heart block (n=9; 9.1%) and ventricular tachycardia (n=8; 8.1%) were rare during pregnant with structurally normal heart. The 56% of arrhythmia cases among the examined patients first occurred during current pregnancy. Studying the peculiarities of arrhythmia manifestations, it was determined that in the I trimester of pregnancy the disease symptoms appeared in 11% of the examined women, in the II trimester – in 59%, in the III trimester – in 31%. In the clinic, the most common symptoms of arrhythmia were palpitations (62.6%), general weakness (59.6%), dyspnea (38,4%) and dizziness (29.9%). Pregnancy course was benign in the majority of cases. Termination of pregnancy was in three cases (3%) – in one case due to extracardial cause, in two cases due to life threatening course of ventricular tachycardia. Premature birth was in 2 cases (2.02%). In 75% of pregnancy was vaginal delivery, in 25% - cesarean section. Preeclampsia was in 2 cases (2.02%). There were 99 live births without maternal and fetal mortality. Conclusions In pregnant women with no structural heart disease supraventricular tachycardia and premature beats are most common. Majority of patients have good course of pregnancy and outcomes.

Maternal and Perinatal Outcome in Placenta Previa: One Year Study in Enam Medical College Hospital

Introduction: Placenta previa is a key risk factor for obstetric hemorrhage particularly occurs in women with a previous uterine scar. It can be defined as an embedding of the placenta in the lower uterine segment, overlying or approaching the internal cervical os. One-third of all cases of APH caused due to placenta previa. Aim of the study: To assess the maternal complications and perinatal outcomes of patients with placenta previa by analyzing its obstetrical factors. Methods: This study is a cross-sectional observational study conducted at the Department of Obstetrics and Gynae, in Enam Medical College and Hospital, Savar, Bangladesh. The study was conducted for the duration of 1 year between January 21 to December 21. The sample size for this study was 109. Result: The most respondents 81(74.3%) were from the age group 25-29 years, 17(16%) were booked and 92(84%) were unbooked. 27(25%) were primi and 82(75%) were multi-para. Pain abdomen was present in only 2(1.8%) cases and absent in most 107(98.2%) cases. LSCS was done in 79(72%) patients and vaginal delivery was done in 30(28%) cases. Type 2b in most of the cases 50(45.9%). Blood transfusion was needed in 20(18.3%) and post hemorrhage was seen in 12(11%). APGAR at birth was 8-10 in 69(63.35) cases, 5-7 in 27(24.8%) cases and &lt;5 in 13(11.9%) cases. Conclusion: Placenta previa is the main cause of maternal and perinatal morbidity and mortality. Maternal and fetal outcome can be improved by regular antenatal check-up, early diagnosis of case. Management should be done in tertiary care center with neonatal management facility.

Association of sFlt-1 and C-reactive protein with outcomes in severe preeclampsia: A cohort study.

To determine the association between soluble FMS-like tyrosine kinase-1 (sFlt-1) and high-sensitivity C-reactive protein (hs-CRP) with maternal and perinatal outcomes in patients with preeclampsia (PE) with severe features.A cohort study was conducted on 100 patients, 60 with PE with severe features, and 40 healthy women in the third trimester of pregnancy. Admission serum levels of sFlt-1 and hs-CRP and clinical and epidemiological parameters were evaluated to quantify the predictive ability of adverse maternal and perinatal outcomes using hierarchical multiple regression and receiver operating characteristic curves.Compared to controls, patients with PE and severe features had significantly higher levels of sFlt-1 but not hs-CRP. sFlt-1 and hs-CRP proved to be reasonable parameters for the prediction of composite adverse maternal outcomes. However, we found no correlation between these 2 biomarkers. PE integrated estimate of risk scores were correlated only with sFlt-1 levels. Regarding fetal outcomes, unlike hs-CRP, sFlt-1 was strongly associated with birth weight and Apgar score < 7 at 5 minutes. Following multivariate analysis, maternal age, previous hypertension, sFlt-1, and hs-CRP levels remained independently associated with composite adverse maternal outcomes.sFlt-1 levels were elevated in patients with PE and severe features. Both sFlt-1 and hs-CRP may predict composite adverse maternal outcomes but do not correlate with each other and differ in perinatal morbidity patterns. These data support the hypothesis that the varied outcomes in PE may result from different pathogenic pathways.

Ultrasound-Indicated Cervical Cerclage Efficacy Between 16 and 28 Weeks of Gestation in Twin Pregnancy: Retrospective Cohort Study.

ObjectiveThe aim of this study is to determine if cervical cerclage administration reduces the preterm birth (PTB) rate at a gestational age (GA) of 16–28 weeks in women with twin pregnancy.MethodsThis is a retrospective cohort study on asymptomatic twin pregnancy with an ultrasound-identified cervix length (CL) of ≦25 mm. The patients were divided into two groups: ultrasound-indicated cerclage (UIC) group and control (expectant management) group. The primary outcome was a PTB rate at <34 weeks. A logistic regression was also performed, and a subgroup analysis stratified by CL and GA at first short cervix diagnosis was planned.ResultsIn all 320 women, there were no differences in the overall <34-week PTB rates and neonatal outcomes between the UIC group and control group. After performing a multivariate logistic regression analysis, the subgroup analyses were planned. In patients with a CL of ≦15 mm, the <34-week PTB rate was significantly decreased in the UIC subgroup compared with the control subgroup (60.78% vs 78.26%; odds ratio (OR) = 0.43, confidence interval (CI) = 95% [0.22–0.86]; and p = 0.020). In patients with a first short cervix diagnosis GA of ≦24 weeks, the <34-week PTB rate was significantly decreased in the UIC subgroup when compared with the control subgroup (61.54% vs 84.75%; OR = 0.29; CI = 95% [0.13–0.63]; and p = 0.001). Furthermore, compared with the control groups, the UIC groups had higher mean birth weight, lower perinatal mortality, and lower NICU admission, and the differences were statistically significant.ConclusionUIC could significantly reduce the <34-week PTB rate and improve perinatal outcomes in patients with a CL of ≦15mm or first short cervix diagnosis GA of ≦24 weeks with asymptomatic twin pregnancy during the second trimester.

Nuchal Cord at Delivery and Neonatal Outcomes: A Retrospective Cohort Study

Objective: The present study was aimed at evaluating the outcome of pregnancies with a nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 2011-2020 in Philippe Maguilen SENGHOR Center was conducted. Perinatal outcome of patients with and without nuchal cord was compared. Results: Among 44,958 deliveries during the study period, 1.8% had a nuchal cord, documented at birth (n = 807). Higher rates of labor induction (9.1% vs. 3.2%; p 0.001) and non-reassuring fetal heart rate patterns (RR = 2.366; CI: 1.631 - 3.432) were noted among pregnancies with nuchal cord as compared with the control group. The cesarean delivery rate was significantly higher among pregnancies with a nuchal cord (39.5% vs. 21.8%; RR = 2333; CI: 2.023 - 2.692). Although 5 min Apgar scores lower than 7 were more common in pregnancies with a nuchal cord (7.8% vs. 3.8%; RR = 2.117; CI: 1.629 - 3.363). There was no statistical significance between the two groups for the perinatal mortality. Conclusion: Nuchal cord is associated with prolonged labor and adverse perinatal outcome.

Subchorionic hematoma and pregnancy outcomes in patients with threatened miscarriage

Objective:To compare maternal and perinatal outcomes in patients with threatened miscarriage with or without subchorionic hematoma (SCH) at a tertiary care hospital.Methods:This retrospective cohort study was conducted at Aga Khan University Hospital. The study included 200 patients of <20 weeks singleton pregnancy with threatened miscarriage from January 2016 till December 2018. These patients were divided into two groups based on the presence (study group) or absence of subchorionic hematoma (control) on ultrasound imaging. Baseline demographic data, and obstetric outcomes were compared for the two groups.Results:The incidence of subchorionic hematoma was observed to be 30.5% (61/200). Most of the patients of SCH and non SCH groups presented in first trimester. Age and BMI were similar for both groups however there were more multigravida patients in the SCH group (63%versus 46.7%, P=0.12). A higher number of patients in the SCH group ended up in spontaneous miscarriage in contrast to patients with no SCH (13%versus6.1%, P=0.07) and also had a greater proportion of small for gestational age (SGA) babies (8.9%versus3.9%) though no statistical significance was observed. There were more preeclamptic patients in SCH group as compared to non SCH group (4.8%versus0.7%) and the trend was statistically significant(P=0.05). However, no significant correlation of hematoma size and adverse pregnancy outcomes was found in SCH group.Conclusion:Our study shows that women with threatened miscarriage having SCH are at a higher risk of having preeclampsia and SGA and hence these pregnancies warrant greater surveillance.

Evaluation of obstetric and perinatal outcome of pregnancy with bad obstetric history

Background: Adverse perinatal outcome has always been a devastating experience for the mother. Advanced maternal age and other risk factors are independent risk factor for perinatal outcome. Therefore, aim of study is to compare the effect of these factor in different study group. Aims and Objectives: Case–control study has been conducted to evaluate obstetrics outcome, maternal morbidity, and perinatal outcome in patients with bad obstetric history. Materials and Methods: A prospective observational case–control study has been conducted in two groups; GROUP A: BOH group (n = 44) and GROUP B: Controls (n = 88) who fulfilled inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical college, Sola during the period of August 2018 to August 2020. Statistical analysis was done by descriptive statistics and qualitative and quantitative method. Results: Incidence of hypertension in Group A was 25%, while in Group B incidence was 6.8%. Incidence of hypertension was 4.5 times higher in Group A than B which was statistically significant (P &lt; 0.05). Incidence of PROM, gestational diabetes mellitus, thyroid dysfunction was higher in Group A than Group B. Higher incidence of preterm delivery found in Group A than in Group B which was statistically significant (P &lt; 0.05). Conclusion: Among all BOH group, cases with previous history of preterm delivery, still birth, recognition of prior learning, and HTD were the major risk factors which could be responsible for adverse obstetric and perinatal outcome.

MATERNAL AND PERINATAL OUTCOMES IN PREGNANCY ASSOCIATED WITH ABRUPTIO PLACENTA

Background: Placental Abruption is an important cause of antepartum haemorrhage. It is defined as the separation of the placenta either partially or totally from its implantation site before delivery. APH is a major cause of maternal and perinatal morbidity and mortality. Therefore the study was planned to study the maternal and perinatal outcomes in patients of abruption placenta. Methods: The present study was conducted in the department of obstetrics and gynaecology, SMGS, Hospital, Govt. Medical College Jammu over a period of 1 year. It was a prospective study and all case of Abruptio placenta ≥ 28 weeks of gestational age were included. Results: It was observed that maximum cases of Abruptio Placenta i.e 67.65% were multigravida. 41.47% of cases of Abruptio Placenta had hypertension. 4.41 % had Polyhydramnios. 61.76% delivered vaginally. 23.53% patients had postpartum haemorrhage whereas only 2.98% had undergone Postpartum Hysterectomy. The most common fetal complication in Abruptio Placenta was prematurity (35.71%). 5.89% patients of Abruptio Placentas died during Peripartum period. Perinatal mortality was high 48.58%. Conclusions: Abruptio placent is associated with significant maternal and perinatal morbidity and mortality. Good regular antenatal care and availability of emergency medical services remains the backbone for the good maternal and perinatal outcomes.