Perinatal Outcomes In Pregnancies Research Articles

Cigarette smoking during pregnancy and adverse perinatal outcomes: a cross-sectional study over 10 years

BackgroundIt has been shown that active exposure to tobacco is associated with adverse pregnancy outcomes including, but not limited to, intrauterine fetal death, reduced fetal weight, and higher risk of preterm birth. We want to investigate these effects in a high-income country.MethodsThis cross-sectional study examined 20,843 pregnant women who delivered over 10 years at the Maternity Hospital of the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland. The objective was to evaluate a dose–response relationship between daily cigarette use during pregnancy and possible adverse perinatal outcomes. The social and clinical characteristics as well as obstetric and neonatal outcomes were compared between the smoking and the non-smoking groups. Adjusted odds ratios (aOR) and trend analyses (ptrend) were calculated.ResultsNineteen thousand five hundred fifty-four pregnant women met the inclusion criteria and 2,714 (13.9%) of them were smokers. Even after adjusting for confounding factors, smoking during pregnancy was associated with preterm birth, birthweight < 2500 g, intrauterine growth restriction, neonatal respiratory and gastrointestinal diseases, transfer to the neonatal intensive care unit, and neonatal intensive care unit admissions > 7 days. Intrauterine death and neonatal infection were associated with heavy smoking (≥ 20 cigarettes/day). Smoking appeared to be a protective factor for pre-eclampsia and umbilical cord arterial pH below 7.1. A significant trend (ptrend < 0.05) was identified for preterm birth, intrauterine growth restriction, birthweight < 2500 g, umbilical cord arterial pH below 7.1, transfers to our neonatal intensive care unit, and neonatal intensive care unit admissions more than 7 days.ConclusionCigarette smoking is associated with several adverse perinatal outcomes of pregnancy with a dose-dependent effect.

Comparison of Maternal and Perinatal Outcomes of Pregnancy with Systemic Lupus Erythematosus in Planned Referrals Compared to Emergency Referrals Based on the Maternal Fetal Triage Index at Dr. Kariadi General Hospital, Semarang, Indonesia

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease that attacks the skin and the musculoskeletal, kidney, neuropsychiatric, hematological, cardiovascular, pulmonary, and reproductive systems. In pregnancies with SLE, early referral to the hospital with the involvement of obstetricians and rheumatologists, and other specialists as needed, as well as individual management plans, regular reviews, and early recognition of flares and complications, are important. This study aimed to determine the differences in maternal and perinatal outcomes referred by planned referrals compared to emergency referrals, especially in pregnant patients with SLE.&#x0D; Methods: This study was an analytic observational study with a retrospective cohort approach. A total of 40 subjects participated in this study. Data analysis using SPSS software was carried out univariate and bivariate to examine the relationship between types of referrals and maternal and perinatal outcomes.&#x0D; Results: There were significant differences between the types of emergency referrals and planned referrals in the variable incidence of preeclampsia and SLE exacerbations. There were no significant differences between the types of emergency referrals and planned referrals on the variable incidence of lupus nephritis, maternal death, premature delivery, fetal growth restriction, fetal death, and the incidence of neonatal lupus syndrome.&#x0D; Conclusion: The incidence of severe preeclampsia and SLE exacerbation was lower in planned referrals compared to emergency referrals in pregnant patients with SLE at Dr. Kariadi General Hospital, Semarang, Indonesia.

Intrauterine transfusion in hydropic fetuses: An outcome analysis.

The objective of this study is to determine the perinatal outcome in pregnancies with hydropic fetuses. The study was a retrospective evaluation of data on intrauterine transfusion (IUT) done in hydropic fetuses for correction of severe anemia from December 2017 to August 2021 in AIIMS Jodhpur. The retrospective case series involves five cases that underwent IUT for severe fetal anemia. All had a sign of hydrops at the time of presentation. Out of five cases, four were of alloimmunized pregnancies while one was of hydrops fetalis secondary to parvovirus infection. The presence of severe hydrops at the time of presentation is a poor prognostic factor affecting fetal survival post-IUT therapy.

Maternal and perinatal outcomes in relation to body mass index

Background and objectives: Maternal obesity has become a global threat and has a major public health burden to the mother and her baby. The prevalence of maternal obesity has risen in the past two decade. The aim of the study is to compare maternal and perinatal outcomes of pregnancy in relation to BMI. Methods: It is an observational case con sectional study which was conducted in Sulaimani maternity teaching hospital/Kurdistan region of Iraq, from August 1st 2015-August 1st 2016. A total of 300 women of prime and multigravida with singleton term pregnancy (37- 42weeks), cephalic presentation, age (18-45) year were included. Weight and height were taken from booking visit. Results: Significant difference was found in mean age of the three groups with older women tend to become more obese. There was significant association of obesity with increase. Obesity will increase the risk of gestational hypertension, gestational diabetes and antepartum hemorrhage. Moreover, the rate of caesarean section increasing with higher body mass index. Postpartum hemorrhage showed significant association with obesity. Higher body mass index women are more likely to give birth to macrocosmic babies and admission to the neonatal intensive care unit. Conclusion: Obesity increases the risk of delivery by caesarean section, and is associated with increased incidence of hypertension, gestational diabetes, post-partum hemorrhage and macrocosmic baby. Babies of obese women have a high incidence of admission to the neonatal intensive care unit.

The use of hydroxychloroquine in pregnancy and its effect on perinatal outcomes in a population with autoimmune abnormalities.

This study was conducted to analyse the medication indications of hydroxychloroquine (HCQ) and to explore the clinical characteristics and perinatal outcomes of pregnancy in women with autoimmune abnormalities. The value of HCQ against placental dysfunction-related pregnancy outcomes in people with autoimmune abnormalities was also explored. ① To collect HCQ application cases during pregnancy who were hospitalized and delivered from 2016 to 2020. The classification and distribution of HCQ indications were analysed. The characteristics of cases and pregnancy outcomes were discussed. ② To include pregnancy combined with autoimmune abnormalities population during the period. Demographic information, clinical characteristics, classification, medication time frame, and pregnancy outcomes were discussed. ① There were 741 cases of HCQ use during pregnancy. Classification by drug indication was as follows: 257 cases (34.68%) had clear indications for autoimmune diseases. There were 359 controversial cases, as follows: 140 (18.89%) cases of antiphospholipid syndrome and 219 (29.55%) cases of autoantibody-positive cases who had no clear drug indication and also used HCQ during pregnancy. No indications were found for 125 cases (16.87%), without autoimmune abnormalities and empirical medication of HCQ during pregnancy. ② In 853 pregnancies with autoimmune abnormalities, women with systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, and undifferentiated connective tissue disease had clear indications for HCQ. The proportions of HCQ applied during pregnancy were 86.67%, 85.71%, 73.53%, and 75.00%. The start of medication before pregnancy only accounted for 74.44%, 65.31%, 64.71%, and 43.38%. ③ Medication indicated antiphospholipid syndrome and simple autoantibody-positive cases in the controversial population. The proportions of cases in which HCQ was used during pregnancy were 74.47% (140/188) and 64.79% (219/338). Application of HCQ during pregnancy significantly reduced pre-eclampsia (19.8% vs. 8.91%, P < 0.001), early-onset pre-eclampsia (7.78% vs. 2.51%, P = 0.007), and pregnancy loss during the middle and late pregnancy stages (2.99% vs. 0.56%, P = 0.036) in this controversial population. Empirical, over-indicated, or even no indications usage of HCQ in pregnancy is common. The strength of standardized and specialist management are needed in populations with clear HCQ indications. HCQ-indicated controversial population should avoid overdiagnosis and guard against the potential risks of combined anticoagulation and glucocorticoid therapy. The incidence of placental dysfunction diseases in people with autoimmune abnormalities increases. HCQ application may alleviate the incidence of adverse pregnancy outcomes in this population. Key Points •The incidence of placental dysfunction diseases in people with autoimmune abnormalities increases. •Our work have discovered the unique value of HCQ in improving placental dysfunction diseases in autoimmune abnormal cases, not just in AID such as SLE, SS, UTCD, and RA. •HCQ is a potential drug option for autoimmune abnormalities to improve placental function, by providing synergistic prevention and treatment of these disorders, not just single target of antispasmodic, anti-hypertensive, and circulatory improvement. •Empirical, over-indicated, or even no indications usage of HCQ in pregnancy is common. However, the strength of standardized and specialist management are needed in populations with clear HCQ indications.

Evaluation of adolescent pregnancies in terms of maternal and perinatal risks

Objective: We aimed to evaluate adolescent pregnancy rates and both maternal and perinatal adverse pregnancy outcomes in a secondary care public hospital. Methods: Maternal and perinatal pregnancy outcomes of pregnant women of adolescent age who applied to a secondary level public hospital between June 2018 and March 2021 were evaluated. The study was started with 1803 patients. After the exclusion criteria, the study was continued with 1753 patients. Results: When the parameters that are significant in the binary analysis are analyzed by logistic regression analysis; 2.13-fold the risk of preterm birth (CI: 1.319–4.625), 1.621-fold the risk of premature rupture of membranes (CI: 1.461–2.328), 2.412-fold the risk of low birth weight (CI: 2.894–4.297), and 1.768 fold the need for NICU (CI: 1.013–2.121) were observed to increase. Conclusion: Negative characteristics of adolescent pregnancies should also be taken into account while developing health policies in the coming years. Poor outcomes of adolescent pregnancies should be transferred to both healthcare professionals and society, and adolescent pregnancies should be reduced.

Impact of COVID-19 Infection on the Maternal and Perinatal Outcome of Pregnancies Associated with Preeclampsia

Impact of COVID-19 Infection on the Maternal and Perinatal Outcome of Pregnancies Associated with Preeclampsia

Perinatal outcomes of prenatal diagnosis of congenital pulmonary airway malformation: an experience.

This study aimed to assess the perinatal outcomes of pregnancies with a prenatal diagnosis of congenital cystic adenomatoid malformation. We conducted a retrospective cohort study based on information contained in the medical records of pregnant women whose fetuses had been prenatally diagnosed with congenital cystic adenomatoid malformation by ultrasonography. Sample analysis was based on 21 singleton pregnancies with confirmed isolated fetal congenital cystic adenomatoid malformations. The mean maternal±standard deviation age was 28±7.7 years. Types I, II, and III congenital cystic adenomatoid malformation were detected in 19% (4/21), 52.4% (11/21), and 28.6% (6/21), respectively. All fetuses presented with unilateral congenital cystic adenomatoid malformation (21/21) without associated anomalies, and 52.3% (11/21) were in the right lung. In total, 33.3% (7/21) of fetuses presented a "congenital cystic adenomatoid malformation volume ratio" >1.6 and were managed with maternal betamethasone administration. The mean gestational age at the time of steroid administration was 28.5±0.9 weeks, with a reduction in the lesion dimensions of 9.5% (2/21) (Types I and III of congenital cystic adenomatoid malformation). The mean gestational age at delivery was 38.7±2.4 weeks, and a cesarean section was performed in 76.2% (16/21) cases. Postsurgical resection was necessary for 23.8% (5/21) of the patients, and 4.7% (1/21) of them died because of respiratory complications after surgery. Pulmonary hypoplasia occurred in 9.5% (2/21) of the patients, and 4.7% (1/21) of them died because of respiratory insufficiency. The survival rate was 90.5% (19/21), and 57.2% (12/21) remained asymptomatic. Despite the isolated prenatal diagnosis of congenital cystic adenomatoid malformation, which showed good survival, congenital cystic adenomatoid malformation is associated with significant perinatal morbidity. Maternal betamethasone administration did not significantly reduce fetal lung lesion dimensions.

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.&#x0D; AIM: The aim of this study was to analyze perinatal outcomes of pregnancy and childbirth in the presence of moderate and severe COVID-19.&#x0D; 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.&#x0D; 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.&#x0D; 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.&#x0D; 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.

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

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

Obstetrical and neonatal complications in hereditary haemorrhagic telangiectasia: A retrospective study.

To retrospectively describe a large series of pregnancies in women with hereditary haemorrhagic telangiectasia followed in our reference centre, plus neonatal outcomes, to better understand the risks of complications and to improve their prevention. A retrospective descriptive study conducted through a phone questionnaire. Reference centre for hereditary haemorrhagic telangiectasia in Lyon, France. Women meeting the following criteria: (1) alive and aged ≥18 years; (2) with a definite clinical and/or genetic diagnosis of hereditary haemorrhagic telangiectasia; and (3) with at least one full-term pregnancy. Maternal and perinatal outcomes of pregnancies in women with hereditary haemorrhagic telangiectasia. Five hundred and sixty-two pregnancies were reported in 207 women with hereditary haemorrhagic telangiectasia. A total of 271 complications (48.2%) were registered. Of these, 149 (55%) non-specific complications, 110 (40.6%) non-severe specific complications and 12 (4.4%) severe specific complications were registered. There were four cases of haemoptysis and two cases of transient ischaemic attack related to pulmonary arteriovenous malformations. Four patients had severe decompensated dyspnoea, related to pulmonary arteriovenous malformations in three cases and to pulmonary arteriovenous malformations associated with severe hepatic arteriovenous malformations in one case. Hepatobiliary necrosis occurred in one case. Epidural or spinal anaesthesia was performed in 139 of 452 deliveries (31%), without complications. There were 12 reports of congenital anomalies in 461 live births (3%). Most pregnancies in hereditary haemorrhagic telangiectasia women are uneventful; complications are rare but can be severe. Women thus need to be educated about screening and possible pregnancy-related risks before becoming pregnant.

Adverse perinatal outcomes in pregnancies affected by severe COVID-19 infection

BackgroundSevere COVID-19 infection in pregnancy has been associated with an increase in adverse perinatal outcomes, though studies differ regarding which outcomes are affected. Increased characterization of obstetric and neonatal outcomes are needed including details on indications for preterm delivery and additional neonatal adverse outcomes.ObjectiveTo determine whether there is a higher rate of adverse perinatal outcomes amongst severe-critical COVID-19 infection compared to non-severe COVID-19 infection diagnosed during pregnancy.Study DesignThis was a retrospective observational cohort study that compared rates of adverse perinatal outcomes amongst singleton pregnancies identified as having a positive laboratory PCR diagnosis of COVID-19 infection with severe-critical COVID-19 infection versus non-severe (asymptomatic, mild or moderate). Primary outcomes included hypertensive disorders of pregnancy, cesarean delivery, fetal growth restriction, preterm birth, and neonatal intensive care unit (NICU) admission. Additional neonatal outcomes analyzed include need for CPR, low birthweight (<2500g), 1 or 5 min Apgar <7, need for supplemental oxygen, need for intubation, interventricular hemorrhage, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusion, necrotizing enterocolitis, hypoxic ischemic encephalopathy, birth trauma or neonatal death. Appropriate bivariate analyses were used to compare groups. Logistic regression was used to examine primary outcomes adjusting for confounders.ResultsA total of 441 participants were identified and confirmed via detailed chart review to be pregnant with a singleton pregnancy while diagnosed with COVID-19. Of these, 44 (10%) met NIH criteria for severe-critical COVID-19 infection. The median gestational age at the time of maternal COVID-19 diagnosis was 36.4 weeks (IQR 29.6 – 38.6). Severe-critical COVID-19 infection had a higher risk of a composite adverse neonatal outcome (36.4% vs 21.4%, p=0.03). There was a high incidence of hypertensive disorders of pregnancy overall (20.6%) but this outcome was not higher in the severe-critical vs non-severe group. There were no maternal deaths. There was a low incidence of neonatal COVID-19 test positivity amongst those tested (1.8%). When adjusting for presence of heart disease and gestational age at COVID-19 diagnosis, severe-critical COVID-19 was strongly associated with fetal growth restriction (aOR 2.73, 1.03 – 7.25) and NICU admission (aOR 3.50, CI 1.56 – 7.87). Preterm delivery was more common but was no longer significant after adjustment (aOR 2.23, CI 0.99 – 5.05).ConclusionSevere-critical COVID-19 infection during pregnancy is associated with higher rates of adverse neonatal outcomes and strongly associated with NICU admission and fetal growth restriction compared to non-severe disease. There is a high rate of hypertensive disorders of pregnancy overall in all those affected by COVID-19, regardless of severity. Pregnant persons should be counseled on these risks to encourage vaccination, and those with infection during pregnancy should be monitored for fetal growth disorders.

The Maternal and Perinatal Outcomes of Pregnancies Complicated by Covid-19: A Retrospective Study at a Tertiary Facility in Guyana (Georgetown Public Hospital Corporation)

Background: In December 2019, there was an outbreak of pneumonia cases in the city of Wuhan, China. The outbreak was first manifested as a cluster of mysterious pneumonia cases mostly related to the Huanan Seafood market in Wuhan, the capital of Hubei Province. Genomic investigations of the pathogen found that the disease was caused by a new strain of coronaviruses and the disease was given the name “Covid 19”. Pregnant women with Covid-19 may be at greater risk of severe illness although the full impact of the infection in pregnancy is unknown. Amongst the Guyanese population, several pregnant mothers have tested positive to Covid-19 thereby generating major concerns. Objectives: To ascertain the maternal, perinatal and immediate neonatal outcomes of pregnancies complicated by Covid-19 infection at the Georgetown Public Hospital Corporation, Guyana. Method: This study is a retrospective chart review of pregnant patients who were diagnosed with Covid-19 from August, 2020 to April 2021 and delivered at GPHC. The data collected include socio-demographics of patients, parity, gestational age at delivery, birth weight amongst others. Results: This retrospective study was able to show the outcomes of Covid-19 in pregnant patients at the Georgetown Public Hospital from August, 2020 to April, 2021. During this study period, the total study population of this research was 4,686 of which only seventy-nine (79) participants fit the study criteria. Conclusion: This retrospective study shows there was no statistically significant impact seen in the maternal and neonatal outcomes of pregnancies complicated by Covid-19 infection at Georgetown Public Hospital Corporation (GPHC). Keywords: Maternal and Perinatal Outcomes of Pregnancies, Covid-19, Georgetown Public Hospital Corporation

A Clinical Study on Maternal and Perinatal Outcome of Oligohydramnios

Background : Oligohydramnios is one of the pregnancy associated common complications facing by obstetrician which is associated with adverse maternal and perinatal outcome such as birth defects, miscarriage, intrauterine growth restriction, still birth, preterm birth, increased operative interference etc. Objective: To assess the impact of oligohydramnios on maternal and perinatal outcome. Methods: This cross-sectional descriptive study was conducted at Department of Obstetrics and Gynecology, BSMMU, Dhaka from October 2017 to March 2018.Total 50 patients were enrolled by purposive sampling method according to the inclusion and exclusion criteria. Clinical evidence of oligohydramnios was looked for &amp; confirmed by ultrasonography (USG). Based on Amniotic fluid index (AFI)measurements patients were divided into two groups. Those who have AFI &lt;5cm and 5-8cm. The significance of difference or comparison of means was measured by Chi square test. Maternal and perinatal outcome in pregnancies with oligohydramnios were compared with those with 5-8cm amniotic fluid volume. Results: The mean age of the study population was 23.3±4.06 years and majority of the cases were multipara (56%) and presented at term (58%). Borderline oligohydramnios (AFI 5-8cm) was found in 74% cases and severe oligohydramnios (AFI &lt;5cm) were found in 26% cases. Most common etiological factor was idiopathic. Fifteen cases (30%) had vaginal delivery and caesarean section rate 70%, no maternal mortality occurred in this study, perinatal mortality rate was 10%, low birth weight baby was 63.6% and NICU admission rate was 53.8%. Conclusion: An antepartum or intrapartum oligohydramnios is associated with significantly increased incidence of caesarean section for fetal distress and increased incidence of low-birth-weight babies and increased rate of neonatal complications. Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 489-492

Analyzing pregnancy course and outcomes in women with varying degrees of severity of novel coronavirus infection COVID-19 in Saint Petersburg: the lessons from pandemic

Introduction. Today, two years after the first outbreak of the novel coronavirus infection (NCI) COVID-19, there is still insufficient data to fully assess risks and pattern of the course of this infectious disease in pregnant women.Aim: to conduct a comparative analysis of perinatal pregnancy outcomes as well as clinical and laboratory data in COVID-19 patients at the time of delivery and those suffering from the disease during pregnancy.Materials and Methods. A retrospective comparative study was carried out after analyzing pregnancy and childbirth histories in 191 women admitted for delivery in three obstetric medical organizations of Saint Petersburg in the years 2020–2021. Perinatal outcomes of pregnancy as well as clinical and laboratory data in patients suffering from COVID-19 during pregnancy were analyzed: Group 1 – 57 patients with asymptomatic and mild form of verified COVID-19; Group 2 – 50 patients with COVID-19 of moderate and severe course; Group 3 – 52 patients who underwent COVID-19 in the third trimester of pregnancy. Group 4 (control) consisted of 32 women lacking COVID-19.Results. Comparing delivery outcomes in Group 1 vs. Group 2 revealed a significantly higher rate of urgent deliveries – 54 (94.7 %) and 38 (76.0 %) (χ2 = 7.76) respectively, as well as a significantly lower number of premature births – 3 (5.3 %) and 12 (24.0 %) (χ2 = 7.76) respectively. Comparison of Group 1 vs. Group 3 showed significantly fewer natural births – 33 (57.8 %) and 42 (80.8 %) (χ2 = 6.63) respectively, but a greater rate of caesarean section – 24 (42.0 %) and 10 (19.2 %) (χ2 = 6.63). Comparison of Group 1 vs. Group 4 revealed a significantly higher number of women with acute and progressive fetal hypoxia (fetal distress) – 16 (28.1 %) and 2 (6.3 %) (χ2 = 6.05) respectively. These data allow us to state about an impact of the severity of infectious process SARS-CoV-2-caused disease and its timeframe during pregnancy on the timing and method of delivery. No significant data were obtained that might allow to state that the infectious process directly caused increased rate of premature birth in pregnant women with moderate and severe COVID-19. At hospital admission and discharge, patients with mild and asymptomatic COVID-19 were significantly less likely to have neutrophilia – 5 (8.8%) and 42 (84.0%) (χ2 = 61.2; p &lt; 0.001) respectively, increased aspartate aminotransferase – 4 (7.0 %) and 38 (76.0 %) (χ2 = 53.15; p &lt; 0.001), lactate dehydrogenase (LDH) – 0 (0.0 %) and 12 (24.0 %) (χ2 = 15.41; p &lt; 0.001), C-reactive protein (CRP) – 6 (10.5 %) and 49 (98.0 %) (χ2 = 81.58; p &lt; 0.001), creatinine reduction – 0 (0.0 %) and 11 (22.0 %) (χ2 = 13.98; p &lt; 0.001) respectively. In groups with severe, mild and asymptomatic COVID-19, a strong direct correlation was established the CRP level and leukocyte count, between level of serum CRP and alanine aminotransferase; a less noticeable relationship was observed between serum CRP and LDH concentrations, CRP and total protein level.Conclusion. It was shown that no specific effect of SARS-CoV-2 infection was exerted on majority of parameters related to normal course of labor, as well as on condition of neonates born to patients with COVID-19 of varying severity. In patients with COVID-19 at the time of delivery, changes in clinical and laboratory parameters corresponded to the disease severity.

Middle cerebral artery to uterine artery pulsatility index ratios in pregnancy with fetal growth restriction regarding negative perinatal outcomes

Background/Aim: Fetal growth restriction (FGR) causes a high risk of perinatal morbidity and mortality, and the timing of the correct delivery time decision remains controversial. Cerebroplacental ratio (CPR), umbilical artery, uterine artery (UA) and middle cerebral artery (MCA) Doppler studies are used to predict adverse perinatal outcomes in FGR. However, since there is insufficient reliability for each separately and together, the search for new methods continues. This retrospective study was conducted to determine the degree of neonatal morbidity in fetuses suspected of having FGR by evaluating the MCA to UA pulsatility index (PI) ratios together with frequently used Doppler examinations. Methods: This was a retrospective cohort study conducted in a single-center hospital with the approval of the Medical Institutional Ethics Committee. A total of 424 pregnant women admitted to a tertiary hospital and diagnosed with FGR between July 2020 and December 2021 who were informed and approved were included in the study. Gestational age was confirmed by first trimester sonographic measurements of pregnancy. All pregnant women were examined by Doppler USG and umbilical artery, mean UA, fetal MCA, ductus venosus, CPR (MCA/umbilical artery pulsatility index ratio) and cerebrouterine ratio (MCA/UA) PI values were measured. Negative perinatal outcomes were recorded as blood gas level of the newborn at 7.2 and below, Apgar score of 7 and below at the fifth minute, and needing neonatal intensive care (NICU). Adverse perinatal and postnatal outcomes were recorded and compared with Doppler findings. If there were no signs of a negative perinatal outcome, it was considered a positive outcome. If at least one of the symptoms of adverse perinatal outcomes was present, it was considered a negative outcome Results: Decreased CPR and decreased MCA to UA PI were significantly and positively associated with an increased likelihood of exhibiting negative perinatal outcomes in pregnancies with FGR (P &lt; 0.001, P &lt; 0.001, respectively). The receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off value for MCA to uterine artery PI was 1.41 to predict FGR with 57.37% sensitivity and 62.50% specificity (AUC: 0.629; 95% CI: 0.581–0.675). When the CPR cut-off value was taken as 1.2069, the sensitivity was 42.86% and the specificity 83.93% in predicting negative perinatal outcomes in CPR values below this value (P &lt; 0.001). Conclusion: CPR is the most successful criterion in distinguishing between positive and negative perinatal outcomes. It has been demonstrated that the MCA to uterine artery PI ratio values after CPR can also be used for this distinction. MCA to UA PI ratio sensitivity was higher than CPR and umbilical artery. This situation shows that MCA to uterine artery PI ratio (alone or when evaluated together with PPV and NPV ratios) is a criterion that can be added to other Doppler examinations in predicting negative perinatal outcomes.

Diagnostic Accuracy of Modified Biophysical Profile in Predicting Poor Perinatal Outcome in Pregnancies Complicated by Hypertension at Term

Background: Hypertension in pregnancy has an impact to improve the perinatal and maternal morbidity and mortality which is very important determinant to improve sustainable developmental goals. The high perinatal mortality in women with hypertension in pregnancy is mainly due to fetal growth restriction and iatrogenic preterm delivery. Aim: The diagnostic accuracy of modified biophysical profile is assessed in predicting perinatal outcome in hypertensive pregnancies taking Apgar score at 5 minutes at gold standard Methods: A cross sectional study was conducted in Department of Obstetrics &amp; Gynecology, Unit II Services Hospital, Lahore from 26-6-2021 to 26-12-2021. After meeting the inclusion criteria 180 females were enrolled. Then all females underwent assessment of MBPP. All females were managed efficiently as per standard management protocols. Then females followed-up till delivery of baby. Data analysis was done on SPSS version 22. Results: In this study the mean age of the females was 30.27±5.91 years, there were 29(16.11%) females were nulliparous, 44(24.44%) females had parity 1. MBBP predict poor perinatal outcome in 42(23.3%) females. The sensitivity, specificity and diagnostic accuracy of MBPP was 72%, 95.38% &amp; 88.89% respectively. Conclusion: This present study concluded that the modified biophysical profiles a useful and cost effective tool for predicting perinatal outcome in hypertensive pregnancies Keywords: Pregnancy, Perinatal outcome, Modified Biophysical Profile

Maternal-fetal characteristics, etiological factors and perinatal outcome in pregnancies with polyhydramnios

Basket impaction is a rare complication of Endoscopic Retrograde Cholangiopancreatography (ERCP). This complication is usually treated non- operatively. Surgery is required when non-operative methods fail. In this study, we retrospectively evaluated the results of five patients who underwent surgery for basket impaction between January 2017 and December 2021. The median mean age was 50 (21-82) years. Basket impaction was in the common bile duct in three patients and the pancreatic duct in two. There was no operative complication. Wound infection developed in one patient and evisceration in one in the postoperative period. The length of hospital stay was 10 (7-12) days. The overall morbidity rate was 33.3%. There was no postoperative mortality. Basket impaction can usually be treated with non-operative interventions. Surgical intervention should be preferred last.

Maternal and Perinatal Outcome in Pregnancy Complicated by Intrahepatic Cholestasis.

IntroductionIntrahepatic cholestasis of pregnancy (IHCP) is characterized by pruritus of the hand and sole with abnormal liver function test and bile acid metabolism. IHCP occurs in the second and third trimesters of pregnancy and usually resolves after delivery. The overall prevalence is about 1.2 to 1.5%. This study was conducted to assess the fetomaternal outcome according to maternal serum bile acids levels and its correlation with liver function tests in patients with IHCP.Material and methodsThis ambispective observational study was conducted in the department of Obstetrics and Gynecology (OBG) for two years at AIIMS Jodhpur, Rajasthan. It included all the pregnant women attending the outpatient department of OBG with the complaint of pruritis in the palm and sole after 28 weeks of pregnancy and diagnosed with intrahepatic cholestasis of pregnancy after investigations.ResultsOnly 152 patients were diagnosed with IHCP out of 4,148 deliveries, with a prevalence of 3.6%. Among these, 140 (92.11%) had mild IHCP, 10 (6.58%) had moderate IHCP and two (1.32%) had severe IHCP. There was a significant difference between the birth weight in mild, moderate and severe IHCP (P-value 0.004). About 12.5% (n=19) of patients had meconium-stained liquor during delivery. Two patients (1.32%) with moderate IHCP had intrauterine fetal death in the third trimester, and 6.58% (n=10) neonates were kept on continuous positive airway pressure.ConclusionsIHCP is associated with adverse fetal outcomes like spontaneous or iatrogenic preterm delivery, low birth weight, increase in the rate of lower section cesarean section (LSCS) and intrauterine death of a fetus. A significant correlation found between raised bile acid levels and variables of liver function test, hence cost-effectiveness and feasibility of liver function test (LFT) should be considered for the management of IHCP.

The features of the fetoplacental complex in women with retrochorial hematomas in the I trimester of pregnancy

The problem of placental dysfunction is one of the most important in modern obstetrics. Pregnant women with retrochorial hematomas (RCH) in the I trimester are at risk of placental pathology development, which leads to appearance of other negative obstetrical and perinatal pregnancy outcomes. The objective: to study the parameters of the fetoplacental complex in pregnant women with various forms of RCH based on the data of instrumental examinations. Materials and methods. The study included 140 pregnant women with RCH which appeared from 6 weeks of gestation till delivery: 60 women with recurrent RCH (1st group); 50 pregnant women, in whom RCH was diagnosed only in the early terms of gestation – 6–12 weeks included (2nd group), and 30 prospectively examined patients with uncomplicated pregnancy, without significant extragenital pathology and negative factors in the obstetrical and gynecological history (control group). Results. The frequency of placental dysfunction in recurrent RCH was 70.0%, in primary RCH – 30.0%; the level of early forms (up to 32 weeks) of fetal development retardation in the 1st group was 65.0%, with a significant prevalence of 2nd-3rd degree – 23.3%. Premature maturation of the placenta in recurrent RCH was found in 33.3% of cases, in primary form – in 16.0%. Echo-signs of mesenchymal dysplasia and heterogeneity of the placenta were found in 11.7% and 4.0% of women of the 1st and 2nd groups, respectively. With recurrent RCH, the frequency of oligohydramnios was 16.7% versus 4.0% – with primary RCH; blood flow disorders were diagnosed in 23.3% and 6.0% of cases. In 5.0% of patients of the 1st group, decompensated placental dysfunction with the development of acute fetal distress was diagnosed. Conclusions. In women with retrochorial hematomas in the I trimester of pregnancy, the course of pregnancy is characterized by disorders in the fetoplacental complex, which are more pronounced by recurrence of hematomas.