Placental Risk Factors Research Articles

Umbilical Vascular Thromboembolism: High-Risk Factors, Diagnosis, Management, and Pregnancy Outcomes: A Scoping Review.

Umbilical vascular thromboembolism is a rare condition that can lead to serious consequences such as fetal hypoxia, fetal growth restriction, and even stillbirth. However, there is currently a lack of research on the pathology, pathogenesis, clinical management, and prognosis of this condition. Therefore, the purpose of this article is to analyze this condition's high-risk factors, clinical characteristics, pregnancy management, and discuss its corresponding pregnancy outcomes. Databases such as PubMed are searched using the relevant keywords of umbilical vascular thromboembolism in worldwide. And related information is analyzed such as maternal risk factors, fetal risk factors, umbilical cord and placental risk factors, and pregnancy outcomes. The literature search yields 113 articles, 64 of which meet the inclusion criteria for umbilical vascular thromboembolism. There are 4 retrospective cohort studies and 8 case series, the rest are all case reports. A total of 262 cases of umbilical vascular thromboembolism are found. The most common maternal complications and fetal related risk factors are diabetes (25 cases, 9.5%) and stillbirths (106 cases, 40.5%), respectively. Among these 262 cases, 98 (37.4%) cases are found by prenatal ultrasound to have umbilical vascular thromboembolism and the fetus is in a viable state with complete clinical information. In addition, considering the effectiveness and safety of low molecular weight heparin in thromboembolic conditions, twenty-four patients of umbilical artery thromboembolism attempted to use low molecular weight heparin during observation. Maternal diabetes was the highest risk factor for this condition. When umbilical artery thromboembolism occurs, the incidence of stillbirth increases. Premature patients with this condition can continue their pregnancy under close external monitoring. However, due to the small sample size, further research is needed.

Maternal and Placental Risk Factors for Small Gestational Age and Fetal Malnutrition.

This case-control study was conducted to identify maternal and placental risk factors of small-for-gestational-age (SGA) and fetal malnutrition. Cases comprised 104 consecutively delivered SGA neonates (determined as per INTERGROWTH- 21st standard). An equal number of next-born gestation and gender-matched appropriatefor- gestational age (AGA) neonates served as controls. Maternal risk factors were enquired, and placentae were evaluated by clinical and histopathological examination. Nutrition of the neonates was assessed by the clinical assessment of nutrition (CAN) score. Univariate and multivariate logistic regression analysis was done to identify the maternal and placental risk factors. The prevalence of SGA in the present study was 23.9%. Maternal fever [adjusted Odds Ratio (aOR), 95% confidence interval (CI), 16.3 (3.5-124.1); p = 0.001], presence of placental syncytial knots [aOR (95% CI), 2.9 (1.1-9.1); p = 0.04] and placental calcifications [aOR (95% CI), 3(1.1- 8.7); p = 0.03], were identified as independent predictors of SGA using multivariate logistic regression analysis. Malnutrition (SCORE <25) affected 64% of SGA and 16.3% of AGA neonates. The only risk factor significantly associated with malnourished SGA was prematurity, whereas malnourished AGA was significantly associated with prematurity and fetal distress. In-hospital morbidities significantly higher in SGA were perinatal asphyxia, respiratory distress, need for respiratory support, polycythemia, hypoglycemia, and feeding intolerance. Mortality before discharge was 4.8% and 3.8% in SGA and AGA population, respectively (p > 0.05). Neonatal outcomes were comparable among well-nourished, malnourished SGA and AGA groups. Maternal fever, placental syncytial knots, and calcifications were independent risk factors of SGA, whereas prematurity and fetal distress were responsible for malnutrition.

Risk factors associated with intrauterine growth restriction: A scoping review

Background: Intrauterine growth restriction (IUGR) is said to be present in those babies whose birth weight is below the 10th percentile of the average for gestational age. Those fetuses are prone to perinatal morbidity and mortality. IUGR remains prevalent in developing countries even after advancements in obstetric care. Aim: The current scoping analysis is conducted to review observational studies reporting on various sociodemographic, medical and obstetrics, and placental risk factors associated with IUGR. Methods: We performed a systematic meta-analysis of relevant studies obtained by electronic databases PubMed and Google Scholar from 2010 to 2022. Relevant research articles were searched forward and backward. Citation searches were also undertaken and all relevant literature were included. Of the 68 studies reviewed, 10 studies were included. Results: Pooled results after investigating 10 articles show that younger maternal age, low-socioeconomic status, primiparity, hypertensive disorders in pregnancy, and anemia are significantly associated with the risk of developing IUGR. Conclusion: By studying the risk factors, we will be able to identify the high-risk group. Focus on early detection and high-quality antenatal care will help to overcome the problem of IUGR in the community.

Association of Placental Risk Factors and Birth Weight of Newborn: A Case–Control Study

Association of Placental Risk Factors and Birth Weight of Newborn: A Case–Control Study

Perinatal Stroke; Risk Factors and Outcome. A Study from Aga Khan University Hospital Karachi

Objective: To determine the frequency, risk factors and the outcomes of a perinatal stroke.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Neonatal Intensive Care Unit, Department of Pediatrics, Aga Khan University Hospital, Karachi Pakistan, from Jan to Dec 2019.&#x0D; Methodology: Neonates with perinatal stroke confirmed on the neuroimaging, were included in the study. The primary outcomes were risk factors, divided into 3 groups, maternal, placental and neonatal. The secondary outcome was the condition at the time of the discharge.&#x0D; Results: A total of 58 patients were included in the study. Maternal risk factors identified in the study, were intrauterine infections 10 (17.2%), anti-phospholipid syndrome, gestational diabetes 8 (13.8%) and preeclampsia 7 (12.1%). Chorioamnionitis 9 (15.5%), antepartum hemorrhage 6 (10.3%), and placenta previa 4 (6.9%) were the placental risk factors. Neonatal risk factors were birth asphyxia 35 (60.3%), sepsis/meningitis 8 (13.8%), premature birth 6 (10.3%) and fetal bradycardia 4 (6.9%). Resuscitation was needed in 35 (60.3%) neonates with birth asphyxia. Haemorrhagic stroke was observed in 38 (65.5%) cases, ischemic stroke in 14 (24.1%) cases and mixed type of stroke was found in 6 (10.3%) patients. The total mortality rate in our study was13.8%.&#x0D; Conclusion: Haemorrhagic stroke was more common than ischemic or mixed stroke among the patients of perinatal stroke at our healthcare facility. Patients with low APGAR score at 5 minutes, birth asphyxia and male gender, were most affected.

Risk Factors for Intrauterine Growth Restriction: 9 Years Analysis in Tertiary Care Hospital

Background: Intrauterine growth restricted (IUGR) fetuses are at higher risk of developing neonatal complications and also known to develop metabolic syndrome in adult life. So, an early antenatal detection, choosing the optimal time and method of delivery and intervention when required could minimize the risk significantly.&#x0D; Objective: To find out the prenatal outcome and the maternal and placental risk factors.&#x0D; Methods: A prospective study was conducted from January 2010 to January 2019, at a Teaching Hospital. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 23.0 software.&#x0D; Results: Maternal risk factors like low pregnancy body mass index, preeclampsia, anaemia, hypothyroidism and placental factors like retro placental hemorrhage were mainly responsible for intrauterine growth restriction.&#x0D; Conclusions: The early identification of risk factors and management of the same antenatal is an important issue to prevent adverse prenatal outcomes associated with IUGR.

The relationship between histologic chorioamnionitis and decidual macrophage polarization and their influence on outcomes of neonates born before the 32nd gestational week

Purpose To explore the relationship between histologic chorioamnionitis (HCA) and decidual macrophage (DM) polarization and their influence on outcomes of neonates born before the 32nd gestational week. Materials and Methods Eighty-four neonates and their placentas were included in this retrospective case-control study and divided into two groups: with and without HCA present (HCA + and HCA–). Neonatal, maternal, and placental risk factors were explored and their influence on neonatal outcomes was examined. We used CD68 and iNOS as markers for polarized DMs type 1 (M1) and CD163, CD206 and arginase (Arg-1) for polarized DMs type 2 (M2). Results HCA was present in 47 (56%) cases, and 37 (44%) cases were without the present HCA. There was no statistically significant difference in neonatal risk factors between the two groups (HCA + and HCA–). Higher rates of HCA (p = .042) were observed in mothers who received antepartum corticosteroid therapy. The frequency of vaginal deliveries in HCA + pregnancies was significantly higher than in HCA– pregnancies where deliveries by cesarean section were more frequently observed (p < .001). M2 DM were more abundant in the HCA + group (p = .035). Multiple regression model assessed the association between the presence of HCA, M1, and M2 DM with ROP stages. It has been observed that HCA is a risk factor for ROP stages (β coefficient = 0.34, r partial = 0.246, p = .024). With the logistic regression model, the association between the presence of HCA, M1, and M2 DM with neonatal nCPAP respiratory support and necrotizing enterocolitis (NEC) was assessed. The presence of M2 macrophages in decidua is an independent risk factor for neonatal nCPAP respiratory support (coefficient −0.07, OR = 0.928, 95% CI 0.87–0.99, p = .024) and the presence of M1 macrophages in decidua increases the risk for NEC (coefficient 0.010, OR = 1.0108, 95% CI 1.00–1.02, p = .032). Conclusions The significantly more abundant presence of M2 DM was detected in HCA + placentas and their association with the increased risk for neonatal nCPAP respiratory support was observed. On the contrary, the presence of M1 DM increases the risk for NEC. The presence of HCA is a risk factor for ROP stages.

Maternal and placental risk factors associated with the development of necrotizing enterocolitis (NEC) and its severity

Background/purposeAntenatal factors play an important role in NEC. This study aimed to identify antenatal risk factors associated with the development of NEC, the role of the placental alterations, and the presence of prenatal signs predisposing to a severe NEC. Materials/methodsData of NEC patients including antenatal findings [preeclampsia, diabetes, cholestasis, abnormal antenatal umbilical artery flow (AAUF), clinical chorioamnionitis (CC), and histology of placentas] were compared to unaffected cases between 2002 and 2016 in a single center. Unaffected infants were matched for gestational age. Newborns with cardiovascular diseases were excluded. Bivariate and multivariate analyses were performed. ResultsWe identified 136 cases and 134 controls. The group of mothers of NEC-neonates had a higher prevalence of preeclampsia, CC, and AAUF. Histology of Placentas from 123/136 cases and 126/133 unaffected newborns was available. Chorioamnionitis was significantly more present in NEC cases vs controls. There weren't differences in vascular anomalies and necrotic alterations. Multivariate analysis identified AAUF, CC and histological chorioamnionitis (HC) as predictors of NEC. Bivariate tests show that preeclampsia and HC occurred more often in severe cases of NEC. ConclusionThis study suggests that AAUF, CC, and HC can independently predict the risk of NEC. Preeclampsia and HC seem associated to more severe cases. Level of evidenceIIIA.

A prospective study on the effects and prevalence of maternal, fetal and placental risk factors on low birth weight neonates

Background: Maternal, foetal and placental risk factors have a causative effect in the prematurity and failure to thrive in the early infantile period. Timely diagnosis helps in the anticipation of complications specific to risk factors and managing by impairing their harmful effects on the growth and development of the baby.Methods: The study was conducted prospectively in Department of Paediatrics, Rajah Muthiah Medical College and Hospital, Chidambaram from January 2018 to June 2018. 361 Low birth weight babies were included. Neonates (n=361) weighing less than 2.5 kilograms with parental informed consent are included, whereas those with severe congenital anomaly, systemic disease or infection were excluded from the study. Various known maternal, placental and foetal risk factors are observed during the course of the study. The gestational age of the neonates was estimated using modified Dubowitz scoring. Other factors like mode of delivery of the babies were also noted. Statistical analysis (descriptive statistics) was done by using Microsoft Word 2010.Results: Out of 1040 babies born from January to July 2018, 341 babies weight less than 2.5 kg. Out of which 162 (44.88%) babies were born preterm. Of the full term births 52% were low birth weights The risk factors of the neonates are not mutually exclusive. In the present study 28 maternal risk factors were studied. The prevalence of maternal, fetal and placental risk factors was 85.32%, 74.79% and 6.65% respectively.Conclusions: Period prevalence of low birth weight babies and prematurity is 34.71% and 15.58% respectively. Risk factors are not independent to each other with maternal and foetal risk factors have almost have an effect on nearly three fourths of low birth weight neonates.

A Prospective study on the effects &amp; prevalence of maternal, fetal &amp; placental risk factors on low birth weight neonates

A Prospective study on the effects &amp; prevalence of maternal, fetal &amp; placental risk factors on low birth weight neonates

Risk factors analysis and a scoring system proposal for the prediction of retained placenta after vaginal delivery

IntroductionRetained placenta (RP) is an obstetric complication of third stage of labour. We aimed to evaluate risk factors for RP and to propose a scoring system in order to predict this potentially fatal disorder. MethodsThis was a retrospective case-control study, comparing women with RP after vaginal delivery (≥ 24 weeks of gestation) and women with regular placental separation. Data were collected from January 2007 to October 2017, in two 2nd level University Hospitals. Eligibility was limited to singleton pregnancies in vertex presentation with no major foetal anomaly. A nomogram was developed to predict RP risk. ResultsAmong 22,749 women who delivered vaginally, 138 (0.6%) had RP. RP was directly related with previous uterine curettage (OR = 1.92, 95% CI 1.04–3.54, p = 0.04) and labour induction with prostaglandins (OR = 4.29, 95% CI 1.83–10.02, p = 0.001), while vaginal spontaneous delivery (OR = 0.03, 95% CI 0.01-0.15, p = 0.0001) and higher Apgar score at 1 min (OR = 0.5, 95% CI 0.33-0.76, p = 0.001) were inversely related to RP. Our predictive model showed an overall diagnostic accuracy of 0.803. DiscussionRP is associated with several maternal, pregnancy, foetal and placental risk factors. The development of a new scoring system, with a high predictive power, able to identify the risk of RP, could be a useful tool for physicians in order to promptly face this life-threatening condition.

A Conglomerate of Pathology in Placental Disorders

Background: There is a vast diversity in placental pathology and several factors contribute to this diversity. A detailed placental examination is mandatory to assess any disorder and predict fetal outcome. Aims and objectives: To study the placental pathology in various maternal, fetal and placental disorders and also the fetal outcome in these conditions. Materials and methods: A one and a half year prospective study of fifty consecutive placentae was done. A proforma was prepared with relevant clinical details. Maternal, fetal, placental risk factors were analyzed along with gross and microscopic lesions. Appropriate sections were taken from representative sites and Hematoxylin and eosin, Periodic acid Schiff stains were done. Results: Out of fifty cases of placentae studied, forty seven cases (94%) showed evidence of pathology associated with maternal, fetal and placental risk factors, either singly or in combination. Maternal risk factors were twenty five cases (50%) of which the highest percentage being pregnancy related (84 %). Grossly infarcts and retro placental hematomas were common findings. Histological features of accelerated maturation were lesions commonly seen in these cases. In cases where the fetal outcome was poor like in abortions, intrauterine fetal death and still births all (100%) placentae were abnormal. Conclusions: In this study high percentage of placentae showed evidence of pathology, the majority of which were associated with maternal, fetal or placental risk factors either singly or in combination. Those cases in which fetal outcome were poor all the placentae were abnormal. A careful examination of placentae is required as it is a clue for various diseases and to determine fetal outcome. Histopathological examination of both gross and microscopy proved to be valuable tools in determining placental pathology.

Analysis of frequency and risk factors for intrauterine growth restriction

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Intrauterine growth restricted (IUGR) fetuses are at greater risk of developing fetal hypoxia, neonatal complications, impaired neurodevelopment, and also neonatal intensive care unit stay and neonatal mortality. They are also known to develop metabolic syndrome in adult life. So, the main objective of this study was to find out the frequency of intrauterine growth restriction, to identify the maternal and placental risk factors associated with intrauterine growth restriction and its perinatal outcome amongst pregnant women attending the Obstetric Outpatient Department in Dhulikhel Hospital, Kathmandu University Hospital&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;A prospective study was conducted from June 2011 to June 2017, at Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal. A singleton pregnancy, above 28 weeks of gestation with clinical diagnosis of IUGR and confirmed by ultrasonography were included in the study. The statistical analysis was performed by Statistical Package of Social Sciences (SPSS) 20.0 software. &lt;/span&gt;&lt;span lang="EN-IN"&gt; &lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Maternal risk factors like preeclampsia, anaemia, low pregnancy body mass index and placental factors like retroplacental hemorrhage were mainly responsible for intrauterine growth restriction&lt;/span&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; &lt;span lang="EN-IN"&gt;Antenatal risk factors responsible for IUGR are important for the management of IUGR pregnancies and to prevent adverse perinatal outcome. &lt;/span&gt;&lt;/p&gt;

Maternal Demographic and Placental Risk Factors in Term Low Birth Weight in Ghana

Background: Several studies report on factors that associate preterm birth and intrauterine growth restriction with low birth weight (LBW). However, few studies discuss risk factors that associate with LBW for full-term births. No such studies exist that involve a population from Ghana. Method: We used a nested case-control study approach to examine maternal socio-demographic and placental factors that contribute significantly to term LBW in Ghana. We assessed also the incidence of LBW in general at a major teaching hospital facility in Ghana. Results: Univariate and multivariate logistic regression analysis were used to investigate maternal sociodemographic and placental factors that associate with LBW. Following the preliminary univariate analysis, a stepwise logistic regression analysis showed that unstable income source, single motherhood, combined effect of pre-eclampsia and anaemia; ORs of 5.366 (95% CI: 1.986 to 14.497), 21.390 (95% CI: 3.610 to 126.734) and 3.246 (95% CI: 1.074 to 9.814), respectively, and placental weight and irregular insertion of the umbilical cord (variables scaled by a factor of 10-2 to aid interpretation) ORs 0.28 (95% CI: 0.115 to 0.683), 0.010 (95% CI: 0.001 to 0.173 respectively) on the chorionic plate, were risk factors for LBW. The socio-demographic and placental factors reveal a core role of maternal and infant nutritional deficiencies in term LBW in Ghana. The general prevalence of LBW in the Hospital facility was 6.2%. Conclusion: We conclude that poor maternal and infant nutrient supply is key factors in term LBW in Ghana. These factors are amenable to appropriate nutritional and educational interventions.

Maternal and Placental Factors Associated with Congenital Hearing Loss in Very Preterm Neonates

Sensorineural hearing loss (SNHL) is a multifactorial disease that more frequently affects preterm newborns. Although a number of maternal conditions have been reported to be associated with preterm birth, little information is available concerning maternal risk factors for the development of SNHL. We aimed to identify maternal and placental risk factors associated with a "refer" result on the newborn hearing screening (NHS) test and subsequently confirmed SNHL in very preterm neonates. This retrospective cohort study included 267 singleton neonates who were born alive after≤32weeks. Histopathologic examination of the placenta was performed, and clinical data were retrieved from a computerized perinatal database. Cases with two abnormal findings, "refer" on the NHS test, and presence of SNHL on the confirmation test were retrospectively reviewed based on electronic medical records. Forty-two neonates (15.7%) showed a "refer" result, and, on the confirmation test, permanent SNHL was identified in 1.87% (5/267) of all neonates. Multivariate regression analysis revealed that the presence of funisitis was independently associated with a "refer" on the NHS test, whereas use of antenatal corticosteroids was statistically significantly associated with a reduced incidence of "refer" on the screening test. Neither histologic chorioamnionitis nor prematurity (as defined by low gestational age and birth weight) was associated with a "refer" on the NHS test. By contrast, multivariate analysis with occurrence of SNHL as a dependent variable identified no significant associations with the parameters studied, probably owing to the small total number of neonates with permanent SNHL. Presence of funisitis was significantly and independently associated with increased risk of abnormal NHS results, while administration of antenatal corticosteroids was related to a normal NHS result. These findings support the hypothesis that a systemic fetal inflammatory response, manifested as funisitis, might play a role in the pathogenesis of SNHL in preterm neonates.

Maternal and Placental Risk Factors for Developing Necrotizing Enterocolitis in Very Preterm Infants

Despite the clinical relevance of necrotizing enterocolitis (NEC), it remains difficult to predict which preterm infants are more likely to develop NEC. Contrary to the neonatal risk factors for the development of NEC, little information is available regarding maternal (prenatal) risk factors. We aimed to identify maternal risk factors associated with the subsequent development of NEC in very preterm infants and to determine whether the placental inflammatory lesions were related to the NEC. This retrospective cohort study examined newborns born at <32 weeks (n=354) between July 2003 and July 2014 at a university teaching hospital. Medical records of eligible newborns and their mothers were reviewed. Maternal blood white blood cell and differential counts were measured at admission and the placentas were examined histologically after delivery. The primary outcome measure was NEC Bell Stage≥IIa. Bivariate analyses and multivariate logistic regression were used for the statistical analyses. NEC was diagnosed in 26 of 354 very preterm infants (7.3%), including 19 Stage II and seven Stage III infants. Multivariate regression analysis identified maternal neutrophil-to-lymphocyte ratio [odds ratio (OR)=1.08, p=0.002], multiparity (OR=3.41, p=0.013), and birth weight (OR=0.07 per kg increase, p=0.01), but not clinical and histological chorioamnionitis and funisitis as significant predictors of NEC. Maternal neutrophil-to-lymphocyte ratio, parity, and birth weight can independently predict the risk of NEC in very preterm infants, whereas clinical and histological chorioamnionitis and funisitis are not predictive of NEC.

Maternal and placental risk factors for light-for-gestational-age births.

We conducted a cross-sectional study to investigate risk factors for births of light-for-gestational-age (LGA) infants. A survey was conducted at the Department of Obstetrics and Gynecology at Sapporo Medical University Hospital in Sapporo, Japan from 2013 to 2014. LGA and appropriate for gestational age (AGA) are defined as having a birthweight below the 10th percentile and between the 10th percentile and 90th percentile for gestational age at birth in the population standard of gestational age, sex, and parity, respectively. An odds ratio (OR) and its 95% confidence interval (95%CI) for LGA were calculated by analysis using the logistic regression model. In total, 307 inpatients (94.2%) participated in the study out of 326 consecutive post-partum inpatients. Among them, 37 infants and 237 infants were classified into the LGA and AGA groups, respectively. As a result of multivariable analysis, prevalence of gestational hypertension (OR = 8.96, 95%CI 1.81-44.35) and the presence of placental infarction (OR = 9.65, 95%CI 1.76-53.01) were significantly associated with an increased risk of LGA. Placentas weighing 510-603 g and ≥604 g were significantly associated with reduced risk of LGA (OR = 0.04, 95%CI 0.01-0.29 and OR = 0.03, 95%CI 0.01-0.32, respectively), and higher placental weights were significantly observed in the trend for reduced LGA risk (P for trend < 0.001). We found that the prevalence of gestational hypertension, lower placental weight, and the presence of placental infarctions were all independently associated with the risk of LGA. Placental abnormalities may be etiologically important for LGA risk, though further research is necessary.

Vasa previa: diagnosis and management

Vasa previa is a rare condition that is associated with a high rate of fetal or neonatal death when not diagnosed antenatally. The majority of available studies are either small, do not include antepartum data, limited to single institutions, or are biased by inclusion of patients from registries and online vasa previa support groups. The purpose of this study was to investigate the diagnostic and management strategies for this potentially catastrophic entity and to describe further maternal and placental risk factors that may aid in the establishment of a screening protocol for vasa previa. This was a retrospective multicenter descriptive study that included all pregnancies that were complicated by vasa previa that delivered between January 1, 2000, and December 31, 2012. Nine maternal fetal medicine practices and the hospitals in which they practice participated in data collection of diagnosis, treatment, and maternal-neonatal outcomes. Sixty-eight pregnancies were identified that included the diagnosis of vasa previa or "possible vasa previa" either in the ultrasound record or in the hospital record at the time of delivery. Four cases (5.8%) appeared to resolve on repeat ultrasound examination. Fifteen of the 64 cases that were suspected of having vasa previa could not be verified or were not documented at delivery. Of the remaining 49 cases, where vasa previa was documented, 47 cases (96%) were diagnosed by ultrasound scanning antenatally. Known risk factors for vasa previa were present in 41 of 47 cases (87%). Of the 49 cases, 41 were delivered by planned cesarean delivery at a mean gestational age of 34.7 weeks, and 8 cases required emergent cesarean delivery at a mean gestational age of 34.6 weeks (range, 32.4-36.0 weeks gestation). Seven of these emergent cesarean deliveries had been diagnosed previously; 1 case had not. All of the emergent cesarean deliveries were for vaginal bleeding; 1 case was also for a concerning fetal heart rate, but only 1 of the known cases had a documented ruptured fetal vessel. None of these cases were found to have cervical shortening before the onset of bleeding. One of the undiagnosed cases resulted in a ruptured fetal vessel and a baby with no heart beat at birth who survived but had periventricular leukomalacia at 1 month of age with mild white-matter atrophy. Of the remaining neonates in this group, there were no deaths and no major complications beyond mild respiratory distress syndrome in 9 cases. There were no other major neonatal complications, which included no cases of periventricular leukomalacia, neonatal sepsis, necrotizing enterocolitis, or any grade of intraventricular hemorrhage in the confirmed cases of vasa previa. This study confirms most current recommendations that include risk-based ultrasound screening, early hospitalization at 30-34 weeks gestation, antenatal corticosteroids at 30-32 weeks gestation, and elective delivery at 33-34 weeks gestation. Thus, with these recommendations for current identification and management of vasa previa in this series of geographically diverse mostly private practice maternal fetal medicine practices, we have confirmed recent reports that show a dramatic improvement in neonatal survival and complications compared with earlier reports.

Do Placental Histopathologic Characteristics Differ with Gestational Ages in Preterm and Term Deliveries?

The study aim is to evaluate the placental histopathological characteristics and maternal risk factors in preterm and term births according to their weeks of gestation. We designed a prospective study involving a patient population (n = 355) composed of pregnant women who delivered preterm (n = 216) and term neonates (n = 139). The preterm births were divided into three groups as extremely (n = 22), moderate (n = 96) and late preterm (n = 98) births. The statistical analyses were performed using SPSS version 15 software. There was significant difference regarding maternal vascular underperfusion and inflamation in the extremely preterm group compared with the other groups (P = 0.001), but fetal vascular obstruction and villitis of unknown etiology were not found significantly different. According to our study results, the careful examination of the placenta of premature babies, particularly those of extremely preterm births, should be part of routine obstetrical management to determine the causes of preterm birth.

Factors associated with increased cesarean risk among African American women: evidence from California, 2010.

We studied if both observed and unobserved maternal health in African American women in hospitals or communities were associated with cesarean delivery of infants. We examined the relationship between African American race and cesarean delivery among 493 433 women discharged from 255 Californian hospitals in 2010 using administrative data; we adjusted for patient comorbidities and maternal, fetal, and placental risk factors, as well as clustering of patients within hospitals. Cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8% vs 32.7%), as were both elective and emergency primary cesarean rates. Elevated risks persisted after risk adjustment (odds ratio generally > 1.27), but the prevalence of particular risk factors varied. Although African American women were clustered in some hospitals, the proportion of African Americans among all women delivering in a hospital was not related to its overall cesarean rate. To address the higher likelihood of elective cesarean delivery, attention needs to be given to currently unmeasured patient-level health factors, to the quality of provider-physician interactions, as well as to patient preferences.