Prediction Of Adverse Perinatal Outcome Research Articles

The association between increased fetal movements in the third trimester and perinatal outcomes; a systematic review and meta-analysis

BackgroundFetal movement monitoring is one of the strategies used to assess the fetus’s health. Until now, most studies focused on the decreased fetal movement and neonatal outcome, although this systematic review and meta-analysis is designed to assess the association between increased fetal movements (IFM) with perinatal outcomes.MethodThe electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched for studies investigating the perinatal outcome of women with increased fetal movements from inception to July 2023. Following that, a random-effect meta-analysis model was used to obtain the combined diagnostic and predictive parameters including perinatal mortality (still birth and early neonatal mortality), operative delivery, Apgar score, neonatal resuscitation at birth and NICU Admission.ResultsAfter the initial screening, seven studies examining the association between increased third trimester fetal movement and various perinatal outcomes were included. Meta-analysis revealed a significant reduction in the risk of cesarean delivery among patients with IFM compared to controls, suggesting a potential protective effect during childbirth. However, no statistically significant difference was observed in birth weight, small or large for gestational age births, neonatal intensive care unit admission, maternal age, umbilical cord around the neck, gestational diabetes mellitus, and hypertension, indicating that IFM may not be a major predictor of adverse perinatal outcomes or maternal conditions. Notably, IFM was significantly associated with a higher likelihood of labor induction.ConclusionThe findings suggest that IFM may have a protective effect against cesarean delivery. Additionally, IFM does not appear to be significantly associated with maternal age, umbilical cord around the neck, gestational diabetes mellitus and hypertension. However, the observed significant association with labor induction warrants further investigation.

Low amniotic fluid index at term as a predictor of adverse perinatal outcome.

Objective: To assess the prevalence of adverse perinatal outcomes in antenatal women with low amniotic fluid index at term. Study Design: Observational Cross-sectional Analysis. Setting: Department of Gynaecology and Obstetrics Hayatabad Medical Complex, Peshawar. Period: 2nd February 2020, to 5th February 2021. Methods: The study involved a total of 165 patients, in 37 to 40-weeks of gestation period, the research included antenatal women with a low amniotic fluid index, with any parity, gravidity, and 18-35 years of age. While Excluded patients with any medical disorders during pregnancy (e.g., PIH, anemia, cardiac disease etc.), and those with gestational period <37 weeks from the study. Thorough history, clinical examination and ultrasound were carried out of all the women included in the study from OPD and emergency department, to confirm a low amniotic fluid index. Patient follow-up was extended to their arrival in the Obstetric suite during established labor, APGAR scores were calculated and recorded at birth, and at the 5-minute of birth for the neonate. Adverse Perinatal Outcome was considered positive if the APGAR Score was <7/10 at five minutes of life of neonate. Data analysis was performed using SPSS 23. Results: Out of 165 patients 57% of the patients were induced while 43% spontaneously delivered, similarly 66.7% were delivered vaginally while 33.3% were delivered via C Section. Low neonatal APGAR score was recorded in 67.9% patients which is a significant percentage, hence our study results showed positive correlation of low AFI with adverse perinatal outcome. We also observed that probability of satisfactory values of AFI is 1.5 times more in spontaneous deliveries (p=0.04, OR=1.5), however no such relation exists for period of gestation or number of parity. Similarly, there is a significant relation of mode of delivery with satisfactory values of AFI (p=0.00), however no such relation exists for period of gestation or number of parity. However, the probability of vaginal deliveries is 1.6 times more with an increased in number of para (p=0.02, OR=1.6). Conclusion: Reduced amniotic fluid index is linked with significant Unfavorable Perinatal Outcomes proved by low APGAR score (<7/10 at five minutes).

Study of Doppler-derived Myocardial Performance Index in Growth-restricted Fetuses as a Predictor of Adverse Perinatal Outcome

Study of Doppler-derived Myocardial Performance Index in Growth-restricted Fetuses as a Predictor of Adverse Perinatal Outcome

Maternal and perinatal outcomes of hypertensive disorders in pregnancy: Insights from the National Hospital of Obstetrics and Gynecology in Vietnam.

Hypertension is the common disorder encountered during pregnancy, complicating 5% to 10% of all pregnancies. Hypertensive disorders in pregnancy (HDP) are also a leading cause of maternal and perinatal morbidity and mortality. The majority of feto-maternal complications due to HPD have occurred in the low- and middle-income countries. However, few studies have been done to assess the feto-maternal outcomes and the predictors of adverse perinatal outcome among women with HDP in these countries. A prospective cohort study was conducted on women with HDP who were delivered at National Hospital of Obstetrics and Gynecology, Vietnam from March 2023 to July 2023. Socio-demographic and obstetrics characteristics, and feto-maternal outcomes were obtained by trained study staff from interviews and medical records. Statistical analysis was performed using SPSS version 26.0. Bivariate and multiple logistic regressions were done to determine factors associated with adverse perinatal outcome. A 95% confidence interval not including 1 was considered statically significant. A total of 255 women with HDP were enrolled. Regarding adverse maternal outcomes, HELLP syndrome (3.9%), placental abruption (1.6%), and eclampsia (1.2%) were three most common complications. There was no maternal death associated with HDP. The most common perinatal complication was preterm delivery developed in 160 (62.7%) of neonates. Eight stillbirths (3.1%) were recorded whereas the perinatal mortality was 6.3%. On bivariate logistic regression, variables such as residence, type of HDP, highest systolic BP, highest diastolic BP, platelet count, severity symptoms, and birth weight were found to be associated with adverse perinatal outcome. On multiple logistic regression, highest diastolic BP, severity symptoms, and birth weight were found to be independent predictors of adverse perinatal outcome. Our study showed lower prevalence of stillbirth, perinatal mortality, and maternal complication compared to some previous studies. Regular antenatal care and early detection of abnormal signs during pregnancy help to devise an appropriate monitoring and treatment strategies for each women with HDP.

Maternal near miss as a predictor of adverse perinatal outcomes: findings from a prospective cohort study in southwestern Uganda

BackgroundDespite efforts, Uganda has not met the World Health Organization target of < 12 newborn deaths per 1,000 live births. Severe maternal morbidity or ‘near miss’ is a major contributor to adverse perinatal outcomes, particularly in low-resource settings. However, the specific impact of maternal near miss on perinatal outcomes in Uganda remains insufficiently investigated. We examined the association between maternal near miss and adverse perinatal outcomes at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda.MethodsWe conducted a prospective cohort study among women admitted for delivery at MRRH’s maternity ward from April 2022 to August 2022. We included mothers at ≥ 28 weeks of gestation with singleton pregnancies, while intrauterine fetal death cases were excluded. For the near-miss group, we consecutively included mothers with any one of the following: antepartum hemorrhage with shock, uterine rupture, hypertensive disorders, coma, and cardiac arrest; those without these complications constituted the non-near-miss group. We followed the mothers until delivery, and their infants until seven days postpartum or death. Adverse perinatal outcomes considered were low birth weight (< 2,500 g), low Apgar score (< 7 at five minutes), intrapartum stillbirths, early neonatal death, or admission to neonatal intensive care unit. Multivariable log-binomial regression was used to determine predictors of adverse perinatal outcomes.ResultsWe enrolled 220 participants (55 maternal near misses and 165 non-near misses) with a mean age of 27 ± 5.8 years. Most of the near misses were pregnancies with hypertensive disorders (49%). Maternal near misses had a four-fold (adjusted risk ratio [aRR] = 4.02, 95% CI: 2.32–6.98) increased risk of adverse perinatal outcomes compared to non-near misses. Other predictors of adverse perinatal outcomes were primigravidity (aRR = 1.53, 95%CI: 1.01–2.31), and gestational age < 34 weeks (aRR = 1.81, 95%CI: 1.19–2.77).ConclusionMaternal near misses, primigravidity, and preterm pregnancies were independent predictors of adverse perinatal outcomes in this study. We recommend implementing maternal near-miss surveillance as an integral component of comprehensive perinatal care protocols, to improve perinatal outcomes in Uganda and similar low-resource settings. Targeted interventions, including specialized care for women with maternal near misses, particularly primigravidas and those with preterm pregnancies, could mitigate the burden of adverse perinatal outcomes.

Predictors of adverse perinatal outcomes in women at 40 weeks or more of pregnancy

Introduction and aim. To evaluate the clinical features of women at ≥40 weeks of pregnancy and the utility of obstetric Doppler indices in predicting adverse perinatal outcomes in these pregnancies. Material and methods. This prospective study was conducted at a single academic medical center between 2020 and 2022. Women aged 18 years and older with no risk factors who were at ≥40 weeks of pregnancy and delivered their babies in our hospital were included in the study. The fetal biometry, placental maturity grading, and doppler velocytometry indices of the pregnant women were evaluated. The cases were divided into two groups according to the development of adverse perinatal outcomes. The relationship between clinical features and adverse perinatal outcomes was evaluated. Results. Adverse perinatal outcomes developed in 19.6% (42) of the 214 cases. The multiple logistic regression analysis was performed to identify factors affecting perinatal outcomes. Accordingly, a maternal age of ≥35 years (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.29–3.96, p=0.038), nulliparity (OR: 1.42, 95% CI: 1.13–4.63, p=0.040), and grade 3 placental calcification (OR: 1.98, 95% CI: 1.11–4.53, p=0.029) were independent predictors of adverse perinatal outcomes. Conclusion. Care should be taken in terms of adverse perinatal outcomes in the presence of nulliparity, a maternal age of ≥35 years, and grade 3 placental calcification in ≥40 week pregnancies.

Prenatal prediction of adverse outcome using different charts and definitions of fetal growth restriction.

Antenatal growth assessment using ultrasound aims to identify small fetuses that are at higher risk of perinatal morbidity and mortality. This study explored whether the association between suboptimal fetal growth and adverse perinatal outcome varies with different definitions of fetal growth restriction (FGR) and different weight charts/standards. This was a retrospective cohort study of 17 261 singleton non-anomalous pregnancies at ≥ 24 + 0 weeks' gestation that underwent routine ultrasound at a tertiary referral hospital. Estimated fetal weight (EFW) and Doppler indices were converted into percentiles using a reference standard (INTERGROWTH-21st (IG-21)) and various reference charts (Hadlock, Fetal Medicine Foundation (FMF) and Swedish). Test characteristics were assessed using the consensus definition, Society for Maternal-Fetal Medicine (SMFM) definition and Swedish criteria for FGR. Adverse perinatal outcome was defined as perinatal death, admission to the neonatal intensive care unit at term, 5-min Apgar score < 7 and therapeutic cooling for neonatal encephalopathy. The association between FGR according to each definition and adverse perinatal outcome was compared. Multivariate logistic regression analysis was used to test the strength of association between ultrasound parameters and adverse perinatal outcome. Ultrasound parameters were also tested for correlation. IG-21, Hadlock and FMF fetal size references classified as growth-restricted 1.5%, 3.6% and 4.6% of fetuses, respectively, using the consensus definition and 2.9%, 8.8% and 10.6% of fetuses, respectively, using the SMFM definition. The sensitivity of the definition/chart combinations for adverse perinatal outcome varied from 4.4% (consensus definition with IG-21 charts) to 13.2% (SMFM definition with FMF charts). Specificity varied from 89.4% (SMFM definition with FMF charts) to 98.6% (consensus definition with IG-21 charts). The consensus definition and Swedish criteria showed the highest specificity, positive predictive value and positive likelihood ratio in detecting adverse outcome, irrespective of the reference chart/standard used. Conversely, the SMFM definition had the highest sensitivity across all investigated growth charts. Low EFW, abnormal mean uterine artery pulsatility index (UtA-PI) and abnormal cerebroplacental ratio were significantly associated with adverse perinatal outcome and there was a positive correlation between the covariates. Multivariate logistic regression showed that UtA-PI > 95th percentile and EFW < 5th percentile were the only parameters consistently associated with adverse outcome, irrespective of the definitions or fetal growth chart/standard used. The apparent prevalence of FGR varies according to the definition and fetal size reference chart/standard used. Irrespective of the method of classification, the sensitivity for the identification of adverse perinatal outcome remains low. EFW, UtA-PI and fetal Doppler parameters are significant predictors of adverse perinatal outcome. As these indices are correlated with one other, a prediction algorithm is advocated to overcome the limitations of using these parameters in isolation. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Re-evaluation of umbilical cord coiling index in adverse pregnancy outcome – Does it have role in obstetric management?

IntroductionThe placenta with the umbilical cord is a vital link between the mother and fetus. Umbilical cord supplies water, nutrients and oxygen from the mother to the fetus. The most unique character of the umbilical cord is its coiling, where the contents of the cord course in a coiled helical fashion. The umbilical coiling index(UCI) can be measured antenatally using ultrasonography. In the present study we have attempted to assess the UCI antenatally by ultrasound screening and correlate abnormal antenatal UCI with the adverse maternal and neonatal outcome of pregnancy. AimsTo study umbilical coiling index ultrasonographically and to correlate it with pregnancy outcome. Methodology150 antenatal cases in the second trimester of pregnancy between 22 and 28weeks of gestation attending the outpatient department were included for the study in a continuous manner and subjected to antenatal UCI measurement. The cases were followed up till delivery and various factors were noted. ResultsWe confirmed that maternal medical comorbidities ( gestational hypertension and anemia) have a significant correlation with abnormal umbilical cord coiling index, either hyper-coiling or hypo-coiling or both.Some studies have shown a particular adverse effect being manifested in both hypo and hypercoiling. In the present study significant correlation of abnormal coiling has been found with only anaemia and hypertension in pregnancy. The question, therefore, arises:“Does abnormal UCI have any significant role in prediction of adverse outcome in pregnancy or is it just a random association?” This study does not reflect any significant role of abnormal UCI in the prediction of adverse perinatal outcome. Hence efforts to monitor UCI in the antenatal period may not have any justification in the present scenario. The latest edition of William’s Obstetrics also makes a similar comment. A population based larger study to generate cut offs for hypo and hyper coiling and finding any association between abnormal coiling and perinatal outcome may throw more light on the utility of UCI as a predictor of adverse outcome in pregnancy.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy. It suggested that the cerebroplacental ratio may be calibrated in the software of the Doppler ultrasonography machine for routine use in high-risk pregnancies.

Management of fetuses with apparent normal growth and abnormal cerebroplacental ratio: A risk-based approach nearterm.

Cerebroplacental ratio (CPR) has been shown to be an independent predictor of adverse perinatal outcome at term and a marker of failure to reach the growth potential (FRGP) regardless of fetal size, being abnormal in compromised fetuses with birthweight above the 10th centile. The main aim of this study was to propose a risk-based approach for the management of pregnancies with normal estimated fetal weight (EFW) and abnormal CPR near term. This was a retrospective study of 943 pregnancies, that underwent an ultrasound evaluation of EFW and CPR at or beyond 34 weeks. CPR values were converted into multiples of the median (MoM) and EFW into centiles according to local references. Pregnancies were then divided into four groups: normal fetuses (defined as EFW ≥10th centile and CPR ≥0.6765 MoM), small for gestational age (EFW <10th centile and CPR ≥0.6765 MoM), fetal growth restriction (EFW <10th centile and CPR <0.6765 MoM), and fetuses with apparent normal growth (EFW ≥10th centile) and abnormal CPR (<0.6765 MoM), that present FRGP. Intrapartum fetal compromise (IFC) was defined as an abnormal intrapartum cardiotocogram or pH requiring cesarean delivery. Risk comparisons were performed among the four groups, based on the different frequencies of IFC. The risks of IFC were subsequently extrapolated into a gestational age scale, defining the optimal gestation to plan the birth for each of the four groups. Fetal growth restriction was the group with the highest frequency of IFC followed by FRGP, small for gestational age, and normal groups. The "a priori" risks of the fetal growth restriction and normal groups were used to determine the limits of two scales. One defining the IFC risk and the other defining the appropriate gestational age for delivery. Extrapolation of the risk between both scales placed the optimal gestational age for delivery at 39 weeks of gestation in the case of FRGP and at 40 weeks in the case of small for gestational age. Fetuses near term may be evaluated according to the CPR and EFW defining four groups that present a progressive risk of IFC. Fetuses in pregnancies complicated by FRGP are likely to benefit from being delivered at 39 weeks of gestation.

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

EP13.14: The role of fetal right heart modified myocardial performance index in prediction of adverse perinatal outcomes in fetal growth restriction

Abdominal circumference growth velocity as a predictor of adverse perinatal outcomes in small-for-gestational-age fetuses

Objective To assess the predictive value of abdominal circumference growth velocity (ACGV) between the second and third trimesters to predict adverse perinatal outcomes in a cohort of small-for-gestational-age fetuses without evidence of placental insufficiency (i.e. fetal growth restriction). Material and methods This is a single-center retrospective cohort study of all singleton pregnancies with small-for-gestational-age fetuses diagnosed and delivered at a quaternary institution. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between abnormal ACGV (i.e. ≤10th centile) and adverse perinatal outcomes defined as a composite outcome (i.e. umbilical artery pH <7.1, 5-min Apgar score <7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). Furthermore, the area under the receiver-operating characteristic curve (AUC) of three logistic regression models based on estimated fetal weight and ACGV for predicting the composite outcome is also reported. Results A total of 154 pregnancies were included for analysis. The median birthweight for the cohort was 2,437 g (interquartile range [IQR] 2280, 2635). Overall, the primary composite outcome was relatively common (29.2%). In addition, there was a significant association between abnormal ACGV and adverse perinatal outcomes (OR 3.37, 95% CI 1.60, 7.13; adjusted OR 4.30, 95% CI 1.77, 10.49). Likewise, the AUC for the ACGV was marginally higher (0.64) than the estimated fetal weight (0.54) and ACGV + estimated fetal weight (0.54). Still, no significant difference was detected between the curves (p = 0.297). Conclusions Our results suggest that an ACGV below the 10th centile is a risk factor for adverse perinatal outcomes among small-for-gestational-age fetuses.

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies.

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.

The significance of ultrasound features of sub-chorionic haemorrhage as a predictor of adverse perinatal outcome: A retrospective review

IntroductionThis retrospective single centre study considers the predictive value of specific ultrasound features of sub-chorionic haemorrhage (SCH) as potential indicators of adverse pregnancy outcome. MethodsUltrasound reports and images were reviewed for 160 participants presenting to an early pregnancy assessment unit from January 2018 to January 2019. Participants were selected based upon the presence of SCH within the first trimester. The outcome of each pregnancy and the features of SCH, including the size, location and echogenicity were recorded and multinominal logistic regression was used to establish predictive value. ResultsThe majority of participants were asymptomatic and delivered healthy babies. 24% miscarried prior to delivery or had stillborn babies; the features of bleed within this group revealed an increased prevalence of adverse outcome in the presence of moderate sized haemorrhage (p = 0.02). 61% of miscarried pregnancies presented with “wrapping” SCH, in which haemorrhage encased the gestation sac, suggesting wrapping posed a probable risk (p = 0.01). 71% of miscarriages occurred within 5 + 0–10 + 0 weeks gestation. Persistent SCH was of greater incidence within those participants with adverse outcome (57%). There was no association between fetal abnormality and miscarriage. Jaundice babies and premature delivery occurred more frequently (p = 0.001) and may be a secondary finding following SCH. ConclusionThere was a strong correlation between presence of SCH in early pregnancy and rate of miscarriage. Specific ultrasound features of SCH, most notably a wrapping location with moderate size, may be indicative of increased risk of miscarriage or post-natal complications. Jaundice and premature births may have an association with placental compromise.

Cerebroplacental versus Umbilicocerebral Ratio-Analyzing the Predictive Value Regarding Adverse Perinatal Outcomes in Low- and High-Risk Fetuses at Term.

Background and Objectives: The aim of this study was to investigate the prediction of adverse perinatal outcomes using the cerebroplacental (CPR) and umbilicocerebral (UCR) ratios in different cohorts of singleton pregnancies. Materials and Methods: In this retrospective cohort study, we established our own Multiple of Median (MoM) for CPR and UCR. The predictive value for both ratios was studied in the following outcome parameters: emergency cesarean delivery, operative intervention (OI), OI due to fetal distress, 5-min Apgar < 7, admission to neonatal intensive care unit, and composite adverse perinatal outcome. The performance of the ratios was assessed in the following cohorts: total cohort (delivery ≥ 37 + 0 weeks gestation, all birth weight centiles), low-risk cohort (delivery ≥ 37 + 0 weeks gestation, birth weight ≥ 10. centile), prolonged pregnancy cohort (delivery ≥ 41 + 0 weeks gestation, birth weight ≥ 10. centile) and small-for-gestational-age fetuses (delivery ≥ 37 + 0 weeks gestation, birth weight < 10. centile). The underlying reference values for MoM were estimated using quantile regression depending on gestational age. Prediction performance was evaluated using logistic regression models assessing the corresponding Brier score, combining discriminatory power and calibration. Results: Overall, 3326 cases were included. Across all cohorts, in the case of a significant association between a studied outcome parameter and CPR, there was an association with UCR, respectively. The Brier score showed only minimal differences for both ratios. Conclusions: Our study provides further evidence regarding predictive values of CPR and UCR. The results of our study suggest that reversal of CPR to UCR does not improve the prediction of adverse perinatal outcomes.

Interpretable machine learning to predict adverse perinatal outcomes: examining marginal predictive value of risk factors during pregnancy

The timely identification of nulliparas at high risk of adverse fetal and neonatal outcomes during pregnancy is crucial for initiating clinical interventions to prevent perinatal complications. Although machine learning methods have been applied to predict preterm birth and other pregnancy complications, many models do not provide explanations of their predictions, limiting the clinical use of the model. This study aimed to develop interpretable prediction models for a composite adverse perinatal outcome (stillbirth, neonatal death, estimated Combined Apgar score of <10, or preterm birth) at different points in time during the pregnancy and to evaluate the marginal predictive value of individual predictors in the context of a machine learning model. This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be data, a prospective cohort study in which 10,038 nulliparous pregnant individuals with singleton pregnancies were enrolled. Here, interpretable prediction models were developed using L1-regularized logistic regression for adverse perinatal outcomes using data available at 3 study visits during the pregnancy (visit 1: 6 0/7 to 13 6/7 weeks of gestation; visit 2: 16 0/7 to 21 6/7 weeks of gestation; visit 3: 22 0/7 to 29 6/7 weeks of gestation). We identified the important predictors for each model using SHapley Additive exPlanations, a model-agnostic method of computing explanations of model predictions, and evaluated the marginal predictive value of each predictor using the DeLong test. Our interpretable machine learning model had an area under the receiver operating characteristic curves of 0.617 (95% confidence interval, 0.595-0.639; all predictor variables at visit 1), 0.652 (95% confidence interval, 0.631-0.673; all predictor variables at visit 2), and 0.673 (95% confidence interval, 0.651-0.694; all predictor variables at visit 3). For all visits, the placental biomarker inhibin A was a valuable predictor, as including inhibin A resulted in better performance in predicting adverse perinatal outcomes (P<.001, all visits). At visit 1, endoglin was also a valuable predictor (P<.001). At visit 2, free beta human chorionic gonadotropin (P=.001) and uterine artery pulsatility index (P=.023) were also valuable predictors. At visit 3, cervical length was also a valuable predictor (P<.001). Despite various advances in predictive modeling in obstetrics, the accurate prediction of adverse perinatal outcomes remains difficult. Interpretable machine learning can help clinicians understand how predictions are made, but barriers exist to the widespread clinical adoption of machine learning models for adverse perinatal outcomes. A better understanding of the evolution of risk factors for adverse perinatal outcomes throughout pregnancy is necessary for the development of effective interventions.

Prolonged second stage of labor: Predictors of adverse maternal and perinatal outcomes in a sub-Saharan setting.

To determine the predictors of adverse maternal and perinatal outcomes among parturients with prolonged second stage of labor. This study isa cross-sectional study of women with prolonged second stage of labor from January 1 to June 30, 2021, in four tertiary hospitals in Ethiopia. Data were collected prospectively using a structured questionnaire. Descriptive statistics were used to analyze baseline characteristics. Bivariate and multivariate logistic regression analyses were applied to determine predictors of adverse maternal and perinatal outcomes. A total of 406 women were included in the study. More than half (25/46, 54%) of the women with a prolonged second stage of 4 h or longer had vaginal delivery, which was lower than the 73% (140/190) of women who had a second stage of 2-3 h and the 63.4% (64/101) of women with a second stage duration of 3-4 h. Duration of second stage of labor was not a predictor of composite adverse maternal outcomes nor was it a predictor of adverse perinatal outcome. Operative vaginal delivery (adjusted odds ratio [aOR] 6.0, 95% confidence interval [CI] 2.41-14.9) and nulliparity (aOR 4.1, 95% CI 1.58-10.41) were predictors of adverse maternal outcome, but nulliparity (aOR 1.8, 95% CI 1.05-3.04) and duration of rupture of membranes greater than 18 h (aOR 2.4, 95% CI 1.21-4.93) were predictors of adverse perinatal outcomes. Under strict fetal and maternal well-being monitoring, women with a prolonged second stage of labor can labor for an additional 2 h (up to a total of 4 h) without increasing adverse maternal and neonatal outcomes.

STUDY OF LIPID PROFILE IN HYPERTENSIVE DISORDERS OF PREGNANCY

Introduction : Hypertensive disorders complicate 5-10% of all pregnancies. endothelial cell injury are important in the pathogenesis of preeclampsia. Serum lipids have a direct effect on endothelial function. Abnormal lipid metabolism has a basic role in the pathogenesis of the disease. So study of lipid profile may be of good predictive value in hypertensive disorders of pregnancy. Method: This was a longitudinal study, done in the dept of OBGY, GMERS Medical College, sola, Ahmedabad, from August 2020 to July 2022. 93 women in each group were studied. Outcome was measured by serum lipid level, severity of hypertension, mode of delivery, need for neonatal resuscitation, NICU admission. Result: Serum Total cholesterol ≥240 mg/dl was observed to be 38.7% in group A and 14 % in group B. In group A with normal lipid profile 97.5% had mild hypertension, 2.5% had severe hypertension while in hypertensive with abnormal lipid profile group 53.8% had mild hypertension and 46.2% had severe hypertension. Normal vaginal delivery observed 64.52% in group A and 79.57% in group B. In group A, 35.48% babies and in group B ,5.37% babies required resuscitative measures. NICU admission was needed by 27.95 % in group A and 5.37% in group B. Conclusion: Serum lipid levels in hypertensive disorders of pregnancy is an important parameter for prediction of adverse perinatal outcome. Hypertensive disorders of pregnancy with dyslipidemia are associated with adverse perinatal outcome as compare to hypertensive disorders of pregnancy without dyslipidemia.

Study of low amniotic fluid index and its effect on perinatal outcome

AFI may be an important predictor for deciding timing of delivery and adverse maternal and fetal outcome. Hence, we aimed at determining whether an antepartum low amniotic fluid index (AFI) is a predictor of adverse perinatal outcome in normal pregnancy and to determine a threshold level of AFI that could predict an adverse outcome. This study was conducted as an observational study on a total of 100 antenatal females presenting with term pregnancy at Department of Obstetrics and Gynecology, Lord Mahavir Civil Hospital, Ludhiana during study period. Detailed history and clinical examination was done. AFI was assessed with help of USG. The study was conducted on a total of 100 antenatal females. AFI was &amp;#60;5 in 38%. Low AFI was associated with LSCS and negative fern test was statistically significant (p&amp;#60;0.05). We observed a significant association of low AFI with low birth weight, poor APGAR score at 1 as well as 5 minutes and higher risk of NICU admission (p&amp;#60;0.05). The area under the curve and sensitivity as well as specificity at cutoff (4.5) was maximum for NICU admission followed by LSCS (p&amp;#60;0.05). AFI is an important determinant of adverse maternal and fetal outcome. AFI &amp;#60;5 is associated with adverse maternal outcome in the form of higher operative delivery and adverse fetal outcome i.e. low birth weight, meconium stained liquor, low APGAR score and higher NICU admission. Intensive intrapartum care along with fetal surveillance may help in minimizing adverse perinatal outcomes.

Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high-risk pregnancies before and after 34 weeks.

The objective of the study was to compare the accuracy of the ductus venosus pulsatility index (DV PI) with that of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome at two gestational ages: <34 and ≥34 weeks' gestation. This was a retrospective study of 169 high-risk pregnancies (72 < 34 and 97 ≥ 34 weeks) that underwent an ultrasound examination of CPR, DV Doppler and estimated fetal weight at 22-40 weeks. The CPR and DV PI were converted into multiples of the median, and the estimated fetal weight into centiles according to local references. Adverse perinatal outcome was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean delivery, 5' Apgar score <7, neonatal pH <7.10 and admission to neonatal intensive care unit. Values were plotted according to the interval to labor to evaluate progression of abnormal Doppler values, and their accuracy was evaluated at both gestational periods, alone and combined with clinical data, by means of univariable and multivariable models, using the Akaike information criteria (AIC) and the area under the curve (AUC). Prior to 34 weeks' gestation, DV PI was the latest parameter to become abnormal. However, it was a poor predictor of adverse perinatal outcome (AUC 0.56, 95% CI: 0.40-0.71, AIC 76.2, p > 0.05), and did not improve the predictive accuracy of CPR for adverse perinatal outcome (AUC 0.88, 95% CI: 0.79-0.97, AIC 52.9, p < 0.0001). After 34 weeks' gestation, the chronology of the DV PI and CPR anomalies overlapped, but again DV PI was a poor predictor for adverse perinatal outcome (AUC 0.62, 95% CI: 0.49-0.74, AIC 120.6, p > 0.05), that did not improve the CPR ability to predict adverse perinatal outcome (AUC 0.80, 95% CI: 0.67-0.92, AIC 106.8, p < 0.0001). The predictive accuracy of CPR prior to 34 weeks persisted when the gestational age at delivery was included in the model (AUC 0.91, 95% CI: 0.81-1.00, AIC 46.3, p < 0.0001, vs AUC 0.86, 95% CI: 0.72-1, AIC 56.1, p < 0.0001), and therefore was not determined by prematurity. CPR predicts adverse perinatal outcome better than DV PI, regardless of gestational age. Larger prospective studies are needed to delineate the role of ultrasound tools of fetal wellbeing assessment in predicting and preventing adverse perinatal outcome.