Rate Of Obstetric Complications Research Articles

1087 Risk of adverse perinatal outcomes after recovery from antepartum sepsis

Maternal sepsis causes significant morbidity and mortality, but little is known about outcomes of patients who recover from antepartum sepsis. This study evaluates perinatal outcomes of patients with sepsis who were discharged prior to delivery. We performed a retrospective cohort study of patients who delivered at our institution from 8/1/2012 to 8/1/2018 and had a prior antepartum admission for sepsis with subsequent discharge prior to delivery. Multifetal pregnancies, major fetal structural or genetic anomalies, TORCH infections, and patients who delivered during their antepartum admission were excluded. Primary outcomes were composites of obstetric and neonatal complications. Between group differences were assessed by Fisher’s exact test or t-test. 70 of 15,055 patients (0.5%) had an antepartum admission for sepsis. 59 of 70 patients (84%) were discharged without delivery. Of these, 8% were admitted to the intensive care unit (ICU), overall mortality was 1.7%, and median days from hospital discharge to delivery was 79 (IQR 34–141). Patients with sepsis were more often Black (22% vs 6%, p < 0.001), more likely to have pregestational diabetes mellitus (9% vs 2%, p = 0.003), and younger (30.6 vs 33.1 years, p < 0.001) than patients without sepsis. There were no differences in composite neonatal complications between the groups (25% vs 28%, p = 0.77). Patients with sepsis had higher rates of obstetric complications (49% vs 34%, p = 0.02), cesarean delivery (39% vs 25%, p = 0.02), postpartum hemorrhage (24% vs 14%, p = 0.04), and hypertensive disease of pregnancy (24% vs 11%, p = 0.006) than patients without sepsis. In subgroup analyses, severe sepsis defined by ICU admission was associated with earlier gestational age at delivery (36.1 vs 38.9 weeks, p = 0.01) and a trend towards more neonatal complications (60% vs 28%, p = 0.14). Patients that recover from sepsis during the antepartum period may have higher rates of adverse perinatal outcomes. Close surveillance for obstetric and neonatal complications is warranted in these patients.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

597 Impact on neonatal outcomes with late preterm and early term delivery in women with diabetes

Late preterm and early term deliveries are common in pregnancies complicated by diabetes because of higher rates of obstetric complications, as well as concerns of increased stillbirth risk. Early delivery is associated with multiple neonatal adverse outcomes. The aim of this study was to investigate the rates of adverse neonatal outcomes with delivery at late preterm and early term gestational ages in women with either pregestational or gestational diabetes (GDM). This was a retrospective cohort study of all women with a singleton, non-anomalous pregnancy delivering at a single academic medical center in the late preterm (34 0/7-36 6/7 weeks) or early term (37 0/7-38 6/7 weeks) period between 2010-2019. Women were categorized by diabetes status: no diabetes, type 1 (T1DM), type 2 (T2DM), or GDM. Multivariate logistic regression was used to calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for risk of both mild and severe composite neonatal outcome with delivery in the late preterm or early term period using pregnancies without diabetes as the referent. There were 8,072 pregnancies included in the analysis with T1DM, T2DM, and GDM complicating 1.8%, 5.6%, and 9.9% of pregnancies, respectively. Expected demographic differences were seen among groups such as higher rates of non-Hispanic Black race, chronic hypertension and higher BMI in women with T2DM (all p<.001, Table 1). The probability of severe composite adverse neonatal outcome was significantly increased with late preterm delivery in women with T1DM (aOR 3.2; CI 1.5-6.6) and GDM (aOR 1.0; CI 1.01-3.5), but this was largely driven by need for mechanical ventilation. The mild composite outcome was increased among all women with diabetes with early term delivery, but highest in women with T1DM (Table 2). Pregnancies complicated by diabetes, particularly those with T1DM, have higher rates of neonatal adverse outcomes independent of gestational age of delivery. These data are important to consider when late preterm and early term delivery is planned in these pregnancies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

495 Maternal and fetal outcomes of pregnancies complicated with urolithiasis: a retrospective cohort study

Although renal calculi are common in the general population, information on their impact on pregnancy is scarce. The objectives of this study are to identify the incidence of urolithiasis in pregnancy, as well as to compare maternal and fetal outcomes of kidney stones with pregnancies not affected by kidney stones. A population-based cohort study consisting of pregnant women was carried out using the United States’ Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from 1999-2015. Exposure was classified by the presence or absence of the ICD-9-CM code 592.X which identified those women diagnosed in admission with calculus of the kidney and/or ureter. Logistic regression was used to evaluate the effect of urolithiasis on maternal and newborn outcomes. A cohort of 13,792,544 pregnant patients was identified, of which 11,528 had urolithiasis during pregnancy and/or delivery. The overall incidence of urolithiasis in pregnancy was 8.3 per 10,000 pregnancies. Women with urolithiasis were more likely to have preeclampsia/eclampsia (OR 1.35, 95%CI 1.24-1.47), gestational diabetes (OR 1.29, 95%CI 1.20-1.30), abruptio placenta (OR 1.41, 95% CI 1.22-1.64), and placenta previa (OR 1.55, 95%CI 1.27-1.90). They were more likely to deliver by cesarean (OR 1.20, 95%CI 1.15-1.25). Postpartum, pyelonephritis (OR 88.87, 95% CI 81.69-96.69) and maternal death (OR 2.85, 95%CI 1.07-7.60) were more common. Pregnancies complicated by renal calculi had greater risk of congenital anomalies (OR 2.84, 95%CI 2.43-3.31) and preterm birth (OR 1.92, 1.82-2.03), with a lower risk of intrauterine fetal death (OR 0.60, 95%CI 0.45-0.81). After observing higher rates of obstetrical complications and poor neonatal outcomes among women with kidney stones, we hypothesize that these women experience a more challenging pregnancy compared with women whom did not have renal calculi during pregnancy.

Report of a pregnant woman with mosaic Turner syndrome

Spontaneous pregnancy in women with Turner syndrome is rare (5%) and relative- ly high risk. A number of methods to preserve fertility in such women have been discussed. Careful follow-up is required during these pregnancies due to the high incidence rates of neonatal, obstetric, maternal, and cardiovascular complications. A 39-year-old multigravid woman (G5, P3, A2) with mosaic Turner syndrome with a history of three spontaneous pregnancies and two miscarriages was evaluated at our clinic. The analysis showed mos 45,X [9]/46,XX [38] mosaic Turner syndrome. Her first and fourth pregnancies resulted in miscarriages during the first trimester. Here, we discuss a pregnant woman with mosaic Turner syndrome with unaffected fertility but with a history of spontaneous pregnancies/miscarriages, with reference to the current literature.

Evaluation of maternal serum afamin and vitamin E levels in pregnant women with COVID-19 and its association with composite adverse perinatal outcomes.

To evaluate the maternal serum afamin and vitamin E levels in pregnant women with coronavirus disease 2019 (COVID-19) and to investigate their association with composite adverse perinatal outcomes. This prospective, case-control study consisted of 60 pregnant women with COVID-19 infection and 36 age-matched pregnant women without any defined risk factors. Demographic features, laboratory test results, afamin and vitamin E levels were compared between the groups. Areceiver operating characteristic (ROC) curve was used to assess the relationship of afamin and vitamin E levels in predicting composite adverse perinatal outcomes. A correlation analysis was performed between afamin and C-reactive protein (CRP) levels in pregnant women with COVID-19. The obstetric complication rate was higher in the COVID-19 group (13.3% vs. 2.8%) (p = .01). Afamin levels were higher and vitamin E levels were lower in the COVID-19 group (p = .02 andp < .001, respectively). Vitamin E levels were lower in the COVID-19 group for the all trimesters (p < .001, p < .001, andp = .004, respectively). Afamin levels were higher in the COVID-19 group for the all trimesters without reaching statistical significance (p > .05). The values in the ROC curves with the best balance of sensitivity/specificity for afamin and vitamin E were 0.424 mg/l (70.6% sensitivity, 44.3% specificity) and 3.150 µg/ml (76.5% sensitivity, 58.2% specificity), respectively. A positive moderate statistically significant correlation was found between afamin and CRP levels (r = .264, p = .009).Higher afamin and lower vitamin E levels may support the elevated oxidative stress in the etiopathogenesis of COVID-19 and the relationship with composite adverse perinatal outcomes.

Comparison of VEGF-A values between pregnant women with COVID-19 and healthy pregnancies and its association with composite adverse outcomes.

The aim is to compare VEGF-A values between pregnant women with coronavirus disease 2019 (COVID-19) and healthy controls. Furthermore, the association of inflammation parameters, disease severity, and obstetric complications with VEGF-A was investigated. This prospective case-control study was conducted on pregnant women who were admitted to Ankara City Hospital between June 14, 2020 and August28, 2020. Pregnant women with COVID-19 (n = 95) were compared with a control group of healthy pregnant women (n = 92) with similar clinical and demographic characteristics. Demographic features, clinical characteristics, laboratory test results, VEGF-A values were compared between the groups. A correlation analysis was performed between VEGF-A levels, inflammation parameters, and clinical characteristics of the cases for pregnant women with COVID-19. VEGF-A levels were also compared between patients with composite adverse outcome and patients without any complication in the COVID-19 group. The two groups were similar except for obstetric complications(p > .05).The obstetric complication rate was higher in the COVID-19 group (p =.02).The two groups were comparable in terms of neutrophil to lymphocyte ratio and VEGF-A values. VEGF-A values were slightly different between the trimesters. A negative moderate statistically significant correlation was found between the neutrophil and VEGF-A values (r = -0.231, p =.02). VEGF-A values were similar between patients with and without composite adverse outcomes (p > .05).VEGF-A values were similar between pregnant women with COVID-19 and healthy controls.

Neonatal Preterm Respiratory Care in Ukraine: An Observational Study of Outcomes in Relation to Timing and Methods of Surfactant Treatment.

Timely and effective noninvasive respiratory support and surfactant administration are the key determinants of clinical outcomes in very preterm infants. The objective of this study was to evaluate the impact of the changes in clinical practice of surfactant administration on clinical outcomes and the incidence of continuous positive airway pressure (CPAP) failure defined as the need for mechanical ventilation (MV) during the first 5 days of life in preterm infants <32 weeks. One hundred sixty-five outborn very preterm infants with respiratory distress syndrome (RDS), initially managed on CPAP, were enrolled in a retrospective cohort study. Fifty-two infants treated with surfactant using less invasive or INSURE technique were included in the surfactant group. One hundred thirteen control infants received surfactant only in case of CPAP failure. The study groups were similar in gestational age, rates of main obstetric complications, and antenatal steroid prophylaxis. The rate of cesarean delivery was significantly higher but birth weight and need for resuscitation were lower in infants from the surfactant group. Fifty-five infants with CPAP failure (49%) received surfactant after initiation of MV in the control group in comparison with 52 (100%) in the surfactant group (p < 0.001). The incidence of CPAP failure was significantly higher in the control group (49 vs. 27%; p < 0.01) and it occurred earlier (median [interquartile range age: 4 [2-5] vs. 47 [36-99] hours, respectively; p < 0.001). Early surfactant administration significantly and independently affected the probability of CPAP failure (adjusted odds ratio: 0.29, 95% confidence interval: 0.13-0.67; p < 0.01). There were no differences in morbidities between the groups, but CPAP failure was significantly associated with higher morbidity and mortality. Adherence to the European RDS guidelines with early rescue, less invasive surfactant administration in very preterm infants decreased the probability of CPAP failure which was significantly associated with higher morbidity and mortality. · Early surfactant decreases the probability of CPAP failure.. · Timing and methods of surfactant administration are important.. · Randomized comparisons of prophylactic LISA and CPAP are needed..

Charcot-Marie-Tooth neuropathy and pregnancy: general and specific issues

Abstract Background: Charcot-Marie-Tooth (CMT) neuropathies represent an important group of neuromuscular disorders and are mostly autosomal dominantly inherited. The question, if there is a higher complication rate in pregnancy and delivery in CMT neuropathy and if there is a possible influence of pregnancy on muscles and nerves themselves, is important for medical care and prepregnancy counselling of affected women. Objectives: In this review we first address general issues of the clinical picture of CMT disease and physiological adaptations in pregnancy. In the second part of this paper we summarise specific results of two comparable studies on the obstetric history of women with CMT neuropathy in order to address the obstetric complication rate, newborn vitality, possible deterioration of CMT in or after pregnancy and personal attitudes. The results are based on two combined cohort studies with 21 and 54 participants. Results: We documented 148 pregnancies (129 deliveries), resulting in 131 infants. There were no increased complication rates in the recorded pregnancies. Miscarriage rate was 12.8 % and thus as high as in unaffected women. Deliveries were not associated with specific risks; there were no increased preterm deliveries, vaginal operations or caesarean sections, and no increased postpartum haemorrhages. Newborn vitality was normal and birth measurements were within the normal range. A deterioration of CMT related symptoms was reported in about one-third of the pregnancies and after delivery, however, the functional impact on everyday life was rather low in classical CMT. Most women expressed a positive attitude towards having own children and family life but those with a larger handicap would recommend medical advice and assistance in caring for the family. Discussion and conclusion: Pregnancy can be safely undertaken in women with classical CMT, despite the fact that a negative influence on the disease course appears possible. The data of a Norwegian study which found higher rates of presentation anomalies and operative deliveries and a higher risk of postpartum haemorrhage have not been confirmed in our study.

Comparison of fertility outcomes after laparoscopic myomectomy for barbed versus nonbarbed sutures

To assess the impact on women's reproductive outcomes of barbed sutures to repair uterine breaches during laparoscopic myomectomy compared with traditional smooth sutures. Retrospective, monocentric cohort study, with information on subsequent pregnancies prospectively acquired for some women. Tertiary-level academic referral center. Women older than 18 years who had undergone a laparoscopic myomectomy and had sought pregnancy afterward, divided into two groups based on type of suture used to repair the uterine wall: group A (nonbarbed) and group B (barbed). Laparoscopic removal of FIGO types 3, 4, 5, and 6 uterine leiomyomas by use of either only barbed sutures or only traditional smooth sutures to reconstruct the uterine defect. Pregnancy achievement rates, delivery modes, main pregnancy complications, perioperative complications for both kinds of suture, and the trend of the use of barbed sutures over time at our center. Of 164 patients included, 83 were in group A and 81 in group B. Ninety-one patients (55.5%) experienced at least one postoperative pregnancy, with no differences between the groups (group A 60.5%; group B 50.6%). Of the 103 recorded postoperative pregnancies, 70 (68%) resulted in live births, 29 (28.1%) in first-trimester miscarriages, and 4 (3.9%) were ongoing. Barbed sutures have a similar impact on reproductive outcomes as smooth conventional threads, both in terms of pregnancy and obstetric complication rates, after laparoscopic myomectomy.

Baby on board: what you need to know about pregnancy in the hemoglobinopathies.

Pregnancy poses a unique challenge to patients with sickle cell disease and β-thalassemia, who often have exacerbations of hemolysis or anemia during the gestational period, experience higher rates of obstetric and fetal complications, and may have distinct underlying comorbidities related to vasculopathy and iron overload that can endanger maternal health. Optimal management of pregnant women with hemoglobinopathies requires both an understanding of the physiologic demands of pregnancy and the pathophysiology of disease-specific complications of inherited blood disorders. A multidisciplinary team of expert hematologists and high-risk obstetricians is therefore essential to ensuring appropriate antenatal maternal screening, adequate fetal surveillance, and early recognition of complications. Fortunately, with integrated and targeted care, most women with sickle cell disease and β-thalassemia can achieve successful pregnancy outcomes.

Pregnancy and its Outcomes in Patients After Uterine Fibroid Embolization: A Systematic Review and Meta-Analysis.

Uterine artery embolization (UAE) has been introduced for uterine fibroid treatment for two decades. Most of the patients are in reproductive age and many want future pregnancy. In this study, we will assess fertility, pregnancy and its outcomes in patients who have undergone UAE. In this systematic review, a systematic search was performed on important databases including PubMed and Medline, Web of Knowledge, Google Scholar, EMBASE and Scopus. Studies reported enough data about pregnancy after UAE were considered to be enrolled in the review. We assessed obstetric indices (pregnancy and delivery rates, pregnancy losses, complications and fetal outcomes). Study evaluation was done based on STROBE checklist by two reviewers. Totally, 24 original papers were included. Data were analyzed by Stata and MedCalc softwares. Among women wishing fertility, totally 40.5% experienced at least one pregnancy after UAE (95% confidence interval [CI]: 33.3%-48.2%). Pooled estimate of pregnancy loss rate was 33.5% (95% CI: 26.3-41%). Most pregnancy losses were due to spontaneous abortion (81.3% of all losses (95% CI = 76%-86.1%)). Rate of obstetrical complications was 25.4% (95% CI = 13-40.2%) among all finished pregnancies. Pooled estimate of preterm labor was 12.8% (95% CI = 8.7%-17.5%), and pooled estimate of low birth weight (LBW) was 10% (95% CI = 6.2-14.6%). Considering the findings of the study, a safe pregnancy after UAE is obviously possible resulting to a healthy and normal baby delivery. In addition, pooled obstetrical complication rates, pregnancy losses, preterm labor and LBW seem to be mostly similar to the general population. Registration: The study was registered in International Prospective Register of Systematic Reviews (PROSPERO) on Nov 3, 2017, and was confirmed with a registration code of CRD42017076074.

Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta-analysis.

Epidemiological data on obstetric and oncologic complications in twin pregnancies combining a complete hydatidiform mole (CHM) coexisting with a normal fetus and placenta are limited. To evaluate perinatal and obstetric outcomes for mother and fetus and risk of gestational trophoblastic neoplasia (GTN) in twin pregnancies including a CHM. PubMed, MEDLINE and EMBASE and the grey literature were searched for articles published between May 1980 and May 2019 using a protocol designed a priori and registered on PROSPERO (CRD42018112524). Observational cohort studies of four or more cases confirmed by histopathology and providing data on pregnancy outcomes and GTN. Two reviewers independently reviewed abstracts and full-text articles. The quality of the studies was assessed with the Newcastle-Ottawa scale and a meta-analysis was performed. Of the 344 abstracts identified, 14 studies (244 cases) met the eligibility criteria. The incidence of maternal complication in ongoing pregnancies was 80.8% and included vaginal bleeding, hyperthyroidism and pre-eclampsia. There were overall 91 (50%) live births in ongoing pregnancies and 83 (34%) of the total cases were subsequently diagnosed with GTN. Substantial and significant (P<0.001) heterogeneity was found for the incidence of preeclampsia indicating variability in reporting the incidence of some obstetric complications between studies. Patients diagnosed with a twin pregnancy combining a CHM and an apparently normal fetus have a high risk of perinatal complications, low live-birth rates and around a third of them will develop a GTN and should be managed by specialised multidisciplinary teams. Our study indicates a high rate of obstetric and oncologic complications in patients presenting with a complete hydatidiform mole and coexistent normal fetus.

Twin pregnancies with uterine fibroids are not at increased risk for obstetric complications: single center cohort study

BackgroundTwin pregnancies with uterine fibroid(s) (UFs) may not be at increased risk for obstetric complications compared to those without UFs. However, there was no reported comparison study with obstetric outcomes and complications of twin pregnancy after myomectomy. We aimed to compare the pregnancy outcomes in twin pregnancies with or without uterine fibroid(s), and also compared in patients with previous myomectomy history in Korean women.MethodsA cohort of twin pregnancies delivered in a single institution between January 2011 and March 2019 were retrospectively analyzed. UFs group was defined by the presence of UFs during pregnancy (≥1 fibroid, measuring ≥2 cm or multiple fibroids regardless of the size). Previous myomectomy group included patients with history of abdominal or laparoscopic or hysteroscopic myomectomy of ≥1 fibroid, measuring ≥2 cm or multiple fibroids whatever the size. Patients with monochorionic monoamniotic twins, myoma less than 2 cm in size, missed abortion or intrauterine fetal death (IUFD) of one fetus before 14 weeks, history of previous conization, and uterine anomalies were excluded. Pregnancy outcomes and obstetric complications were compared.ResultA total 1388 patients were included in this study, 191 (13.8%) had UFs and 89 (6.4%) had a history of myomectomy. Maternal age was younger in non-UFs group and primiparity was more common in UFs group (p < 0.001, and p = 0.019). No significant differences were found in the gestational age at delivery (p = 0.657), delivery before 37 weeks (p = 0.662), delivery before 34 weeks (p = 0.340), and sum of birth weight of twin (p = 0.307). There were also no statistical differences in rates of obstetrical complications, such as preeclampsia, gestational diabetes mellitus, placenta previa, placenta abruption, cerclage, small for gestational age, IUFD, postpartum hemorrhage and peripartum transfusion or ICU care. These obstetrical outcomes and complications showed no statistical differences between UFs group and previous myomectomy group.ConclusionIn patients with twin pregnancies, the presence of UFs or history of previous myomectomy did not relate to negative effects on pregnancy outcomes and obstetrical complications.

Pregnancy and Parenthood Remain Challenging During Surgical Residency: A Systematic Review.

To examine common themes and synthesize data surrounding pregnancy and parenthood during surgical residency training. The authors conducted a systematic search of the literature in March 2019. They searched MEDLINE, EMBASE, and Scopus, seeking articles published from 2003 to 2018 that focused on pregnancy, parenthood, and the experience of surgical residents. They excluded articles that examined nonsurgical programs, as well as editorials, abstracts, and commentaries. Two investigators independently reviewed all citations, selected articles for full-text review, and extracted data from the selected articles. Of 523 titles and abstracts screened, 27 were included. Overall, female surgical residents had fewer children during residency training than their male counterparts (18%-28% vs 32%-54%). As compared with the general population, surgical residents had their first child later in life (30-34 vs 25 years old), and had fewer children overall (0.6-2.1 vs 2.7). Infertility rates were higher among female surgeons than in the general population (30%-32% vs 11%), as were assisted reproductive technology rates (8%-13% vs 1.7%). Pregnant surgical residents experienced a high rate of obstetrical complications; working more than 6 overnight calls shifts per month or 60 hours per week were predictors of increased complication rates. The authors noted no differences in attrition, caseload, or exam pass rates amongst female surgical residents who had become pregnant as compared with other residents. Despite these similar academic outcomes, negative attitudes and perceptions toward pregnancy during residency were consistently identified. Female surgical residents experience high rates of infertility and obstetrical complications, contend with negative attitudes and stigma during their pregnancies, and voluntarily delay childbearing. Formal maternity policies, a shift in surgical culture, and ongoing discussion with all stakeholders are needed to attract and retain female surgical residents.

Analysis of risk factors for complications and adverse obstetrical outcomes in women with Takayasu arteritis: a French retrospective study and literature review.

Takayasu arteritis (TAK) is a large vessel vasculitis affecting young women of childbearing age. The outcome of pregnancies in TAK patients, factors associated with maternal and foetal complications and adverse outcomes were analysed. All pregnancies in women with a TAK diagnosis were retrospectively included from 20 French hospitals providing care for TAK, until August 2015. The study consisted of 43 pregnancies in 33 women, including 29 with a pre-existing TAK diagnosis and 4 diagnosed during pregnancy. Complications were observed in 20 pregnancies (47%), including 35% with arterial hypertension (n = 15), 9% with pre-eclampsia (n = 4), 2% with HELLP syndrome (n = 1) and 14% with intrauterine growth restriction (IUGR, n = 6, leading in one case to a medically indicated termination of pregnancy). There were 42 live births (98%) at a median term of 38 [27-42] weeks gestation including 9 before 37weeks (21%). The median birth weight was 2940 [610-4310] grams. Five children (12%) required transfer to a neonatal intensive care unit. One premature boy (27weeks gestation) died after 2days. Treatment during pregnancy included steroids (n = 25/43; 58%), azathioprine (n = 9/43; 21%) and infliximab (n = 1/43; 2%). The risk of developing arterial hypertension during pregnancy was associated with previous chronic arterial hypertension and with an infra-diaphragmatic vasculitis injury (P = 0.01 and P = 0.04, respectively). No correlation was reported between TAK activity and any of the obstetrical complications described in the study. This study showed a high rate of adverse obstetrical complications without significant impact on live birth rates. Pregnancy did not appear to influence TAK disease activity. Key Points • We observed a high rate of adverse obstetrical complications in women with Takayasu arteritis; however, the rate of live births was high. Pregnancy did not appear to influence TA disease activity.

Pregnancy in a Sickle Cell Disease Patient: A Nightmare!

ABSTRACT Aim To discuss the effect of pregnancy in sickle cell disease (SCD) patients and its associated complications. Background Sickle cell disease is the most common inherited disorder worldwide and in certain regions of India with varying clinical severity and potentially serious complications. Sickle cell disease can magnify complications during pregnancy and in turn negatively influence the pregnancy outcomes. The physiological adaptations during pregnancy that occur in the circulatory, hematologic, renal, and pulmonary systems can overburden organs that already have chronic injuries secondary to SCD, thus increasing the rate of obstetric complications like miscarriage, anemia, preeclampsia, worsening of vaso-occlusive crisis, and acute chest syndromes. Case description A 23-year-old Indian primigravida patient, known case of SCD with anemia and splenic infarct with h/o multiple blood transfusions. The patient presented at 12 weeks with intrauterine fetal demise and was medically aborted. The post-abortion patient was posted for splenectomy as she had episodes of hemolytic jaundice. Post-splenectomy patient further developed bowel obstruction and thrombus formation in the infrarenal part of inferior vena cava (IVC). She was again operated and for obstruction and the band was removed. For thrombi, patient was given low molecular weight heparin (LMWH). The patient was finally discharged on tb. hydroxyurea and other antibiotics. Conclusion The higher rate of complications occurs in women with sickle cell crisis exaggerated by underlying factors such as long-term anemia and pregnancy increases the risk further. Thus, a multidisciplinary approach with regular follow-up of SCD patients since the time of preconceptional time is important to avoid pregnancy-related complications and also for a better pregnancy outcome. Clinical significance The physiological changes of pregnancy like increased blood volume, increased metabolic demand, increased blood viscosity, and hypercoagulability get aggravated in SCD patients leading to increased incidence of complications. Prepregnancy anemia and other complications of a mother can further affect the outcome, thus preconceptional counseling is a crucial part of management. How to cite this article Doshi B, Mehendale MA, Nayak AH, et al. Pregnancy in a Sickle Cell Disease Patient: A Nightmare!. J South Asian Feder Obst Gynae 2020;12(5):323–325.

Maternal characteristics and pregnancy outcomes of women with chronic hypertension: a population-based study.

Background We aimed to study the maternal characteristics and obstetric and neonatal outcomes in pregnant mothers with chronic hypertension (CHTN) compared to non-CHTN. Methods The study was a population-based cohort study, and a PEARL-Peristat Study (PPS) for the year of 2017. There were 20,210 total births including 19,762 singleton and 448 multiple births. We excluded multiple gestations from the analysis as they differ in fetal growth, duration of gestation and have a higher rate of obstetric and neonatal complications. We compared the maternal characteristics of mothers with pre-existing HTN with non-hypertensive mothers and studied the obstetric and neonatal outcomes including cesarean section, stillbirths, prematurity, macrosomia and postpartum hemorrhage (PPH). Results We identified 223 births of mothers with essential HTN. The overall prevalence of CHTN in our population was 1.1% (223/20,210). In regard to maternal characteristics, women with CHTN were at or above 35 years of age at the time of delivery 58.9% compared to non-CHTN women 18.7%, P-value <0.001. Pre-existing diabetes was found more in women with CHTN 15.1% compared to non-CHTN women 1.9%, P-value <0.001; while obesity was found in 64% of women with CHTN compared to 32.5% in non-CHTN women, P-value <0.001. Preterm birth was noted in 26% compared to 8% in CHTN compared to non-CHTN women, respectively, P-value <0.001. The rate of stillbirth was similar between the two groups, 0.9% compared to 0.6% in CHTN compared to non-CHTN women, respectively, P-value 0.369. Conclusion Hypertensive mothers have multiple other comorbidities. When compared to the general population, they are older, parous, diabetic and obese with an increased risk of preterm birth and cesarean deliveries. Lifestyle modification, extensive pre-conceptional counseling and multidisciplinary antenatal care are required for such a high-risk group.

Fertility and obstetrical outcomes after robot-assisted laparoscopic myomectomy.

To evaluate fertility after robot-assisted laparoscopic myomectomy (RALM) in terms of pregnancy rates, and obstetrical outcomes. This is a retrospective cohort of RALM performed for symptomatic leiomyomas among women who want to conceive. Medical data were retrospectively reviewed. An office hysteroscopy was prescribed 3 months after the surgery. Fifty-three patients were included. The mean number of myomas was 2 ± 1.5 with a mean size of 69 ± 17.7 mm. A breach of the cavity was noticed in 15.1% of the cases. Two cases of intrauterine adhesions were diagnosed and treated during the post-operative office hysteroscopy (5.7%). Clinical pregnancy rates were 52.8% with a live birth rate of 41.5% in patients desiring pregnancy. A caesarean section was performed in 17 cases (70.8%). No case of uterine rupture was reported. More than half of the patients became pregnant after RALM. A low rate of obstetrical complications was reported, with no uterine ruptures, highlighting the promise of this technique for infertile patients.

In vitro fertilization outcome in women with endometrial tuberculosis and tubal tuberculosis

Purpose: To evaluate in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcome in women with genital tuberculosis (GTB).Methods: One hundred and fifty-five women with genital tuberculosis constituted the study group (Group A), consisting of 25 patients with endometrial tuberculosis (Group A1) and 130 patients with tubal tuberculosis (Group A2). Women with non-tuberculous tubal infertility were matched by age and study period served as controls (Group B).Results: Patients with GTB had significantly reduced endometrial thickness, high-quality embryos rate, implantation rate as compared with controls (p < .05), no differences were found in other pregnancy parameters. In addition, the endometrial thickness, fertilization rate, high-quality embryos rate and implantation rate were also significantly lower in women with endometrial tuberculosis as compared with controls. And the cumulative pregnancy rate in endometrial tuberculosis was significantly decreased compared with tubal tuberculosis and controls (p < .05). However, IVF/ICSI pregnancy outcomes in patients with tubal tuberculosis showed no difference as compared with controls (p > .05). Also, rates of miscarriage, preterm birth, obstetrical complications, and neonatal problems did not differ among three groups.Conclusions: In conclusion, IVF/ICSI-ET remains the most optimal method for the treatment of female infertility associated with tubal tuberculosis. However, patients with endometrium tuberculosis showed significantly reduced fertilization, implantation and cumulative pregnancy rates.

Pregnancy after direct cerebral bypass for moyamoya disease.

Moyamoya disease (MMD) disproportionately affects young to middle-aged women. The main treatment for this challenging disease is cerebral bypass surgery. Vascular neurosurgeons often need to counsel women regarding pregnancy following bypass for MMD, but there is a paucity of data. The authors set out to examine neurological and obstetric outcomes in an extensive cohort of MMD patients who had pregnancies following cerebral revascularization at the Stanford Medical Center. The authors identified all patients at their institution who underwent cerebral bypass for MMD from 1990 through 2018 and who later became pregnant. Some of these patients also had pregnancies prior to undergoing bypass surgery, and the authors examined these pregnancies as well. They performed a chart review and brief telephone survey to identify obstetric complications, transient ischemic attacks (TIAs), and strokes. Neurological and obstetric outcomes were compared to published rates. They also compared pre- and post-bypass pregnancy complication rates using logistic regression techniques. There were 71 pregnancies among 56 women whose mean age was 30.5 years. Among 59 post-bypass pregnancies, there were 5 (8%) perinatal TIAs. There were no MRI-confirmed strokes or strokes with residual deficits. Among 12 pre-bypass pregnancies, there were 3 (25%) TIAs and 2 (17%) MRI-confirmed strokes. There were no hemorrhagic complications in either group. In the generalized estimating equations analysis, performing cerebral revascularization prior to pregnancy versus after pregnancy was associated with lower odds of perinatal stroke or TIA (OR 0.15, p = 0.0061). Nine pregnancies (13%) were complicated by preeclampsia, and there was one (1%) instance of eclampsia. The overall rate of cesarean delivery was 39%. There were 2 miscarriages, both occurring in the first trimester. There were no maternal deaths. The authors present neurological and obstetric outcomes data in a large cohort of MMD patients. These data indicate that post-bypass pregnancy is accompanied by low complication rates. There were no ischemic or hemorrhagic strokes among post-bypass pregnant MMD patients. The rate of obstetric complications was low overall. The authors recommend close collaboration between the vascular neurosurgeon and the obstetrician regarding medical management, including blood pressure goals and continuation of low-dose aspirin.