Rate Of Placental Abruption Research Articles

The impact of maternal epilepsy on perinatal outcome in singleton gestations

Objective: We sought to evaluate perinatal outcomes in women with epilepsy.Methods: We performed a retrospective cohort study between 2007 and 2014, at a tertiary, university-affiliated medical center. All women with singleton gestation who delivered during the study period were included, except for pregnancies in which fetuses with chromosomal or structural anomalies were diagnosed. Perinatal outcome was compared between two groups: women diagnosed with epilepsy and women without epilepsy.Results: Out of 62,102 deliveries during the study period, 61,455 met the inclusion criteria, of whom 206 (0.3%) had epilepsy. The only difference found in maternal demographics was higher rate of nulliparity in the epilepsy group (p = .02). As for maternal adverse outcome, higher rates of placental abruption and longer postpartum admission were found in women with epilepsy (p = .02 and p < .001, respectively). Comparing neonatal outcomes between the two groups, higher rates of neonatal intensive care unit admission (16.5 versus 9.2%), seizures (1.9 versus 0.4%), transient tachypnea of the newborn (2.4 versus 1.0%) and respiratory distress syndrome (1.9 versus 0.4%) were significantly higher to newborns of women with epilepsy (p < .05 for all). On multivariable logistic regression, epilepsy was found to be independently and significantly associated with placental abruption (OR 4.04, 95%CI 1.27–12.83, p = .02), neonatal intensive care unit (NICU) admissions (OR 1.84, 95%CI 1.25–2.70, p = .002), seizures (OR 4.33, 95%CI 1.60–11.77, p = .004), transient tachypnea of the newborn (OR 2.47, 95%CI 1.005–6.05, p = .049) and respiratory distress syndrome (OR 7.16, 95%CI 2.47–20.76, p < .001).Conclusions: Epilepsy in pregnant women is associated with adverse perinatal outcomes, including neonatal seizures, placental abruption and respiratory problems.

Increased risk of placental abruption after solomon laser treatment of twin-twin transfusion syndrome

To evaluate the relative risk of placental abruption in monochorionic (MC) twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) and treated with endoscopic laser coagulation of placental vessels (ELCPV).A retrospective analysis from January 2004 and December 2015 of 373 TTTS pregnancies, treated with selective ELCPV until January 2012 (287 cases), after which the Solomon technique was introduced (86 cases), compared with 243 normal MC pregnancies.A significant improvement in perinatal survival was observed after the introduction of the Solomon technique when compared to the selective procedure (77% vs 54%, p < 0.001).The rate of placental abruption was 1% (3/243) in normal MC pregnancies, 6% (21/373) in TTTS group, increased with Solomon technique (12/86, 14%, vs 9/287, 3%, p < 0.001).MC twin pregnancies treated with laser coagulation of placental vascular anastomoses could be at increased risk of placental abruption, especially when the Solomon technique is used.

First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome.Materials and methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery.Results: Four thousand five hundred and four women were included in the final analysis – 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0–3.28 for TSH 2.5–4.0 mIU/L and OR 2.33, 95% CI 1.11–4.42 for those with TSH > 4 4.0 mIU/L).Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome – low birth weight and placental abruption – although this needs to be further explored.

Obstetric outcomes in pregnancies with normal nuchal translucency and abnormal ductus venosus Doppler in the first trimester ultrasonography

In the present case–control study, we evaluated obstetric outcomes of pregnancies with normal nuchal translucency (NT) and abnormal ductus venosus (DV) Doppler findings in the first trimester combined screening test for chromosomal abnormalities. All study patients underwent DV Doppler examination, concurrent with the combined screening test. DV Doppler revealed pathologic findings in 14 pregnant women despite normal NT after the elimination of lost to follow-up and foetal anomaly. Obstetric outcomes of the case patients were compared with a control group that were matched for mean gestational age, and Crown–rump length with normal NT and DV Doppler measurements was selected comprising 88 pregnant women. Regarding maternal outcomes, women with abnormal DV Doppler findings had a higher rate of placental abruption, delivered at an earlier mean gestational age (preterm delivery). Interestingly, a higher rate of spontaneous vaginal delivery rate was observed in these patients. From the foetal perspective, pregnancies with abnormal DV Doppler had lower birth weight and received lower Apgar scores. In conclusion, an abnormal DV Doppler test in the first trimester was associated with poor maternal and foetal obstetric outcomes. These findings should be elucidated in future studies.

Value of non phosphorylated insulin-like growth factor binding protein-1 in cervical vaginal excretion and residual amniotic fluid index monitoring in the diagnosis of premature rupture of membranes

Objective To explore the method of rapid diagnosis preterm premature rupture of membrane (PPROM)and prognosis factors of residual amniotic fluid in mother and infant through monitoring nonphosphorylated insulin-like growth factor binding protein-1(IGFBP-1)and the residual amniotic fluid index(AFI)of the cervi-covaginal secretions from PPROM women. Methods 96 cases of PPROM were tested IGFBP-1 of cervicovaginal secretions, AFI were tested by abdominal ultrasound through fast chromatography methods, and the cause was ana-lyzed. The pregnancy outcome and neonatal prognosis were compared. Results 92 cases positive of IGFBP-1 were diagnosed with PPROM. The risk factors of PPROM were mainly reproductive tract infections, abortion, induced labor history and unknown causes(including no evidence of infection, fetal membrane dysplasia unclear or other factors), the twins, multiplets, macrosomia, breech or cephalopelvic disproportion, gestational hypertension disease, uterine fibroids or deformity, malnutrition and polyhydramnios. In the 92 patients with PPROM pregnant women, the duration from premature rupture of membrane to delivery was(105.7±13.9)h, cesarean section rate was 51.1%, fever rate of pregnant women was 7.6%, the rate of placental abruption was 4.3%,the rate of fetal distress was14.1%, perinatal infection rate was 21.7%, and neonatal asphyxia rate was 7.6%, the neonatal mortality was 7.6%. To compare the AFI≤40mm group with AFI＞40 mm group, the duration from premature rupture of membrane to delivery was short-ened remarkably(t＝10.904,P＜0.05), the neonatal mortality rate was significantly increased(χ2＝4.359,P＜0.05). Conclusion Measurement of IGFBP-1 and AFI in cervicovaginal secretions can rapid diagnosis PPROM and evaluate the results of pregnancy and neonatal prognosis, and can guide clinical improvement of pregnancy safety and reduce neonatal mortality. Key words: Premature rupture of membranes; Insulin-like growth factor binding protein-1; Amniotic fluid index; Diagnose

181: Recurrence rate of placental abruption: a longitudinal linked cohort study in the Netherlands

181: Recurrence rate of placental abruption: a longitudinal linked cohort study in the Netherlands

Decision-to-delivery interval in suspected placental abruption – association with pregnancy outcome

Objective: To determine the association between decision to delivery interval (DDI) and short-term perinatal outcome in cases of suspected placental abruption delivered by cesarean section (CS).Study design: A retrospective cohort study of all cases of placental abruption delivered by CS (2010–2012) in a single university affiliated tertiary center. Composite adverse neonatal and maternal outcome were assessed.Results: The rate of placental abruption was 0.5% (140/27 677 deliveries) and 65/140 (46%) were delivered by CS. Indications for CS were non-reassuring fetal heart rate (NRFHR) in 32/65 (49.3%), maternal bleeding 20/65 (30.7%) and other indications in 13/65 (20%). Obstetrical and labor characteristics were similar unrelated to the indication for CS. Gestational age at delivery was higher in the group operated due to NRFHR (36 ± 4.3, 34 ± 3.7 and 32 ± 4.1 weeks, respectively, p = 0.03). DDI was shortest when CS was due to NRFHR followed by CS due to maternal bleeding or other indications (23 ± 19, 30 ± 16, 50 ± 40 min, respectively, p = 0.001). The umbilical artery PH was lower in those who operated due to NRFHR (7.17 ± 0.17, 7.23 ± 0.06 and 7.30 ± 0.09, respectively, p = 0.002). The overall rate of neonatal and maternal composite outcome was 66% and 40%, respectively with no significant difference in relation to indication for CS.Conclusion: In cases of suspected placental abruption, fetal short-term morbidity is probably related to the indication for CS and not only to DDI.

Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies

ObjectiveTo compare maternal and perinatal outcomes in twin pregnancies conceived via assisted reproductive techniques (ART) compared with spontaneous twin pregnancies. Study designThis retrospective study examined 345 dichorionic, di-amniotic twin pregnancies (207 conceived spontaneously and 138 conceived via ART), delivered between January 2007 and June 2011 at the San Pietro Fatebenefratelli Hospital, Rome, a tertiary medical centre. Maternal and perinatal outcomes were compared. A multiple logistic regression analysis was performed to calculate risk estimates as odds ratios (OR) adjusted for maternal age, parity and systemic diseases. Patient data were obtained from a computerized database and analyzed using Statistical Package for the Social Sciences Version 17. ResultsGestational age and birth weight were lower in the ART group, and preterm delivery, gestational diabetes and placental abruption were higher in the ART group compared with the spontaneous conception group. The incidence rates of respiratory complications, patent ductus arteriosus and admission to the neonatal intensive care unit were higher among ART newborns. Length of hospital stay for mothers and newborns was longer in the ART group. No differences in mode of delivery, Apgar score at 5min, congenital anomalies, perinatal mortality, and other considered pregnancy and neonatal complications were found between the two groups. Multivariate analysis adjusted for maternal age, parity and systemic diseases revealed that only the rates of placental abruption [OR 7.45, 95% confidence interval (CI) 2.05–26.98] and patent ductus arteriosus (OR 3.39, 95% CI 1.01–11.46) were significantly higher for the ART group. ConclusionsTwin pregnancies conceived via ART are at greater risk of poorer outcomes than spontaneous twin pregnancies. This may be related to the type of conception and specific negative features of subfertile patients undergoing infertility treatment.

Perinatal implications of motor vehicle accident trauma during pregnancy: identifying populations at risk

The purpose of this study was to examine the association between restraint use, race, and perinatal outcome after motor vehicle accidents (MVAs) during pregnancy. The Duke Trauma Registry and medical records were searched for information on pregnant women at >14 weeks' gestation who were involved in an MVA and who received care through the Emergency Department and the Obstetric Units. Between January 1994 and December 31, 2010, 126 women were identified. Variables that were collected included type of trauma, gestational age at presentation, and delivery outcomes. A prognostic study was performed that evaluated the associations between maternal demographics, details of the accident that included restraint use, and maternal treatment that was related to the accident in relationship to perinatal outcome. There was no difference in the mean age or median gravidity or parity by race among pregnant women who were cared for after an MVA. There was no difference in mean age or racial distribution between women who were restrained compared with women who were unrestrained; unrestrained women were more likely to be nulliparous. Unrestrained women were more likely to require nonobstetric surgery that was related to the trauma. The overall rate of placental abruption was 6%. There were 6 intrauterine fetal deaths, 3 each in the unrestrained (25%) and restrained groups (3.5%; P = .018). Airbags deployed in 17 accidents. Among the 7 women with placenta abruption, 4 women (57%) experienced air bag deployment. Lack of restraint use during pregnancy is associated with an increased risk of fetal death.

Placental Abruption

Placental abruption, classically defined as a premature separation of the placenta before delivery, is one of the leading causes of vaginal bleeding in the second half of pregnancy. Approximately 0.4-1% of pregnancies are complicated by placental abruption. The prevalence is lower in the Nordic countries (0.38-0.51%) compared with the USA (0.6-1.0%). Placental abruption is also one of the most important causes of maternal morbidity and perinatal mortality. Maternal risks include obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, disseminated intravascular coagulopathy and renal failure. Maternal death is rare but seven times higher than the overall maternal mortality rate. Perinatal consequences include low birthweight, preterm delivery, asphyxia, stillbirth and perinatal death. In developed countries, approximately 10% of all preterm births and 10-20% of all perinatal deaths are caused by placental abruption. In many countries, the rate of placental abruption has been increasing. Although several risk factors are known, the etiopathogenesis of placental abruption is multifactorial and not well understood.

Consumo de drogas durante la gestación y su repercusión neonatal. Análisis de los períodos 1982-1988 y 2002-2008

Background and objective The use of illicit drugs during pregnancy becomes a high risk situation. Our objective is to determine the currently prevalence, pregnancy, delivery and newborn's characteristics of mothers who use illicit drugs. Patients and methods Retrospective study of children exposed prenatally to illicit drugs in the Neonatology's Unit of the Hospital del Mar during 2002-2008 and comparison with 1982-1988 data. Results Heroin use is lower currently and it is always associated with other drugs, mainly inhaled or smoked. There is an increase of the maternal age (28.4 years), an improved gestational control (60.5%) and more newborns are attended in shelters (13.1%). Methadone programs provide better overall results. Human immunodeficiency virus (HIV) (25%) and hepatitis B (BHV) (2.5%) infections have decreased. Placental abruption rate in cocaine users is very high (11%). By comparing both periods, there were statistically significant differences in maternal age, gestational control, delivery way, neonatal withdrawal syndrome treatment and newborn destination. Conclusions Drug abuse remains prevalent in native pregnants. Heroin use has decreased. At present, there is a better gestational control and less HIV and HBV infections. The gestational age and somatometric parameters have not changed over the years. Methadone programs improve the deleterious aspects of opioid use. Placental abruption in pregnancy and neurobehavioral disorders in newborn are common in cocaine users.

Placental abruption: epidemiology, risk factors and consequences

Placental abruption, classically defined as a premature separation of the placenta before delivery, is one of the leading causes of vaginal bleeding in the second half of pregnancy. Approximately 0.4-1% of pregnancies are complicated by placental abruption. The prevalence is lower in the Nordic countries (0.38-0.51%) compared with the USA (0.6-1.0%). Placental abruption is also one of the most important causes of maternal morbidity and perinatal mortality. Maternal risks include obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, disseminated intravascular coagulopathy and renal failure. Maternal death is rare but seven times higher than the overall maternal mortality rate. Perinatal consequences include low birthweight, preterm delivery, asphyxia, stillbirth and perinatal death. In developed countries, approximately 10% of all preterm births and 10-20% of all perinatal deaths are caused by placental abruption. In many countries, the rate of placental abruption has been increasing. Although several risk factors are known, the etiopathogenesis of placental abruption is multifactorial and not well understood.

Pregnancy Outcomes in Women With Thyroid Peroxidase Antibodies

To estimate the prevalence of antithyroid peroxidase antibodies in the general obstetric population and to compare pregnancy outcomes in women who are antithyroid peroxidase-antibody positive with those who are antithyroid peroxidase-antibody negative. Between November 2000 and April 2003, all women who presented for prenatal care underwent thyroid screening. Serum samples from women without clinical hypothyroidism who had been screened in the first 20 weeks of gestation and delivered a singleton newborn weighing 500 g or more were analyzed for concentrations of antithyroid peroxidase antibodies. Serum thyroid peroxidase antibody levels were determined using a chemiluminescent immunoassay. Pregnancy outcomes in women with positive antithyroid peroxidase antibodies (more than 50 international units/mL) were compared with those with negative levels. Serum samples from 17,298 women were tested. Of these, 1,012 (6%) women were identified with positive antithyroid peroxidase antibodies. Women who were antithyroid peroxidase-antibody positive were older, heavier, and more often parous than women with negative antithyroid peroxidase antibodies. Rate of placental abruption was threefold higher in women with antithyroid peroxidase antibodies (1.0% compared with 0.3%, odds ratio 3.4, 95% confidence interval 1.7-6.7) after adjustment for differences in maternal demographics. Seven of the 10 abruptions associated with antithyroid peroxidase antibody occurred in women with normal thyroid-stimulating hormone and free thyroxine levels. Antithyroid peroxidase antibodies are present in 6% of the general obstetric population and are associated with a threefold increase in the rate of placental abruption. However, this increase in placental abruption does not currently warrant routine antithyroid antibody screening during pregnancy. II.

Residue amniotic fluid volume after preterm premature rupture of membranes and maternal-fetal outcome.

To determine the relationship between the residue amniotic fluid volume after preterm premature rupture of membranes (PPROM) and maternal-fetal prognosis. One hundred and forty-five pregnant women with PPROM during 28 - 34 gestational weeks were studied, hospitalized in department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University from Jan. 2002 to Feb. 2009, and Chongqing Health Center For Women And Children from Jan. 2005 to Feb. 2009. All patients are willing to take part in these experiments. According to Amniotic fluid index (AFI) by ultrasound, patients were devided into three groups: (1) Group of oligohydramnios: AFI < 50 mm; (2) Group of borderline oligohydramnios: 50 mm </= AFI < 80 mm; (3) Group of normal amniotic fluid: 80 mm </= AFI < 180 mm. All the groups were similar with patient's age, gravidity and parity, white blood cell count (WBC), gestational age at rupture of membrane, rates of placental abruption, neonatal jaundice, neonatal hypoglycemia, neonatal respiratory distress syndrome (NRDS), neonatal hypoxic ischemic encephalopathy (HIE) and neonatal respiratory failure (RF; P > 0.05). (1) Group of oligohydramnios had a shorter latent period (P < 0.05) compared with other two groups; (2) Group of oligohydramnios had a high rates of cesarean section (69%), Intra-amniotic infection (IAI, 36%), fetal distress (19%), neonatal asphyxia (28%), early-onset neonatal sepsis (28%) and hypoxic-ischemic myocardial injury (56%) than those in Group of normal amniotic fluid (39%, 9%, 3%, 8%, 9%, 13%; P < 0.01); (3) Logistic regression analysis showed that group of oligohydramnios was an independent risk factor of IAI and early-onset neonatal sepsis (P < 0.05). Oligohydramnios after pprom is associated with the shorter latent period, as well as the increasing risks of pregnancy complications of cesarean section, IAI, fetal distress, neonatal asphyxia, early-onset neonatal sepsis and neonatal hypoxic-ischemic myocardial injury. So, the amniotic fluid volume might be an important prognostic indicator to assess the outcomes of maternal and neonatal when PPROM happened.

Maternal pre-gravid body weight and risk for placental abruption among twin pregnancies

Objectives. Placental abruption is a major cause of fetal and neonatal death and has been reported more frequently in twin pregnancies than among singleton gestations. The purpose of this article is to investigate the role of maternal pre-gravid body mass index (BMI) on the risk for placental abruption among twin pregnancies.Methods. We used the Missouri maternally linked cohort files (years 1989–1997) consisting of twin live births (gestational age 20–44 weeks). Maternal pre-gravid weight was classified based on the following BMI-based categories: normal (18.5–24.9), underweight (<18.5), overweight (25–29.9), and obese (>30). We used logistic regression for generated adjusted odds ratios with correction for the presence of intra-cluster correlation using generalized estimating equations.Results. Overall, 261 cases of placental abruption were registered over the entire study period, yielding a placental abruption rate of 14.9/1000. The frequency of placental abruption correlated negatively with maternal BMI in a dose–effect pattern: underweight (19.3/1000); normal weight (16.1/1000); overweight (13.9/1000); and obese (9.5/1000) mothers (p for trend < 0.01). After adjusting for confounders, the likelihood of placental abruption was still lower in obese women (OR = 0.58; 95% CI = 0.38–0.87). By contrast, women who were underweight had a 20–30% greater likelihood for placental abruption when compared with normal weight mothers, although these findings were statistically not significant.Conclusions. There is an inverse relationship between pre-gravid maternal BMI and placental abruption. The mechanism by which obesity impacts the likelihood of placental abruption in twin pregnancies requires further study.

Impact of Cirrhosis and Liver Transplant on Maternal Health During Labor and Delivery

The impact of cirrhosis or prior liver transplant on maternal health during pregnancy has not been studied. We sought to characterize outcomes during labor and delivery among pregnant women with these 2 conditions. A population-based cohort study of women admitted for labor and delivery to US hospitals between 1998 and 2005 was conducted using the Nationwide Inpatient Sample database. We compared health outcomes between pregnant women with cirrhosis or liver transplant with those without known liver disease, adjusting for potential confounders. The rates of cesarean section were higher among pregnant women with cirrhosis (n = 187; adjusted odds ratio [aOR], 2.4; 95% confidence interval [CI], 1.7-3.4) and those with prior liver transplant (n = 86; aOR, 1.8; 95% CI, 1.0-3.2), compared with general obstetrical patients (n = 662,408), as were the rates of preterm labor, peripartum infection, and hypertension. The rates of death (aOR, 42.5; 95% CI, 8.5-214), venous thromboembolism (aOR, 12.3; 95% CI, 4.9-31.0), and protein-calorie malnutrition (aOR, 67.4; 95% CI, 7.5-603), as well as the rates of placental abruption and peripartum blood transfusion, were specifically higher in cirrhotic women. Women with clinically apparent decompensated cirrhosis had higher rates of cesarean delivery, preterm labor, placenta previa, and peripartum blood transfusion than women with compensated cirrhosis. Pregnant women with cirrhosis or prior liver transplant are at higher risk of developing numerous adverse health problems than pregnant women without these conditions. Further prospective studies are warranted to assess the benefit of aggressive preventative measures and involvement of multidisciplinary health care teams.

&lt;![CDATA[&lt;B&gt;Maternal factors and perinatal results in placental abruption&lt;/B&gt;: &lt;B&gt;a comparative study of two periods&lt;/B&gt;]]&gt;

OBJETIVOS: comparar o perfil dos fatores maternos, aspectos clínicos e os resultados perinatais no descolamento prematuro da placenta (DPP), em dois períodos. MÉTODOS: avaliação retrospectiva dos casos de DPP ocorridos entre 01 de janeiro de 1994 e 31 de dezembro de 1997 (período 94-97), e entre 1 de abril de 2001 e 31 de março de 2005 (período 01-05), em gestações únicas com peso do recém-nascido superior a 500 g e idade gestacional acima da 20ª semana. Foram analisados os fatores: idade materna, cor, antecedentes obstétricos, pré-natal, rotura prematura de membranas, intercorrências clínicas e/ou obstétricas, sangramento, tônus uterino, malformação fetal, tipo de parto, hemoâmnio e complicações maternas (histerectomia, atonia uterina, CIVD, insuficiência renal aguda e morte materna), e os resultados perinatais. RESULTADOS: no período 94-97, foram realizados 7692 partos e o DPP ocorreu em 0,78% (60 casos), e, no período 01-05, foram 8644 partos com 0,59% (51 casos) de DPP (sem diferença significativa). Observou-se diferença significativa entre os períodos 94-97 e 01-05 em relação à média do número de gestações (3,5±2,4 e 2,6±1,8; p=0,04), não realização de pré-natal (13,3 e 2,0%; p=0,03) e intercorrências maternas (38,3 e 64,7%; p=0,01). Não foram observadas diferenças significativas quanto ao sangramento, à alteração no tônus e aos resultados perinatais, entre os períodos, verificando-se apenas maior proporção de hemoâmnio no período 94-97 que no 01-05 (28,3 e 11,8%, p=0,03). CONCLUSÕES: apesar dos avanços da obstetrícia, as complicações maternas e os resultados perinatais foram semelhantes nos períodos analisados. A gravidade e a imprevisibilidade do fenômeno alertam para a prevenção e controle adequados diante dos fatores associados ao DPP, na abordagem desta doença.

Induction of labor with misoprostol in pregnancies with advanced maternal age

Objective The objective was to compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in advanced aged pregnancies with a Bishop score of <6. Study design A hundred advanced aged (≥35 years) pregnant patients with a Bishop score of <6 were randomized into two groups. The first group (50 patients) received 50 μg intravaginal misoprostol four times with 4 h intervals and the second group received oxytocin infusion for induction of labor starting from 2 mIU/min and was increased every 30 min with 2 mIU/min increments up to a maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome, and maternal complications were recorded. Statistical analyses were performed using the Mann–Whitney U, Chi-squared and t tests to determine differences between the two groups. A p value ≤0.05 was considered significant. Results Misoprostol was superior for induction of labor in advanced aged pregnancies with Bishop score of <6, as the mean time from induction to delivery was 9.61 ± 4.12 h and 11.46 ± 4.86 h in the misoprostol and oxytocin groups respectively, with a significant difference between the groups ( p = 0.04). The rate of vaginal delivery was higher in the misoprostol group (84.0%) than in the oxytocin group (80.0%), but the difference did not reach significance ( p = 0.60). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no cases of uterine rupture occurred. The 1- and 5-min mean Apgar scores were 6.98 ± 1.17 to 9.08 ± 0.99 and 6.88 ± 1.81 to 9.00 ± 1.35 in the misoprostol and oxytocin groups respectively, with no significant differences between the groups ( p = 0.74, p = 0.83). No cases of asphyxia were present. The rate of admission to the neonatal intensive care unit was similar in both groups. Conclusion Intravaginal misoprostol seems to be an alternative method to oxytocin in the induction of labor in advanced aged pregnant women with low Bishop scores, as it is efficacious, cheap, and easy to use. But large studies are necessary to clarify safety with regard to the rare complications such as uterine rupture.

Induction of labor in great grandmultipara with misoprostol

Objective To compare the efficacy and complications of intravaginal misoprostol application with oxytocin infusion for induction of labor in great grandmultiparous pregnancies with a Bishop score of <6. Study design Sixty-four great grandmultiparous (delivering the tenth, or greater, infant) pregnant patients with a Bishop score of <6 were randomized in two groups with 32 patients receiving 50 μg intravaginal misoprostol four times with 4 h intervals, and 32 patients receiving oxytocin infusion for induction of labor starting from 2 mIU/min, increasing it every 30 min with 2 mIU/min increments up to maximum of 40 mIU/min. The time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. Statistical analyses were performed using Mann–Whitney U-test, Chi-Square test and hypothesis test about differences for two proportions ( t-test) to determine differences between the two groups. P ≤ 0.05 was considered significant. Result The mean time from induction to delivery was 9.91 ± 4.30 and 10.88 ± 4.72 h in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups. The rate of vaginal delivery was 84.4 and 87.5% in the misoprostol and oxytocin administered group, respectively, with no significant difference between the groups ( P = 0.72). The rates of placental abruption and postpartum hemorrhage were similar in both groups and no case of uterine rupture occurred. The 1 and 5 min mean Apgar scores were 6.91 ± 1.57–8.88 ± 1.39 and 7.22 ± 1.24–9.06 ± 0.84 in the misoprostol and oxytocin administered group with no significant differences between the groups ( P = 0.38 and 0.51). No case of asphyxia was present. The rate of admission to neonatal intensive care unit was higher in the misoprostol administered group, but the difference was not significant. Conclusion Intravaginal misoprostol is an alternative method to oxytocin in induction of labor in great grandmultiparous pregnant women with low Bishop scores, as it is effective, cheap and easy to use. Safety about rare complications and neonatal morbidity needs clarifications with further studies.

Folic Acid and Placental Pathology

ArticlePlus Click on the links below to access all the ArticlePlus for this article. Please note that ArticlePlus files may launch a viewer application outside of your web browser. https://links.lww.com/EDE/A157 https://links.lww.com/EDE/A158 To the Editor: Placental abruption (premature placental separation from the uterus) and placental infarction (often resulting from microscopic thrombi or clots within placental blood vessels) are associated with increased risks of stillbirth,1 intrauterine growth restriction,1,2 and preterm delivery.1–3 Folate deficiency has been suggested to be associated with placental abruption and infarction (pooled odds ratio = 26; 95% confidence interval = 0.9–736).4 Canadian white flour has been fortified with folic acid since January 1998. We performed an analysis to determine if there was a change in the rate of placental abruption and infarction in relation to folic acid food fortification. We conducted a retrospective population-based study of the monthly prevalence of placental abruption and infarction (calculated by dividing the number of women hospitalized with a diagnosis of either condition in a given month by all women who gave birth to a live-born or stillborn infant >20 weeks’ gestation age within the same month). The exposure of interest was the mandatory folic acid food fortification, with the prefortification period was defined as January 1, 1995, to September 30, 1998 (allowing a lag effect of 9 months for gestation) and postfortification from October 1, 1998, to March 31, 2001. Pregnancies affected by placental abruption or placental infarction were identified using the Canadian Institute for Health Information Discharge Abstract Database, which contains up to 16 diagnoses, coded by International Classification of Diseases, 9th Revision. Codes used are listed in Appendix 1 (available with the electronic version of this letter). Complete data for the province of Quebec and the Northwest Territories, Yukon and Nunavut, were not available and were excluded. A crude prevalence ratio (PR) compared the prevalence of placental abruption in the periods before and during fortification. Poisson regression was used to adjust the PR for maternal age >35 years, as well as the covariates listed in electronic Appendix 1. These analyses were repeated for placental abruption or placental infarction. All patient identifiers were removed before database extraction. Permission to conduct this study was granted by the Research Ethics Board of Mount Sinai Hospital, Toronto. There were 1,159,329 deliveries before fortification and 695,154 in the period thereafter. Participant characteristics are presented in electronic Appendix 2. Monthly prevalences of placental pathologic events are shown in electronic Appendix 3. No change in association with fortification was observed in the risk of placental abruption in either univariate (1.02; 0.99–1.05) or multivariate analyses (1.02; 0.98–1.05) (Table 1). Similar risk estimates were observed for placental abruption or placental infarction separately.TABLE 1: Risk of Placental Abruption or Infarction in Association With Folic Acid Food FortificationWe had no information on maternal weight or cigarette smoking (risk factors for placental disease), folic acid supplement use, or serum folate concentrations. However, since fortification began, red cell folate concentrations have increased by more than 40% among Canadian women,5 and the relative prevalence of folate deficiency declined by more than 85%.6 Our study included nearly all Canadian women who delivered over a 6-year period, with nearly 100% statistical power to detect as little as a 1% change in the prevalence of placental abruption. Thus, it is unlikely that folic acid can prevent abruption or infarction. ACKNOWLEDGMENTS Supported by the physicians of Ontario through the Physicians’ Services Incorporated Foundation, Sunnybrooke and Women's College Foundation, and John Kingdom. Sarah D. McDonald Clinical Epidemiology Unit Ottawa Hospital Ottawa, Ontario, Canada [email protected] Marian J. Vermeulen Institute for Clinical Evaluative Sciences Toronto, Ontario, Canada Joel G. Ray St. Michael's Hospital, University of Toronto Toronto, Ontario, Canada