Risk Factor For Maternal Complications Research Articles

Risk factors for maternal complications following uterine rupture: a 12-year single-center experience.

To determine maternal outcomes and risk factors for composite maternal morbidity following uterine rupture during pregnancy. A retrospective cohort study including all women diagnosed with uterine rupture during pregnancy, between 2011 and 2023, at a single-center. Patients with partial uterine rupture or dehiscence were excluded. We compared women who had composite maternal morbidity following uterine rupture to those without. Composite maternal morbidity was defined as any of the following: maternal death; hysterectomy; severe postpartum hemorrhage; disseminated intravascular coagulation; injury to adjacent organs; admission to the intensive care unit; or the need for relaparotomy. The primary outcome was risk factors associated with composite maternal morbidity following uterine rupture. The secondary outcome was the incidence of maternal and neonatal complications following uterine rupture. During the study period, 147,037 women delivered. Of them, 120 were diagnosed with uterine rupture. Among these, 44 (36.7%) had composite maternal morbidity. There were no cases of maternal death and two cases of neonatal death (1.7%); packed cell transfusion was the major contributor to maternal morbidity [occurring in 36 patients (30%)]. Patients with composite maternal morbidity, compared to those without, were characterized by: increased maternal age (34.7 vs. 32.8years, p = 0.03); lower gestational age at delivery (35 + 5 vs. 38 + 1weeks, p = 0.01); a higher rate of unscarred uteri (22.7% vs. 2.6%, p < 0.01); and rupture occurring outside the lower uterine segment (52.3% vs. 10.5%, p < 0.01). Uterine rupture entails increased risk for several adverse maternal outcomes, though possibly more favorable than previously described. Numerous risk factors for composite maternal morbidity following rupture exist and should be carefully assessed in these patients.

Repeat low order caesarean delivery, risk factors for complications: A retrospective, longitudinal study.

One-third of cesarean deliveries (CDs) are repeat operations, of which the majority are low-order, second (CD2) and third (CD3). The study objectives were to identify risk factors for a complicated maternal CD among women undergoing a repeat low-order CD and to develop a predictive model for at-risk women. A retrospective longitudinal follow-up study was conducted in a single medical center, during 2005-2016. Women who underwent both CD2 and CD3 at the site were included. Those with placenta accreta or a caesarean hysterectomy were excluded. A composite complicated maternal CD was defined by either uterine rupture/dehiscence, blood transfusion, relaparotomy, admission to the intensive care unit or prolonged operative time >90th percentile. Data was analyzed comparing between CD2 to CD3, each woman served as her own control. Univariate analysis followed by a multivariate logistic regression modeling were performed with an OR of 95% CI defining significance. The study group comprised of 1,331 women. A complicated CD occurred in 159 (12%) vs. 226 (17%) of CD2 vs. CD3 respectively, (p<0.001). Women with a complicated CD2 were at higher risk for complications in CD3, aOR 2.3 (95% CI 1.5, 3.3). Sub-Saharan African origin and preterm delivery at CD3 were both risk factors for a complicated CD3, aOR 3.7 (95% CI 1.9, 7.3) and aOR 1.7 (95% CI 1.1, 2.7), respectively. The multivariate regression model included 1328 cases, was statistically significant, χ2(7) = 50.760, p <0.001, explained 6.3% of the variance of composite complicated maternal CD3 and correctly classified 82.9% of cases. Although a complicated CD2, Sub-Saharan African origin and preterm delivery are risk factors for maternal complications in CD3, it is hard to predict which specific women will experience complications. Sensitivity, specificity, positive and negative predictive value of a complicated CD2 for detecting complications in CD3 were 21%, 90%, 30% and 85% respectively.

Fetal Hydrothorax Treated with Pleuro-Amniotic Shunting: Fetal and Maternal Complications and Long-Term Outcomes

Introduction: We aimed to identify maternal and fetal complications and investigate postnatal and long-term outcomes of fetal hydrothorax (FHT) treated with pleuro-amniotic shunting (shunt). Methods: Single-center retrospective observational cohort of shunt cases performed from 2000 to 2021. Risk factors for maternal complications, fetal demise, neonatal death (NND), and postnatal outcomes were identified. Results: Out of 88 cases, 70 (79.5%) were complicated by hydrops, with an average gestational age (GA) at diagnosis of 27 weeks (range 16–34). In 16 cases, definitive etiology of FHT was identified; five cases of Noonan syndrome and three cases of monogenic disorders diagnosed by whole-exome sequencing (EPHB4, VEGFR3, RASA1). Shunt was performed at an average GA of 28 weeks (20–34), with a dislodgement in 10 cases (11.4%). Maternal: Complications occurred in three cases; survival rate was 76.1% (67/88). Follow-up data were available for 57/67 (85.1%) children. Incidence of severe neurodevelopmental impairment and pneumopathy (broncho dysplasia, persistent pulmonary hypertension of newborn, and asthma) was 5.3% and 8.8%, respectively. Post-treatment persistence of hydrops, FHT associated with genetic syndromes, and GA at birth were risk factors for fetal demise, NND, and postnatal complications. Conclusion: In truly isolated FHT, whenever indicated, pleuro-amniotic shunting is a safe procedure associated with good survival rate and long-term outcome.

Obstetric complications and outcomes of singleton pregnancy with previous caesarean section according to maternal age

IntroductionTo delineate obstetric complications and neonatal outcomes by maternal age in singleton pregnancies with previous caesarean section (CS). MethodsA retrospective study involved 7715 singleton gestations with previous CS was conducted in a single centre. Statistical methods were used to describe and analyse the incidence of various complications and adverse outcomes classified by maternal ages. After selecting the reference group (30–34 years), multivariate logistic-binomial regression model was used to investigate the outcomes using SPSS. ResultsFrom 2013 to 2017, the proportion of advanced maternal age (AMA, ≥35 years) women with a history of CS increased yearly, especially in the 35–39 years age group. AMA women accounted for 39.4% of all pregnancies and has a high incidence of in vitro fertilization(IVF), progesterone therapy in early pregnancy, pregnancy-induced hypertension (PIH), gestational diabetes mellitus (GDM), placenta previa, premature rupture of membranes (PROM) and postpartum haemorrhage (PPH). Compared to the 30–34 years group, the risks of PIH, GDM, placenta previa, PROM and PPH increased in AMA pregnancies. Very advanced age (≥40 years) may be associated with placenta accreta while young mothers (20–24 years) have a higher prevalence of premature birth. Vaginal bleeding during pregnancy is a risk factor for maternal complications, maternal and neonatal morbidity. DiscussionAMA is associated with increased risk of PIH, GDM, placenta previa, PROM and PPH. Vaginal bleeding may be a predictor during pregnancy.

Maternal Outcome in Overweight and Obese Women: A Comparison between Revised Consensus Body Mass Indices (BMI) for Asian Indians and WHO Criteria

International Journal of Medicine and Public Health,2022,12,1,20-23.DOI:10.5530/ijmedph.2022.1.4Published:January 2022Type:Original ArticleMaternal Outcome in Overweight and Obese Women: A Comparison between Revised Consensus Body Mass Indices (BMI) for Asian Indians and WHO CriteriaAncy T Jacob, Deepu Rajendran, Anaswara T, and Sheela Jacob Ancy T Jacob1, Deepu Rajendran2,*, Anaswara T3, Sheela Jacob4 1Department of Obstetrics and Gynaecology, Travancore Medical College, Kollam, Kerala, INDIA. 2Consultant, Interventional Cardiologist and Assistant Professor in Department of General Medicine, Travancore Medical College, Kollam, Kerala, INDIA. 3Department of Obstetrics and Gynaecology, ESI Super Speciality Hospital, Asramom, Kollam, Kerala, INDIA. 4Department of Obstetrics and Gynaecology, Travancore Medical College, Kollam, Kerala, INDIA. Abstract:Background: Overweight or obesity is a major risk factor for maternal complications. Most western countries adhere to WHO guidelines for classifying obesity. In India, revised consensus Body Mass Indices (BMI) for Asian Indians are used for BMI classification. The present study aims to compare WHO and revised consensus BMI criteria for Asian Indians on the maternal outcome in overweight and obese women. Methodology: This was a retrospective study done in 399 women with singleton deliveries during a period of six months in a tertiary care center in South India. Data were gathered from medical records in accordance with the inclusion and exclusion criteria. Two proportion Z-test and Independent t test were used for the comparison between the WHO and revised consensus BMI for Asian Indian criteria. Results: Overweight/obesity prevalence was 40.60% as per WHO criteria and 63.91% as per Asian Indian criteria. Proportionate difference was significant for the parameters GDM, PIH, and preterm labor between obese and nonobese women in Asian Indian criteria. WHO criteria showed significant difference in GDM and PIH only (p <0.05). Preterm labor was found to be insignificant between both criteria among non-obese women (p>0.05). Conclusion: The study could not find statistically significant differences between the two criteria. As the body fat distribution in Asian Indians differs considerably from other ethnic groups, we recommend the use of revised consensus BMI for Asian Indians for BMI classification to prevent maternal morbidity and mortality. Keywords:Obesity, Overweight, Pregnancy., Revised Consensus BMI for Asian Indians, WHO BMI guidelineView:PDF (178.45 KB)

Pregnancy and delivery in women receiving maintenance hemodialysis in Japan: analysis of potential risk factors for neonatal and maternal complications

IntroductionAverage dialysis vintage in Japan is among the longest in the world, providing a unique opportunity to characterize pregnancy under conditions of long dialysis vintage. In 2017, we carried out a nationwide survey following up on a similar survey in 1996, in which we investigated the prevalence and outcomes of pregnancy in women undergoing dialysis and assessed risk factors associated with neonatal and maternal complications.MethodsThe target population was women aged 15–44 years undergoing maintenance dialysis between 2012 and 2016. The survey was conducted in 2693 dialysis units.ResultsA response was obtained from 951 dialysis units, yielding a target population of 1992 women of childbearing age receiving hemodialysis or peritoneal dialysis. Pregnancy occurred only among women receiving hemodialysis, with 25 pregnancies (1.26% in 5 years) being reported for 20 women. Detailed information about 19 pregnancies (mean age 34.6 ± 5.7 years at conception, mean dialysis vintage 8.4 ± 7.3 years) indicated 4 spontaneous abortions, 1 elective abortion, no neonatal deaths, and 14 surviving infants, including 5 full-term (≥ 37 weeks at birth), 2 late preterm (34–36), and 3 extremely preterm (< 28) cases. Neonatal complications occurred in the offspring of 3 mothers who had end-stage renal disease (ESRD) caused by primary glomerulonephritis and serum albumin levels (sAlb) ≤ 3.2 mg/dL in the first trimester. These mothers had started dialysis at 12, 17, and 30 years of age. ESRD caused by diabetic nephropathy or primary glomerulonephritis, age at conception ≥ 38 years, and sAlb ≤ 3.2 mg/dL were associated with maternal complications, although not significantly.ConclusionsIn this study, the pregnancy rate of Japanese women with ESRD was 0.25% per year. The study generates the hypothesis that ESRD caused by diabetic nephropathy and age at conception ≥ 38 years are potential risk factors for maternal complications but not for neonatal complications in dialysis patients, and that hypoalbuminemia is a potential risk factor for both kinds of complications.Graphic

Hubungan Obesitas dengan Komplikasi Maternal dan Luaran Perinatal

Obesity is a global health problem which numbers continue to increase from year to year. Obesity is a risk factor for maternal complications and adverse perinatal outcomes. This systematic review aims to evaluate the association of obesity with maternal complications and perinatal outcomes. This systematic review was conducted by searching for studies on databases such as Pubmed, Google Scholar, Science Direct or Clinical Key and the studies observed are studies published in 2016-2020 in Indonesian and English. The results of the study search were obtained as many as 74 studies and 31 studies that met the inclusion and exclusion criteria of the study. Of the 31 studies examined, there were 16 studies that analyzed the associtation between obesity and preeclampsia, 25 studies that analyzed the association between obesity and gestational diabetes, 16 studies that analyzed the association between obesity and preterm birth, 15 studies that analyzed the association between obesity and fetal death, and 19 studies that analyzed the association between obesity and macrosomia. Based on this systematic review it can be concluded that obesity was associated with the incidence of preeclampsia, gestational diabetes, preterm birth and macrosomia. But, obesity was not associated with perinatal mortality.

Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors?

To evaluate maternal complications of first trimester and second trimester termination of pregnancy (TOP) performed after first or second trimester positive prenatal diagnosis (PD). We performed a retrospective study from January 2007 to December 2011, on 844 patients, who underwent a TOP after positive amniocentesis or chorionic villus sampling (CVS) for foetal aneuploidies, performed for maternal age ≥35 years of age, positive prenatal screening (PS) or for genetic reasons. Exclusions criteria were gestational age >22+0 weeks, twin pregnancy and co-existing maternal pathologies. We compared maternal complications of first trimester and second trimester TOP and we established which risk factors were correlated to higher maternal complications (haemorrhages, transfusion, repeated uterine curettage and infections). Maternal complications were significantly higher in second trimester TOP. Previous uterine surgery is a significant risk factor for maternal complications in second trimester TOP, but not in first trimester TOP. Six uterine ruptures and three hysterectomies occurred, all in multiparous women with second trimester TOP. All uterine ruptures occurred in women with previous caesarean sections. First trimester TOP in women with risks factors for maternal complications guarantees better maternal outcomes and less health costs. Thus, in these women we should prefer a first trimester PS and PD.

Maternal complication prevention: evidence from a case-control study in southwest Nigeria.

BackgroundThe importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes.AimThis study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention.SettingThe study was carried out in a postnatal ward in a secondary health facility.MethodsThis was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases) was done, and one booked pregnant woman (control) was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05.ResultsBooked women had a lower median length of labour (10 hours) compared to unbooked women (13 hours). More women in the booked control group (139; 35.1%) than in the unbooked case group (96; 23.6%) reported at least one type of morbidity during the index pregnancy (p = 0.0004). Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery.ConclusionStrengthening antenatal and secondary healthcare services as short- and medium-term measures might be cost-effective as a preventive strategy in complications of pregnancy, whilst socio-economic dimensions of health are accorded priority in the long term.

Is ethnicity a risk factor for maternal complications in operative vaginal delivery?

Is ethnicity a risk factor for maternal complications in operative vaginal delivery?