Risk Of Placental Abruption Research Articles

Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study.

STUDY QUESTIONWhat is the association between endometriosis and adverse pregnancy outcomes with ART use and non-use?SUMMARY ANSWEREndometriosis and ART use are both associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth (caesarean delivery or induction of labour).WHAT IS KNOWN ALREADYThere are contradictory findings on the association between endometriosis and adverse pregnancy outcomes, and many large studies have not considered the effect of ART use.STUDY DESIGN, SIZE, DURATIONPopulation-based cohort study of 578 221 eligible pregnancies during 2006–2015, comparing pregnancy outcomes across four groups (No endo/no ART, No endo/ART, Endo/no ART and Endo/ART).PARTICIPANTS/MATERIALS, SETTING, METHODSAll female residents of New South Wales, Australia aged 15–45 years and their index singleton pregnancy of at least 20 weeks gestation or 400 g birthweight. Linked hospital, pregnancy/birth and mortality data were used. Modified Poisson regression with robust error variances was used to estimate adjusted risk ratios (aRRs) and 99% CIs, adjusting for sociodemographic and pregnancy factors.MAIN RESULTS AND THE ROLE OF CHANCECompared to women without endometriosis who had pregnancies without ART use, there was increased risk of preterm birth (<37 weeks) in all groups [No endo/ART (aRR 1.85, 99% CI 1.46–2.34), Endo/no ART (aRR 1.24, 99% CI 1.06–1.44), Endo/ART (aRR 1.93, 99% CI 1.11–3.35)] and antepartum haemorrhage [No endo/ART (aRR 1.99, 99% CI 1.39–2.85), Endo/no ART (aRR 1.31, 99% CI 1.03–1.67), Endo/ART (aRR 2.69, 99% CI 1.30–5.56)] among pregnancies affected by endometriosis or ART use, separately and together. There was increased risk of placenta praevia [No endo/ART (aRR 2.26, 99% CI 1.42–3.60), Endo/no ART (aRR 1.66, 99% CI 1.18–2.33)] and planned birth [No endo/ART (aRR 1.08, 99% CI 1.03–1.14), Endo/no ART (aRR 1.11, 99% CI 1.07–1.14)] among pregnancies with endometriosis or ART use, separately. There was increased risk of placental abruption [No endo/ART (aRR 2.36, 99% CI 1.12–4.98)], maternal morbidity [No endo/ART (aRR 1.67, 99% CI 1.07–2.62)] and low birthweight (<2500 g) [No endo/ART (aRR 1.45, 99% CI 1.09–1.93)] among pregnancies with ART use without endometriosis. There was decreased risk of having a large-for-gestational age infant [Endo/no ART (aRR 0.83, 99% CI 0.73–0.94)] among pregnancies with endometriosis without ART use.LIMITATIONS, REASONS FOR CAUTIONEndometriosis is often under-diagnosed and women with a history of hospital diagnosis of endometriosis may represent those with more symptomatic or severe disease. If the effects of endometriosis on pregnancy are greater for those with more severe disease, our results may over-estimate the effect of endometriosis on adverse pregnancy outcomes at a population level. We were unable to assess the effect of endometriosis stage or typology on the study outcomes.WIDER IMPLICATIONS OF THE FINDINGSThese results suggest that women with endometriosis including those who used ART to achieve pregnancy are a higher-risk obstetric group requiring appropriate surveillance and management during their pregnancy.STUDY FUNDING/COMPETING INTEREST(S)This study was supported by the Prevention Research Support Program, funded by the New South Wales Ministry of Health. The funder had no role in the design, data collection and analysis, interpretation of results, manuscript preparation or the decision to submit the manuscript for publication. The authors have no conflicts of interest.TRIAL REGISTRATION NUMBERN/A.

Parental ageing and Assisted Reproduction Technologies: analysis of risk of chronic diseases in the progeny

Conception of a child at advanced parental age (> 35 years) has been steadily increasing in recent decades, especially in developed countries. Socio-economic factors, effective contraceptives, and the availability of Assisted Reproduction Technologies (ART) have a direct impact on postponing the decision to have a baby. ART enables reproductive success for people diagnosed as infertile or with reduced possibilities of becoming pregnant due to concomitant pathologies. Epidemiological studies indicate that both advanced parental age and ART are associated with pathologies of pregnancy, such as gestational diabetes, risk of pre-eclampsia, miscarriage, placental abruption, preterm labor, stillbirth, neurodevelopmental disorders and chronic disease of the offspring. In our work, we will focus on the available information on metabolic changes that increase the risk of developing cardiovascular diseases in the offspring of parents at an advanced age and conceived through ART. Finally, we will address the sources of the observed disturbances at the gamete and embryo level, related to oxygen stress, epigenetic modifications and DNA damage, considering possible rescue actions.

Treatment for Mild Chronic Hypertension During Pregnancy

(Abstracted from N Engl J Med 2022;386:1781–1792) Chronic hypertension develops in 2% of pregnancies in the United States. As this condition disproportionately affects Black women and is associated with 3 to 5 times the risk of placental abruption, preeclampsia, preterm birth (PTB), small-for-gestational-age (SGA) birthweight, and perinatal death, optimizing treatment is critical to possibly preventing these associated complications.

Obstetric outcomes following ovarian hyperstimulation syndrome in IVF – a comparison with uncomplicated fresh and frozen transfer cycles

BackgroundWe aimed to assess the correlation between ovarian hyperstimulation syndrome (OHSS) in the early course of in vitro fertilization (IVF) pregnancies and obstetric outcomes.MethodsWe identified records of patients admitted due to OHSS following IVF treatment at our institution between 2008 and 2020. Cases were included if pregnancy resulted in a live singleton delivery (OHSS group). OHSS cases were matched at a 1:5:5 ratio with live singleton deliveries following IVF with fresh embryo transfer (fresh transfer group) and frozen embryo transfer (FET group), according to maternal age and parity. Computerized files were reviewed, and maternal, obstetric and neonatal outcomes compared.ResultsOverall, 44 OHSS cases were matched with 220 fresh transfer and 220 FET pregnancies. Patient demographics were similar between the groups, including body mass index, smoking and comorbidities. Gestational age at delivery, the rate of preterm births, preeclampsia and cesarean delivery were similar between the groups. Placental abruption occurred in 6.8% of OHSS pregnancies, 1.4% of fresh transfer pregnancies and 0.9% of FET pregnancies (p=0.02). On post-hoc analysis, the rate of placental abruption was significantly higher in OHSS pregnancies, compared with the two other groups, and this maintained significance after adjustment for confounders. Birthweights were 3017 ± 483, 3057 ± 545 and 3213 ± 542 grams in the OHSS, fresh transfer and FET groups, respectively (p=0.004), although the rate of small for gestational age neonates was similar between the groups.ConclusionsOHSS in the early course of IVF pregnancies is associated with an increased risk of placental abruption.

MATERNAL CHARACTERISTICS, FETO-MATERNAL OUTCOME AND SEASONAL VARIATION IN PRE-ECLAMPSIA WITH SEVERE FEATURES AND ECLAMPSIA

Aims&amp;objectives:- To study prevalence of pre-eclampsia, co-relation of severe pre-eclampsia and eclampsia with maternal characteristics,feto-maternal outcome,seasonal variation and sex of the fetus, if any. Materials&amp;Methoods- It was prospective observational study, carried out in obstetrics and gynecology department, MMIMSR, Mullana, Ambala, a tertiary care rural hospital in North India, from 1st June,2020 to 31st December,2020. Maternal characteristics, risk factors, sex of fetus, adverse maternal and fetal outcomes were recorded and data analyzed. Retrospective analysis of patients with severe pre-eclampsia and eclampsia, for a period of 3 years from January,2018 to December,2020 was done to see seasonal variation. Results:- A total of 1275 births were recorded from 1st June,2020 to 31st Dec,2020. 114 women were diagnosed with Hypertensive disorders of pregnancy with a prevalence of 8.94%. An increased incidence(75%) of severe pre-eclampsia/eclampsia in unbooked patients was seen. 87.5% patients were less than 30 years. 55% patients were primigravida. Severe preeclampsia-eclampsia was more in rural population(80%) with low literacy level(45%) and low socio-economic status(70%). Signicantly increased incidence(72.5%) of pre-eclampsia in women with dark complexion. 52.5% cases were seen in BMI range of 30.0-34.9. 42.5% patients presented before 34 weeks, 47.5% beyond 34 weeks and 10% within 48 hours post-partum. Singleton pregnancy was seen in 92.5% cases. Anemia was contributing factor in 42.5% and. 12.5% had APS. Caesarean rate was very high. Increased risk of severe pre-eclampsia has been observed while carrying a male fetus(67.5%). Patients with severe pre-eclampsia had increased risk of eclampsia(27.5%) and placental abruption(17.5%). FGR seen in 20%, with oligohydramnios in 15% cases. ICU admission with ventilator support needed by 10% while 5% had maternal deaths. Fetal complications, like pre-maturity seen in 50%, NICU admission required in 57.5% and intra-uterine death in 27.5%. Peak incidence recorded in summers(June-July). Conclusion-Unbooked/referred-in pregnancy, illiteracy, low socio-economic status, undiagnosed maternal risk factors, anemia pose a challenge for early diagnosis and management of severe pre-eclampsia&amp;eclampsia. Severe disease is usually early onset, more in dark complexion with male fetus in-utero with peak incidence in summer. Regular antenatal check-up with diagnosis of high-risk factors in rst trimester, to implement preventive measures should be universal guideline.

15 Victoria: A case of obstetric success

Hypertensive disorders of pregnancy constitute one of the leading causes of maternal and perinatal mortality worldwide. These disorders increase the risk of placental abruption, amongst others, an obstetric emergency that requires lifesaving procedures.

Levothyroxine Supplementation in Euthyroid Pregnant Women With Positive Autoantibodies: A Systematic Review and Meta-Analysis.

ObjectivesTo explore the role of levothyroxine (LT4) supplementation in affecting the outcome of pregnant euthyroid women with thyroperoxidase (TPO) antibodies.MethodsMEDLINE, EMBASE, Google Scholar, and the Web of Science databases were searched. The primary outcome was pre-term birth (PTB), defined as live birth before 37 weeks of gestation; secondary outcomes were gestational hypertension, pre-eclampsia (PE), placental abruption, miscarriage, intra-uterine death (IUD), and admission to neonatal intensive care unit (NICU). All these outcomes were explored in euthyroid women with TPO antibodies receiving compared to those not receiving LT4 supplementation in pregnancy. Random-effect meta-analyses were used to analyze the data and results reported as pooled odds ratios (OR) with their 95% confidence intervals (CI).ResultsThe risk of PTB was lower in women with TPO antibodies receiving compared to those not receiving LT4 supplementation (OR of 0.60 (95% CI 0.4-0.9). However, this association came mainly from observational studies (OR: 0.29, 95% CI 0.1-0), while RCTs did not show any beneficial effect of LT4 supplementation in affecting such outcomes. Conversely, there was no difference in the risk of gestational hypertension, preeclampsia, placental abruption, miscarriage, and admission to NICU between the two groups.ConclusionsLT4 supplementation in TPO euthyroid women is not associated with a reduced risk of PTB in TPO-positive women with normal thyroid function.

Pregnancy Outcomes in Women with Thyroid Diseases.

Introduction: Overt hyperthyroidism and hypothyroidism are associated with pregnancy complications; however, most women with these conditions are diagnosed before conception and are under treatment during pregnancy, especially in high-income countries. The purpose of this study was to investigate pregnancy complications among these women. Methods: A retrospective cohort study was conducted, and data on pregnant women who gave birth to a singleton at Nagoya University Hospital in Japan in 2005-2014 was collected. The pregnancy outcomes were divided and compared among three groups: the control group (n = 3531), the hyperthyroidism group (n = 48), and the hypothyroidism group (n = 61). Additionally, risk factors for placental abruption were evaluated by multivariable logistic regression analysis. Moreover, in hyperthyroidism, thyroid function at the placentation period was compared between placental-related diseases and nonplacental-related disease groups, and the latter group included placental abruption and preeclampsia. Results: The incidence of placental abruption was higher in hyperthyroidism than in control and hypothyroidism groups. Hyperthyroidism was independently associated with an increased risk of placental abruption (adjusted odds ratio, aOR = 8.21, 95% confidence interval, CI: 1.76-38.34), as well as preeclampsia (aOR = 4.10, 95% CI: 1.13-14.76) and preterm labor (aOR = 3.38, 95% CI: 1.19-9.64). Additionally, thyroid-stimulating hormone (TSH) at the placentation period was significantly lower in the placental-related disease group than in the nonplacental-related disease group (p < 0.05). Conclusions: Pregnancy outcomes in women with hyperthyroidism and hypothyroidism would be comparable with those without thyroid disease. Hyperthyroidism was an independent risk factor for placental abruption as well as preterm labor and preeclampsia. However, its frequency was extremely low, and further research is required to validate our findings.

Predictors of placental abruption during expectant management of premature preterm rupture of membranes

ObjectiveTo predict the risk factors of placental abruption during expectant management of preterm rupture of membranes.BackgroundA frequency of abruption of 4.0%–6.8% has been reported in patients with preterm premature rupture of membranes (PPROM). Antepartum vaginal bleeding occurs during the period of expectant management, the associated risk of developing placental abruption is high. It may be possible to approximate the risk for placental abruption based on these simple prepregnancy risk factors.Patients and methodsAn observational study was conducted on 100 pregnant women. The patients were randomly selected from those attending labor ward at Menoufia University Hospital and Shebin EL-Kom Teaching Hospital. All women included in this study are with PPROM, divided into group I that included 79 without placental abruption and group II included 21 with placental abruption. Full analysis of detailed history and examination and primarily samples are taken during the study period from January 2019 to December 2020.ResultsThere were statistically significant differences among patients with placental abruption than those without placental abruption regarding antepartum or intrapartum fetal distress requiring urgent cesarean section and gestational age. The majority of patients with placental abruption had gestational age more than 32 weeks (P < 0.05). Most of the patients with placental abruption had latency to its occurrence more than 48 h since the time of admission with PPROM with a percentage of 85.71%.ConclusionPlacental abruption is a complex disease. Although several risk factors are known, the etiopathogenesis is not fully understood and its occurrence often remained unpredictable or unpreventable. Placental abruption was absent in 79% of our patients.

Pregnancy management in patients with uterine fibroids. Case report

Uterine fibroids (UF) are the most common tumor in women of reproductive age. The growth of myomatous nodes during pregnancy is non-linear and mainly occurs in the first trimester. In most cases, UF do not burden the course of pregnancy. Large size (5 cm), retroplacental location, and/or deformity of the uterine cavity by the myomatous node are associated with increased risks of spontaneous miscarriage, placental abruption, bleeding, preterm birth, and cesarean section. Myomectomy during pregnancy is undesirable, with the development of pain syndrome, the use of acetaminophen is safe. Indications for cesarean section in UF are the presence of a large size of fibroids that prevent delivery through the natural birth canal, red degeneration of myomatous nodes, torsion of the subserous myomatous node (degree 2C).

Assisted reproduction technology outcomes in women with infertility and preexisting diabetes mellitus: a systematic review.

To assess maternal and neonatal outcomes in women with or without preexisting diabetes mellitus (DM) undergoing assisted reproduction technology (ART) treatment. Prospective or retrospective controlled trials reporting on women with or without preexisting DM undergoing ART treatment were considered eligible. Twelve electronic databases were systematically searched up to December 2020. The risk of bias was assessed by the Cochrane Risk OF Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. Each primary outcome was extracted and pooled as maternal- or neonatal-related. Two studies were included in the systematic review, reporting on both maternal- and neonatal-related parameters after ART treatment. Due to the limited data, no meta-analysis was conducted. Preterm birth, placenta previa, and excessive bleeding during pregnancy were observed more often in pregnancies complicated by preexisting DM conceived by ART compared with pregnancies without DM. There was no difference in the risk for placental abruption between the groups. Regarding the neonatal outcomes, large-for-gestational-age (LGA) embryos and neonatal intensive care unit (NICU) admission were more commonly reported for women with preexisting DM. In one study, preexisting DM was marginally associated with infant mortality. Despite the scarce data, preexisting DM in pregnancies conceived by ART is associated with increased risk for maternal and neonatal complications. Registered in PROSPERO (registration number: 143187).

Acute Polyhydromnios: A Rare Entity

Acute Polyhydramnios is defined as accumulation of amniotic fluid rapidly complicating approximately 0.2 TO 1.6% of all pregnancies, whereas gestational diabetes (GD) is glucose intolerance in pregnant women, a major health issue in pregnant women. The prevalence rate of glucose intolerance in pregnant women is between 4.6%–14% in well developed areas and 1.7%–13.2% in rural areas. Pregnancies conceived by in vitro fertilisation (IVF) have been associated with higher risk of gestational diabetes mellitus (11.7%), gestational hypertension (9.3%), preeclampsia (4.0%), ICP (11.8%), placenta previa (7.1%), placental abruption (1.6%), PROM (9.9%), placental adherence (7.7%), postpartum haemorrhage (7.3%), and polyhydramnios (2.2%), as compared to spontaneously conceived pregnancies.&#x0D; Case Description: A 35 years primigravida, 33 weeks gestational age with IVF conception with preeclampsia with breech came with pain in abdomen since 2-3days.On clinical examination, polyhydramnios was diagnosed. On admission she presented with deranged sugar level which was abnormal and sudden rise in Glycosylated hemoglobin seen. Patient was managed conservatively by termination of pregnancy and successful outcome of pregnancy was obtained despite of liquor more than adequate and deranged sugar levels.&#x0D; Objectives: We examined the routine antenatal profile, radiological changes as well as doppler changes in IVF conceived pregnancies and further management on the basis of clinical, haematological and radiological investigations will be planned accordingly.&#x0D; Conclusion: Acute polyhydramnios and Gestational diabetes is common in patients conceived through in vitro fertilisation and is associated with poor foe to maternal outcome. Regular antenatal investigations and radiological investigations done to keep her pregnancy in check and reduce the long term effects by modifying treatment modality and by following healthy lifestyles in such patients.

RISK OF ANTEPARTUM ADMISSIONS IN ART COMPARED TO SPONTANOUSLY CONCEIVED PREGNANCIES

Over the past decade there has been a significant increase in the use of assisted reproductive technology (ART) across the United States. In 2017 there were 284,385 ART cycles performed and these cycles resulted in 78, 052 infants1. Multiple studies have identified an increase risk of preterm birth, placenta previa, placental abruption and preeclampsia in the first and second trimester in women with singleton pregnancy resulting from ART compared to naturally conceived pregnancies2-4. Yet, it is important to evaluate if this correlates to an increased risk of antepartum admissions for ART compared to spontaneously conceived pregnancy and that burden on the health care system.

Ischemic Placental Disease, Preterm Delivery, and Their Association With Opioid Use During Pregnancy.

Opioids affect placental development and function in animal models, but human data on their association with ischemic placental disease are limited. Using a cohort of pregnant women in the US nationwide Medicaid Analytic eXtract (2000-2014), we compared women with ≥2 opioid dispensings in pregnancy with unexposed women. Given an uncertain etiologically relevant window, we assessed exposure occurring in early pregnancy, late and not early pregnancy, and both early and late pregnancy. For placental abruption, preterm delivery, small for gestational age (SGA), and preeclampsia, we estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) using Cox proportional hazard models adjusting for demographic factors, indications/comorbidities, and medications. Among 1,833,871 eligible pregnancies, ≥2 opioid dispensings were filled in 6.5%. We observed an early exposure aHR of 1.34 (95% CI: 1.26, 1.43) for placental abruption, 1.21 (95% CI: 1.18, 1.23) for preterm delivery, 1.13 (95% CI: 1.09, 1.17) for SGA, and 0.95 (0.91, 0.98) for preeclampsia. Estimates for late exposure were attenuated. Early and late exposure was associated with higher aHRs for placental abruption, 1.62 (95% CI: 1.47, 1.78); preterm delivery, 1.37 (95% CI: 1.33, 1.42); and SGA, 1.26 (95% CI: 1.19, 1.33); but not preeclampsia, 0.99 (95% CI: 0.93, 1.05). Prescription opioids may modestly increase risk of placental abruption, preterm birth and SGA, but they do not appear to be associated with preeclampsia.

Molecular Changes on Maternal-Fetal Interface in Placental Abruption-A Systematic Review.

Placental abruption is the separation of the placenta from the lining of the uterus before childbirth. It is an infrequent perinatal complication with serious after-effects and a marked risk of maternal and fetal mortality. Despite the fact that numerous placental abruption risk factors are known, the pathophysiology of this issue is multifactorial and not entirely clear. The aim of this review was to examine the current state of knowledge concerning the molecular changes on the maternal–fetal interface occurring in placental abruption. Only original research articles describing studies published in English until the 15 March 2021 were considered eligible. Reviews, book chapters, case studies, conference papers and opinions were excluded. The systematic literature search of PubMed/MEDLINE and Scopus databases identified 708 articles, 22 of which were analyzed. The available evidence indicates that the disruption of the immunological processes on the maternal–fetal interface plays a crucial role in the pathophysiology of placental abruption. The features of chronic non-infectious inflammation and augmented immunological cytotoxic response were found to be present in placental abruption samples in the reviewed studies. Various molecules participate in this process, with only a few being examined. More advanced research is needed to fully explain this complicated process.

Uterine Fibroids and Pregnancy: How Do They Affect Each Other?

The present narrative review is aimed to rekindle discussion regarding whether and how uterine leiomyoma and pregnancy may impact each other. Although fibroids are hormone-dependent lesions, their growth during pregnancy seems to have a nonlinear trend. Besides placental estrogens and progesterone, an array of endocrine and paracrine factors affect fibroid blood supply, growth rate, and risk of degeneration along the gestational and puerperal periods. According to current evidence, the presence of leiomyomas might increase the risk of some adverse pregnancy outcomes. Although a causative relation between fibroids and spontaneous abortion is questionable, the presence of multiple submucosal lesions in certain populations, such as infertile women, may increase the risk of pregnancy loss. Slightly increased risks of placenta previa, placental abruption and fetal malpresentation may occur, mainly due to the mechanical influence of multiple and large fibroids. Cesarean section and preterm birth rates are also probably increased in the presence of fibroids. The risk associations are based on meta-analyses of cohort studies (level of evidence 2a), retrospective cohort studies (2b), case-control (3a), and cross-sectional studies (3b), but with a predominantly low risk of bias. For evaluating the growth pattern of leiomyomas and their real influence on obstetric outcomes, future studies should enroll women with fibroids diagnosed prior to pregnancy and follow them prospectively throughout the gestation and puerperium.

Evidence of under-reporting of early-onset preeclampsia using register data.

Early-onset preeclampsia, traditionally defined as presenting before 34 gestational weeks, is associated with even higher risks of perinatal death, placental abruption, and stroke, than late-onset preeclampsia. We estimated the degree of misclassification in a high-risk population of lupus pregnancies and a general population comparator when gestational age at delivery defined preeclampsia phenotype compared to first preeclampsia diagnosis. Patients with lupus and general population comparators from Sweden with ≥1 singleton pregnancy in the Medical Birth Register with a documented ICD code for preeclampsia were included (2002-2016). We used gestational age at delivery (<34 versus ≥34weeks) to phenotype preeclampsia early- versus late-onset and then reclassified based on first preeclampsia diagnosis date in the Patient Register. We cross-tabulated the two definitions and calculated sensitivity using the visit-based definition as the reference standard for general population and lupus pregnancies, overall and among nulliparous women. 331 pregnancies were diagnosed with preeclampsia, of which 322 were in both registers. Of those, 58 were early-onset based on gestational age at delivery (n=29 in lupus pregnancies). Overall, 9% of early-onset preeclampsia in lupus (sensitivity 91%, 95% confidence interval [CI] 75, 98) was misclassified as late-onset compared to 19% in the general population (sensitivity 81%, 95% CI 64, 92). We noted similar misclassification (4% vs 22%) among nulliparous women. In the general population, early-onset preeclampsia was more likely misclassified as late-onset than in the high-risk lupus population. Relying on gestational age at delivery to phenotype preeclampsia, this way underestimates the occurrence of early-onset preeclampsia. This also suggests that the burden of early-onset preeclampsia as a public health concern may be under-reported, although this may be more applicable to milder preeclampsia where expectant management is employed. Research of biological and maternal predictors of early-onset preeclampsia may be dealing with differentially misclassified outcomes or samples.

27. PREDICTIVE VALUE OF LACTATE DEHYDROGENASE FOR POOR MATERNAL AND PERINATAL OUTCOMES IN PATIENTS WITH PRE-ECLAMPSIA: A META-ANALYSIS

Background: A large number of studies have reported the relationships between serum lactate dehydrogenase (LDH) and prognosis of pre-eclampsia. However, the result is still controversial and no consensus has been reached. Objective: The aim of the study was to find out the role of serum LDH in prediction of poor maternal and perinatal outcomes in patients with pre-eclampsia. Methods: We performed a systematic computerized search for eligible articles from PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar databases from inception to January 2021. The pooled odds ratio (OR) and 95% confidence intervals (CIs) of all events of interest and event-free subjects were obtained to assess the predictive value of serum LDH in predicting composite poor outcomes. Results: A total of 11 studies that assessed patients with pre-eclampsia were included. Overall, elevated serum LDH level in pre-eclamptic patients was associated with poor maternal and perinatal outcomes [pooled OR: 7.92 (95% CI = 5.75–10.93); pooled OR: 8.08 (95% CI = 4.40–14.83) respectively]. Subgroup analyses showed that elevated LDH also increased risk of placental abruption, disseminated intravascular coagulation, acute renal failure, eclampsia, and HELLP syndrome. The resulting P-value showed no heterogeneity among articles (P &gt; 0.01). No evidence of asymmetry was shown in the funnel plot, thus no publication bias existed in the included studies. Conclusions: This meta-analysis demonstrates that elevated serum LDH level is apparently associated with poor outcomes in patients with pre-eclampsia and serum LDH could be a prognostic biomarker for pre-eclamptic patients.

Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis.

Background: This systematic review and meta-analysis summarizes the evidence for the association between endometriosis and adverse pregnancy outcome, including gestational hypertension, pre-eclampsia, low birth weight, and small for gestational age, preterm birth, placenta previa, placental abruption, cesarean section, stillbirth, postpartum hemorrhage, spontaneous hemoperitoneum in pregnancy, and spontaneous bowel perforation in pregnancy. Methods: We performed the literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), by searches in PubMed and EMBASE, until 1 November 2020 (PROSPERO ID CRD42020213999). We included peer-reviewed observational cohort studies and case-control studies and scored them according to the Newcastle–Ottawa Scale, to assess the risk of bias and confounding. Results: 39 studies were included. Women with endometriosis had an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth, compared to women without endometriosis. These results remained unchanged in sub-analyses, including studies on spontaneous pregnancies only. Spontaneous hemoperitoneum in pregnancy and bowel perforation seemed to be associated with endometriosis; however, the studies were few and did not meet the inclusion criteria. Conclusions: The literature shows that endometriosis is associated with an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth.

Pregnancy Outcomes of Women Hospitalized for Physical Assault, Sexual Assault, and Intimate Partner Violence.

Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23-1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19-1.71), stillbirth (RR 1.83, 95% CI 1.27-2.63), preterm birth (RR 1.70, 95% CI 1.54-1.87), and low birthweight (RR 1.78, 95% CI 1.58-2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.