Significant Differences In Obstetric Outcomes Research Articles

Effect of the New Diagnostic Criteria of Fetal Growth Restriction on Obstetric and Neonatal Outcomes [ID: 1376466

INTRODUCTION: The diagnostic criteria of fetal growth restriction (FGR) was modified by the Society of Maternal-Fetal Medicine in 2020 to include both an abdominal circumference (AC) and estimated fetal weight (EFW) less than the 10th percentile as opposed to previous definition using only the EFW. We sought to evaluate the outcomes of this criteria modification. METHODS: This retrospective study compared the incidence, obstetrical and neonatal outcomes before (group 1, 2020) and after (group 2, 2021) the implementation of the modified diagnostic criteria at a single institution. This is an IRB-approved study. RESULTS: Of the 459 pregnancies with FGR included in this study, 100 were diagnosed in 2020 (group 1) and 359, in 2021 (group 2). An increase in the incidence of FGR was noted after the modification, 1.5% versus 5.3% (P<.05). Median gestational age (weeks) at delivery decreased from 38.1 (Q1, 37.1; Q3, 39.1) in 2020 to 37.4 (Q1, 36.1; Q3, 38.3) in 2021 (P<.05). There were no statistically significant differences in obstetrical outcomes. An increase in the frequency of respiratory distress syndrome was observed, 6 (6%) versus 51 (14.2%), P<.05, and median length of neonatal stay 2.0 (Q1, 1.0; Q3, 3.0) and 2.0 (Q1, 2.0; Q3, 12.0) in group 1 compared to group 2 (P<.05). CONCLUSION: The new diagnostic criteria for FGR is associated with increased incidence of diagnosis, neonatal respiratory distress, longer neonatal hospital admissions, and lower gestational age of delivery with no difference in obstetrical outcomes. It remains uncertain whether this modification will translate to improved outcomes, and larger multicenter prospective studies are needed.

Does radical trachelectomy (RT) during pregnancy have higher obstetrical and oncological risks than RT before pregnancy?

Radical trachelectomy (RT) with pelvic lymphadenectomy has become a new treatment option for young patients with uterine cervical cancer stages 1A2-1B1 who desire the preservation of their fertility. However, the application of RT for pregnant patients is still controversial. We comparatively studied both obstetrical and oncological outcomes of pregnant patients who underwent vaginal RT during pregnancy and those who underwent vaginal RT before pregnancy. Both obstetrical and oncological results of eight patients who underwent vaginal RT with pelvic lymphadenectomy during pregnancy in our institute between 2010 and 2020 (Group A), and ten pregnant patients who underwent vaginal RT with pelvic lymphadenectomy before pregnancy during the same period (Group B) were reviewed based on their medical charts. There were neither significant differences in blood loss, surgical time, or surgical completeness between Group A and Group B, nor were there significant differences in obstetrical outcomes between the two groups. However, two of the eight patients in Group A had recurrence of the cancer. None of the patients in Group B has shown any signs of recurrence thus far. Vaginal RT during pregnancy does not affect the obstetrical prognoses of patients with early invasive uterine cervical cancer, and it might be a tolerable treatment modality for them. However, oncologically, it should be performed carefully as there is a risk of recurrence.

Nutritional Health Education in Pregnant Women in a Rural Health Centre: Results in Spanish and Foreign Women

The dietary behaviour of pregnant women, as well as the socio-cultural conditions in which pregnancy takes place, influence obstetric outcomes. To analyse the influence of socioeconomic factors and dietary habits on obstetric outcomes in Spanish and foreign pregnant women living in a rural environment, a population-based, prospective-observational study in a cohort of Spanish and foreign pregnant women in the town of Yepes, in the province of Toledo, Spain was conducted. Foreign pregnant women are ecodependent on their partners, have secondary education and low socioeconomic level. Spanish pregnant women have secondary education, a medium socio-economic level, live with their partners and are economically independent. Moreover, 85% of Spanish pregnant women gave birth at term and reached a gestational age of 40 ± 1.83 weeks. However, only 55% of foreign pregnant women reached a gestational age of 39.72 ± 2.28 weeks. Through health education, pregnant women in this geographical area of Castilla la Mancha, Spain, adopted bicultural dietary patterns, thus reaching the prescribed diet of 2000 Kcal. Through this diet, both Spanish and foreign pregnant women maintained albumin and plasma protein levels within the established range, with no significant differences in obstetric outcomes among pregnant women in the study.

Clinical and Demographic Risk Factors for COVID-19 during Delivery Hospitalizations in New York City.

This study was aimed to review 4 weeks of universal novel coronavirus disease 2019 (COVID-19) screening among delivery hospitalizations, at two hospitals in March and April 2020 in New York City, to compare outcomes between patients based on COVID-19 status and to determine whether demographic risk factors and symptoms predicted screening positive for COVID-19. This retrospective cohort study evaluated all patients admitted for delivery from March 22 to April 18, 2020, at two New York City hospitals. Obstetrical and neonatal outcomes were collected. The relationship between COVID-19 and demographic, clinical, and maternal and neonatal outcome data was evaluated. Demographic data included the number of COVID-19 cases ascertained by ZIP code of residence. Adjusted logistic regression models were performed to determine predictability of demographic risk factors for COVID-19. Of 454 women delivered, 79 (17%) had COVID-19. Of those, 27.9% (n = 22) had symptoms such as cough (13.9%), fever (10.1%), chest pain (5.1%), and myalgia (5.1%). While women with COVID-19 were more likely to live in the ZIP codes quartile with the most cases (47 vs. 41%) and less likely to live in the ZIP code quartile with the fewest cases (6 vs. 14%), these comparisons were not statistically significant (p = 0.18). Women with COVID-19 were less likely to have a vaginal delivery (55.2 vs. 51.9%, p = 0.04) and had a significantly longer postpartum length of stay with cesarean (2.00 vs. 2.67days, p < 0.01). COVID-19 was associated with higher risk for diagnoses of chorioamnionitis and pneumonia and fevers without a focal diagnosis. In adjusted analyses, including demographic factors, logistic regression demonstrated a c-statistic of 0.71 (95% confidence interval [CI]: 0.69, 0.80). COVID-19 symptoms were present in a minority of COVID-19-positive women admitted for delivery. Significant differences in obstetrical outcomes were found. While demographic risk factors demonstrated acceptable discrimination, risk prediction does not capture a significant portion of COVID-19-positive patients. · COVID-19 symptoms were present in a minority of COVID-19-positive women admitted.. · COVID-19 symptomatology did not appear to differ before or after the apex of infection in New York.. · Demographic risk factors are unlikely to capture a significant portion of COVID-19-positive patients..

Obstetric outcomes in major vs minor placenta praevia: A retrospective cohort study.

Placenta praevia (PP) is a rare obstetric condition associated with significant maternal and perinatal morbidity. Traditionally, the degree of PP has been classified into minor and major; however, there are very few robust studies that compare the maternal outcomes of these types of PP. To identify any significant differences in obstetric outcomes between major and minor PP, including antepartum, intraoperative and postpartum complications. A retrospective cohort study was conducted at the Royal Brisbane & Women's Hospital between 2009 and 2018; all women were diagnosed with PP. Of the total of 368 women recruited, over half of the participants were diagnosed with major PP (57%), while the remaining had minor PP. Women with major PP, compared to women with minor PP, had an increased risk of antepartum haemorrhage (odds ratio (OR) 2.77, P<0.001), delivery at an earlier gestational age (36.1 vs 37.4weeks), general anaesthesia (OR 3.25, P<0.001), greater proportion of emergency lower segment (51% vs 40%) and classical caesarean (7.7% vs 3.8%), increased number of uterotonics (incidence rate ratio (IRR) 1.17, P<0.031), greater blood loss (IRR 1.32, P<0.001) and higher frequency of blood transfusion (IRR 2.00, P<0.027), and longer postpartum hospital stay (IRR 1.26, P<0.001). Hysterectomy was performed for three women with major PP, compared to one with minor PP. The degree of PP significantly impacts obstetric outcomes, with major PP associated with worse maternal morbidity antenatally, intraoperatively and postpartum. Therefore, to optimise patient care, this study emphasises the importance of identifying and distinguishing between different types of PP.

Accidental Dural Puncture During Labor Analgesia and Obstetric Outcomes in Nulliparous Women

(Int J Obst Anesth. 2019;38:46–51) An accidental dural puncture (ADP) is a common adverse event during epidural procedures, occurring in up to 1.5% of patients receiving neuraxial analgesia for labor. Yet, little is known about the effect of ADP on obstetric outcomes. Possible interventions following ADP in obstetric patients include intrathecal catheter placement or a repeat epidural catheter placement—both of which can provide effective analgesia with no evidence of significant differences in obstetric outcomes. However, comparisons of obstetric outcomes between women with an ADP and those with uncomplicated epidural analgesia have not been reported. This study aimed to investigate whether ADP was associated with a prolonged second stage of labor or a higher incidence of instrumented vaginal delivery or cesarean delivery due to the failure of labor to progress compared with uneventful epidural placement.

2756 Obstetric Outcomes in a Contemporary Cohort of Women with Endometriosis at an Academic Medical Center

Study Objective Previous literature shows that women with endometriosis have higher rates of adverse pregnancy outcomes compared to the general population, including preterm birth, fetal growth restriction, and cesarean section. We aim to identify disease-specific risk factors and surgical treatments that impact obstetric outcomes. Design Retrospective cohort study. Setting Academic medical center. Patients or Participants Women who delivered at our institution from January 2002 to December 2018 with ICD-9/10 codes of endometriosis. Interventions We obtained demographic characteristics and pregnancy information from a prospectively-maintained dataset, and linked this to gynecologic data, including symptoms, infertility treatments, lesion types (superficial, deeply-infiltrative [DIE], endometrioma, adenomyosis), and prior surgeries for endometriosis—dichotomous variables for diagnostic laparoscopy, ablation/fulguration, ovarian cystectomy, superficial excision, and excision of DIE. Patients were stratified by gynecologic characteristics, and obstetric outcomes compared across groups. Measurements and Main Results Of 148 deliveries, 54 (36%) had superficial endometriosis, 14 (9.5%) DIE, 75 (51%) endometriomas, and 13 (8.8%) adenomyosis. Compared to other lesions, adenomyosis was associated with prior miscarriage (62% vs. 22%, p=0.004). Almost three-quarters (72%) of patients had undergone previous surgery, including 68% diagnostic laparoscopy, 22% ablation, 28% cystectomy, 8.8% superficial excision, and 4.1% DIE excision. 38% had previously been diagnosed with infertility, while 28% conceived through in vitro fertilization. Women with DIE more often delivered via cesarean section (71% vs. 40%, p=0.044). Compared to patients with zero or one prior surgery, the 25 patients with multiple prior surgeries (range 2 to >5) more frequently had small for gestational age infants (32% vs. 14%, p=0.015), which was independent of gestational age. There were no significant differences in obstetric outcomes (gestational age, delivery method or newborn weight) by type of endometriosis surgery. Conclusion More extensive surgical history, as evidenced by multiple prior endometriosis surgeries, was associated with having infants who were small for gestational age.

Urgent Medical Aid and Associated Obstetric Mortality in Belgium.

Most Belgian citizens are covered by comprehensive medical insurance (AMI). Due to recent and significant undocumented immigration, an increasing number of patients have no health coverage. They may, however, qualify for "Urgent Medical Aid" (AMU). Still, some patients have no health insurance of any kind (no coverage). This study, conducted in a hospital which cares for a large number of undocumented immigrants, looked at the proportion of women benefiting from either "AMI" or "AMU" and those who have "No coverage" and addressed obstetrical outcomes in each of the three groups. Design: retrospective observational study. We collected data of all singleton pregnancies and deliveries from the CHU St Pierre maternity ward, between 1.10.2015 and 31.3.2016. Women were classified, prospectively, by our social workers, as having access to AMI, AMU or having "No coverage". Demographic, obstetrical and perinatal data were systematically collected and validated on a day-to-day basis and comparisons were then made between the three groups of women. During the follow up period, 1.439 women had access to regular social security (AMI) (87%), 142 women (10%) to AMU and 38 (3%) had no coverage. Women who benefited from AMU were younger and their first prenatal consultation occurred later in the pregnancy than it did for women with AMI. There were no significant differences in obstetrical outcomes between the three groups of women. Urgent medical aid (AMU) confers a certain normalisation of obstetrical care to pregnant women who would otherwise have no access to health care coverage.

The effectiveness of surgical interventions for women with FGM/C: a systematic review.

Female genital mutilation/cutting (FGM/C) changes normal genital functionality and can cause complications. There is an increasing demand for treatment of FGM/C-related complications. We conducted a systematic review of empirical quantitative research on the outcomes of interventions for women with FGM/C-related complications. A search specialist searched 16 electronic databases. Selection was performed independently by two researchers. We accepted quantitative studies that examinedtheoutcome of an intervention for an FGM/C-related concern. We extracted data into a pre-designed form, calculated effect estimates, and performed meta-analyses. We included 62 studies (5829 women), which investigated the effect of defibulation, excision of cysts, and clitoral reconstruction. Meta-analyses of defibulation versus no defibulation showed a significantly lower risk of caesarean section(relative risk, RR: 0.33; 95% confidence interval, 95% CI: 0.25-0.45) and perineal tears with defibulation: second-degree tear (RR: 0.44, 95% CI: 0.24-0.79), third-degree tear (RR: 0.21, 95% CI: 0.05-0.94), fourth-degree tear (RR: 0.06, 95% CI: 0.01-0.41). The meta-analyses detected no significant differences in obstetric outcomes of antenatal versus intrapartum defibulation. Except for one study, none of the studies on the excision of cysts indicated any complications, and the results were deemed favourable. Reconstructive surgery resulted in a visible clitoris in about 77% of women. Most women self-reported improvements in their sexual life, but up to 22% experienced a worsening in sexuality-related outcomes after reconstruction. Women with FGM/C who seek therapeutic surgery should be informed about the scarcity of evidence for benefits and the potential harms of the available procedures. Systematic review shows defibulation after FGM/C has obstetric benefits; effect of reconstruction is uncertain.

Double versus single thrombophilias during pregnancy

Objective: The primary objective of this study was to evaluate whether women with double thrombophilias have a greater risk for obstetric complications as compared with women who have single thrombophilias.Study design: This is a retrospective cohort study of all patients in a single practice with a clinically significant inherited thrombophilia and treated with anticoagulation between 2005 and 2013. Thrombophilias evaluated include: factor V Leiden, prothrombin G20210A gene mutation, protein S deficiency, protein C deficiency, and antithrombin III deficiency. Double thrombophilia was defined as the presence of two thrombophilias or homozygosity for factor V Leiden or prothrombin Gene Mutation. Demographic and obstetrical outcome data were collected. Data on all patients with double thrombophilias who met inclusion criteria was reported. Data was then compared between the patients with double thrombophilias and single thrombophilias with singleton gestations. The data was analyzed with Pearson’s chi-squared or Student’s t-test as appropriate with p value <.05 used for significance.Results: Eighteen patients with clinically significant double thrombophilias who met inclusion criteria were identified. Most patients delivered full term (88.9%) and appropriate for gestational age (77.8%) infants. One hundred thirty-two patients with single thrombophilias and 14 patients with double thrombophilias with singleton gestations were then compared. Demographic characteristics were not significantly different between the two groups. There were no significant differences in obstetrical outcomes between patients.Conclusions: There were no significant differences in obstetrical outcomes for patients with clinically significant double thrombophilias versus single thrombophilias when treated with anticoagulation.

Perinatal Outcomes in Pregnancies With a Low Fetal Fraction on Non Invasive Prenatal Testing [4N

INTRODUCTION: Placental-origin cell-free maternal DNA is known as the fetal fraction (FF). Low FF is a risk factor for aneuploidy, and may be a risk factor for poor perinatal outcome. Our objective was to evaluate the relation between low FF, and perinatal outcome. METHODS: This is a retrospective review of singleton pregnancies who had NIPT. We compared the maternal BMI, gestational age of delivery (GA), birth weight (BW), and composite perinatal morbidity (CPM) between patients with a FF &lt; 4% on NIPT (LFF), and those with a normal FF on their NIPT (NFF). The CPM was defined as the presence of any of the following complications: spontaneous abortion, hypertensive disorders of pregnancy, abruption, IUFD, preterm birth, low BW, NICU admission, or neonatal death. RESULTS: 256 patients were included. 28 (10.9%) had LFF, while 228 (89.1%) had NFF. Median age was 35-years, and median GA was 39 weeks. The rate of CPM in the entire cohort was 26.5%. Median BMI was significantly higher in the LFF group (27.4 vs. 22.1 kg/m2; p&lt; .001). There were no significant differences in CPM, gestational age at delivery or BW. Among the 28 patients in the LFF group, median FF in cases with CPM was significantly lower than in cases without CPM (2.0% vs. 3.2%; p=.04). CONCLUSION: There were no significant differences in obstetric outcomes between the two groups. Within the LFF group, lower FFs were associated with a higher rate of CPM. Larger studies are necessary to evaluate the association between uncommon outcomes and FF.

Analysis of Clinically Significant Double Thrombophilias Versus Single Thrombophilias During Pregnancy [8R

INTRODUCTION: Pregnancy is a hypercoaguable state and for patients with inherited thrombophilias, it may represent a period of heightened risk. There have been some data suggesting that women with double thrombophilias (DT) have an even greater risk of obstetrical complications. A paucity of data analyzing the impact of DT when compared to single thrombophilias (ST) has been published due to the rarity of these conditions identified in patients. METHODS: This is a retrospective cohort study of all patients in a single maternal-fetal medicine practice who were found to have a clinically significant inherited thrombophilia and treated with anticoagulation between 2005–2013. Thrombophilias evaluated included: Factor V Leiden (FVL), Prothrombin G20210A gene mutation (PGM), Protein S deficiency (PSD), Protein C deficiency (PCD), and Antithrombin III deficiency (ATIII). DT were defined as the presence of 2 clinically significant thrombophilias or homozygosity for FVL or PGM. Patients with DT were compared to those patients with ST. Demographic and obstetrical outcome data were collected and compared between the two groups. The data was analyzed with Pearson's chi-squared or Student's t test as appropriate. RESULTS: 156 pregnancies with clinically significant thrombophilias were identified. Demographic characteristics were equivalent between the two groups. There were no significant differences for obstetrical outcomes between patients for birthweight <10%, intrauterine fetal demise, preterm delivery (spontaneous or iatrogenic), pregnancy induced hypertension, or neonatal intensive care unit admission. CONCLUSION: There were no significant differences in obstetrical outcomes for patients with clinically significant DT versus ST when treated with anticoagulation. This information may be reassuring for patients with DT.

Risk Factors for the Requirement of Antenatal Insulin Treatment in Gestational Diabetes Mellitus.

Poor maternal glycemic control increases maternal and fetal risk for adverse outcomes, and strict management of gestational diabetes mellitus (GDM) is recommended to prevent neonatal and maternal complications. However, risk factors for the requirement of antenatal insulin treatment (AIT) are not well-investigated in the pregnant women with GDM. We enrolled 37 pregnant women with GDM and investigated the risk for AIT by comparing the patients with AIT (AIT group; n = 10) and without insulin therapy (Diet group; n = 27). The 1-h and 2-h plasma glucose levels and the number of abnormal values in 75 g OGTT were significantly higher in AIT group compared with Diet group. By logistic regression analysis, plasma glucose level at 1-h was significant predictor for AIT and the odds ratios were 1.115 (1.004–1.239) using forward selection method and 1.192 (1.006–1.413) using backward elimination method. There were no significant differences in obstetrical outcomes and neonatal complications. 1-h plasma glucose levels in 75 g OGTT are useful parameters in predicting the requirement for AIT in GDM. Both maternal and neonatal complications are comparable in GDM patients with and without insulin therapy.

Obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization compared with those conceived spontaneously

Aim: To examine the obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization (IVF) compared with those conceived spontaneously. Methods: Data were collected from primiparous women aged 35years and older with a singleton pregnancy conceived by IVF (n=89) or spontaneously (n=849). Data included antenatal data, gestational age at delivery, obstetric complications, such as pregnancy-induced hypertension, gestational diabetes, placental previa and placental abruption, mode of delivery, birth weight, fetal demise and the Apgar score at 1min. Results: The elective Cesarean rate in pregnancies following IVF was significantly higher than that in the control group (P=0.014). However, there were no significant differences in obstetric outcomes between the two groups. Conclusions: The current results did not support the IVF-related risks of elderly primiparous singleton pregnancies. (Reprod Med Biol 2007; 6: 219-222).