Significant Perinatal Complications Research Articles

Should Severe Preeclampsia Be Considered a Risk Factor for Postpartum Depression and Anxiety? [ID: 1376999

INTRODUCTION: Postpartum mood disorders are common and seen in approximately 20% of women. It is important to understand risk factors associated with this diagnosis so that earlier interventions can be initiated. To date, the effect of preeclampsia on postpartum mood disorders has not been thoroughly investigated. The purpose of this study was to investigate whether severe preeclampsia (SPE) acts as a risk factor for postpartum depression (PPD) or postpartum anxiety (PPA). METHODS: A retrospective chart review of participants who delivered between January 1, 2015, and April 1, 2022, was conducted after IRB approval. Inclusion criteria required: 1) at least one prenatal visit, 2) a postpartum visit, 3) an Edinburgh Postnatal Depression Scale (EPDS) score, 4) a SPE diagnosis, and 5) no other significant perinatal complications. Control records met #1–3 and #5 criteria. Data analysis was conducted using an independent-samples t test. RESULTS: Of 216 SPE participants and 253 control participants queried, 150 and 200 participants respectively met inclusion criteria. An independent-samples t test comparing EPDS scores of SPE and control participants found no significant difference, t(299)=0.40, P=.693. Comparing EPDS anxiety scores (EPDS-3A) likewise found no significant difference between the two groups, t(240)=.85, P=.397. CONCLUSION: Results indicate that SPE is not a risk factor for PPD or PPA diagnosis. Despite null findings, those with and without preeclampsia must be screened for PPD because of its prevalence and detrimental effect if left untreated. Future studies should examine PPD and PPA diagnoses within 12 months postpartum instead of the immediate postpartum period.

Diagnosis of Fetal Congenital Malformation as Risk Factor for Postpartum Depression [ID: 1377045

INTRODUCTION: Annually, more than 7.9 million children, or 6% of all neonates worldwide, are diagnosed with fetal congenital malformations (FCMs). This diagnosis is the second largest cause of infant mortality and is an important cause of maternal vulnerability during pregnancy. This study aims to determine whether the incidence of postpartum depression (PPD) is increased in mothers with FCM, in comparison to mothers without such diagnosis. METHODS: A retrospective chart review was conducted between January 1, 2015, and April 1, 2022. Inclusion criteria required a) at least one prenatal visit, b) a postpartum visit, c) completion of Edinburgh Postpartum Depression Scale (EPDS), and d) prenatal diagnosis of FCM. The control group required a–c with absence of significant perinatal complications. Two hundred FCM and 200 control participants were included. An EPDS score of greater than 12 was considered positive and at risk of PPD. Independent-samples t test and χ2 analysis were conducted. RESULTS: Independent-samples t test, comparing the study and control participants, noted a statistically significant difference in at-risk EPDS scores. Mothers with FCM diagnosis scored higher on questions 3, 7, and 8. Chi-square analysis noted a statistically significant difference in risk of PPD between mothers with FCM and those without such diagnosis. CONCLUSION: Mothers with a diagnosis of FCM are more likely to score higher on EPDS and be at-risk for PPD, thereby revealing the importance to closely monitor their psychiatric status. Future studies should analyze the incidence of maternal psychiatric diagnoses based on the severity of newborn intervention required postpartum.

A Novel Homozygous Variant in the CHRNE Gene in 2 Siblings with Congenital Myasthenic Syndrome (P9-9.009)

<h3>Objective:</h3> To report a homozygous variant of uncertain significance in the CHRNE gene in two siblings presenting with symptoms consistent with congenital myasthenic syndrome that is responsive to pyridostigmine. <h3>Background:</h3> A 17-year-old female and a 9-year-old male born to consanguineous parents, with no significant perinatal complications or family history, developed predominantly proximal weakness around 4–5 years of age. The sister additionally developed bilateral fatigable ptosis. Both siblings underwent genetic testing that revealed a homozygous mutation in the CHRNE gene for a variant of uncertain clinical significance, c.322C&gt;T (p.Pro108Ser). Since the mutation was in the CHRNE gene, which codes for the epsilon subunit of the acetylcholine receptor, the brother was initially treated with fluoxetine, which had no response. The sister was previously treated with pseudoephedrine for 2 weeks without response. Both siblings began a trial of pyridostigmine and showed improvement of their symptoms, contrary to slow-channel mutation cases that can worsen with acetylcholinesterase inhibitors. EMG/NCS with RNS on the sister was performed 48 hours after stopping pyridostigmine and showed significant decrements on RNS of the left facial nerve and left spinal accessory nerve. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> Not applicable <h3>Conclusions:</h3> Two siblings born to consanguineous parents both shared a homozygous mutation in the CHRNE gene, presenting similarly with symptoms consistent with congenital myasthenic syndrome, responded favorably to pyridostigmine. Given then, we rationalize that the homozygous c.322C&gt;T (p.Pro108Ser) variant in the CHRNE gene causes an acetylcholine receptor deficiency type of congenital myasthenic syndrome. <b>Disclosure:</b> Dr. Chan has nothing to disclose. Ms. Emery has nothing to disclose. Ermal Aliu has nothing to disclose. Dr. Naik has nothing to disclose. Dr. Paul has nothing to disclose. Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Audentes Therapeutics. Dr. Kumar has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for PTC therapeutics. Dr. Kumar has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sarepta. Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avexis. Dr. Kumar has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for PTC therapeutics. The institution of Dr. Kumar has received research support from PTC therapeutics. The institution of Dr. Kumar has received research support from Sarepta Therapeutics. The institution of Dr. Kumar has received research support from Novartis. The institution of Dr. Kumar has received research support from Fibrogen . Dr. Kumar has received personal compensation in the range of $500-$4,999 for serving as a Draft Report Reviewer with PCORI Health Care Horizon Scanning System.

Factors associated with adverse obstetric events following induction of labour: a retrospective study in a tertiary hospital in Ghana.

Induction of labour (IOL) remains an indispensable intervention in obstetric practice; however, it may be associated with significant untoward perinatal outcomes. This study determined the major adverse outcomes of IOL and the associated factors at a tertiary hospital in Ghana. Retrospective study involving women with singleton gestations, conducted at the Korle Teaching Hospital in Ghana. Multivariable logistic regression was used to explore the factors associated with adverse outcomes of IOL. A total of 195 women who had IOL were analysed with 161 (82.6%) and 34 (17.4%) undergoing vaginal and caesarean deliveries respectively. The main IOL methods used included Misoprostol (91.3%), Oxytocin (5.1%) and Foley's catheter (3.6%). Composite adverse perinatal outcomes occurred in 46 neonates (23.6%) comprising perinatal deaths (7.2%) and or NICU admission (21.0%). Caesarean delivery following IOL was significantly associated with nulliparity, gestational age <41 weeks, hypertensive disorders in pregnancy and birth weight ≥3.5kg. Gestational age <41 weeks and birth weight <2.5kg were significantly associated with adverse perinatal outcome. Five women (2.6%) had uterine rupture all of which occurred in the misoprostol group. Induction of labour may result in significant perinatal complications which are related to both maternal (nulliparity and hypertension) and fetal (gestational age and birth weight) factors. Strict selection criteria and continuous fetal-maternal monitoring are strongly recommended to improve the birth outcomes of IOL.

Perinatal presentations of non-immune hydrops fetalis due to recessive PIEZO1 disease: A challenging fetal diagnosis.

Hydrops fetalis is a rare disorder associated with significant perinatal complications and a high perinatal mortality of at least 50%. Nonimmune hydrops fetalis (NIHF) is more frequent and results from a wide variety of etiologies. One cause of NIHF is lymphatic malformation 6 (LMPHM6) due to biallelic loss-of-function (LoF) variants in PIEZO1. Most individuals are diagnosed postnatally and only few clinical data are available on fetal presentations. We report six novel biallelic predicted LoF variants in PIEZO1 identified by exome sequencing in six fetuses and one deceased neonate from four unrelated families affected with LMPHM6. During the pregnancy, most cases are revealed by isolated NIHF at second trimester of gestation. At post-mortem examination ascites, pleural effusions and telengectasies can guide the etiological diagnosis. We aim to further describe the perinatal presentation of this condition which could be underdiagnosed.

What is the “cost” of reducing adverse pregnancy outcomes in patients with gestational diabetes mellitus - risk factors for perinatal complications in a retrospective cohort of pregnant women with GDM

BackgroundGestational diabetes mellitus (GDM) is a frequent pregnancy complication, affecting the maternal and neonatal health. The new diagnostic strategy for GDM, proposed by the International Association of Diabetes and Pregnancy Study Groups in 2010 and World Health Organization in 2013, raised hope to reduce perinatal complications. The purpose of the study was to compare risk factors influencing maternal and foetal outcomes in a group of pregnant women diagnosed with GDM, and in a group of pregnant women without GDM, regardless of the adopted diagnostic criteria. Also, the aim of the study was to evaluate the impact of risk factors on perinatal results and the “cost” of reducing adverse pregnancy outcomes in patients with GDM.MethodsIt was a retrospective study based on the analysis of births given after 37 weeks of pregnancy at the 2nd Department of Obstetrics and Gynaecology, Warsaw Medical University during the years 2013 to 2015. All pregnant women had a 75 g OGTT between the 24th and 28th weeks of pregnancy. The study compared risk factors for perinatal complications in 285 GDM patients and in 202 randomly selected women without GDM. The impact of selected risk factors on perinatal outcomes was analysed.ResultsBoth the diagnosis of GDM and maternal BMI prior to pregnancy, significantly modified the risk of excessive and insufficient weight gain during pregnancy. The parameters significantly influencing the risk of the composite adverse maternal outcome were the maternal abdominal circumference [OR: 1.08 (1.04; 1.11)] and multiparity, which reduced the risk by almost half [OR: 0.47 (0.30; 0.75)]. The maternal abdominal circumference before the delivery was a strong factor correlating with the occurrence of perinatal complications in both the mother and the foetus in the entire cohort. A circumference over 100 cm increased the risk of at least one maternal complication (increased blood loss, soft tissue injury, pre-eclampsia) by almost 40% (OR 1.38, p < 0.001).ConclusionsNo differences were found in maternal and foetal outcomes in GDM and non-GDM women except gestational weight gain below Institute of Medicine recommendations. The only “cost” of reducing adverse pregnancy outcomes in GDM patients seems to be lowering gestational weight gain, the future impact of which on GDM pregnant population should be assessed. The maternal abdominal circumference measured before delivery not the severity of carbohydrate intolerance, remained the main predictor for significant perinatal complications.

A study of clinical, etiological and neurodevelopmental profile of epilepsy in children aged 0-5 years

Background: Seizures constitute the most common neurological problem in children. Appropriate diagnosis and management of childhood epilepsy is essential to improve quality of life in them. Objectives of the study were to study the clinical and etiological profile of early childhood epilepsy and its effect on neurodevelopment.Methods: This was a time bound study; duration being one year from September, 2018 to September 2019. All new patients with acute seizures or status epilepticus admitted in paediatric emergency ward were evaluated and those meeting inclusion criteria were enrolled. On the basis of history, neurological and systemic examination and available investigations primary diagnosis of epilepsy was reached. Neurodevelopmental parameters like vision, hearing, and DQ were assessed. EEG was done in all patients. Other relevant investigations like neuroimaging were carried out when indicated. Collected data was analysed in form of frequency and percentage.Results: A total of 52 patients were enrolled. 60% patients were younger than 2 years. Maximum patients had generalised convulsions; generalised tonic-clonic being the most prevalent. 38% patients had significant perinatal complications like perinatal asphyxia, pyogenic meningitis and kernicterus. Fifty per cent patients had delayed milestones and half of those had severe delay. 67% had abnormal EEG and 20 patients had abnormal neuro-imaging findings. The most common etiologies for epilepsy were hypoxic ischaemic encephalopathy, idiopathic, epilepsy syndromes, metabolic disorders and CNS infections.Conclusions: Majority of early childhood epilepsy is a result of either genetic conditions or perinatal events. They have neurodevelopmental and behavioural associations. While treating epilepsy all these factors should be considered in order to ensure a near-normal life for these patients.

Bradycardia-to-Delivery Interval and Fetal Outcomes in Umbilical Cord Prolapse

(Abstracted from Acta Obstet Gynecol Scand 2021;100:170–177) Umbilical cord prolapse can lead to significant perinatal complications, including fetal hypoxia and birth asphyxia. In these cases, prompt delivery is required to preserve the life of the fetus and to reduce the risk of brain injury.

Bradycardia-to-delivery interval and fetal outcomes in umbilical cord prolapse.

Umbilical cord prolapse is a major obstetric emergency associated with significant perinatal complications. However, there is no consensus on the optimal decision-to-delivery interval, as many previous studies have shown poor correlation between the interval and umbilical cord arterial blood gas or perinatal outcomes. We aim to investigate whether bradycardia-to-delivery or decision-to-delivery interval was related to poor cord arterial pH or adverse perinatal outcome in umbilical cord prolapse. This was a retrospective study conducted at a university tertiary obstetric unit in Hong Kong. All women with singleton pregnancy complicated by cord prolapse during labor between 1995 and 2018 were included. Women were categorized into three groups. Group 1: persistent bradycardia; Group 2: any type of decelerations without bradycardia; and Group 3: normal fetal heart rate. The main outcome was cord arterial blood gas results of the newborns in different groups. Maternal demographic data and perinatal outcomes were reviewed. Correlation analysis between cord arterial blood gas result and time intervals including bradycardia-to-delivery, deceleration-to-delivery, and decision-to-delivery were performed for the different groups with Spearman test. There were 34, 30, and 50 women in Groups 1, 2, and 3, respectively. Cord arterial pH and base excess did not correlate with decision-to-delivery interval in any of the groups, but they were inversely correlated with bradycardia-to-delivery interval in Group 1 (Spearman's ρ=-.349; P=.043 and Spearman's ρ=-.558; P=.001, respectively). The cord arterial pH drops at 0.009 per minute with bradycardia-to-delivery interval in Group 1 (95% CI 0.0180-0.0003). The risk of significant acidosis (pH<7) was 80% when bradycardia-to-delivery interval was >20minutes, and 17.2% when the interval was <20minutes. There is significant correlation between bradycardia-to-delivery interval and cord arterial pH in umbilical cord prolapse with fetal bradycardia but not in cases with decelerations or normal heart rate. The drop of cord arterial pH is rapid and urgent delivery is essential in such situations.

Malaria in Pregnancy: What the Obstetric Provider in Nonendemic Areas Needs to Know.

Globally, more than 125 million women each year are at risk of malaria during pregnancy. Endemic regions carry the greatest burden; however, with globalization, providers in nonendemic regions are encountering increasing numbers of women exposed to or infected with malaria. The aim of this article is to provide obstetric providers in nonendemic areas with updated information on malaria infection in pregnancy focusing on pregnancy management and malaria prevention and treatment. This article is based on review of the most recent peer-reviewed articles and guidelines from the Centers for Disease Control and Prevention and the World Health Organization. Malaria infection in pregnancy causes maternal anemia, low birth weight, preterm birth, stillbirth, and miscarriages through placental malaria and severe infections. Pregnant women traveling to malaria-endemic areas should be advised against travel. If travel must occur, they should be provided with region-specific chemoprophylaxis and given methods for preventing infection. In the event that a pregnant patient has an acute malarial infection, prompt evaluation is needed to determine whether there are severe features. Medications for uncomplicated or severe malaria infection should be started as soon as the diagnosis is made. Malaria in pregnancy causes significant perinatal complications. Obstetric providers should be aware of the impact and how to prevent and treat malaria infection during pregnancy. Malaria infection should be suspected in women with concerning symptoms and recent travel to endemic areas. Providers should know the management of uncomplicated and severe malarial infection in pregnancy.

Predictors of Outcomes of Non-Elective Cervical Cerclages.

Non-elective cervical cerclages are associated with significant perinatal complications. There is scant available information about what the predictors of these outcomes are, thus making counselling difficult. To identify which factors predict delivery at or beyond 28, 34, and 37 weeks' gestation in women with emergency/rescue cervical cerclage. We conducted a retrospective cohort study of nonelective cerclages over 10 years in our centre. We included women with singleton pregnancies, morphologically normal fetuses, and a cervix dilated to at least 1 cm. Our primary outcome was delivery at or beyond 28 weeks' gestation, and secondary outcomes consisted of delivery at or beyond 34 and 37 weeks' gestation. Descriptive statistical and logistic regression analyses were performed. We identified a total of 69 cases, and 47 met the inclusion criteria; 44.6% of these women delivered at or beyond 28 weeks' gestation. Membranes seen in the vagina on ultrasound and postcerclage preterm premature rupture of membranes decreased the chance of delivery at or beyond 28 weeks by 81.7% (OR 0.183; 95% CI 0.048 to 0.703) and 95% (OR 0.050; 95% CI 0.006 to 0.429), respectively. The same factors were predictive of deliveries at or beyond 34 and 37 weeks' gestation. Membranes seen in the vagina on ultrasound and postcerclage pre-labour premature rupture of membranes were the strongest predictors of failure to reach 28 weeks' gestation. This information is of critical importance when counselling patients about non-elective cervical cerclage.

Continuous intrapartum electronic fetal monitoring – impact of the introduction of new practices

BackgroundElectronic fetal monitoring (EFM) is recommended in high risk pregnancies during labour, aiming to improve perinatal outcome. Previous studies indicate poor interpretation is associated with significant perinatal complications. To reduce...

Apneic Seizures: A Sign of Temporal Lobe Hemorrhage in Full-Term Neonates

Intracranial hemorrhage is a common cause of neonatal seizures in full-term infants. However, only some infants with intracranial hemorrhage come to clinical attention. A right temporal lobe hemorrhage with resulting apneic seizures was described previously in one neonate. In this case report, we review three full-term male neonates with no significant perinatal complications who presented with apneic events and temporal lobe hemorrhage. One neonate had apnea as the sole manifestation of a seizure that was confirmed electrographically. One neonate had motor manifestations of seizures, in addition to apnea, that were confirmed as seizures electrographically. The third neonate had pure apneic events before initiation of electroencephalogram monitoring which were presumed to be seizures, because the electroencephalogram demonstrated epileptiform abnormalities. At follow-up, all three children were neurodevelopmentally normal. This case report emphasizes that, although uncommon, full-term neonates may present with apnea as the initial manifestation of temporal lobe hemorrhage. Because apnea could be a manifestation of a seizure, continuous electroencephalogram monitoring should be considered in a full-term neonate with unexplained apnea.

Absent/reverse flow in the umbilical artery: A very poor prognosis

ANNA ARYA, BERNARD STUART, SEAN DALY, Coombe Women’s Hospital, Dublin 8,Ireland, OB/GYN, Dublin, Ireland, Coombe Women’s Hospital, Dublin, Ireland OBJECTIVE: From a tertiary referral unit with more than 8000 births a year and a corrected perinatal mortality rate of 5-6 per annum, we report a six year study of outcome data on all women whose pregnancies were complicated with absent or reverse flow in the umbilical artery. STUDY DESIGN: Using the database generated from the ultrasound department we identified all women whose pregnancies were complicated with either absent or reverse flow in the umbilical artery. The obstetric and paediatric charts were reviewed. Statistical analysis was parametric and nonparametric where appriopiate. RESULTS: The total number of births over the study period was 45,620. Eighty six cases were identified giving an incidence of 0.19%. The mean gestational age at diagnosis was 30.5 (4.2) weeks. Delivery was as indicated by fetal testing (CTG and Biophysical Profile Score). The indication for the ultrasound evaluation was clinical concern about growth in 78 cases. Fifty three cases (61.6%) were hypertensive. The median birth weight was 1110g, there were 9 infants whose birth weight was!500g and none survived. Nine of the 52 times a cord ph was obtained the value was 7.2 or less. There were ten stillbirths (11.6) and 65 infants were admitted to the SCBU. There were 14 neonatal deaths giving a perinatal mortality rate of 279. The median duration of stay was 41 days (IQR 56). Fifty four (62.7%) of infants were discharged home well. CONCLUSION: Abnormal umbilical artery Doppler is associated with significant perinatal complications, even when managed and delivered within a tertiary referral unit. While these outcomes are influenced by the gestational age and birth weight intervention options to improve outcomes need to be investigated. 321 INTEGRATING DOPPLER AND BIOPHYSICAL PARAMETERS IN MANAGEMENT OF INTRAUTERINE GROWTH RESTRICTION (IUGR): MIDDLE CEREBRAL ARTERY (MCA) DOPPLER IS IRRELEVANT AHMET BASCHAT, MICHELLE KUSH, ANITA MANOGURA, DOLORES MOYANO, SIFA TURAN, CHRISTOPH BERG, AMARNATH BHIDE, BASKARAN THILAGANTHAN, HENRY GALAN, SARAH BOWER, KYPROS NICOLAIDES, ULRICH GEMBRUCH, CHRISTOPHER HARMAN, University ofMaryland at Baltimore, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, Maryland, University of Maryland at Baltimore, Obstetrics & Gynecology Maternal Fetal Medicine, Baltimore, Maryland, King’s College Hospital, Obstetrics &Gynaecoloy, London, United Kingdom, King’s College Hospital, London, United Kingdom, Friedrich Wilhelm University, Bonn, Obstetrics & Prenatal Medicine, Bonn, Germany, St. George’s Hospital Medical School, Fetal Medicine Unit, London, United Kingdom, St. George’s Hospital Medical School, London, United Kingdom, University of Colorado Health Sciences Center, Obstetrics and Gynecology, Denver, Colorado OBJECTIVE: The best assessment of IUGR fetuses requires a combination of parameters testing both circulatory and behavioral responses to placental insufficiency. Integration of five Doppler measures and five componments of biophysical profile scoring may be difficult, producing a combination of alarming and reassuring results. This study addresses the need to eliminate redundant parameters from this assessment. STUDY DESIGN: In 502 IUGR fetuses (!5%ile abdominal circumference, O95%ile umbilical artery resistance), behavior of multiple test parameters was studied. Umbilical artery end-diastolic velocity, brain sparing in middle cerebral artery (MCA), ductus venosus (DV) index, reversal of a-wave in DV (DV-RAV), umbilical venous pulsation, fetal movement, tone, breathing movement, amniotic fluid volume and non-stress test were assessed in both abnormal (alarming) and normal (reassuring) domains. Using a Chi square matrix, with p value adjusted to 0.01 recognizing multiple tests, we evaluated individual parameter ability to stratify prediction of critical outcomes. A test stratified by multiple other parameters (per cent stratification O90%) was defined as redundant. A test infuencing results of other parameters !10 %, had weak stratifying power. RESULTS: Individual parameters had varying stratifying power: DV-RAV 66%, UA-EDV 61%, fetal movement 56% were most dominant, while weakest were Non-reactive NST (5.6%) and MCA (0%), for prediction of stillbirth. The tests least dependent on other tests were: UA positive EDV (0)%), DV-RAV (0%) and reactive NST (0%) and oligohydramnios (11% stratification). MCA brain sparing was 100% stratified by other tests when present, and 89% acocounted for when absent. These results were emulated for all four critical outcome paramteres. CONCLUSION: In the complex evaluation of IUGR fetsuses, multiple tests must be integrated to give the best prediction. Most parameters yield significant improvement when added to the assessment, although they differ in strength. MCA Doppler, whether alarming or reassuting, adds little or nothing.

Long‐term visual pathology in children with significant perinatal complications

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comprehensively, long‐term outcome of functional vision. Seventy‐six children (38 males, 38 females), between the corrected ages of 2 years 11 months and 10 years 2 months (mean 6y 6mo) with various significant complications (e.g. very preterm birth, bronchopulmonary dysplasia, intraventricular hemorrhage) were compared to normally developing, age‐matched control children (n=61; mean age 7y 1mo) on measures of visual acuity, contrast sensitivity, stereoacuity, peripheral vision, color vision, astigmatism, and binocular alignment. Results showed that at‐risk children had more test results that fell within the suspect or abnormal range. At‐risk children also had a slightly higher incidence of ocular disorders (e.g. strabismus) and refractive error. These data imply that children who experienced significant perinatal risk factors are at risk for long‐term deficits of functional vision. However, most of these deficits appear to be relatively mild.

Long-term visual pathology in children with significant perinatal complications

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comprehensively, long-term outcome of functional vision. Seventy-six children (38 males, 38 females), between the corrected ages of 2 years 11 months and 10 years 2 months (mean 6y 6mo) with various significant complications (e.g. very preterm birth, bronchopulmonary dysplasia, intraventricular hemorrhage) were compared to normally developing, age-matched control children (n = 61; mean age 7y 1mo) on measures of visual acuity, contrast sensitivity, stereoacuity, peripheral vision, color vision, astigmatism, and binocular alignment. Results showed that at-risk children had more test results that fell within the suspect or abnormal range. At-risk children also had a slightly higher incidence of ocular disorders (e.g. strabismus) and refractive error. These data imply that children who experienced significant perinatal risk factors are at risk for long-term deficits of functional vision. However, most of these deficits appear to be relatively mild.

Significance of success rate of external cephalic versions and vaginal breech deliveries in counseling women with breech presentation at term

Objective: To appreciate the role of success rates of external cephalic versions and breech deliveries, in order to assess the risk reduction in women with breech presentation at term. Study design: We reviewed the patient files of all women with breech presentation whom had an attempt of external cephalic version (ECV) at term. Most of the ECVs were performed under intravenous ritodrine infusion. All women had a trial of labor (TOL) as long as they did not meet one or more of the exclusion criteria of vaginal delivery. Success rates of ECV and TOL were assessed, and statistical analysis was performed by using the student t-test for continuous data, and the Chi-square and Fisher’s exact tests for categorical data. Statistically significant differences required a P value of <0.05. Results: Of all women with breech presentation at term and not in labor, who had no contraindication for an ECV, 164 consented and were included in the study. The success rate of ECV was 30% (22/74) and 67% (60/90) for nulliparae and multiparae, respectively. Multiparity was the only significant positive predicting variable for ECV success (OR=4.73, 95% CI 4.19–5.27, P=0.00001). Of all the women that underwent a successful ECV, 18/22 primiparae (82%), and 52/60 multiparae (87%) had a vaginal delivery, compared to only 52% of the primiparae and 63% of the multiparae that reached labor with a breech presentation. There were no significant perinatal complications except for one case of mild placental abruption. In the primiparous women, ECV decreased the chance of cesarean delivery by only 9% ( P=0.2), compared to a 16% decrease in the multiparae ( P=0.019). Conclusions: When counseling women with breech presentation at term, complete information is needed for consent, and should take into account the success rate of ECVs and of vaginal breech deliveries in the specific center.

469 SERUM PROLACTIN IS ELEVATED IN CHILDREN WITH CONGENITAL GROWTH HORMONE DEFICIENCY ASSOCIATED WITH PERINATAL COMPLICATIONS

Children with idiopathic congenital growth hormone deficiency (ICGHD) frequently have a history of significant perinatal complications. We have investigated the hypothesis that children with perinatal complications represent a discreet etiologic subset of children with ICGHD characterized by abnormalities of prolactin secretion. Thirty-two children with newly diagnosed ICGHD were studied by measuring the prolactin response to TRH. Fifteen normal children were studied as controls. Children were classified as ICGHD on the basis of documented growth hormone deficiency, growth records compatible with a congenital onset and absence of findings suggesting an acquired or definable lesion. Sixteen of the ICGHD children had a history of significant complications during the perinatal period. Mean baseline prolactin in this group was 22.0 ± 4.2 ng/ml (Mean ± SEM). This was significantly greater than the baseline prolactin in children with ICGHD and normal perinatal histories (11.4 ± 1.7 ng/ml) and normal children (8.7 ± 1.6 ng/ml, p < .03, Student's t-test). There was no significant difference in peak prolactin concentration 15 minutes after TRH injection in the three groups (51.7 ± 7.3, 52.1 ± 7.8 and 45.8 ± 4.7 ng/ml, p > .05). We conclude that hypothalamic compromise associated with perinatal complications is the etiology of growth hormone deficiency in a subset of children with ICGHD. Vigorous follow-up of at-risk children is recommended.

Gastric Ischemia: The Primary Factor in Neonatal Perforation

The incidence of perinatal asphyxia and evidence for gastric ischemia were investigated in six patients from the Yale-New Haven Hospital and 87 previously reported cases having neonatal gastric perforation. All our patients and 69 per cent of the collected series were found to have significant perinatal complications predisposing to asphyxia; five of our patients and 41 per cent of those reviewed had evidence of gastric ischemia as manifested by mucosal hemorrhage, ulceration, or necrosis. Gastric ischemia is the primary factor in neonatal perforation although pneumatic distention with separation of the gastric musculature, the effects of the acid pepsin response on the gastric mucosa, and direct trauma to the stomach wall are important contributing factors which make gastric perforation unique.