Term Live Births Research Articles

Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages

Objective: To determine the perinatal outcomes of selective termination in dichorionic twin pregnancies discordant for major but non-lethal fetal anomalies performed at different gestational ages.Methods: Thirty-one dichorionic twin pregnancies that underwent selective termination for discordant major but non-lethal fetal anomalies between January 2004 and February 2015 were retrospectively reviewed. The patients were grouped into three, according to the gestational age at which selective termination of pregnancies was performed; Group 1 (15–19 weeks), Group 2 (20–24 weeks) and Group 3 (30–33 weeks). Perinatal outcomes in all the three groups were reviewed and analyzed.Results: The overall live birth, term birth and pregnancy loss rate were 93.6%, 54.8% and 9.6%, respectively. The overall live birth rate was 66.6% in Group 1, this rate was 100% in Group 2 and Group 3 (p = 0.01). The rate of pregnancy loss was significantly higher in Group 1 (p = 0.01). The overall preterm delivery rate was 38.7%. While the overall preterm delivery rate was significantly higher in Group 3 (p = 0.04), the rate of extremely and very preterm birth was significantly lower (p = 0.03).Conclusion: Late selective feticide performed during the third trimester of pregnancy seems to be a safe approach and can be offered as an alternative method to reduce the total pregnancy loss and extremely and early pre-term birth rates.

Inter-pregnancy Weight Change and Risks of Severe Birth-Asphyxia-Related Outcomes in Singleton Infants Born at Term: A Nationwide Swedish Cohort Study.

BackgroundMaternal overweight and obesity are associated with increased risks of birth-asphyxia-related outcomes, but the mechanisms are unclear. If a change of exposure (i.e., maternal body mass index [BMI]) over time influences risks, this would be consistent with a causal relationship between maternal BMI and offspring risks. Our objective was to investigate associations between changes in maternal BMI between consecutive pregnancies and risks of birth-asphyxia-related outcomes in the second offspring born at term.Methods and FindingsThis study was a prospective population-based cohort study that included 526,435 second-born term (≥37 wk) infants of mothers with two consecutive live singleton term births in Sweden between January 1992 and December 2012.We estimated associations between the difference in maternal BMI between the first and second pregnancy and risks of low Apgar score (0–6) at 5 min, neonatal seizures, and meconium aspiration in the second-born offspring. Odds ratios (ORs) were adjusted for BMI at first pregnancy, maternal height, maternal age at second delivery, smoking, education, mother´s country of birth, inter-pregnancy interval, and year of second delivery. Analyses were also stratified by BMI (<25 versus ≥25 kg/m2) in the first pregnancy.Risks of low Apgar score, neonatal seizures, and meconium aspiration increased with inter-pregnancy weight gain. Compared with offspring of mothers with stable weight (BMI change of −1 to <1 kg/m2), the adjusted OR for a low Apgar score in the offspring of mothers with a BMI change of 4 kg/m2 or more was 1.33 (95% CI 1.12–1.58). The corresponding risks for neonatal seizures and meconium aspiration were 1.42 (95% CI 1.00–2.02) and 1.78 (95% CI 1.19–2.68), respectively. The increased risk of neonatal seizures related to weight gain appeared to be restricted to mothers with BMI < 25 kg/m2 in the first pregnancy. A study limitation was the lack of data on the effects of obstetric interventions and neonatal resuscitation efforts.ConclusionsRisks of birth-asphyxia-related outcomes increased with maternal weight gain between pregnancies. Preventing weight gain before and in between pregnancies may improve neonatal health.

Parental Characteristics can Explain Why Japanese Women Give Birth to the Smallest Infants in the United States.

Whether birthweight differences observed between races are due to modifiable factors remains controversial. In the United States, Asian infants weigh less than white infants and Japanese infants weigh the least. Using US Natality data, we evaluated 4132319 singleton term livebirths to parents of non-Hispanic white or Japanese race/ethnicity from 2009 to 2012. Infants were categorised by parental race/ethnicity (both white, n=4116637; Japanese father/white mother, n=2377; white father/Japanese mother, n=7478; both Japanese, n=5827). We used multivariable regression to sequentially adjust for maternal characteristics to determine to what extent they explained differences in fetal growth due to maternal race/ethnicity. Infants born to Japanese mothers were smaller by 132 (95% CI 101, 122) grams, with higher risk of small for gestational age (relative risk ratio (RRR) 1.56 (95% CI 1.47, 1.65) and lower risk of large for gestational age RRR 0.49, 95% CI 0.44, 0.54), compared to infants of white mothers. Differences in social factors and in maternal age, parity, and gestational age only minimally explained this difference. However, additionally adjusting for maternal height, body mass index and gestational weight gain substantially attenuated this difference to 20 (95% CI 12, 29) grams in birthweight, 0.91 (95% CI 0.86, 0.97) times risk of small for gestational age, and 1.06 (95% CI 0.96, 1.17) times risk of large for gestational age, with the effect similar across strata of paternal race/ethnicity. Differences in fetal growth between infants from Japanese and white mothers could be explained by differences in maternal height, pre-pregnancy weight, and gestational weight gain. Fetal growth potential appears to be similar across racial/ethnic groups when parental sizes are similar.

Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use

Early diagnosis and timely treatment of early onset neonatal sepsis (EOS) are essential to prevent life threatening complications. Subtle, nonspecific clinical presentation and low predictive values of biomarkers complicate early diagnosis. This uncertainty commonly results in unnecessary and prolonged empiric antibiotic treatment. Annually, approximately 395,000 neonates (7.9% of live term births) are treated for suspected EOS in the European Union, while the incidence of proven EOS varies between 0.01 and 0.53 per 1000 live births. Adherence to guidelines for the management of suspicion of EOS is poor. Pragmatic approaches to minimise overtreatment in neonates with suspected EOS, using combined stratified risk algorithms, based on maternal and perinatal risk factors, clinical characteristics of the neonate and sequential biomarkers are promising.

Rodent Hypoxia-Ischemia Models for Cerebral Palsy Research: A Systematic Review.

Cerebral palsy (CP) is a complex multifactorial disorder, affecting approximately 2.5–3/1000 live term births, and up to 22/1000 prematurely born babies. CP results from injury to the developing brain incurred before, during, or after birth. The most common form of this condition, spastic CP, is primarily associated with injury to the cerebral cortex and subcortical white matter as well as the deep gray matter. The major etiological factors of spastic CP are hypoxia/ischemia (HI), occurring during the last third of pregnancy and around birth age. In addition, inflammation has been found to be an important factor contributing to brain injury, especially in term infants. Other factors, including genetics, are gaining importance. The classic Rice–Vannucci HI model (in which 7-day-old rat pups undergo unilateral ligation of the common carotid artery followed by exposure to 8% oxygen hypoxic air) is a model of neonatal stroke that has greatly contributed to CP research. In this model, brain damage resembles that observed in severe CP cases. This model, and its numerous adaptations, allows one to finely tune the injury parameters to mimic, and therefore study, many of the pathophysiological processes and conditions observed in human patients. Investigators can recreate the HI and inflammation, which cause brain damage and subsequent motor and cognitive deficits. This model further enables the examination of potential approaches to achieve neural repair and regeneration. In the present review, we compare and discuss the advantages, limitations, and the translational value for CP research of HI models of perinatal brain injury.

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

To evaluate factors associated with elective single-embryo transfer (eSET) utilization and its effect on assisted reproductive technology outcomes in the United States. Historical cohort. Not applicable. Fresh IVF cycles of women aged 18-37years using autologous oocytes with either one (SET) or two (double-embryo transfer [DET]) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with ([+]) or without ([-]) supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET. None. The likelihood of eSET utilization, live birth, and singleton non-low birth weight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). The study included 263,375 cycles (21,917 SET[-]cryopreservation, 20,996 SET[+]cryopreservation, 103,371 DET[-]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87-8.53) and was more likely with assisted reproductive technology insurance coverage (aOR 1.60, 95% CI 1.54-1.66), Asian race (aOR 1.26, 95% CI 1.20-1.33), uterine factor diagnosis (aOR 1.48, 95% CI 1.37-1.59), retrieval of ≥16 oocytes (aOR 2.85, 95% CI 2.55-3.19), and the transfer of day 5-6 embryos (aOR 4.23, 95% CI 4.06-4.40); eSET was less likely in women aged 35-37years (aOR 0.76, 95% CI 0.73-0.80). Compared with DET cycles, the likelihood of the ideal outcome, term non-low birth weight singleton live birth, was increased 45%-52% with eSET. Expanding insurance coverage for IVF would facilitate the broader use of eSET and may reduce the morbidity and healthcare costs associated with multiple pregnancies.

Title Weight of human placenta and maternal and fetal parameters: An Observational study

The aim of the study is to determine variations of human placental weight in live singleton term births and study their relationship with maternal and fetal parameters. Subjects were mothers of live, singleton, full term neonates delivered at the Tertiary care hospital Pune, Western Maharashtra between June 2010’ to June 2012.

Reproductive outcome, duration of pregnancy and mode of delivery after hysteroscopic metroplasty in patients with infertility

Introduction: Reproductive outcome can be negatively affected in patients with congenital uterine anomalies (CUA), increasing the number of un- successful pregnancies and obstetric complications. Standard, safe and minimally invasive method for the treatment of correctible types of congenital uterine anomalies is hysteroscopic metroplasty (HM). The aim of the study was to analyze the reproduc- tive outcome, duration of pregnancy and mode of deli- very in group of patients with infertility after hystero- scopic metroplasty. Material and methods: We analyzed 48 patients with previous history of fetal loss (abortion) to whom hysteroscopy was done in the period of 01. 11. 2009 to 01. 05. 2013 year at the University Clinic of Obstetrics and Gynecology in Skopje. In patients who were diag- nosed having CUA hysteroscopic metroplasty was do- ne. Patients and their reproductive outcome were follo- wed for a period of at least 2 years after the interven- tion. Reproductive outcome was followed considering pregnancy rate, fetal loss (abortion) up to 22 gestatio- nal week, rates of preterm and term deliveries, live births and mode of delivery. Statistical analysis was performed using computer software and value for the confidence interval (± 95% CI) was considered to be statistically significant with level of p < 0.05. Results: After hysteroscopic metroplasty, there was a significant decrease of the abortion rate to 13.9%, and significant increase in pregnancy rates of 86.1%. Overall pregnancy rate was 75%, and term delivery was noted in 93,6% of the patients, with spontaneus deliveri- es in 58,6%. There were no complications during the hysteroscopic metroplasty, nor during the deliveries. Conclusion: Hysteroscopic metroplasty has a sig- nificant effect on the reproductive outcome, resulting in a large number of live births and no significant com- plication during consecutive pregnancy and delivery.

Outcome of attempted vaginal delivery after a previous vacuum extraction: a population-based study.

Few studies have investigated long-term effects of a first vaginal instrumental delivery on subsequent mode of delivery. We investigated risks of repeat vacuum extraction and risk factors associated with a repeat vacuum extraction delivery. This is a population-based register study including 391 160 women with two consecutive singleton term (≥37 weeks) live births in cephalic presentation between/within the time period of 1992-2010 in Sweden. Rates and risk ratios of mode of delivery in second pregnancy in relation to primary mode of delivery were calculated using descriptive analyses and generalized linear models. Risk of repeat vacuum extraction was adjusted for maternal age and height, interpregnancy interval, gestational length, birthweight, induction, sex and occiput posterior position. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction had an almost five-fold risk of vacuum extraction delivery and nearly a three-fold risk of emergency cesarean section at second delivery. For women with a primary emergency cesarean section, corresponding risks were substantially higher. Risk factors for a repeat vacuum extraction were increasing maternal age and an interpregnancy interval >4 years, decreasing maternal stature, increasing gestation length and birthweight, induction, giving birth to a male infant and occiput posterior position. Nine of ten women who attempted a vaginal birth after a primary vacuum extraction succeeded in having a spontaneous vaginal delivery at second delivery. Compared with women with a primary spontaneous vaginal delivery, women with a primary vacuum extraction were at increased risk of repeat vacuum extraction and emergency cesarean section in subsequent delivery although their risk was not as high as that of women with a primary emergency cesarean section.

Clinical analysis of essential thrombocythemia and pregnancy: treatment and outcomes

Objectives To summarize the maternal and fetal outcomes of patients with essential thrombocythemia (ET), and tentatively propose possible solutions for different clinical scenarios. Methods We retrospectively studied the clinical data, treatment, outcomes and follow-up status in 18 consecutive cases of young women with ET visited Peking University People's Hospital, among whom 22 pregnancies occurred from March 2005 to January 2015. Rank-sum test, Chi-square test or Fisher exact test were applied for statistics. Results (1) Out of the total 22 pregnancies, 17 (77%) were successful (term live births) and five (23%) ended in miscarriages, among which four were spontaneous abortion in first trimester. (2) Six pregnancies did not received any therapy, while 16 received various treatments before and/or during pregnancy, including oral Aspirin(single/joint), Hydroxyurea, Interferon-α(IFN-α) and platelet apheresis. (3) Treatments before/during pregnancy improved the live birth rate significantly (15/16 vs 2/6, P=0.009). Platelet (PLT) count of the newborns were all normal till the time at follow-up. (4) The median PLT count in those patients before Aspirin therapy was 761×109/L[ (448-1 213) ×109/L, and 639×109/L[ (283-1 908) ×109/L] thereafter, which showed no significant difference (Z=-0.405, P=0.686) . (5) The PLT counts in those patients before combination therapy of Aspirin and IFN-α was 989×109/L[ (435-1 504) ×109/L], and 498×109/L[ (186-559) ×109/L] thereafter, which decreased significantly (Z=-2.366, P=0.018). Conclusions (1) First-trimester spontaneous abortion is the most common complication of ET in pregnancy. (2) A specific treatment strategy may improve the pregnant outcomes without long-term harmful effect up to now. (3) IFN-α and/or Aspirin might be the first-line therapy in women with ET during pregnancy. Key words: Pregnancy complications, hematologic; Thrombocythemia, essential; Aspirin; Interferon-alpha; Pregnancy outcome

Antithrombotic Treatment for Recurrent Miscarriage: Bayesian Network Meta-Analysis and Systematic Review.

Combined use of heparin and aspirin is frequently prescribed for treatment of recurrent miscarriage (RM) in patients with antiphospholipid syndrome (APS), or in those without apparent cause of RM other than thrombophilia; however, this strategy is largely based on expert opinion and has not been well studied. The option for the use of different antithrombotic therapies to improve live birth remains unclear. In this network meta-analysis, we incorporated direct and indirect evidence to evaluate effects of different antithrombotic treatments on prevention of pregnancy losses.We searched PubMed and Embase for randomized clinical trials comparing effects of at least 2 antithrombotic treatments on live birth in RM patients published from 1965 through the early of May 2015. Potential risk bias of eligible trials was evaluated according to the Cochrane Collaboration guidelines. Bayesian network meta-analysis was used to estimate relative effects on live birth.A total of 19 trials involving 2391 RM patients with or without thrombophilia and 543 with APS were included. No beneficial effect of antithrombotic treatment was observed either in RM patients with or without thrombophilia or in patients with APS; however, for patients with or without thrombophilia, low molecular weight heparin therapy had the greatest probability (61.48%) of being the best option in terms of live birth; for patients with APS, unfractionated heparin plus aspirin was the superior treatment for RM with the highest possibility (75.15%) of being top 2 places for reducing pregnancy losses. Aspirin was inferior in both groups.Our results do not support the use of combined low molecular weight heparin and aspirin for RM treatment, and suggested aspirin may have negative effects for lowering the risk of pregnancy loss.

T-Piece based airway management in the ‘wet newborn’: Potential for hyperventilation

s / Resuscitation 96S (2015) 43–157 129 the study. Main outcome measures: five-minute Apgar scores, PAcaused neonatal mortality and incidence of HIE. Results:Newborns (116169)were included. Incidenceof infants born with 5-minute Apgar scores of ≤6 in group I – 1.25% vs group II – 0.7% (p<0.001). PA-caused neonatal mortality per 1000 live births (0–27 days): group I – 0.65/1000 vs group II – 0.35/1000 (p – 0.004), early neonatal mortality (0–6 days): group I – 0.55/1000 vs group II – 0.1/1000 (p<0.001). PA-caused neonatal mortality per 1000 term live births: group I – 0.3/1000 vs group II – 0.15/1000, perinatal PA-caused mortality for term live births: gr. I – 0.2/1000 vs group II – 0.3/1000 (p – 0.04). Incidence of HIE: group I–10.3% vs group II 3.0% (p – 0.03). Conclusion: Since the introduction of Neonatal Resuscitation Program (NRP) in Lithuania, neonatal mortality and morbidity associated with PA decreased near double and the rate of the neonatal hypoxic-ischaemic encephalopathy in terms decreased threefold. http://dx.doi.org/10.1016/j.resuscitation.2015.09.305

Cumulative live birth rate: time for a consensus?

Traditionally, IVF success rates have been reported in terms of live birth per fresh cycle or embryo transfer. With the increasing use of embryo freezing and thawing it is essential that we report not only outcomes following fresh but also those after frozen embryo transfer as a complete measure of success of an IVF treatment. Most people agree that an individual's chance of having a baby following fresh and frozen embryo transfer should be described as cumulative live birth rate. However, views on the most appropriate parameters required to calculate such an outcome have been inconsistent. There is an additional dimension-time for all frozen embryos to be used up by a couple, which can influence the outcome. Given that cumulative live birth rate is generally perceived to be the preferred reporting system in IVF, it is time to have an international consensus on how this statistic is calculated, reported and interpreted by stakeholders across the world.

Blastocyst versus cleavage-stage elective single embryo transfer - a comparative retrospective study

To compare cumulative term live birth rates (ctLBR) after elective single embryo transfer (eSET), using data from two countries -- Finland where cleavage stage (day 2/3) eSET is almost exclusively used, and the U.S. where blastocyst (day 5/6) eSET is more common.

Elective single embryo transfer (eSET) is associated with non-low birthweight term singleton outcomes: an analysis of 263,375 cycles

Multiple gestation and its concomitant risk of prematurity is the major complication of ART. The adoption of “good perinatal outcome” as a more relevant measure of term live birth with a normal birth weight neonate has been recently advocated. The objective of this study is to evaluate the likelihood of non-low birth weight (NLBW) term singleton live birth outcomes with single (SET) and double embryo transfer (DET) in the United States.

Asphyxie perpartum à terme : facteurs de risque de survenue et conséquences à court terme. À propos de 82 cas

Intrapartum asphyxia is a rare yet serious complication during labor with immediate consequences and possible long-term neurological impairment. The international Cerebral Palsy Task Force established criteria that attribute a cerebral palsy to intrapartum asphyxia: metabolic acidemia measured at birth with pH<7and base deficit≥12mmol/L. To determine the risk factors of an intrapartum asphyxia occurring in term live births, to evaluate the short-term consequences. Our retrospective study included all births between 2002and 2010in a level 3maternity of a university hospital center. Inclusion criteria were those of the Cerebral Palsy Task Force associated with a gestational age≥34weeks of gestation. We studied the conventional markers of intrapartum asphyxia: Apgar score at 5minutes, abnormal cardiotogographic recordings whether they occurred after a sentinel hypoxic event or not before and during labor. The duration of expulsive efforts, the amniotic fluid aspects, the delivery mode as well as the preexisting pregnancy pathologies were also evaluated. On the other hand, we studied the short-term consequences at the newborns: death, multiorgan failure and especially the occurring of a neonatal encephalopathy using Sarnat and Sarnat staging. One hundred and twenty-nine newborns (0.43%) out of 29,416live births had a pH<7of whom only 82 (0.27%) presented a real intrapartum asphyxia and were included in this study. A preexisting pregnancy pathology was found in 22% of the women. Hypoxic events were noted in only 9/82of the cases. Abnormal cardiotocographic recordings were present in 97.6% of the cases. The duration of expulsive efforts as well as the amniotic fluid aspects did not interfere with the occurring of a metabolic acidemia. Caesarean rate was at 46.3% and instrumental extraction rate was at 34.1%. Thity-eight newborns (46.3%) were admitted in neonatal intensive care in which we noted 3deaths (3.65%), 2multiorgan failures (2.4%) and 17neonatal encephalopathy (20.7%). The pH value seemed to influence the occurring of an encephalopathy: 50% when pH<6.9vs. 13.6% when pH≥6.9 (P=0.0013), as well as for the base deficit: 50% when BD<-18vs. 15.7% when BD≥-18 (P=0.0068). Apgar score at 5minutes also seemed predictive for a neonatal encephalopathy: 100% when<4, 46% between 4and 6and 11% when>6 (P<0.001). Our results showed an intrapartum asphyxia rate half the one widely recorded of 0.5% of total live births. Our study also validates the commonly used markers to evaluate a high risk of an early neonatal encephalopathy. This study should be continued with the evaluation of hypoxia long-term consequences on the psychomotor development of these kids and especially the occurring of cerebral palsy.

Luteal phase support post IVF: individualized early stop

While the need for progesterone-based luteal phase support is well documented, the required treatment duration is not well established, and a practitioners' survey showed a wide range of empiric stopping points. It is suggested that an early stop can be based on assessing endogenous luteal activity on the day of pregnancy test. To examine this approach, data were retrospectively collected on 99 patients with positive pregnancy test and high serum concentrations of oestradiol and progesterone (≥1000 pmol/l and ≥110 nmol/l, respectively), whose luteal support was stopped, and compared with those of 85 patients who did not meet the above criteria, and so luteal support was continued until gestational week 9. Both groups were comparable in terms of live birth and miscarriage rates. We conclude that in the face of strong endogenous luteal activity, exogenous support can be stopped on pregnancy test day, without affecting pregnancy outcome. Further research is needed to substantiate this finding.

Maternal Colonization with Group B Streptococcus Is Associated with an Increased Rate of Infants Transferred to the Neonatal Intensive Care Unit

Background:Streptococcus agalactiae (group B Streptococcus, GBS) is the most common cause of early neonatal infection, but restricting the diagnosis to culture-positive infants may underestimate the burden of GBS disease. Our objective was to determine whether maternal GBS colonization was associated with an increased risk of transfer of term infants to the neonatal intensive care unit (NICU) and, if so, to estimate the incidence of probable early-onset GBS disease. Methods: We conducted a prospective cohort study of 1,694 term infants whose mothers had vaginal-rectal swabs collected at delivery. Data collected on each mother and infant included demographics, clinical findings and laboratory investigations. The medical staff were unaware of the maternal GBS colonization status. Results: A total of 26% of the mothers were colonized. Infants born to colonized mothers did not differ from infants born to non-colonized mothers with respect to birth weight or Apgar score. Altogether, 30 (1.8%) of the term infants were transferred to the NICU. Only 1 infant born to a colonized mother had culture-positive early-onset GBS disease. Infants born to colonized mothers were more than 3 times as likely to be transferred to the NICU compared to infants of non-colonized mothers (3.6 vs. 1.1%; OR 3.4, 95% CI 1.6-6.9, p = 0.001); 5 infants of colonized mothers had probable GBS disease with tachypnoea and raised C-reactive protein (3.0/1,000 live term births). Conclusions: Maternal GBS colonization is associated with increased risk of transfer to the NICU in term infants. The burden of neonatal GBS disease may be greater than indicated by the number of culture-positive cases.

Maternal exposure to ambient PM2.5 and term low birthweight in the State of Georgia

A growing body of evidence suggests that ambient air pollution could be associated with low birthweight (LBW). In this study, we examined pregnancy exposure to ambient PM2.5 and the risk of LBW in the State of Georgia. The study population consisted of 48,172 full-term live births between 1 January 2004 and 31 December 2004 in nine counties of Georgia, which was obtained from the national natality dataset. County-level air quality index data obtained from the U.S. Environmental Protection Agency was used to estimate exposure to ambient levels of PM2.5. Multivariate logistic regression revealed that infants with maternal exposure to PM2.5 falling within 75 to < 95th percentiles were at increased risk of LBW (OR: 1.36; 95 % CI: 1.03, 1.79), after adjusting for potential confounders. This study provided more evidence on the role of PM2.5 in LBW. Reducing exposure for pregnant women would be necessary to improve the health of infants.

Gestational trophoblastic neoplasia: a prospective study of pregnancy outcome following successful chemotherapy

Gestational Trophoblastic Neoplasia (GTN) is the only neoplasia that is really curable and patients can preserve fertility with different medical and surgical treatment modalities. The aim of this study was to explore the conception rates and the outcome of pregnancy after successful chemotherapy for GTN. Between January 1998 to December 2008, 199 patients who went in for GTN were all treated with chemotherapy depending on the risk scoring. Medical records were analyzed retrospectively for the time interval between completion of chemotherapy and pregnancy, conception rate and the pregnancy outcome. 176 (94.1%) had subsequent conceptions, 8 (4.2%) had secondary infertility and 3 (1.6%) adopted contraception for the fear of the side effects of chemotherapy on their babies.12 were lost for follow up. 58 (33%) of the pregnancies happened within one year and 118 (67%) after one year. Majority of the subsequent conceptions resulted in term live birth 147 (83.6%). Of the remaining pregnancies, 5 (2.8%) went in for preterm delivery, 22 (12.5 %) ended up in abortion and 2 (1.1%) unfortunately turned out to be molar pregnancy again. No anomalies were reported from our study group. Outcome was almost similar in those who conceived within one year and beyond. 123 (70%) had a normal vaginal delivery and 53 (30%) needed caesarian section. Majority of the neonates were females 102 (58%) and 118 (67%) had a birthweight of 2.5-3 Kg. Our study indicates that patients who do conceive following chemotherapy for GTN and are desperate to have a child can definitely be assured of a promising reproductive future which is comparable to the general population.