Terms Of Maternal Outcomes Research Articles

A Retrospective Cohort Study on Maternal and Neonatal Clinical Characteristics and Outcomes of COVID-19: Does the Gestational Age Affect the Outcome?

Background To evaluate the maternal and neonatal clinical characteristics and outcomes of COVID-19 during pregnancy and to see whether infection with COVID-19 before or after the 20th gestational week affects these outcomes. Methods We conducted a retrospective study with data from pregnant women who were followed up and delivered at Acibadem Maslak Hospital between April 2020 and December 2021. Their demographics and clinical data were reviewed and compared. Results Among 1223 pregnant women, 42 (3.4%) were diagnosed with COVID-19 (SARS-CoV-2-positive). Approximately 52.4% of the 42 pregnant women with COVID-19 were diagnosed during or before the 20th gestational week, while 47.6% were positive after the 20th gestational week. The preterm birth rate was 11.9% and 5.9% in infected and uninfected pregnant women, respectively (p>0.05). In the infected pregnant women, the rate of preterm rupture of membranes (PROM) was 2.4%, small for gestational age (SGA) was 7.1%, cesarean delivery was 76.2%, and neonatal intensive care unit (NICU) admission was 9.5%. These rates among uninfected women were 0.9%, 9.1%, 61.7%, and 4.1%, respectively (p>0.05). Maternal ICU admission and intrapartum complications were higher in infected pregnant women (p>0.05). Postpartum hemorrhage (PPH), intrauterine growth retardation (IUGR), neonatal infection, and fetal demise were absent in SARS-CoV-2-positive pregnant women. Having a high school or lower education level significantly increased the risk of SARS-CoV-2 infection during pregnancy 10 times. Also, a one-week increase in gestational age significantly reduced the risk of SARS-CoV-2 infection during pregnancy. When SARS-CoV-2-positive pregnant women were compared according to whether or not they were positive before or after the 20th gestational week, there was no statistically significant difference between the two groups in terms of maternal outcomes, neonatal outcomes, and demographic characteristics. Conclusions COVID-19 during pregnancy did not adversely affect maternal and neonatal outcomes. Also, whether pregnant women were infected before or after the 20th gestational week did not have a negative impact on maternal and neonatal outcomes. However, infected pregnant women should be followed closely, and they should be informed in detail about the possible adverse outcomes and the importance of precautions for COVID-19.

Pregnancy Outcomes in Women With Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease affecting multiple joints and can also be a systemic widespread, affecting major organs. Rheumatoid arthritis is associated with greater adverse maternal and neonatal outcomes in comparison to the general obstetric population. This systematic review and meta-analysis aims to investigate the pregnancy outcomes in RA patients in comparison to the general pregnant population.Nine studies involving 11,999 RA patients met the eligibility criteria with 9,921,808 controls. Rheumatoid arthritis patients were compared with their control counterparts according to random-effects model statistical analysis.We searched databases from inception to September 8, 2021. Eligible studies reported maternal outcomes (preeclampsia, cesarean delivery, and preterm delivery) and/or neonatal outcomes. Data were pooled across using random-effects model. Subgroup analysis was conducted on RA patients alone. The review was registered prospectively with PROSPERO (CRD42021250521).In terms of maternal outcomes, there was an increased rate of cesarean delivery (odds ratio [OR], 1.55), preeclampsia (OR, 1.61), and preterm delivery (OR, 1.83) in RA patients compared with their control counterparts. In terms of neonatal outcomes, a higher rate of lower gestational weight (mean difference [MD], -0.19 kg), requirement for neonate intensive care unit admission (OR, 1.34), and stillbirths (OR, 1.99) were observed in RA patients compared with the controls. A subgroup analysis of 4 studies involving only RA patients (n = 3761) was conducted. A total of 33.2% of patients had a cesarean delivery, 7.3% had preeclampsia, 14.8% had a preterm delivery, and 9.5% of neonates had low birth weight.Compared with the general pregnant population, women with RA tend to have a higher risk of maternal and neonatal complications. As a result, this study hopes to increase awareness into the importance of counseling and managing RA patients.

Invasive and in situ cervical cancer associated with pregnancy: analysis from the French cancer network (CALG: Cancer Associé à La Grossesse).

To describe the oncologic and obstetric outcomes of patients diagnosed with invasive cervical cancer (ICC) and in situ adenocarcinoma (ISA) during pregnancy or during the year following delivery. This retrospective observational study involved a cohort of 28 patients diagnosed with invasive cervical cancer (20 patients) or in situ adenocarcinoma (eight patients) during pregnancy or during the year following delivery who received expert opinion from physicians of the Cancer Associé à La Grossesse (CALG) network between 2005 and 2018. Descriptive results were expressed in median, range and interquartile range (IQR). Between 2005 and 2018, 20 patients with ICC and eight with ISA received expert opinion from physicians of the CALG network. Both ICC and ISA were mostly diagnosed during pregnancy with a median term at diagnosis of 23.3weeks of gestation (WG) for ICC and 7.3 WG for ISA. Overall, the median age at diagnosis for both ICC and ISA was 33years. Most ICCs (n = 9) had FIGO stage ≥ IB2 and five underwent neoadjuvant chemotherapy at a median term of 22.5 WG. Seventeen patients with ICC underwent surgery. Three patients had medical termination of the pregnancy. Two patients experienced recurrence and three died. Median time of follow-up was 59.3months (IQR 30.5-129.2). Management of cervical cancer during pregnancy is challenging especially in terms of maternal outcomes with a relative poor prognosis requiring a multidisciplinary expert advice.

Outcomes of Water Immersion During The Second Stage of Labor [11E

INTRODUCTION: Water immersion during labor and delivery has become popularized, resulting in questions regarding outcomes, safety, and efficacy. Our study analyzed neonatal and maternal outcomes of water immersion during the first and second stage of labor and delivery, and compared outcomes to land births as controls. METHODS: Retrospective cohort study of singleton, cephalic presentation term pregnancies between January 2013-March 2017. This study was IRB approved. Comparison groups included: labor and land birth, water immersion exposure, and all deliveries in the study period. Obstetrical and neonatal outcomes were reviewed and analyzed. Student t-test, Mann Whitney test, Test of Proportion and Chi square tests were utilized for analysis. Significance was set at P=<0.05. RESULTS: Vaginal delivery (P<.001) and vaginal birth after cesarean section (VBAC) (P<.001) rates were higher in the water immersion exposure group compared to land births. The cesarean (P<.001) and operative delivery (P<.001) rates were lower. The uterine rupture rate was not significant (P=.94) between water immersion exposure and land birth groups. NICU admission rates were not significantly different between the immersion exposure and land birth groups (P=.99). CONCLUSION: Water immersion has positive outcomes in terms of increased rates of vaginal delivery and successful VBAC, and decreased rates of cesarean section. Water immersion for the second stage of labor and delivery is similar, if not better, than land birth in terms of maternal outcomes. Neonatal outcomes after water immersion exposure were similar to land births.

Comparison between Sublingual and Vaginal Misoprostol for Induction of Labour in Primigravida

Aims: To compare the outcome and side effects of administration of sublingual misoprostol with vaginal misoprostol for induction of labour and cervical ripening.&#x0D; Methods: It was a hospital based comparative study which was carried out in 120 patients in each group of sublingual and vaginal route of misoprostol induction from August 2016 to February 2017 at Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu. Patients with Bishops score &lt;6 were subjected for Misoprostol 25 μg (for maximum 2 doses) 6 hours apart. Results were analyzed using SPSS 21 taking p-value &lt;0.05 as statistically significant.&#x0D; Results: The mean change in Bishops score after 6 hours of misoprostol was statistically signifi cantly (p=0.001) in sublingual group in comparison to vaginal group. The diff erence in augmentation rate was not statistically signifi cant (p= 0.811). The mean time interval from drug administration to delivery was almost similar in both groups. The indications for cesarean section were similar in both the groups, the most common being fetal distress, (67.33% in sublingual and 58.065% in vaginal group). In terms of maternal and neonatal outcome there was no difference.&#x0D; Conclusions: Sublingual route results in significant changes of Bishop’s score as compared to vaginal route. It was also significantly better in terms of fetal outcome. However, both routes appeared similar in terms of maternal outcome.

Incidencia de hemorragia posparto con base en el uso terapéutico de uterotónicos. Resultados maternos en un hospital de mediana complejidad de Bogotá, Colombia

Objetivo: describir la incidencia de hemorragia obstétrica posparto (HPP) severa por el uso de medicamentos uterotónicos, como también las intervenciones realizadas y los desenlaces maternos en las primeras 24 horas.Materiales y métodos: serie de casos de gestantes que presentaron HPP luego de parto vaginal o cesárea entre el 1 de febrero y el 31 de octubre de 2016, según el uso terapéutico de uterotónicos, en una institución pública de mediana complejidad en Bogotá. Muestreo consecutivo. Se midieron las características sociodemográficas, clínicas y los factores de riesgo para HPP. Como desenlace se determinó la causa de la hemorragia, grado de choque, sangrado posparto estimado, activación del código rojo obstétrico, intervenciones realizadas, ingreso a unidad de cuidado intensivo, necesidad de transfusión sanguínea y mortalidad. Se realizó análisis descriptivo.Resultados: de 1.633 nacimientos (1.080 partos y 553 cesáreas) se presentaron 35 (2,1 %) casos de HPP por uso de oxitócicos (26 y 9 respectivamente), y se activó el código rojo obstétrico en 11 casos (0,67 %). No hubo mortalidad materna. La principal causa de HPP fue hipotonía uterina 29/35 (82 %), y en el 82,8 % de los casos se resolvió con manejo médico; 4/35 (11,4 %) requirió taponamiento uterino adicional para control del sangrado; 2/35 (5,6 %) de las mujeres requirió manejo quirúrgico: sutura hemostática 1/35 (2,8 %) e histerectomía 1/35 (2,8 %).

Pregnancy outcomes in patients with acute kidney injury during pregnancy: a systematic review and meta-analysis

BackgroundPresently, the matter of pregnancy outcomes of patients with pregnancy related AKI (PR-AKI) were disputed. Thus, we conducted a meta-analysis to evaluate the impact of PR-AKI on pregnancy outcomes.MethodWe systematically searched MEDLINE, Embase, VIP, CNKI and Wanfang Databases for cohort or case-control studies in women with PR-AKI and those without AKI as a control group to assess the influence of PR-AKI on pregnancy outcomes and kidney outcome. Reduction of odd ratio (OR) was calculated by a random-effects model.ResultsOne thousand one hundred fifty two articles were systematically reviewed, of those 11 studies were included, providing data of 845 pregnancies in 834 women with PR-AKI and 5387 pregnancies in 5334 women without AKI. In terms of maternal outcomes, women with PR-AKI had a greater likelihood of cesarean delivery (OR, 1.49; 95% confidence interval [CI], 1.37 to 1.61), hemorrhage (1.26; 1.02 to 1.56), HELLP syndrome (1.86; 1.41 to 2.46), placental abruption (3.13; 1.96 to 5.02), DIC (3.41; 2.00 to 5.84), maternal death (4.50; 2.73 to 7.43), but had a lower risk of eclampsia (0.53; 0.34 to 0.83). Women with PR-AKI also had a longer stay in ICU (weighted mean difference, 2.13 day [95% CI 1.43 to 2.83 day]) compared with those without PR-AKI. As for fetal outcomes, higher incidence of stillbirth/perinatal death (3.39, 2.76 to 4.18), lower mean gestational age at delivery (−0.70 week [95% CI -1.21 to −0.19 week]) and lower birth weight (−740 g [95% CI -1180 to 310 g]) were observed in women with PR-AKI. The occurrence of kidney outcome, defined as ESRD requiring dialysis, in women with PR-AKI was 2.4% (95% CI 1.3% to 4.2%).ConclusionsPR-AKI remains a grave complication and has been associated with increased maternal and fetal mortality.

Comparison Between Use of Oral Misoprostol Versus Vaginal Misoprostol for Induction of Labour at Term.

In modern obstetrics, around 30% of cases require induction of labour for various reasons. Misoprostol is gaining popularity as pharmacological inducing agent, though the route and dosage of administration are not standardised. The objective of the study is to compare the safety and efficacy of the two routes of misoprostol administration-oral (100μg 4th hourly) and vaginal (25μg 4th hourly), for induction of labour at term. In this randomised trial, 104 women having crossed the expected date of delivery without going into spontaneous labour and cases which had premature rupture of membranes <12h were considered for labour induction and were divided into two equal groups. Group A received 100μg misoprostol orally 4th hourly, and group B received 25μg misoprostol vaginally 4th hourly. Labour characteristics and maternal and foetal outcome were compared. In terms of maternal outcome, mean number of doses for oral group is 2.73 and vaginal group is 3.04. In oral group, mean induction to vaginal delivery interval was 13h 43min and in vaginal group interval is 13h 26min which was statistically not significant. The need for oxytocin augmentation was also statistically not significant. Both groups had equal number of failed inductions. Emergency LSCS done for foetal distress was more in vaginal group 2.9% compared to oral group which is 1%, but difference was not statistically significant (p value -0.55). Number of thick MSL in oral group was 3.2% as compared to vaginal group which is 10.7% which was statistically significant (p value -0.04). APGAR score at 5min 7/10 was seen in 7.7% in vaginal group as compared to 0% in oral group which was also statistically significant (0.004). Number of NICU admissions was also more in vaginal group compared to oral group. Misoprostol in either oral or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. However, occurrence of lesser incidence of meconium-stained liquor and NICU admissions and fewer caesareans with better neonatal outcome in women induced with oral misoprostol outweighs its advantages over the vaginal misoprostol.

Comparison of Maternal and Fetal Outcomes in Pregnancies with Preterm Premature Rupture of Membrane (PPROM) Terminating in 34th or 36th Gestational Weeks: A Clinical Trial

present study, we aimed at studying maternal and neonatal outcomes in patients with terminated pregnancy in 34th and 36th gestational weeks. Materials and methods: 40 pregnant women, with PPROM who underwent pregnancy termination at 34 group (A) or 36 group (B) gestational weeks, were included to be evaluated and compared for maternal and neonatal outcomes. Type of delivery, birth complications, chorioamnoionitis, endometritis, sepsis, maternal mortality, infant gender, birth weight, Apgar scores, respiratory distress syndrome, Meconium-stained amniotic fluid, NICU admission, abruption, umbilical cord prolapse, maternal and neonatal outcomes were compared between the two groups. Results: There was no statistically significant difference between the two groups regarding maternal age, level of education, or gravity. The percentage of cases with birth weight between 1500 and 2500 g was significantly higher in group A P&lt;0.001). Frequency of NICU admission in group A was significantly more than group B (P&lt;0.001). In conclusion: Termination of pregnancy at 36 weeks compared to 34 weeks in pregnant women with PPROM is preferred in terms of neonatal outcomes and it is recommended; also, there might be no preference in terms of maternal outcomes.

Induction of Labour Versus Expectant Management for Large-for-Date Fetuses

Macrosomia can increase risk of operative vaginal delivery, perineal trauma, shoulder dystocia, and other neonatal morbidities. To reduce these risks, patients can either elect for cesarean delivery or induction of labor that will prevent further fetal growth. In regard to the latter strategy, previous studies have reported increased risk of cesarean delivery without decrease in risk of neonatal trauma. However, these studies were limited by small sample sizes, gestational age (>40 weeks), and use of birth weight (>4000 g) instead of estimated fetal weight. Consequently, the authors of the present study hypothesize that upon addressing these limitations induction of labor would, in fact, decrease risk of major neonatal and maternal morbidities with no significant changes in the risk of cesarean delivery. This was a large, multicenter (19 tertiary-care university hospitals), randomized, unblinded, controlled trial. A total of 818 women with macrosomic fetuses (eligible for the study if estimated weight of fetus was >95th percentile, or 3500 g at 36 weeks, 3700 g at 37 weeks, and 3900 g at 38 weeks) were randomized into 2 groups, the induction-of-labor group (n = 407) and expectant management or control group (n = 411). Authors induced labor between 37 and 38 weeks’ gestation within 3 days of randomization. It is of note that they induced labor in only 89% of the women in the induced-labor group, as the others experienced spontaneous delivery, and so on. The primary outcome was a composite of significant shoulder dystocia, fracture of the clavicle or a long bone, brachial plexus injury, intracranial hemorrhage, or death of the neonate. The secondary outcomes were a range of neonatal and maternal morbidities. Statistical analysis was by intention to treat. Shoulder dystocia and fracture of the clavicle occurred more frequently for neonates in the control group than in the induction-of-labor group (6% vs 2%; risk difference, 4%; P = 0.004). In addition, frequency of primary outcome increased when neonates were 4000 g or greater, especially in the control group (21 vs 5 neonates). No difference was seen in terms of secondary outcomes for the neonates except for phototherapy use, which was higher in the induction group, especially for those randomized before 38 weeks’ gestation (13% induced-labor vs 7% expectant group). In terms of maternal outcomes and morbidities, the incidence of cesarean delivery and operative vaginal delivery did not differ between the 2 groups. However, spontaneous vaginal delivery occurred more often in the induced-labor group than in the expectant group (59% vs 52%). In addition to being unblinded, a limitation of this study was that the sample size was smaller than initially anticipated; authors were intending to recruit 1000 patients, but recruitment was cut short by funding issues. Nevertheless, the findings of this study show that induction of labor for large-for-date fetuses in women between 37 and 39 weeks’ gestation can significantly reduce risk of neonatal shoulder dystocia and bone fracture. There is also increased likelihood of spontaneous delivery without increased risk of cesarean delivery.

Assessment of the Pregnancy Outcome among Non Anemic and Anemic Mothers: a Comparative Study

The aim of the study was to compare and identify the effects of anemia on pregnancy outcome among non anemic and anemic mothers. a comparative study was utilized to assess the pregnancy outcome among non anemic and anemic mothers. Hundred samples were taken i.e. fifty non anemic and fifty anemic mothers were selected by using purposive sampling technique. The tool was consisted of three parts. Part A was consisted of 11 items socio demographic variables. Part B consisted of checklist which included 16 items to assess the pregnancy outcome in terms of maternal outcome, fetal outcome and placental outcome. Part C consisted of recording sheet for pregnancy outcome. Reliability was established by split half method and was calculated by Karl's pearson coefficient of correlation and Spearman's Brown method. The reliability of the tool was 0.9. Data analysis was done by using descriptive and inferential statistics. Tables, bar diagrams were used to depict the findings. Research findings of the study revealed the percentage of pregnancy outcome among non anemic and anemic mothers. Out of 100 samples, 50(100%) non anemic mothers had good pregnancy outcome whereas in case of anemic mothers 22(44%) had good pregnancy outcome and 28(56%) had poor pregnancy outcome. The present study emphasizes the conduct of health education programme to impart the knowledge to antenatal mothers regarding prevention of anemia to improve pregnancy outcome.

Is a planned caesarean section in women with cardiac disease beneficial?

ObjectivesIn the general population, planned caesarean section is thought to be safer in high-risk situations as it avoids the greater risk of an emergency caesarean section. Only limited data exist...

Comparison of Metformin and Insulin in the Treatment of Gestational Diabetes: A Retrospective, Case-Control Study

Limited data are available on metformin therapy in gestational diabetes. The aim of the study was to compare maternal and neonatal outcomes in patients with gestational diabetes mellitus (GDM) treated with metformin with those treated with insulin, or diet alone. We conducted a retrospective study that included 45 GDM women treated with metformin, 45 women treated with insulin and 83 women with no pharmacological treatment. Subjects were matched for pre-pregnancy body mass index (BMI) and age. There were no differences between the metformin-treated group and the other two groups in terms of maternal outcomes (total weight gain during pregnancy or after the diagnosis of GDM, pre-pregnancy hypertension, pregnancy induced hypertension, pre-eclampsia etc.). In the diagnostic 2-hour oral glucose tolerance test, glucose values were slightly, but significantly, higher in the insulin group than in the metformin group (p < 0.003). Eighteen percent of mothers treated with metformin needed supplementary insulin therapy. No differences between the metformin-treated group and the other two groups (insulin, diet only) were observed in relation to mean birth weights, prevalence of macrosomia, or gestational weeks at delivery. The incidence of neonatal hypoglycemia was higher in the insulin group than in the metformin group (p = 0.03). There were no differences between the groups in other neonatal outcomes (small for gestational age, Apgar scores, umbilical artery pH or base excess, etc.). These retrospective data suggest that metformin is effective in controlling gestational diabetes and is not associated with a higher risk of maternal or neonatal complications compared with insulin.

Effect of the Birth Chair on Duration of Second Stage Labor And Maternal Outcome

The effect of delivering in a birth chair on duration of second stage labor, perineal swelling, incidence of episiotomies, lacerations, hemorrhoids, and maternal blood loss was examined in a prospective quasi-experimental study. The sample consisted of 55 primiparous women, 37 to 41 weeks gestation, with normal pregnancy and labor; 22 delivered on a traditional delivery table (DT) and 33 in a birth chair (BC). Comparisons were made between groups for mean duration of second stage labor, mean time bearing down in the delivery room, mean maternal blood loss, frequency of instrument-assisted deliveries, frequency of episiotomies and lacerations, and frequency of perineal swelling and hemorrhoids. The two groups were statistically similar for weight of infant. No significant difference was found between groups for mean duration of second stage labor (BC M = 55 minutes, DT M = 43 minutes) or mean time bearing down (BC M = 60 minutes, DT M = 53 minutes). No difference was found in the amount of blood loss between the two groups as measured by the mean difference in the pre- and postdelivery hemoglobin (BC M change = 1.4 Gms, DT M change = 1.8 Gms). The lack of significant differences in blood loss may be due to the fact that the angle of the birth chair was lowered during or after delivery in 88% of the cases. The incidence of instrument-assisted deliveries (BC = 7, DT = 6), episiotomies (BC = 27, DT = 20), lacerations (BC = 17, DT = 5), and hemorrhoids (BC = 14, DT = 4) was similar between groups.(ABSTRACT TRUNCATED AT 250 WORDS)