Tertiary Perinatal Care Center Research Articles

Perinatal findings of women with pregnancy related haemolytic uremic syndrome: a case series from a single Italian tertiary perinatal care centre

Perinatal findings of women with pregnancy related haemolytic uremic syndrome: a case series from a single Italian tertiary perinatal care centre

Ethical Attitudes and Handling in Prenatal Conflict Situations - A Survey among Obstetricians and Prenatal Diagnosticians in Germany

Various studies have shown that belonging to a professional group has an influence on ethical attitudes. The aim of this study was to assess and compare the attitudes and approaches of obstetrical specialists and prenatal diagnosticians in prenatal conflict situations. Explorative cross-sectional online survey among tertiary perinatal care centers and prenatal diagnosticians with DEGUM Level II/III in Germany. The questionnaire included questions on ethical attitudes in the perinatal context and a case presentation of a fetal hypoplastic left heart syndrome. The response rate was 57.1% (310/543). 55.5% of the respondents practiced both obstetrics and prenatal diagnostics, 24.5% exclusively prenatal diagnostics, and 14.2% purely obstetrics. 27% agreed with the statement "An uncertain prognosis justifies pregnancy termination". For complex fetal malformations joint interdisciplinary counseling was advocated by 98.3%. Addressing the option of postnatal palliative treatment in a case of a hypoplastic left heart syndrome was accepted by 84.3% across all professional groups, while mentioning fetocide was more frequently cited as an option by prenatal diagnosticians than by obstetricians (57.7% vs. 34.1%). Interdisciplinary prenatal parental counseling in complex fetal malformations is uniformly advocated by prenatal diagnosticians and obstetricians in Germany. However, different ethical attitudes appear among specialists groups with regard to the option of termination of pregnancy.

Clinical features of women with thrombotic microangiopathy in pregnancy: A case series from a single Japanese tertiary perinatal care center.

Although perinatal thrombotic microangiopathy has become increasingly understood, the racial characteristics of patients with this condition remain unclear. Herein, we report the characteristics of patients with perinatal thrombotic microangiopathy at a single institution in Japan. We conducted a retrospective study over a 5-year period from January 1, 2017, to December 31, 2021, using the electronic medical records of pregnant women who delivered at the perinatal center of our hospital. We extracted the data of those who developed perinatal thrombotic microangiopathy and evaluated their characteristics at the time of disease onset, final diagnosis, and maternal and fetal outcomes. Of the 10 224 deliveries that occurred during the 5-year period, only seven patients (0.06%) had perinatal thrombotic microangiopathy. The median pre-pregnant body mass index was 18.65 kg/m2 (minimum 17.3 kg/m2 , maximum 20.7 kg/m2 ). More than half of the patients were conceived by in-vitro fertilization, and 42% these had twin deliveries. Four patients had a history of rheumatic disease. The other three patients without underlying diseases developed thrombotic microangiopathy with HELLP syndrome, and one patient transitioned to atypical hemolytic uremic syndrome. Based on low body mass index and in-vitro fertilization, which are characteristic of Japanese women, medical complications and twin pregnancies may be a risk for thrombotic microangiopathy. Additionally, depending on the cause of thrombotic microangiopathy, its timing and onset differed.

Differences in the incidence of obstetric complications depending on the extent and location of adenomyosis lesions

Objectives Although adenomyosis is reportedly associated with adverse pregnancy outcomes, clinical factors related to the high risk of obstetric complications are unclear. This study aimed to elucidate the characteristics of adenomyosis lesions associated with the increased incidence of obstetric complications based on imaging findings. Methods This was a retrospective, observational cohort study conducted in a tertiary perinatal care center. Eighty-eight singleton pregnant women with adenomyosis were included in the study. Based on magnetic resonance imaging or ultrasonography before and/or during pregnancy, patients were classified according to three types of image characteristics: the extent of adenomyosis lesion (focal type or diffuse type), location of the lesion (extrinsic type, intrinsic type, or indeterminate type), the positional relationship between the lesion and the placenta (placenta distant from adenomyosis or placenta over adenomyosis), and the incidence of obstetric complications were examined. Results Patients with diffuse type adenomyosis are significantly more likely to have spontaneous second-trimester miscarriage (diffuse type vs. focal type: 16.7 vs. 0%, p < .01), preterm premature rupture of membranes (19.4 vs. 1.9%, p < .01), and preeclampsia (25.0 vs. 7.7%, p = .02), as compared to those with focal type adenomyosis. In a comparison of the three location types, the incidence of placental malposition was higher in patients with the extrinsic type adenomyosis (extrinsic type vs. intrinsic type vs. indeterminate type: 20.0 vs. 6.7 vs. 2.3%, p = .03). Comparisons between the types of the placenta over or distant from adenomyosis lesion displayed no significant differences in the frequencies of obstetric complications. Conclusions We demonstrated that the frequency of obstetric complications related to adenomyosis varies depending on the extent and location of the lesion; patients with diffuse type adenomyosis have an increased risk of spontaneous second-trimester miscarriage, preterm premature rupture of membranes, and preeclampsia, while patients with extrinsic type adenomyosis have an increased risk of placental malposition. Imaging evaluation of adenomyosis prior to conception or early in pregnancy may be useful for the obstetrical risk assessment among patients with adenomyosis.

Fetal outcomes with and without the use of sugammadex in pregnant patients undergoing non-obstetric surgery: a multicenter retrospective study

BackgroundThe influence of sugammadex exposure during pregnancy on progesterone withdrawal and miscarriage is unknown. We aimed to compare the fetal outcomes in pregnant patients who had undergone non-obstetric surgery with and without sugammadex. MethodsWe retrospectively reviewed the medical charts of pregnant women who underwent non-obstetric surgery at three tertiary perinatal care centers in Japan from January 2013 to December 2020. The women were divided into those who received general anesthesia with sugammadex (GA with SGX) and those who received general anesthesia without sugammadex (GA without SGX). We compared miscarriages and preterm births within four weeks after surgery. ResultsAmong the 124 women, 73 and 51 were included in the GA with SGX and GA without SGX groups, respectively. The two groups showed no differences in the rate of miscarriages or preterm births (3.0 % vs 4.3 %; odds ratio 1.42, 95 % confidence interval 0.19 to 10.47; P = 1.00). The SGX and no SGX groups were missing outcomes for 8.2 % and 7.8 % of cases, respectively. ConclusionsHaving GA with SGX or GA without SGX did not result in different rates of miscarriage or preterm birth within four weeks after the procedure. These findings do not exclude a potential association between sugammadex exposure during pregnancy and adverse pregnancy outcomes. Missing data may have obscured possible adverse outcomes from sugammadex exposure.

Epidemiology, Risk Factors, and Perinatal Outcomes of Placental Abruption-Detailed Annual Data and Clinical Perspectives from Polish Tertiary Center.

Placental abruption (PA) is a separation of the placenta from the uterine wall occurring with the fetus still present in the uterine cavity. It contributes to numerous neonatal and maternal complications, increasing morbidity and mortality. We conducted a retrospective study at a tertiary perinatal care center, which included 2210 cases of labor that took place in 2015 with a PA occurrence of 0.7%. No maternal or fetal death during delivery was reported in this period. The identified PA risk factors were uterine malformations, pPROM, placenta previa spectrum, and oligohydramnios. The significant maternal PA complications identified were maternal anemia, uterine rupture, and HELLP syndrome. Preterm delivery occurred significantly more often in the PA group, and the number of weeks of pregnancy and the birth weight at delivery were both significantly lower in the PA group. PA is a relatively rare perinatal complication with very serious consequences, and it still lacks effective prophylaxis and treatment. Despite its rare occurrence, each center should develop a certain strategy for dealing with this pathology or predicting which patients are at risk. Much work is still needed to ensure the proper care of the mother and the baby in this life-threatening condition.

400 The risk of postpartum glucose intolerance in lean japanese women with gestational diabetes

Although East Asian populations, including the Japanese, are the leanest populations in the world, the prevalence of diabetes in this population tends to be much higher than that in more obese populations. We investigated the risk of developing diabetes during the early postpartum period in lean Japanese women with gestational diabetes (GDM) compared with normal and obese women with GDM. In this retrospective cohort study, we included singleton pregnant women with GDM in a tertiary perinatal care center in Japan. We defined diabetes and impaired glucose tolerance as abnormal glucose tolerance (AGT) at the first postpartum oral glucose tolerance test (OGTT) at 6-9 weeks postpartum, and we then compared the prevalence of AGT between lean (prepregnancy body mass index [BMI] <18.5) and normal (18.5-24.9) and obese (≥25) women. We also compared the insulinogenic index (IGI) and homeostasis model of assessment (HOMA)-β as an index of insulin secretion and the HOMA-insulin resistance (IR) as an index of IR. We included 531 women with GDM, and 55 (10%), 330 (62%) and 146 (28%) were considered lean, normal and obese, respectively. The prevalence of AGT was 36% in the lean group, which was similar to that in the obese group (36%) and significantly higher than that in the normal group (p<0.05). In the lean group, the IGI (0.44±0.35 vs. 0.73±0.57, p<0.005), HOMA-β (55±23 vs. 102±73, p<0.0001) and HOMA-IR (0.72±0.35 vs. 1.81±1.57, p<0.0001) were significantly lower than those in the obese group. Lean Japanese women with GDM were characterized as having pancreas β-cell dysfunction rather than IR and were at a high risk of developing AGT during the early postpartum period, similar to obese women. Such women should be followed up as a high-risk group, similar to obese women.

399 Simple basal insulin regimen in women with mild gestational diabetes

Approximately 30% to 40% of women with gestational diabetes (GDM) receive insulin therapy, and the multiple daily insulin injection (MDI) regimen with a combination of basal and prandial insulin is generally used, as in cases of prepregnancy diabetes. We developed a simple insulin injection (SII) regimen, in which one or two injected doses of basal insulin are used, for women with mild GDM who require insulin therapy. The present study explored whether or not the SII regimen is as effective as the MDI regimen in preventing fetal macrosomia in women with mild GDM. In this retrospective study, we included singleton pregnant women with GDM in a tertiary perinatal care center. Insulin therapy was indicated if glucose control did not reach the target values under diet therapy. At the beginning of the insulin therapy, we used one daily injection of NPH insulin (10 to 20 units) before breakfast and added another injection of NPH insulin at bedtime, if necessary. If the control still did not reach the target values, we switched to an MDI regimen with additional prandial insulin aspart injection. We compared the glucose control levels, gestational weight gain (GWG), and perinatal outcomes between the diet-alone, SII, and MDI groups. Among 397 women with GDM, 66%, 15%, and 19% were in the diet-alone, SII, and MDI groups, respectively. There were no significant differences in the glucose control, maternal GWG, or perinatal outcomes among the groups (Table). Among the 34% of women with GDM requiring insulin therapy, 44% had a well-controlled condition with the SII regimen without any increase in the GWG or adverse perinatal outcomes. In women with mild GDM requiring insulin therapy, nearly half can maintain good control with this simpler insulin regimen.

Clinical profile of neonates delivered from mothers with confirmed COVID-19 infection: An experience from a Tertiary Perinatal Care Center in Dubai, UAE

Clinical profile of neonates delivered from mothers with confirmed COVID-19 infection: An experience from a Tertiary Perinatal Care Center in Dubai, UAE

1395-P: Practical Triage in Women with Gestational Diabetes According to Their Risk Category for Insulin Therapy

Objective: We investigated efficacy of the risk category system in the triage of patients to insulin therapy in a prospective cohort of women with gestational diabetes (GDM). Study Design: In a previous retrospective study, we developed a risk category system for insulin therapy (≥20 U/day), in which we found two risk factors including prepregnancy BMI ≥24 and fasting plasma glucose ≥84 mg/dl. In the current study, we investigated the validity of the risk categories for triage to insulin therapy in a new prospective cohort. We included women with GDM diagnosed at 24-32 weeks of gestation according to the IADPSG criteria in a single tertiary perinatal care center between June 2015 and March 2018. After the diagnosis, all patients underwent self-monitoring of blood glucose (SMBG) under nutrition therapy. Insulin therapy was indicated, if SMBG did not achieve 80% of the target glucose values. Multivariate analysis adjusted for confounders were performed to examine the association between risk categories and insulin therapy (≥20 U/day and ≥30 U/day). Results: Among 240 patients with GDM, 119 (50%) had at least one risk category. Insulin therapy ≥20 U/day and ≥30 U/day was indicated in 86 (35.8%) and 61 (25.4%) patients, respectively. In comparison to women without risk factor, patients with at least one risk factor were significantly at risk for insulin therapy ≥20 and ≥30 U/day with adjusted odds ratio of 3.8 (95%CI 1.7-8.7) and 16.4 (4.9-75.6), PPV of 0.51 and 0.39, and NPV of 0.79 and 0.88, respectively. Conclusion: With keeping SMBG triage first, the risk category system seems to be effective, especially for the triage of patients without risk categories to less intensive care, because of the high negative predictive value. Disclosure H. Yamashita: None. I. Yasuhi: None. S. Suga: None. S. Isokawa: None. M. Fukuoka: None. M. Koga: None. J. Yamaguchi: None. S. Sugimi: None. Y. Umezaki: None. M. Fukuda: None. N. Kusuda: None.

Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care.

To investigate factors associated with high-risk gestational diabetes (GDM) among patients with GDM. The present retrospective study included women with singleton pregnancies diagnosed with GDM using International Association of Diabetes and Pregnancy Study Group criteria at a single tertiary perinatal care center in Japan between July 1, 2010, and October 31, 2014. High-risk GDM was defined as patients who required at least 20units of insulin therapy a day, delivering a large-for-gestational age neonate regardless of insulin therapy, or both. Maternal characteristics and diagnostic test results were investigated to identify associations with the high-risk criteria, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Among 217 patients, 95 (43.8%) were categorized as high risk. After adjusting for confounders, a fasting plasma glucose level at diagnosis of at least 4.66mmol/L (adjusted OR 2.88, 95% CI 1.51-5.58) and pre-pregnancy body mass index (calculated as weight in kilograms divided by the square of height in meters) of at least 24 (adjusted OR 3.27, 95% CI 1.60-6.90) were independently associated with meeting the high-risk criteria. Among Japanese patients with GDM, pre-pregnancy body mass index and fasting plasma glucose levels could be used to identify high-risk patients requiring intensive care during pregnancy.

Rate of intrapartum cesarean section and related factors in older nulliparous women at term.

The aim of this study was to determine the effect of maternal age on emergency cesarean section (CS) during labor, and to identify the independent risk factors for emergency CS. This was a retrospective cohort study using data from 2009 to 2014 from a tertiary perinatal care center in Japan. Inclusion criteria were maternal age ≥ 35 years, nulliparous singleton pregnancy at term and a cephalic presentation without indication of elective CS at onset of labor. The primary outcome was rate of emergency CS, while independent risk factors were elucidated using multivariate logistic regression analysis. Of 953 women, 199 (20.9%) delivered by emergency CS. Rates of emergency CS were 18.3% (129/706) in women aged 35-39 years and 28.3% (70/247) in those aged ≥ 40 years (P < 0.01). Adjusted odds ratios (95% confidence intervals) of independent risk factors were 1.50 (1.03-2.18) for maternal age ≥ 40 years, 1.51 (1.06-2.17) for body mass index ≥ 25 kg/m2 , 2.22 (1.24-3.98) for hypertensive disorder during pregnancy, 3.43 (1.31-8.95) for large-for-date fetus and 4.64 (3.23-6.69) for induction of labor. The rate of intrapartum emergency CS in older nulliparous women at term was approximately 21%. Induction of labor should be recognized as a significant factor for emergency CS.

Influenza infections in the 2014-2015 season and pregnancy outcomes.

The most recent influenza season saw a prominent infectious burden over a period of six months in the Turkish capital, reminding observers of the pandemic in 2009 year. The aim of the present study was to investigate the consequences of seasonal outbreaks in pregnant women during the 2014-2015 influenza season. Forty-seven pregnant female patients with symptoms of influenza-like illness who were admitted to tertiary perinatal care center in Ankara, Tukrey, between October 2014 and May 2015 were included in this case-control study. The subtype determination of influenza was performed with real-time reverse transcriptase-polymerase chain reaction (RT-PCR) testing. Clinical observations and pregnancy outcomes were compared with respect to subtypes. Classifications were available for 35 patients, of whom 12 were determined to have influenza A infection, while 10 had influenza B infection. The remaining 13 patients were influenza-negative. Eight of the 22 (36.4%) influenza-positive patients delivered their babies in the preterm period (< 37 weeks). The corresponding rate was 8.3% (1/12) in the influenza-negative group. This difference was not statistically significant (p = 0.077). Preterm deliveries in pregnant women did not differ significantly among influenza-postive and influenza-negative pregnant women in non-vaccinated study population. Further studies with larger sample sizes may provide more supporting results.

The impact of intrauterine treatment on fetal tachycardia: a nationwide survey in Japan

Objectives: To investigate the clinical course of fetal tachycardia and analyze the impact of intrauterine treatment on the postnatal treatment and patient outcomes.Study design: This was a retrospective review of cases of fetal tachycardia that occurred from 2004 to 2006. Data were collected from questionnaires that were sent to all 750 secondary or tertiary perinatal care centers in Japan.Results: Eighty-two cases (14 with fetal hydrops) were analyzed (supraventricular tachycardia [SVT], n = 52; atrial flutter [AFL], n = 23; and ventricular tachycardia, n = 7). The overall mortality was 3.7%. Intrauterine treatment was performed for 41 fetuses (50.0%). Digoxin, flecainide and sotalol were mainly used for SVT and AFL. Fetal tachycardia resolved in 90.0% (27/30) of the cases without fetal hydrops and 90.9% (10/11) of the cases with fetal hydrops. Intrauterine treatment significantly reduced the incidence of cesarean delivery (29.3 vs. 70.7%, p < .01), preterm birth (12.2 vs. 41.5%, p = .02) and neonatal arrhythmias (48.8 vs. 78.0%, p = .01) in comparison to untreated fetuses.Conclusions: This nationwide survey revealed that intrauterine treatment was performed for approximately half of the cases of fetal tachycardia and was associated with lower rates of cesarean delivery, premature birth and neonatal arrhythmias in comparison to untreated fetuses.

The effect of high-intensity breastfeeding on postpartum glucose tolerance in women with recent gestational diabetes

BackgroundAlthough breastfeeding is expected to reduce the incidence of diabetes in women with gestational diabetes, the effect has not been clearly confirmed. We examined whether or not high-intensity breastfeeding reduces the incidence of abnormal glucose tolerance and investigated the effect of high-intensity breastfeeding on insulin resistance during the first year postpartum in Japanese women with current gestational diabetes.MethodsIn this retrospective study, we included women with gestational diabetes who underwent postpartum 75 g oral glucose tolerance test during the first year (12-14 months) postpartum from 2009 to 2011 at a single tertiary perinatal care center in Japan. High-intensity breastfeeding was defined as the condition in which infants were fed by breastfeeding alone or 80% or more of the volume. We investigated the effect of high-intensity breastfeeding on the prevalence of postpartum abnormal glucose tolerance and the postpartum homeostasis model of assessment of insulin resistance (HOMA-IR), after controlling for confounders, including prepregnancy obesity and weight changes during pregnancy and postpartum.ResultsAmong 88 women with gestational diabetes, 46 (52%) had abnormal glucose tolerance during the postpartum period. High-intensity breastfeeding women (n = 70) were significantly less likely to have abnormal glucose tolerance than non-high-intensity breastfeeding women (n = 18) (46% vs. 78%, p = 0.015). High-intensity breastfeeding was also associated with a lower HOMA-IR at 12-14 months postpartum than non-high-intensity breastfeeding (1.41 ± 1.02 vs. 2.28 ± 1.05, p = 0.035). Those associations remained significant after controlling for confounders. At least six months of high-intensity breastfeeding had a significant effect on lowering both the abnormal glucose tolerance prevalence and HOMA-IR compared with non-high-intensity breastfeeding.ConclusionsIn Japanese women with gestational diabetes, high-intensity breastfeeding ≥6 months had a protective effect against the development of abnormal glucose tolerance during the first year postpartum through improving insulin resistance, independent of obesity and postpartum weight change.

P 32 Postpartum HELLP syndrome – A case report

Introduction HELLP syndrome is a life-threatening obstetric condition and one of the particularly severe forms of preeclampsia. Objective The purpose of this paper is to present a case of preeclamptic patient with HELLP syndrome diagnosed on 2 day after delivery by the cesarean section. Objective A 32-year-old primigravida at 38 + 1 week of gestation was admitted to the tertiary care hospital with PROM, severe hypertension, proteinuria and generalized oedema. Four weeks earlier i.e., at 35 week of gestation, the patient had her last appointment at an outpatients clinic. She was started on antihypertensive therapy and was transported to the operating theatre. The lower segment caesarean section under general anesthesia was carried out that resulted in a son born. At birth, the boy weighed 2190 g. On the second day after the cesarean section, the patient developed diffused haematoma within the abdominal wall. Laboratory tests revealed clinically significant renal and liver dysfunction and thrombocytopenia. HELLP syndrome was diagnosed. The therapy with intravenous Dexamethasone was initiated. Metyldopa in a dose of 500 mg four times daily was continued, some ice gel packs were applied on the haematoma of the abdominal The antibiotic therapy was administered for 7 days. The patient was under close surveillance. We observed continuous gradual progressive improvement in the patient’s condition and her laboratory tests. The blood coagulation function improved. Liver enzymes began to decrease on day 5 and normalized on day 8 after the C-section. The diffused haematoma on the abdominal wall and pubic symphysis disappeared after 5 days. The patient was discharged on day 11 after the C-section with recommendations that involved taking of Methyldopa, systematic control of blood pressure and a follow-up appointment at the Outpatient Nephrological Clinic. Conclusions Although delivery of the infant and placenta constitutes the curative treatment of HELLP, it may occur also in the postpartum period. HELLP syndrome is always a serious and potentially fatal obstetric condition however, it is reversible if an adequate diagnosis is promptly made and emergency intensive treatment is immediately administered. Patients with HELLP syndrome should be treated in a tertiary perinatal care centre with the intensive care unit.

Periconceptional CMV infection prevention in Portugal: population subgroup study in a tertiary perinatal care center

Currently in Portugal, universal screening of pregnant women for Cytomegalovirus (CMV) infection is not performed. However, it is recommended to screen all women attending preconception care. We aimed to assess women’s attendance to preconception care and if their serologic status regarding CMV was known and/or investigated in that consultation. In this cross-sectional study, we interviewed 240 women admitted to the obstetrical ward of a hospital in the Metropolitan Area of Porto (Portugal) about their adherence to preconception care and collected data regarding their CMV serologic status and its investigation. We found that 71.3% of the women who attended preconception care were not screened for CMV infection. Among primigravida, the screening rate was only of 30.4% (upper limit of CI 95%: 44.8%). There were no statistically significant differences between the private and public sectors of healthcare. We observed attendance to preconception care is high (73.1%). For the population subgroup of the metropolitan area of Porto, attendance to preconception care is at least 66%, with a 95% confidence level. Portuguese guidelines stating a woman’s serologic status regarding CMV should be investigated in preconception care are not properly implemented. This suggests guidelines should assure the screening of previously non-screened women during pregnancy.

Maternal and neonatal outcomes in women with severe early onset pre-eclampsia before 26 weeks of gestation, a case series.

To describe the maternal and neonatal outcomes and prolongation of pregnancies with severe early onset pre-eclampsia before 26 weeks of gestation. Nationwide case series. All Dutch tertiary perinatal care centres. All women diagnosed with severe pre-eclampsia who delivered between 22 and 26 weeks of gestation in a tertiary perinatal care centre in the Netherlands, between 2008 and 2014. Women were identified through computerised hospital databases. Data were collected from medical records. Maternal complications [HELLP (haemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, eclampsia, pulmonary oedema, cerebrovascular incidents, hepatic capsular rupture, placenta abruption, renal failure, and maternal death], neonatal survival and complications (intraventricular haemorrhage, retinopathy of prematurity, necrotising enterocolitis, bronchopulmonary dysplasia, and sepsis), and outcome of subsequent pregnancies (recurrent pre-eclampsia, premature delivery, and neonatal survival). We studied 133 women, delivering 140 children. Maternal complications occurred frequently (54%). Deterioration of HELLP syndrome during expectant care occurred in 48%, after 4 days. Median prolongation was 5 days (range: 0-25 days). Neonatal survival was poor (19%), and was worse (6.6%) if the mother was admitted before 24 weeks of gestation. Complications occurred frequently among survivors (84%). After active support, neonatal survival was comparable with the survival of spontaneous premature neonates (54%). Pre-eclampsia recurred in 31%, at a mean gestational age of 32 weeks and 6 days. Considering the limits of prolongation, women need to be counselled carefully, weighing the high risk for maternal complications versus limited neonatal survival and/or extreme prematurity and its sequelae. The positive prospects regarding maternal and neonatal outcome in future pregnancies can supplement counselling. Severe early onset pre-eclampsia comes with high maternal complication rates and poor neonatal survival.

Perinatal outcome associated with assisted reproductive technology in a tertiary perinatal care center between 2006 and 2015

Perinatal outcome associated with assisted reproductive technology in a tertiary perinatal care center between 2006 and 2015

Prognóstico obstétrico de pacientes portadoras de diabetes mellitus pré-gestacional

To describe trends in prevalence, indicators of care and pregnancy outcomes for women with pre-existing type I or type II diabetes. Cohort study of all consecutive singleton pregnancies complicated by pre-existing type I or type II diabetes followed from 2004 to 2011 at a tertiary perinatal care centre (n=194). We collected data from the medical records and described trends in demographics, clinical history, indicators of care before or during pregnancy and glycaemic control. We also studied perinatal outcomes, including gestational age at delivery, mode of delivery, and birthweight. The overall incidence of pregestational diabetes was 4.4 per 1000, with no significant changes throughout the study period. The number of type 2 diabetes cases also remained constant. In 67% of cases delivery occurred after 37 weeks (maximum 80% in 2010 - 11). During this period there was a significant reduction in rates of elective caesarean section (p=0.03) and in the incidence of large infants for gestational age (p=0.04). Indicators of glycaemic control were favorable throughout pregnancy, with no significant trends detected during the study period. However, preconceptional care indicators were substandard, with no significant improvement. A multidisciplinary approach to diabetic management and obstetric practice contributed to adequate glycaemic control throughout pregnancy and to improved pregnancy outcomes. Preconceptional care remains a key challenge.