Unfavorable Perinatal Outcomes Research Articles

Low amniotic fluid index at term as a predictor of adverse perinatal outcome.

Objective: To assess the prevalence of adverse perinatal outcomes in antenatal women with low amniotic fluid index at term. Study Design: Observational Cross-sectional Analysis. Setting: Department of Gynaecology and Obstetrics Hayatabad Medical Complex, Peshawar. Period: 2nd February 2020, to 5th February 2021. Methods: The study involved a total of 165 patients, in 37 to 40-weeks of gestation period, the research included antenatal women with a low amniotic fluid index, with any parity, gravidity, and 18-35 years of age. While Excluded patients with any medical disorders during pregnancy (e.g., PIH, anemia, cardiac disease etc.), and those with gestational period <37 weeks from the study. Thorough history, clinical examination and ultrasound were carried out of all the women included in the study from OPD and emergency department, to confirm a low amniotic fluid index. Patient follow-up was extended to their arrival in the Obstetric suite during established labor, APGAR scores were calculated and recorded at birth, and at the 5-minute of birth for the neonate. Adverse Perinatal Outcome was considered positive if the APGAR Score was <7/10 at five minutes of life of neonate. Data analysis was performed using SPSS 23. Results: Out of 165 patients 57% of the patients were induced while 43% spontaneously delivered, similarly 66.7% were delivered vaginally while 33.3% were delivered via C Section. Low neonatal APGAR score was recorded in 67.9% patients which is a significant percentage, hence our study results showed positive correlation of low AFI with adverse perinatal outcome. We also observed that probability of satisfactory values of AFI is 1.5 times more in spontaneous deliveries (p=0.04, OR=1.5), however no such relation exists for period of gestation or number of parity. Similarly, there is a significant relation of mode of delivery with satisfactory values of AFI (p=0.00), however no such relation exists for period of gestation or number of parity. However, the probability of vaginal deliveries is 1.6 times more with an increased in number of para (p=0.02, OR=1.6). Conclusion: Reduced amniotic fluid index is linked with significant Unfavorable Perinatal Outcomes proved by low APGAR score (<7/10 at five minutes).

Optimizing perinatal wellbeing in pregnancy with obesity: a clinical trial with a multi-component nutrition intervention for prevention of gestational diabetes and infant growth and neurodevelopment impairment.

Pregnancy complicated by obesity represents an increased risk of unfavorable perinatal outcomes such as gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy, preterm birth, and impaired fetal growth, among others. Obesity is associated with deficiencies of micronutrients, and pregnant women with obesity may have higher needs. The intrauterine environment in pregnancies complicated with obesity is characterized by inflammation and oxidative stress, where maternal nutrition and metabolic status have significant influence and are critical in maternal health and in fetal programming of health in the offspring later in life. Comprehensive lifestyle interventions, including intensive nutrition care, are associated with a lower risk of adverse perinatal outcomes. Routine supplementation during pregnancy includes folic acid and iron; other nutrient supplementation is recommended for high-risk women or women in low-middle income countries. This study is an open label randomized clinical trial of parallel groups (UMIN Clinical Trials Registry: UMIN000052753, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000060194) to evaluate the effect of an intensive nutrition therapy and nutrient supplementation intervention (folic acid, iron, vitamin D, omega 3 fatty acids, myo-inositol and micronutrients) in pregnant women with obesity on the prevention of GDM, other perinatal outcomes, maternal and newborn nutritional status, and infant growth, adiposity, and neurodevelopment compared to usual care. Given the absence of established nutritional guidelines for managing obesity during pregnancy, there is a pressing need to develop and implement new nutritional programs to enhance perinatal outcomes.

Obstetric outcomes of teenage pregnancies: A record-based study in a rural hospital of North 24 Parganas district, West Bengal

Background: Teenage pregnancy is a pregnancy in a woman within 10–19 years of age groups. It results from a number of factors such as early age at marriage, illiteracy, poverty, premarital sex, lack of awareness, and access to contraception. Teenage pregnancy imposes serious social and medical implications relating to both maternal and child health. It is a worldwide public health problem in both developed and developing countries. Aims and Objectives: The study was conducted in a rural hospital of North 24 Parganas in West Bengal. The primary objective was to compare different maternal and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers. The secondary objective was to assess the association between various sociodemographic factors on the prevalence of teenage pregnancy. Materials and Methods: The cross-sectional hospital record-based study includes a sample of 78 study subjects each in cases and comparison group. Records were taken from June 2019 to December 2019. Results: Of a total of 379 labor room admissions during the study period, 86 (22.69%) were of the teenage group and 8 cases were excluded from the study. A total of 78 teenage pregnancies were analyzed and compared with 78 adult pregnancies. The mean (standard deviation) age of teenage in our study was 18.10±0.63 and that of the comparison group was 22.74±1.68 years. Results revealed that teenage mothers had a statistically higher proportion of anemia (OR=2.30, P=0.05) and low-birth-weight babies (OR: 3.6, P=0.05) compared to adult-primigravida mothers, respectively. Conclusion: Teenage pregnancy is still a rampant and important public health problem in India with unfavorable perinatal outcomes and needs to be tackled on a priority basis.

Evaluation of Fetal Breathing-Related Nasal Fluid Flow Doppler in the Third Trimester in Pregnant Women with Fetal Growth Restriction: Preliminary Observations.

To investigate the fetal breathing-related nasal fluid flow Doppler waveforms as an indicator of fetal respiratory function in fetuses diagnosed with fetal growth restriction (FGR) in the third trimester. This prospective, non-interventional case-control study was conducted on 96 pregnant women, including 23 pregnant women diagnosed with FGR in the third trimester as the FGR group and 73 healthy pregnant women with fetuses appropriate for gestational age (AGA) as the control group. Fetal breathing-related nasal fluid flow Doppler was examined in the fetuses of the participants. Inspiration and expiration duration, inspiration and expiration peak velocity, total breathing duration, and number of fetal breaths per minute were calculated. Both groups were similar in terms of the duration of inspiration, duration of expiration, and total breathing duration (p=0.463, p=0.711, p=0.520, respectively). Peak inspiratory velocity and peak expiratory velocity were significantly lower in the FGR group than in the control group, and the number of fetal breaths per minute was similar in both groups (p=0.027, p=0.012, p=0.768, respectively). When participants were regrouped into those whose newborn was admitted to the neonatal intensive care unit (NICU) after birth and those who were not, all fetal nasal fluid flow Doppler parameters were similar in both groups. Although the number of participants was too small to draw a definitive conclusion, FGR appears to be associated with a decrease in peak inspiratory and expiratory velocity. The clinical significance of changes in fetal breathing-related nasal fluid flow Doppler parameters in FGR is as yet unclear, and their use in clinical follow-up and predicting unfavorable perinatal outcomes are the subjects of future research.

Prevalence and determinants of adverse perinatal outcomes of preeclampsia with severe features at two selected public hospitals in Addis Ababa, Ethiopia.

Preeclampsia is a new onset of hypertension and either proteinuria or end-organ failure after 20 weeks of gestation. It is a prevalent cause of perinatal mortality, morbidity, and neonatal complications in developing nations including Ethiopia. Thus, the aimed to assess the prevalence and determinants of adverse perinatal outcomes among women with preeclampsia with severity features (PEWSF) at two selected public hospitals in Addis Ababa, Ethiopia, 2023. A cross-sectional study was carried out among 348 mothers between January 1, 2023, and July 1, 2023. A structured, pre-tested questionnaire was used to gather data from in-person interviews and a review of the patient's medical record. The statistical program Epi-Data version 4.6 was used to enter the data, and SPSS version 26.0 was used for analysis. Binary logistic regression analysis was used to find factors that were associated with unfavorable perinatal outcomes. A p-value of less than 0.05 was used to declare the significance level. The overall prevalence of unfavorable perinatal outcomes was 59.2% (95% CI: 54.0-63.8). Among the complications, low birth weight, prematurity, NICU admission, and a low fifth-minute APGAR score, encompass 48.9%, 39.4%, 20.4%, and 14.7%, respectively. No formal education [OR = 5.14, 95% CI: (1.93-13.63)], unemployment [OR = 0.42, 95% CI: (0.24-0.73)], referral cases [OR = 2.03, 95% CI: (1.08-4.06), inadequate antenatal care (ANC) contact [OR = 3.63, 95% CI: (1.22-10.71)], and family history of hypertension [OR = 1.99, 95% CI: (1.03-3.85)] have shown a statistically significant association with unfavorable perinatal outcomes. In this study, the prevalence of unfavorable perinatal outcomes was high compared to other studies in Ethiopia. Level of education, occupation, mode of admission, ANC contact, and family history of hypertension were significant predictors of unfavorable perinatal outcomes. Socio-economic development, improving referral systems, and adequate antenatal care contact are needed to improve unfavorable outcomes. Additionally, antenatal screening and specialized care for high-risk mothers, e.g., those with a family history of hypertension are recommended.

Effect of Low-Quality Embryo on Adverse Obstetric and Perinatal Outcomes

Background: This retrospective study focused on whether low-quality embryos have the risk on perinatal and obstetric outcomes. Methods: This study enrolled 600 women undergoing fresh embryos transfer (ET) cycles between June 2019 and December 2022. The patients were stratified into two groups, high-quality embryo group and low-quality embryo group. In both groups, the perinatal and obstetric outcomes were the primary outcomes. Moreover, we conducted a multi-variable logistic regression analysis, where additional possible confounding factors were controlled, to determine how diverse embryo qualities affected the primary outcomes. Results: The results showed that compared with the low-quality group, the high-quality group showed increased clinical pregnancy (63.33% vs 26.33%) as well as a higher number of live birth rates (52.67% vs 18.33%) (P＜0.001). There were no statistically significant differences in unfavorable perinatal and obstetric outcomes between high- and low-quality groups (p＞0.05). Similarly, the transfer of blastocysts developing from high-quality embryos led to increased clinical pregnancy rates (84.50% vs 48.05%, p<0.001) and live birth rates (74.64% vs 38.96%, p<0.001). Transfer of blastocysts developing from low-quality embryos did not impact the unfavorable perinatal or obstetric outcomes. The logistic regression analysis showed that low-quality could not increase the unfavorable perinatal or obstetric outcomes. Conclusion: In summary, low-quality ET does not increase the risk of unfavorable perinatal or obstetric outcomes. Overall, compared to low-quality embryos, the transfer of high-quality embryos increases the clinical pregnancy and live birth rates.

The development and evaluation of a multidisciplinary consultation between professionals from the medical, social, and public health domains to deliver tailored care and support for pregnant women and young families in vulnerable positions. 

The population in the region South-Limburg (NL) suffers from a deprived health status compared to rest of the Netherlands, including unfavorable perinatal health outcomes that impact the child’s health and development in later life. To turn the tide, South-Limburg aims to achieve a ‘promising start to life’ by focusing on the first 1,000 days of life: pregnant women and families with children aged 0-2 years. In particular, the focus is on pregnant women and families in a vulnerable position, facing (a combination of) medical and, especially, social problems (e.g., housing, financial, relational, psychosocial, addiction). Delivering timely and appropriate tailored care and support to this target group requires close cooperation between professionals from the medical domain (i.e., midwife, maternity care, GP), social domain (i.e., social work, municipal support), and public health domain (youth health care). 
 In three low socioeconomic status municipalities in South-Limburg, a co-creation process was started in 2020 to strengthen cross-domain collaboration in delivering timely care and support tailored to the needs of pregnant women and families with children aged 0-2 years in a vulnerable position. Professionals’ input was derived during meetings with stakeholders from the three domains. Input from pregnant women/young families in a vulnerable position was gained through interviews regarding their experiences with current care/support during pregnancy and in the first years of the child’s life. These showed that, among others, they often feel unheard or ignored by professionals; lack of clarity about who is in charge when several professionals are involved; lack of attention for psychosocial problems; insufficient father involvement by professionals.
 As a result of the co-creation process, a case-based multidisciplinary consultation was developed. Essential elements are: professionals from the medical, social, and public health domain join in, as well as the pregnant woman or family involved; professionals use the shared language of ‘Positive Health’ to match the family’s needs and wishes; agreements on referral to care or support are noted in a care plan and the family is assigned a case director.
 The case-based multidisciplinary consultations in the three municipalities started at the beginning of 2022. A practice-based action research is conducted to gain insight into its creation, implementation, functioning, and further development. Research methods include interviews, observations, and questionnaires. First results are available from 24 interviews with professionals involved in the co-creation process about their views on cross-domain collaboration. Themes addressed are among others: importance of early identification of problems; better understanding of other professionals’ expertise; conditions that facilitate or hinder cross-domain collaboration. Results are discussed in the four-yearly meetings per municipality with professionals from the medical, social, and public health domain. Points for action are prioritized and will be monitored over time. Also, client journeys will be conducted to address families’ experiences with the multidisciplinary consultation and referral to care and support.
 This form of cross-domain collaboration, supported by a practice-based action research, can serve as an example for the international audience interested in improving population health by investing in prevention at the very early onset of life.

Clinical characteristics and outcomes of women with adenomyosis pain during pregnancy: a retrospective study.

Adenomyosis is associated with unfavorable perinatal outcomes, and recent case reports show that some women with adenomyosis experience pain at the adenomyosis lesion during pregnancy and have detrimental perinatal outcomes. This study aimed to clarify the clinical characteristics of this pain and perinatal outcomes associated with this phenomenon. This was a single-center retrospective analysis of pregnant women with adenomyosis. The incidence of pain onset at adenomyosis lesions, defined as persistent pain at the adenomyosis site with administration of analgesics for pain relief, and its association with perinatal outcomes were analyzed. Among 91 singleton pregnancies with adenomyosis, 12 pregnancies (13.2 %) presented with pain. One pregnancy resulted in second-trimester miscarriage, and 5 of the 11 pregnancies (45 %) developed preeclampsia, which resulted in preterm delivery, and 3 of the 12 pregnancies (25 %) achieved term delivery. The incidence of preeclampsia and preterm delivery was higher in those who experienced pain than in those without (45 % [5/11] vs. 15 % [11/74]; p<0.05, and 73 % [8/11] vs. 34 % [25/74]; p<0.05, respectively). Among women with pain, the maximum C-reactive protein level was significantly higher in women who developed preeclampsia than in those who did not (5.45 vs. 0.12 mg/dL, p<0.05). Our study revealed that adenomyosis can cause pain in over one of eight pregnancies with adenomyosis, which may be associated with the increased incidence of preeclampsia resulting in preterm delivery. Women with pain, especially those with high C-reactive protein levels, may be at high risk for future development of preeclampsia and consequent preterm delivery.

Prevalence of anemia and comparison of perinatal outcomes among anemic and nonanemic mothers.

The prevalence of anemia is a significant public health challenge. Approximately half of all pregnant women in India experience anemia during pregnancy. This study aims to determine the prevalence of anemia and perinatal outcomes among anemic and nonanemic pregnant mothers. The quantitative research approach was adopted using a descriptive comparative design. The study was conducted in the Obstetrics and Gynecology and Pediatric departments of a tertiary care hospital. Hemoglobin (Hb) was recorded using antenatal records of pregnant mothers in their III trimester. Based on their Hb level, subjects were divided into two groups, anemic and nonanemic as per World Health Organization criteria. The subjects were followed up until the first week after birth. The prevalence of anemia was 48% [N = 410]; 70.6% had mild, 13.7% had moderate, and 15.7% had severe. The anemic group had a significantly higher incidence of low birthweight (30.9% vs 10.3%, P = 0.001) and preterm births (24.2% vs 3.2%, P = 0.001) compared to the nonanemic group. Additionally, there were significant differences in various quantitative perinatal parameters such as weight (P = 0.001), length (P = 0.001), head circumference (P = 0.001), chest circumference (P = 0.034), APGAR score at one minute (P = 0.022), and APGAR score at five minutes (P = 0.001) between the anemic and nonanemic. The maternal anemia is associated with increased risk of unfavorable perinatal outcomes. Identifying and managing anemia among pregnant women is critical to minimize adverse outcomes. Adequate antenatal care can play a significant role in preventing avoidable complications associated with anemia during the third trimester.

Clinical observation of delivery in a COVID-19-convalescent woman with preeclampsia developing fetal distress during preterm labor

The course of the pandemic revealed that despite the general populational risks for developing novel coronavirus infection (NCI) COVID-19, pregnant women are more susceptible to its severe course and unfavorable perinatal outcomes. Currently, NCI is associated with a high risk of spontaneous miscarriages, premature rupture of fetal membranes, preterm delivery, development of fetoplacental insufficiency, fetal growth retardation, fetal distress, exacerbation of chronic somatic pathology, and postpartum bleeding. A brief literature review and the described clinical case demonstrate a need to thoroughly examine puerperal women with preterm delivery.

Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis

Adenomyosis is associated with unfavorable perinatal outcomes; however, the effect of an adenomyomectomy on pregnancy outcomes remains unclear. Pregnancy following an adenomyomectomy has been reported to be associated with a high risk for uterine rupture; however, the actual incidence remains unknown. This study aimed to evaluate the effect of an adenomyomectomy on pregnancy outcomes by retrospectively comparing the pregnancy outcomes of women who underwent an adenomyomectomy with those of women with adenomyosis. This was a single-center retrospective study in which the pregnancy outcomes of women who underwent an adenomyomectomy and for whom complete resection of the affected tissue under laparotomy was achieved were compared with those of women with adenomyosis. The following pregnancy outcomes were examined: second-trimester miscarriage, preterm prelabor rupture of membranes, preterm delivery, spontaneous preterm delivery, preeclampsia, rate of cesarean delivery, blood loss during cesarean delivery, incidence of placenta accreta spectrum, neonatal body weight, and small for gestational age infants. A total of 18 pregnant women who underwent an adenomyomectomy and 105 pregnant women with adenomyosis were included in this study. All women who underwent an adenomyomectomy delivered via cesarean delivery, and among them, 1 had a uterine rupture at 30 weeks of gestation. Although there was no significant difference between pregnant women who underwent an adenomyomectomy and those with adenomyosis in the incidence of second-trimester miscarriage (0% [0/18] vs 7.6% [8/105], respectively; P=.22), preterm delivery (50% [9/18] vs 32% [34/105], respectively; P=.15), and spontaneous preterm delivery (6% [1/18] vs 15% [16/105], respectively; P=.26), a significant decrease in preterm prelabor rupture of membrane (0% [0/18] vs 12% [13/105], respectively; P<.05), preeclampsia (0% [0/18] vs 12% [13/105], respectively; P<.05), and small for gestational infants (0% [0/18] vs 15% [16/105], respectively; P<.05), as well as a significant increase in the incidence of placenta accreta spectrum (50% [9/18] vs 0% [0/105], respectively; P<.01) and blood loss during cesarean delivery (1748 mL vs 1330 mL, respectively; P<.05) were observed. Uterine rupture following an adenomyomectomy may occur because of the high incidence of placenta accreta spectrum. However, an adenomyomectomy may reduce adverse pregnancy outcomes associated with adenomyosis, such as preterm prelabor rupture of membranes, preeclampsia, and small for gestational age infants. An adenomyomectomy may be a viable option for women among whom the procedure is inevitable before conception.

Frequency of Short Inter-pregnancy Interval in Neonatal Morbidities

Background: The risk of unfavorable perinatal outcomes in the following pregnancy may increase if there has been a short time between the last live birth and the beginning of the current pregnancy. This elevated risk may be brought on by inadequate nutritional replenishment after the delivery of a live newborn, increased cervical insufficiency, or vertical infection transmission after a brief interpregnancy intervals. Aim: To determine frequency of short interpregnancy interval in neonatal morbidities. Study design: The cross-sectional study. Methodology: The Ittefaq hospital's Neonatal ICU served as the study's location. Total 270 neonates, both sexes, 0 to 28 days old, with gestational ages between 37 and 42 weeks (based on a date scan) and birth weights between 2500 and 4000 g were included. Mothers or other witnesses of the included notates were questioned on the time between this pregnancy and the one before it. The term "short interpregnancy interval" (IPI) was used when the time between two successive pregnancies was less than 12 months. Data was analyzed in SPSS 25V. Results: Neonates ranged in age from 13.88 to 7.66 days. Neonatal mortality was 119(44.07%) male and 151(55.93%) female. It took 39.19 weeks on average, plus or minus 1.43 weeks. The average weight at birth was 2720.61 271.56 g. There were 40 neonates (14.81%) with RDS, 58 (14.81%) with NEC, 56 (20.74%) with IVH, 23(8.52%) with ROP, and 93(34.44%) with Sepsis. 200 neonates (74.07%) had a typical inter-pregnancy interval, while 70 (25.93%) had a short inter-pregnancy period. Conclusion: The study's findings indicated that 25.93% of the newborns had short inter-pregnancy intervals, which are frequently associated with neonatal morbidities. IPI is a controllable risk factor for newborn morbidity, hence it is important to urge families to choose the recommended birth spacing. Early identification of this high-risk group can help to prevent negative neonatal outcomes and identify deliveries that may require the attendance of a pediatrician. Keywords: Birth spacing, interpregnancy interval, neonatal morbidity, RDS, NEC, IVH, ROP, Sepsis

Outcome of Pregnancies with Severe Oligohydramnios in the 3rd Trimesters

Background: Amniotic fluid volume (AFV) of less than 200 ml is considered as insufficient, and is referred as significant oligohydramnios. Approximately 8% of pregnant women may experience low amniotic fluid levels ( less than normal / AFI &lt; 8 cm ) But among them about 4% of pregnant women are diagnosed with severe or significant oligohydramnios. A range of unfavorable perinatal outcomes, including fatal growth restriction meconium aspiration of fetus, fetal distress and surgical intervention for foetal distress in labour and even perinatal death, are linked to oligohydramnios which are found during the antepartum period of pregnancy. The purpose of the study was to determine the outcome of pregnancies with severe oligohydramnios in the 3rd trimester. Material &amp; Methods: This prospective observational study was carried out on the admitted patients in the Department of Gynecology &amp; Obstetrics at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from February to July 2013 (6 months). A total of fifty women (N=50) having Oligohydramnios in pregnancy were included in the study. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for Social Sciences (SPSS) Version 25.0. The ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: Mean age of the mothers was 25.8 years and two-fifths of the mothers (20, 40.0%) belonged to 21-25 years old. Twenty-three mothers (23, 46.0%) were nulliparous. Of fifty mothers (N=50), eighteen (18, 36.0%) had borderline oligohydramnios &amp; thirty-two (32, 64.0%) had severe oligohydramnios. Normal CTG tracing was found in eighteen patients (18, 36.0%) and abnormal CTG was found in thirty-two patients (32, 64%). Based on fetal outcome (N=50), 23 babies (23, 46.0%) were admitted to the NICU, of whom 7 (7, 14.0%) had birth asphyxia, 8 (8, 16.0%) had neonatal sepsis, 4 (4, 8.0%) had neonatal jaundice, 2 (2, 4.0%) had meconium aspiration syndrome, 4 had stillbirths, and 5 had died as neonates. Conclusion: Nowadays, routine obstetric USG is more routinely used to detect oligohydramnios. In the third trimester of pregnancy, PIH and postdated pregnancies are the most common causes of decreasing amniotic fluid. Unfavourable perinatal outcomes can be avoided with careful fetal heart rate monitoring during antenatal period and at labour. Every case of oligohydramnios necessitates a comprehensive prenatal assessment, parental counselling, and a personalized delivery time and technique. This study found no connection between meconium-stained liquor and oligohydramnios and found that caesarean section deliveries were considerably more common in these women.

Advanced maternal age (AMA) and 75 g oGTT glucose levels are pedictors for Insulin therapy in women with gestational diabetes (GDM).

Gestational diabetes (GDM) is a common complication during pregnancy that is strongly associated with adverse fetal and maternal outcomes. Advanced maternal age (≥35 years) is a known risk factor for GDM. Studies advocate that GDM comprises distinctive metabolic entities, suggesting an individualized approach based on early pregnancy characteristics (such as 75 g oGTT values, maternal age, obstetric history). The oGTT blood glucose levels of 1,664 women were categorized into isolated fasting hyperglycemia (GDM-IFH), isolated postprandial hyperglycemia (GDM-IPH) and combined hyperglycemia (GDM-CH), using the levels of the fasting, 1 h and 2 h values after glucose application. These three subtypes were analysed regarding baseline characteristics as well as fetal and maternal outcome in the context of maternal age. This analysis reveals that the 75 g oGTT levels and maternal age can distinguish metabolic phenotypes in women with GDM. The overall rate of Insulin therapy required was higher in women from the GDM-CH group and increased with maternal age (31.7 %, 38.2 %, <35 years,≥35-39 years respectively, vs. total Insulin rate 22.3 %, p-value <0.001). Women≥35 years displayed a significantly higher caesarean delivery (CD) rate (<35 years 34.6 %, 38.4 %, 41.1 % vs.≥35 years 54.8 %, 47.6 %, 46.5 %, GDM-IFH, GDM-IPH, GDM-CH respectively, p-value <0.001). Women with fasting hyperglycemia, especially those with combined hyperglycemia and AMA display a higher risk for unfavorable perinatal outcome. A categorization based on oGTT values and maternal age, as well as other characteristics can facilitate a basis for clinical risk stratification. Women at risk should receive an individualized and intensified perinatal care as well as interventional therapies.

Rezultatele naşterii la vârste materne foarte avansate – experienţa unui centru de nivel 2

Background. Advanced maternal age has been linked to unfavorable perinatal outcomes. This study aimed to evaluate the perinatal outcomes in patients with very advanced maternal age. Materials and method. We retrospectively reviewed the records of patients admitted to the Obstetrics and Gynecology Clinic of the Mureş County Clinical Hospital, Romania, between 1 September 2016 and 1 September 2023. The study group comprised 17 patients, while the control group consisted of 661 patients, aged 18-44 years old, who gave birth between 1 January 2023 and 30 June 2023. Results. Patients from rural areas with very advanced maternal age had more pregnancies and births than the control group. The majority of pregnancies were achieved naturally, with a significantly higher incidence of preterm birth before 34 weeks. There were no statistically significant differences in the incidence of pregnancy-induced hypertension and intrauterine growth restriction between groups, while obesity and gestational diabetes were significantly associated with very advanced maternal age. Caesarean section was the most common mode of delivery. Newborns of mothers with very advanced age were more frequently male, had low birth weight, and were frequently admitted to the intensive care unit. Conclusions. Advanced maternal age is associated with an increased risks of gestational diabetes, premature birth, caesarean section, and delivering small-for-gestational-age newborns. Therefore, patients with advanced maternal age require careful obstetric surveillance.

Placental chorioangioma and pregnancy outcome: a ten-year retrospective study in a tertiary referral centre

BackgroundPlacental chorioangioma is a rare disorder in pregnancy. We retrospectively reviewed the perinatal complications and long-term outcomes in pregnancies with placental chorioangioma and evaluated the factors affecting disease prognosis.MethodsWe reviewed pregnant women who delivered at our hospital in the past decade and whose diagnosis of placental chorioangioma was confirmed by pathological diagnosis. Information on maternal demographics, prenatal sonographic findings and perinatal outcomes was obtained by reviewing the medical records. In the latter part of the study, follow-up of children was conducted by phone interview.ResultsIn the 10 years from August 2008 to December 2018, 175 cases(0.17%) were identified as placental chorioangioma histologically and 44(0.04%) of them were large chorioangiomas. Nearly one-third of cases with large chorioangiomas were associated with severe maternal and fetal complications or required prenatal intervention. Although one-fifth of fetuses/newborns complicated with large chorioangiomas were lost perinatally, the long-term prognosis for surviving fetuses was generally good. Further statistical analysis revealed that tumor size and location affect prognosis.ConclusionPlacental chorioangioma may cause an unfavorable perinatal outcome. Regular ultrasound monitoring can provide the tumor characteristics which can be referred to for predicting the tendency of those complications and indicate when intervention may be necessary. It is not clear which factors lead to complications with fetal damage as the main manifestation or polyhydramnios as the main manifestation.

SARS-CoV-2 Footprints in the Placenta: What We Know after Three Years of the Pandemic.

As the COVID-19 pandemic continues into its third year, there is accumulating evidence on the consequences of maternal infection. Emerging data indicate increased obstetrics risks, including maternal complications, preterm births, impaired intrauterine fetal growth, hypertensive disorders, stillbirth, gestational diabetes, and a risk of developmental defects in neonates. Overall, controversial concerns still exist regarding the potential for vertical transmission. Histopathological examination of the placenta can represent a useful instrument for investigation and can contribute significant information regarding the possible immunohistopathological mechanisms involved in developing unfavorable perinatal outcomes. Based on current evidence, SARS-CoV-2 infection can affect placental tissue by inducing several specific changes. The level of placental involvement is considered one of the determining factors for unfavorable outcomes during pregnancy due to inflammation and vascular injuries contributing to complex cascade immunological and biological events; however, available evidence does not indicate a strong and absolute correlation between maternal infection, placental lesions, and obstetric outcomes. As existing studies are still limited, we further explore the placenta at three different levels, using histology, immunohistochemistry, and molecular genetics to understand the epidemiological and virological changes observed in the ongoing pandemic.

Opportunities for predicting adverse pregnancy outcomes in severe COVID-19

Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22–42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality; the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters – lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein; coagulation parameters – prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio; the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6); ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (χ2 = 12.84; p ≤ 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II; most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (χ2 = 5.41; p ≤ 0.05; odds ratio (OR) = 5.0; 95 % confidence interval (CI) = 1.23–20.3); lack of leukocytosis at the initial stages (χ2 = 4.91; p ≤ 0.05; OR = 50; 95 % CI = 5.43–460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (χ2 = 19.79, p ≤ 0.05, OR = 50; 95 % CI = 5.43–460.54); severe lymphopenia (χ2 = 8.09; p ≤ 0.05; OR = 7.29; 95 % CI = 1.74–30.56), neutrophilia (χ2 = 10.17; p ≤ 0.05; OR = 10.29; 95 % CI = 2.21–47.84); high LDH values (χ2 = 17.99; p ≤ 0.05; OR = 31.88; 95 % CI = 5.09–199.49); increased IL-6 level at the peak of the disease (χ2 = 9.66; p ≤ 0.05; OR = 18; 95 % CI = 1.99–162.62) and in dynamics, as well as stably high D-dimer values (χ2 = 9.53, p ≤ 0.05; OR = 11.33; 95 % CI = 2.07–62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.

Clinical presentation, maternal-fetal, and neonatal outcomes of early-onset versus late onset preeclampsia-eclampsia syndrome in a teaching hospital in a low-resource setting: A retrospective cohort study.

Pre-eclampsia-eclampsia syndrome remains the leading cause of maternal and neonatal mortality worldwide. Both from pathophysiologic and clinical stand points, early and late onset preeclampsia are thought to be two different disease entities. However, the magnitude of preeclampsia-eclampsia and maternal-fetal and neonatal outcomes of early and late onset preeclampsia are not adequately investigated in resource-limited settings. This study sought to examine the clinical presentation and maternal-fetal and neonatal outcome of these two entities of the disease in Ayder comprehensive specialized hospital, an academic setting in Tigray, Ethiopia, from January 1, 2015-December 31, 2021. A retrospective cohort design was employed. The patient charts were reviewed to see the baseline characteristics and their progress from the onset of the disease in the antepartum, intrapartum and postpartum periods. Women who developed pre-eclampsia before 34 weeks of gestation were defined as having early-onset pre-eclampsia, and those who developed at 34 weeks or later were identified as late-onset preeclampsia. We used chi-square, t-test and multivariable logistic regression analyses to determine differences between early- and late onset diseases in terms of clinical presentation, maternal-fetal, and neonatal outcomes. Among the 27,350 mothers who gave birth at the Ayder comprehensive specialized hospital, 1095 mothers had preeclampsia-eclampsia syndrome, with a prevalence of 4.0% (95% CI: 3.8, 4.2)]. Of the 934 mothers analyzed early and late onset diseases accounted for 253 (27.1%) and 681 (72.9%) respectively. Overall, death of 25 mothers was recorded. Women with early onset disease had significant unfavorable maternal outcomes including having preeclampsia with severity features (AOR = 2.92, 95% CI: 1.92, 4.45), liver dysfunction (AOR = 1.75, 95% CI: 1.04, 2.95), uncontrolled diastolic blood pressure (AOR = 1.71, 95% CI: 1.03, 2.84), and prolonged hospitalization (AOR = 4.70, 95% CI: 2.15, 10.28). Similarly, they also had increased unfavorable perinatal outcomes, including the APGAR score at the 5th minute (AOR = 13.79, 95% CI: 1.16, 163.78), low birth weight (AOR = 10.14, 95% CI 4.29, 23.91), and neonatal death (AOR = 6.82, 95% CI: 1.89, 24.58). The present study highlights the clinical differences between early versus late onset preeclampsia. Women with early-onset disease are at increased levels of unfavorable maternal outcomes. Perinatal morbidity and mortality were also increased significantly in women with early onset disease. Therefore, gestational age at the onset of the disease should be taken as an important indicator of the severity of the disease with unfavorable maternal, fetal, and neonatal outcomes.

Doppler Indices of the Fetal Middle Cerebral and the Umbilical Arteries in Pregnancies at High Risk Followed Up for Suspected Fetal Growth Restriction

Background: Fetal growth restriction is related to compromised perinatal outcomes. The screening and prevention tools for fetal growth restriction like Doppler indices in high-risk groups compared with general antenatal populations. An evaluation of the correlation between Doppler indices and placental weight and birth weight of the neonate at term pregnancy in high-risk pregnancies is essential. For the early detection of fetal growth limitations in high-risk pregnancies, sensitive screening techniques are few. Objectives: To determine the most accurate indicator for predicting a poor perinatal outcome or intrauterine growth restriction by comparing and correlating the modifications in Doppler ultrasound studies of fetal circulation in general pregnant women with those of high-risk patients both with and without intrauterine growth retardation. Study design: A cross-sectional research including 81 healthy pregnancies and 19 high-risk patients at 31–40 weeks of gestation was conducted. The pulsatility index (PI) of the middle cerebral artery (MCA), the umbilical artery (UA), and the MCA PI to UA PI ratio were all analyzed. We compared the Doppler indices' mean values. Then these values were correlated with placental weight and birth weight of the offspring. Results: A significantly low birth weight and less fetoplacental ratio and placental coefficient ratio were found in high-risk cases than in normal pregnant women (P &lt;0.05). A strong positive relationship was observed between the middle cerebral artery pulsatility index and placental weight, while negative relationship between the pulsatility index of the middle cerebral artery and the Feto-placental ratio (P &lt; 0.05). In addition, a positive association was found between the pulsatility index of the middle cerebral artery and placental coefficient, whereas a negative correlation was observed between the Cerebro-placental ratio and Feto-placental ratio in high-risk cases (P &lt;0.05). Conclusion: Low birth weight can be predicted using Doppler indices since there is a definite correlation between it and unfavorable perinatal outcomes. KEY WORDS: Placenta, birth weight, Doppler indices, Middle cerebral artery pulsatility index, Umbilical artery pulsatility index.