Individual risk assessment of adverse pregnancy outcome by multivariate regression analysis may serve as basis for drug intervention studies: retrospective analysis of 426 high-risk patients including ethical aspects

Maternal complications associated with stillbirth delivery: A cross-sectional analysis

This study sought to identify delivery complications associated with stillbirth labour and delivery. We conducted a retrospective chart review evaluating stillbirth demographics, pregnancy and maternal risk factors, and complications of labour and delivery. We performed bivariable analysis and multivariable logistic regression to evaluate factors associated with medical complications and variations by race. Our cohort included 543 mothers with stillbirth, of which two-thirds were African-American. We noted high rates of shoulder dystocia, clinical chorioamnionitis, postpartum haemorrhage and retained placenta in women with stillbirths. Thirty-three women (6%) experienced at least one serious maternal complication. Complication rates did not vary by maternal race. Providers who perform obstetrical care should be alert to the high rate of maternal medical complications associated with labour and delivery of a stillbirth foetus.

Treatment of high risk pregnancies

Introduction: The efficacy of a therapy with certoparin; also in combination with aspirin and prednisolone; in high-risk pregnancies has been examined prospectively.

Method: Data of 616 pregnancies have been analyzed. 238 patients injected Mono Embolex 3000; 239 patients Mono Embolex 8000 only. 62 patients injected Mono Embolex 8000 and took aspirin 50–100 mg daily; 60 Mono Embolex 3000 and aspirin 50–100 mg daily. 30 patients took aspirin 50–100 mg; prednisolone 2.5–5 mg and 17 injected mono Embolex 8000; 13 Mono Embolex 3000 daily from the start of their pregnancy. The target variable was the life birth rate.

When given aspirin the HPA-status of the partner is measured if the pregnant woman is negative for HPA 1a or 5b. In HPA-negative mothers and HPA-positive fathers a test for HPA-antibodies is performed posterior week 16.

Result: Applied early; a mean life birth rate of 95 % has been achieved in the monotherapy with Mono Embolex. Where heparin and aspirin were applied before pregnancy week 17 a life birth rate of 100 % was achieved. In patientswith a combination of aspirin and prednisolone a life birth rate of 87 % was achieved. Considering the life birth rate the status of thrombophilia gene-polymorphisms is irrelevant. The HPA-status was examined in 139 patients. In one of the HPA 5a-negative and 3 of the HPA 5b-negative women an immunization occurred but the platelet count of the fetus was not decreased. 3.3 % showed local allergic reaction and 0.5 % slight bleeding.

Conclusion: Certoparin, aspirin and prednisolone are safe drugs to increase life birth rate.

Prediction of preeclampsia and induced delivery at <34 weeks gestation by sFLT-1 and PlGF in patients with abnormal midtrimester uterine Doppler velocimetry: a prospective cohort analysis

Background

Women with bilateral abnormal uterine artery Doppler velocimetry (UtADV) are at increased risk for an adverse pregnancy outcome. This study aimed to determine if additional assessment of midtrimester angiogenic factors improves the predictive accuracy of Doppler results for various outcome parameters.

Methods

Women with a bilateral abnormal UtADV, which was defined as a postsystolic incision and/or an increased pulsatility index greater than the 95^th centile, and a singleton pregnancy were prospectively recruited between 19 + 0 and 26 + 6 weeks of gestation. Maternal serum levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFLT-1) were measured with a fully automated immunoassay and their ratio was calculated.

Results

Angiogenic factors could predict the development of preeclampsia (PE), as well as induced delivery at <34 weeks of gestation, but failed to predict the development of normotensive intrauterine growth restriction. Twelve (24.0%) of the 50 recruited women developed PE. Nine of these patients had early-onset disease (<34 + 0 weeks). Six (12.0%) patients were delivered at <34 + 0 weeks. The most useful test results in the prediction of PE and induced delivery at <34 + 0 weeks were observed using the sFLT-1/PlGF >95^th centile ratio with a sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of 66.7%, 89.5%, 66.7%, and 89.5% for PE, and 85.7%, 86.1%, 50.1%, and 97.4% for induced delivery, respectively. Positive and negative likelihood ratios were 6.33 (95% CI 2.31–17.38) and 0.37 (95% CI 0.17–0.84) for PE, and 6.14 (95% CI 2.76–13.69) and 0.17 (0.03–1.02) for induced delivery, respectively. Corresponding odds ratios were 17.0 (95% CI 3.5–83.0) and 37.0 (95% CI 3.8–363.9), respectively.

Conclusions

Measurement of angiogenic factors improves the specificity of an abnormal UtADV for prediction of PE. Compared with prediction of PE an abnormal sFLT-1/PlGF ratio revealed higher sensitivity for prediction of induced delivery at <34 + 0 weeks. The NPV of 97% will help to reassure most patients with an abnormal UtADV and a normal sFLT-1/PlGF ratio.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2393-14-292) contains supplementary material, which is available to authorized users.

Intrauterine growth restriction: screening, diagnosis, and management

BACKGROUND

Intrauterine growth restriction (IUGR) is an obstetrical complication, which by definition would screen in 10% of fetuses in the general population. The challenge is to identify the subset of pregnancies affected with pathological growth restriction in order to allow intervention that would decrease morbidity and mortality.

OBJECTIVE

The purpose of this guideline is to provide summary statements and recommendations and to establish a framework for screening, diagnosis, and management of pregnancies affected with IUGR.

METHODS

Affected pregnancies are compared with pregnancies in which the fetus is at an appropriate weight for its gestational age. History, physical examination, and laboratory investigations including biochemical markers and ultrasound characteristics of IUGR are reviewed, and a management strategy is suggested.

EVIDENCE

Published literature in English was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in January 2013 using appropriate controlled vocabulary via MeSH terms (fetal growth restriction and small for gestational age) and key words (fetal growth, restriction, growth retardation, IUGR, low birth weight, small for gestational age). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table).

BENEFITS, HARMS, AND COSTS

Implementation of the recommendations in this guideline should increase clinician recognition of IUGR and guide intervention where appropriate. Optimal long-term follow-up of neonates diagnosed as IUGR may improve their long-term health.