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Chen Y, Pan X, Xiang G, Liu H. Clinical utility of creatinine-fibrinogen ratio in prediction of placental abruption with composite adverse outcomes. Arch Gynecol Obstet 2024; 310:1285-1286. [PMID: 38438566 DOI: 10.1007/s00404-024-07439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Yunshan Chen
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiuyu Pan
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guochun Xiang
- School of Health Management, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Huishu Liu
- Department of Obstetrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
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Ozkavak OO, Tanacan A, Haksever M, Sahin R, Ersak DT, Iskefiyeli E, Sahin D. A novel predictive marker for placental abruption with composite adverse outcomes: creatinine-fibrinogen ratio. Arch Gynecol Obstet 2024; 310:353-358. [PMID: 38270622 DOI: 10.1007/s00404-023-07355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE To develop a new cost-effective marker named creatinine-fibrinogen ratio (CFR) for the prediction of composite adverse outcomes (CAO) in placental abruption cases. METHODS A total of 109 placental abruption patients (30 with adverse outcomes, 79 without adverse outcomes) were enrolled in this retrospective cohort study. Patients with at least one of the features listed below were included in the abruption with CAO group: requirement of blood product transfusion (erythrocyte suspension, fresh frozen plasma, pooled thrombocyte, thrombocyte apheresis), development of acute kidney injury or disseminated intravascular coagulation, and need for intensive care unit. Laboratory parameters and CFR values at admission to the hospital were compared between the two groups. RESULTS Higher creatinine and lower fibrinogen levels were found in the CAO group (p = 0.007 and p < 0.001 respectively). The CFR value of the CAO group was significantly higher (p < 0.001). In the ROC curve analysis performed to investigate the value of CFR in CAO prediction, the area under the curve (AUC) was calculated as 0,802 (95% CI 0.709-0.895, 77% sensitivity, 65% specificity). CONCLUSION CFR seems to be a practical marker for the prediction of CAOs in pregnant women with ablatio placenta.
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Affiliation(s)
- Osman Onur Ozkavak
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey.
| | - Atakan Tanacan
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
- Department of Obstetrics and Gynaecology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Murat Haksever
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Refaettin Sahin
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Duygu Tugrul Ersak
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
| | - Eda Iskefiyeli
- Department of Obstetrics and Gynaecology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Dilek Sahin
- Department of Perinatology, Ankara Bilkent City Hospital, Cankaya, 06800, Ankara, Turkey
- Department of Obstetrics and Gynaecology, University of Health Sciences, Ankara Bilkent City Hospital, Ankara, Turkey
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3
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Silva MDSFF, de Amorim MMR, Melo B, Lanza AV, Ramos MET, de Carvalho BAD, Tenório NN, Katz L. The profile of patients with postpartum hemorrhage admitted to the obstetric intensive care: a cross-sectional study. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo47. [PMID: 38994461 PMCID: PMC11239208 DOI: 10.61622/rbgo/2024rbgo47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/07/2024] [Indexed: 07/13/2024] Open
Abstract
Objective In Brazil, postpartum hemorrhage (PPH) is a major cause of maternal morbidity and mortality. Data on the profile of women and risk factors associated with PPH are sparse. This study aimed to describe the profile and management of patients with PPH, and the association of risk factors for PPH with severe maternal outcomes (SMO). Methods A cross-sectional study was conducted in Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) obstetric intensive care unit (ICU) between January 2012 and March 2020, including patients who gave birth at the hospital and that were admitted with PPH to the ICU. Results The study included 358 patients, of whom 245 (68.4%) delivered in the IMIP maternity, and 113 (31.6%) in other maternity. The mean age of the patients was 26.7 years, with up to eight years of education (46.1%) and a mean of six prenatal care. Uterine atony (72.9%) was the most common cause, 1.6% estimated blood loss, 2% calculated shock index (SI), 63.9% of patients received hemotransfusion, and 27% underwent hysterectomy. 136 cases of SMO were identified, 35.5% were classified as maternal near miss and 3.0% maternal deaths. Multiparity was associated with SMO as an antepartum risk factor (RR=1.83, 95% CI1.42-2.36). Regarding intrapartum risk factors, abruptio placentae abruption was associated with SMO (RR=2.2 95% CI1.75-2.81). Among those who had hypertension (49.6%) there was a lower risk of developing SMO. Conclusion The principal factors associated with poor maternal outcome were being multiparous and placental abruption.
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Affiliation(s)
| | - Melania Maria Ramos de Amorim
- Instituto de Medicina Integral Prof. Fernando Figueira RecifePE Brazil Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil
- Universidade Federal e Campina Grande Campina GrandePB Brazil Universidade Federal e Campina Grande, Campina Grande, PB, Brazil
| | - Brena Melo
- Instituto de Medicina Integral Prof. Fernando Figueira RecifePE Brazil Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil
| | - André Vieira Lanza
- Instituto de Medicina Integral Prof. Fernando Figueira RecifePE Brazil Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil
- Teaching Hospital Universidade Federal de Uberlândia UberlândiaMG Brazil Teaching Hospital, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Natalia Nunes Tenório
- Faculdade Pernambucana de Saúde RecifePE Brazil Faculdade Pernambucana de Saúde, Recife, PE, Brazil
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira RecifePE Brazil Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brazil
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4
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Andreescu M. Correlation Between Maternal-Fetus Interface and Placenta-Mediated Complications. Cureus 2024; 16:e62457. [PMID: 38882223 PMCID: PMC11180486 DOI: 10.7759/cureus.62457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2024] [Indexed: 06/18/2024] Open
Abstract
Pregnancy is a highly regulated biological phenomenon that involves the development of a semi-allogeneic fetus inside the uterus of the mother. The maternal-fetal interface is a critical junction where communication takes place between the fetal and maternal immune systems, which determine the outcome of the pregnancy. The interface is composed of the decidua and placenta. The main cells present at the maternal-fetal interface include invading trophoblasts, maternal immune cells, and decidual stromal cells. Although maternal tolerance is crucial for maintaining a successful pregnancy, the role of the placenta in pregnancy is also important. Dysregulation of the placenta leads to various placenta-mediated complications, such as preeclampsia, intrauterine growth restriction, and placental abruption. Although the exact mechanism involving these complications is unclear, research has elucidated various factors involved in these pregnancy disorders. This review aimed to provide a summary of the maternal-fetal interface and immune mechanisms involved in placenta-mediated complications.
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Affiliation(s)
- Mihaela Andreescu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, ROU
- Hematology, Colentina Clinical Hospital, Bucharest, ROU
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5
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Farghaly MAA, Aziz HF, Puthuraya S, Abdalla A, Aly H, Mohamed MA. Placental abruption and risk for intraventricular hemorrhage in very low birth weight infants: the United States national inpatient database. J Perinatol 2024:10.1038/s41372-024-02017-y. [PMID: 38811756 DOI: 10.1038/s41372-024-02017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To examine the association of placental abruption with intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants. METHODS We examined the National Inpatient Sample (NIS) datasets. Preterm infants <1500 g birth weight (BW) were included. The odds ratios (OR) of developing IVH and severe IVH in association with placental abruption were calculated. Adjusted OR (aOR) were calculated using logistic regression models. RESULTS The study included 113,445 VLBW infants. IVH occurred in 18.7% in the infants who were born to mothers with history of placental abruption versus 14.7% in infants without placental abruption, aOR 1.25 (95%CI: 1.13-1.38), p < 0.001. Severe IVH occurred in 6.4% in infants born to mothers with history of placental abruption versus 4.0% in those without placental abruption, aOR 1.53 (95%CI: 1.30-1.78), p < 0.001. CONCLUSION Placental abruption is associated with increased prevalence of IVH and severe IVH in VLBW infants.
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Affiliation(s)
- Mohsen A A Farghaly
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
- Faculty of Medicine, Aswan University, Aswan, Egypt.
| | - Hany F Aziz
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Subhash Puthuraya
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Alshimaa Abdalla
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Hany Aly
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Mohamed A Mohamed
- Neonatology Division, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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Muramatsu K, Aoyama Y, Shigemi D, Yasunaga H, Fushimi K, Matsuda S. Association between hospital case volume and maternal adverse events in patients with placental abruption: An analysis using a Japanese national inpatient database. Int J Gynaecol Obstet 2024. [PMID: 38760921 DOI: 10.1002/ijgo.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/22/2024] [Accepted: 04/28/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To clarify the relationship between the prognosis of patients with placental abruption (PA) and the healthcare delivery system using data from a large national inpatient database in Japan. METHODS Using the Diagnosis Procedure Combination database, we conducted a retrospective cohort study with the data of patients in almost 1000 hospitals with the primary diagnosis of PA who were hospitalized from April 2014 to March 2021. We divided the hospitals into four groups based on the number of deliveries per month. We performed multilevel logistic regression analysis to analyze the relationship between hospital case volume and maternal end-organ injury (MEOI). RESULTS Altogether, 8222 patients were included for analysis; among whom, 3575 (44%) were transferred by ambulance. MEOI was noted in 977 patients (12%) with no obvious difference by hospital case volume. Ambulance transfer, age, gestational weeks at admission, delivery on the first day of hospitalization, and history of eclampsia were significantly associated with a higher incidence of MEOI, but the hospital case volume was not. CONCLUSION Using a Japanese administrative database, our study shows that hospital case volume was not significantly associated with the severity of maternal illness among patients with PA.
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Affiliation(s)
- Keiji Muramatsu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Yoko Aoyama
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
| | - Daisuke Shigemi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Japan, Fukuoka, Japan
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7
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Schlein SM, Reno EM, Coffey CH, Casper LM, Klein DA, Claypool MS, Wiitala EL, Keyes LE. Environmental Exposures and Risks During Pregnancy. Wilderness Environ Med 2024:10806032241248626. [PMID: 38706212 DOI: 10.1177/10806032241248626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
The Women in Wilderness Medicine Research Committee of the Wilderness Medical Society conducted a narrative review to address considerations for pregnant individuals in wilderness environments. There is limited evidence behind many opinion-based recommendations on the safety of various environmental exposures in pregnancy. The authors reviewed the literature for the best available evidence, including observational studies, case series, limited controlled trials, and extrapolation from physiological data, as well as evaluating expert consensus statements. The benefits of exposure to natural environments include better pregnancy outcomes and improved maternal mental and physical health. Risks are similar to nonpregnant individuals with the added risks associated with maternal-fetal physiology in wilderness environments and difficulties of evacuation. This narrative review discusses pregnancy-specific concerns in extreme environments, including high altitude, hypothermia, hyperthermia, lightning strikes, envenomations, and common outdoor exposures.
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Affiliation(s)
- Sarah M Schlein
- Larner College of Medicine, University of Vermont, Burlington, VT
| | - Elaine M Reno
- Department of Emergency Medicine, University of Colorado, Aurora, CO
| | | | | | - David A Klein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, San Diego, CA
| | | | - Ellen L Wiitala
- Department of Emergency Medicine, University of Utah, Salt Lake City, UT
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO
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Khattak H, Aleem Husain S, Baker D, Greer I. Use of anticoagulants to improve pregnancy outcomes in couples positive for M2 haplotype: A systematic review. Eur J Obstet Gynecol Reprod Biol 2024; 296:179-184. [PMID: 38452530 DOI: 10.1016/j.ejogrb.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/03/2024] [Accepted: 02/20/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Placental mediated pregnancy complications (PMPC) are common, often recurring, and pose a significant health risk to mother and fetus. Evidence suggests that the hypercoagulable state associated with many PMPC, could reflect reduced expression of Annexin 5 (ANXA5), a naturally occurring anticoagulant protein in placental tissue. The ANXA5 M2 haplotype is a genetic variant, which results in reduced expression of ANXA5 protein. M2 haplotype carrier couples may therefore be at increased risk of PMPC. Evidence regarding the effectiveness of anticoagulation to prevent PMPC is inconsistent. Furthermore, studies have not selected or stratified for M2 haplotype carriers, in whom there is a predisposition to hypercoagulability, to assess the effectiveness of anticoagulation, which may vary from those without the M2 haplotype. OBJECTIVES AND RATIONALE The aim of this study was to systematically review the current evidence to assess whether anticoagulant treatment improves pregnancy outcomes in couples positive for M2 haplotype. SEARCH METHODS The review was registered on PROSPERO (CRD42022343943). A comprehensive literature search was performed using MEDLINE, Embase and Cochrane collaboration databases from inception to January 2023. Two reviewers assessed the articles for eligibility and extracted the data simultaneously. Primary outcome was successful pregnancy and live birth. Secondary outcomes included PMPC (implantation failure, miscarriage, pre-eclampsia, preterm birth and fetal growth restriction). OUTCOMES From a pool of 410 references, 10 were selected for full text review, of which three studies (a post hoc analysis of a randomised controlled trial, cohort study and a case report) were included in this review. Included studies comprised of 223 individuals, 129 of whom who received anticoagulation treatment after testing positive for M2 haplotype. The studies collectively showed an improvement in pregnancy outcomes in M2 haplotype positive individuals however, given the heterogeneity of studies, it was not possible to conduct a meta-analysis and draw firm conclusions. WIDER IMPLICATIONS Current evidence is limited, such that the value of screening couples for the M2 haplotype to select or stratify for treatment with prophylactic anticoagulation remains unknown. Thus, further studies including well designed, large, multi-centre randomised controlled trials are required to assess whether anticoagulation treatment will be effective in improving pregnancy outcomes in M2 haplotype couples.
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Affiliation(s)
- Hajra Khattak
- WHO Collaborating Centre for Women's Health, Institute of Translational Medicine, University of Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2TH, UK; Elizabeth Garrett Anderson Institute for Women's Health, University College, London, UK.
| | - Syed Aleem Husain
- Sandwell and West Birmingham NHS Trust, Dudley Rd, Birmingham B18 7QH, UK
| | - Deborah Baker
- IHG Pharmaco Ltd, 20-22 Wenlock Road, London N17GU, UK
| | - Ian Greer
- Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK
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9
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Oyelese Y, Peltier M, Donovan B, Khadka N, Chiu VY, Fassett MJ, Getahun D. Placental abruption: Incidence and risk of recurrence in subsequent pregnancies. J Obstet Gynaecol Res 2024; 50:821-827. [PMID: 38366767 DOI: 10.1111/jog.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
AIM To estimate the incidence of abruption in first births and recurrence in the subsequent birth in patients of a large US-based integrated health care system. METHODS Retrospective population-based cohort study of patients with first two consecutive singleton births using data from the Kaiser-Permanente South California health care system who delivered over a period of 30 years (1991-2021), using longitudinally linked electronic health records. ICD-9/ICD-10 codes "641.20" and "O45.x" identified placental abruption. We calculated the incidence and rates of abruption in first and second pregnancies. We used logistic regression to estimate the adjusted odds ratios (aOR) for abruption in second pregnancies in patients with and without abruptions in their first pregnancies. RESULTS Of the 126 264 patients with first two consecutive singleton births over the period, 805 had abruptions in their first births, and 861 in their second births. Rates of abruption in first and second births were 0.63% and 0.68%, respectively. Twenty-seven patients had abruptions in both first and second births. Rates of abruption in the second birth among individuals with and without previous placental abruption were 3.35% and 0.66%, respectively, giving an approximately five-fold increased odds of abruption in a second pregnancy in individuals who had abruption in their first birth when compared with those who did not have placental abruption in their first birth (aOR: 4.95, 95% confidence interval: 3.35-7.31, p < 0.00001). Interpregnancy interval had no statistically significant association with recurrence. CONCLUSION Abruption in a first birth is associated with an approximately five-fold increased odds of abruption in a second birth.
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Affiliation(s)
- Yinka Oyelese
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Morgan Peltier
- Department of Psychiatry and Behavioral Health, Jersey Shore University Medical Center, Neptune, New Jersey, USA
- Department of Psychiatry and Behavioral Health, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Bridget Donovan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical School, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nehaa Khadka
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Vicki Y Chiu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Michael J Fassett
- Department of Obstetrics & Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California, USA
- Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Darios Getahun
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
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10
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Ansari AZ, Al Sayed A, Patibandla S, Kumar S, Patibandla L, Ali R. Emergency Hysterectomy Following Placental Abruption in a Patient With a History of Substance Abuse: A Case Report. Cureus 2024; 16:e57997. [PMID: 38738144 PMCID: PMC11087213 DOI: 10.7759/cureus.57997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Placental abruption is a serious medical condition that can occur during pregnancy, involving the premature separation of the placenta from the inner uterine wall before childbirth. This detachment often leads to severe bleeding, and if conventional methods prove ineffective in managing the bleeding, a hysterectomy may be deemed necessary to ensure the mother's safety. This case report details the management of a 22-year-old female, gravida IV, para III, who experienced placental abruption during her fourth pregnancy. An emergent cesarean section resulted in severe postpartum hemorrhage and disseminated intravascular coagulation (DIC). Positive drug tests for cocaine and methamphetamines added further complexity, leading to an unplanned hysterectomy for life-saving measures. This case underscores the critical importance of early recognition, multidisciplinary collaboration, and timely intervention in managing obstetric emergencies within the context of substance abuse.
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Affiliation(s)
- Ali Z Ansari
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Assem Al Sayed
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Srihita Patibandla
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Sarthak Kumar
- Obstetrics and Gynecology, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | | | - Rashad Ali
- Obstetrics and Gynecology, South Central Regional Medical Center, Laurel, USA
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11
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Preston M, Hall M, Shennan A, Story L. The role of placental insufficiency in spontaneous preterm birth: A literature review. Eur J Obstet Gynecol Reprod Biol 2024; 295:136-142. [PMID: 38359634 DOI: 10.1016/j.ejogrb.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Preterm Birth (delivery before 37 weeks of gestation) is the leading cause of childhood mortality and is also associated with significant morbidity both in the neonatal period and beyond. The aetiology of spontaneous preterm birth is unclear and likely multifactorial incorporating factors such as infection/inflammation and cervical injury. Placental insufficiency is emerging as an additional contributor to spontaneous preterm delivery; however, the mechanisms by which this occurs are not fully understood. Serum biomarkers and imaging techniques have been investigated as potential predictors of placental insufficiency, however none have yet been found to have a sufficient predictive value. This review examines the evidence for the role of the placenta in preterm birth, preterm prelabour rupture of the membranes and abruption as well as highlighting areas where further research is required.
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Affiliation(s)
- Megan Preston
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Megan Hall
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK
| | - Andrew Shennan
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK
| | - Lisa Story
- Department of Women and Children's Health, St Thomas' Hospital, King's College, London, UK; Department of Perinatal Imaging, St Thomas' Hospital, King's College, London, UK.
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12
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Jia D, Sun F, Han S, Lu L, Sun Y, Song Q. Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis. J Obstet Gynaecol Res 2024; 50:281-297. [PMID: 38073001 DOI: 10.1111/jog.15848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/26/2023] [Indexed: 03/04/2024]
Abstract
OBJECTIVE This study aimed to investigate the association between a history of recurrent spontaneous abortion (RSA) and adverse outcomes in women with spontaneous conception. METHODS A search strategy from the inception to March 3, 2023 was run in PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratio (OR), and the 95% confidence interval (CI) or point estimation were used as the evaluation indexes. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. Sensitivity analyses were performed to test the credibility of the meta-analysis results. RESULTS Fifteen studies involving 1 475 389 pregnant women were included. A history of RSA was associated with gestational diabetes (OR: 2.21, 95% CI: 1.70-2.87, p < 0.001), preeclampsia (OR: 2.06, 95% CI: 1.49-2.86, p < 0.001), placenta previa (OR: 1.82, 95% CI: 1.09-3.02, p = 0.021), placental abruption (OR: 1.67, 95% CI: 1.36-2.06, p < 0.001), miscarriage (OR: 6.37, 95% CI: 3.83-10.57, p < 0.001), preterm birth (OR: 1.80, 95% CI: 1.36-2.37, p < 0.001), cesarean section (OR: 1.47, 95% CI: (1.13-1.91, p = 0.004), perinatal death (OR: 2.24, 95% CI: 1.39-3.60, p = 0.001), and neonatal intensive care unit admission (OR: 1.39, 95% CI: 1.01-1.92, p = 0.047). However, the associations of a history of RSA with gestational hypertension, small for gestational age, fetal anomalies, fetal growth restriction, and postpartum hemorrhage were not observed. CONCLUSION This meta-analysis indicates a history of RSA was associated with increased risks of several adverse outcomes in pregnant women with spontaneous conception.
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Affiliation(s)
- Dan Jia
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Fengdan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Sisi Han
- Department of Gynecology, Qingdao Women's and Children's Hospital, Qingdao, Shandong Province, People's Republic of China
| | - Lijuan Lu
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Yuanyuan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Qingxia Song
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
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13
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Qiu S, Wu X, Wu Q, Jin X, Li H, Roy R. Pharmacological Action of Baicalin on Gestational Diabetes Mellitus in Pregnant Animals Induced by Streptozotocin via AGE-RAGE Signaling Pathway. Appl Biochem Biotechnol 2024; 196:1636-1651. [PMID: 37436545 DOI: 10.1007/s12010-023-04586-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Baicalin (BC) is a flavonoid reported to have various pharmacological activities, including antioxidant, anti-cancer, anti-inflammatory, anti-allergy, immune regulation, and anti-diabetic. This study examines the probable mechanism for gestational diabetes mellitus (GDM) brought on by streptozotocin (STZ) and the impact of BC on fetal development via AGEs (advanced serum glycation end products) and RAGE (the role of advanced glycation end products). MATERIAL AND METHOD STZ has been used in the current experimental study to induce diabetes mellitus in pregnant animals (gestational diabetes mellitus). GDM pregnant animals were separated into five groups and were treated with BC in a dose-dependent pattern for 19 days. At the end of the experiment, the fetus and blood samples were drawn from all the pregnant rats to assess the biochemical parameter as well as AGE-RAGE. RESULT Administration of BC at varying doses leads to enhancement in the weight of the fetus body and placenta while gestational diabetic pregnant animals induced by STZ had a lower weight of the fetus body and placenta. The dose-dependent pattern of BC also enhanced fasting insulin (FINS), high-density lipoprotein (HDL), serum insulin, and hepatic glycogen. It also significantly enhanced the content of the antioxidant profile and pro-inflammatory cytokines and modulated the gene expression (VCAM- 1, p65, EGFR, MCP-1, 1NOX2, and RAGE) in various tissues in gestational diabetes mellitus pregnant rats. CONCLUSION Baicalin demonstrated the potential impact on the embryo's development via the AGE-RAGE signaling pathway in STZ-induced GDM pregnant animals.
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Affiliation(s)
- Shuqiong Qiu
- Zhucheng Maternal and Child Health Center, No. 343 Dongguan Street, Zhucheng, Weifang, Shandong, 262200, People's Republic of China
| | - Xiaojie Wu
- Department of Obstetrics and Gynecology, The West District of Qingdao Municipal Hospital (Group), No. 2, Chaocheng Road, 266001, Qingdao, Shandong, People's Republic of China
| | - Qingke Wu
- Anser Science Joint Laboratory Platform, Jinan, 250000, People's Republic of China
| | - Xin Jin
- Anser Science Joint Laboratory Platform, Jinan, 250000, People's Republic of China
| | - Huirong Li
- Shandong Provincial Third Hospital, Shandong University, Tianqiao District, No.11 Wuyingshan Middle, RoadShandong Province, Jinan, 250031, People's Republic of China.
| | - Rupak Roy
- SHRM Biotechnologies Pvt. Ltd, Kolkata, India
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Mikkola TS, Ylikorkala O. Pregnancy-associated risk factors for future cardiovascular disease - early prevention strategies warranted. Climacteric 2024; 27:41-46. [PMID: 38174425 DOI: 10.1080/13697137.2023.2287628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
We summarize convincing evidence that future cardiovascular disease (CVD) risk increases one-fold to four-fold for women with a history of pregnancy complicated by hypertensive disorders, gestational diabetes, fetal growth restriction, placental abruption and preterm birth. A concomitant occurrence of two or more complications in the same pregnancy further potentiates the risk. These women should be informed of their future CVD risks during the postpartum check-up taking place after delivery, and also, if needed, treated, for example, for persisting high blood pressure. In these women with high blood pressure, check-up should take place within 7-10 days, and if severe hypertension, within 72 h. Women without diagnostic signs and symptoms should be examined for the first time 1-2 years postpartum and then at intervals of 2-3 years for a complete CVD risk profile including clinical and laboratory assessments. Women should be informed for future CVD risks and their effective prevention with healthy lifestyle factors. Combined oral contraceptives should be avoided or used with caution. If laboratory or other clinical findings indicate, then vigorous treatments consisting of non-medical and medical (antihypertensives, statins, antidiabetic and anti-obesity therapies) interventions should be initiated early with liberal indications and with ambitious therapeutic goals. Low-dose aspirin and menopausal hormone therapy should be used in selected cases. Active control and treatment policies of these women with pregnancy-related risks will likely result in decreases of CVD occurrence in later life.
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Affiliation(s)
- T S Mikkola
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - O Ylikorkala
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, Helsinki, Finland
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15
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Jiang C, Wen H, Hu T, Liu Y, Dai X, Chen Y. Perinatal characteristics and pregnancy outcomes of advanced maternal age women with gestational diabetes mellitus: A retrospective cohort study. Health Sci Rep 2024; 7:e1903. [PMID: 38410499 PMCID: PMC10895077 DOI: 10.1002/hsr2.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Background and Aims The prevalence of gestational diabetes mellitus (GDM) continues to increase, and the phenomenon of women giving birth at an older age is becoming more common worldwide. Less is known abouts the impact of GDM combined with advanced maternal age (AMA) on pregnancy outcomes. To explore the impact of AMA complicated with GDM on pregnancy outcomes. Methods This study included 34,602 pregnancies between 2018 and 2020 in Hangzhou, China. The pregnant women were divided into four groups according to advanced age (≥35 years) and GDM as follows: AMA women without GDM (non-AGDM) group (n = 2614), young pregnant women with GDM (YGDM) group (n = 4016), AMA women with GDM (AGDM) group (n = 850), and young pregnant women without GDM (non-YGDM) group (n = 27,122). Univariate analysis was carried out by Mann-Whitney U test or Pearson's χ 2 test. Multivariate logistic regression analysis was used to investigate the effect of AMA and GDM on pregnancy outcomes. Results Multivariate logistic regression analysis showed that in the comparison against non-YGDM garoup, the ORs of fetal chromosome abnormality, parity, urgent cesarean section, gravidity, scheduled cesarean section, body mass index (BMI) ≥30 kg/m2, pre-eclampsia, thrombocytopenia, hyperlipidemia, BMI 25-29.9 kg/m2, blood urea nitrogen, fasting blood glucose, and creatinine in AGDM group were 16.044, 4.284, 3.530, 3.284, 3.257, 2.049, 1.935, 1.898, 1.690, 1.471, 1.304, 1.216, and 1.026 (all p < 0.05). Conclusions The prevalence of pregnant women with AGDM was 2.46% in Hang Zhou, China. The increasing gravidity of AMA women was related to a greater risk of GDM. The AGDM group associated with a greater risks of chromosomal abnormality in offspring and cesarean section, especially urgent cesarean section.
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Affiliation(s)
- Chen Jiang
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Haiyan Wen
- Department of ObstetricsHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Tingting Hu
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
- Department of Clinical LaboratoryHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Yanfei Liu
- Department of Clinical LaboratoryHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
| | - Xiaoqing Dai
- Department of Medical Technology and Information EngineeringZhejiang Chinese Medical UniversityHangzhouZhejiangChina
| | - Yiming Chen
- Department of Prenatal Diagnosis and Screening CenterHangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital)HangzhouZhejiangChina
- The Fourth School of Clinical MedicalZhejiang Chinese Medical UniversityHangzhouZhejiangChina
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16
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Meng Q, Del Rosario I, Sung K, Janzen C, Devaskar SU, Carpenter CL, Ritz B. Maternal dietary patterns and placental outcomes among pregnant women in Los Angeles. Placenta 2024; 145:72-79. [PMID: 38100961 DOI: 10.1016/j.placenta.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/11/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Epidemiological studies have linked prenatal maternal diet to fetal growth, but whether diet affects placental outcomes is poorly understood. METHODS We collected past month dietary intake from 148 women in mid-pregnancy enrolled at University of California Los Angeles (UCLA) antenatal clinics from 2016 to 2019. We employed the food frequency Diet History Questionnaire II and generated the Healthy Eating Index-2015 (HEI-2015), the Alternate Healthy Eating Index for Pregnancy (AHEI-P), and the Alternate Mediterranean Diet (aMED). We conducted T2-weighted magnetic resonance imaging (MRI) in mid-pregnancy (1st during 14-17 and 2nd during 19-24 gestational weeks) to evaluate placental volume (cm3) and we measured placenta weight (g) at delivery. We estimated change and 95 % confidence interval (CI) in placental volume and associations of placenta weight with all dietary index scores and diet items using linear regression models. RESULTS Placental volume in mid-pregnancy was associated with an 18.9 cm3 (95 % CI 5.1, 32.8) increase per 100 gestational days in women with a higher HEI-2015 (≥median), with stronger results for placentas of male fetuses. We estimated positive associations between placental volume at the 1st and 2nd MRI and higher intake of vegetables, high-fat fish, dairy, and dietary intake of B vitamins. A higher aMED (≥median) score was associated with a 40.5 g (95 % CI 8.5, 72.5) increase in placenta weight at delivery, which was mainly related to protein intake. DISCUSSION Placental growth represented by volume in mid-pregnancy and weight at birth is influenced by the quality and content of the maternal diet.
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Affiliation(s)
- Qi Meng
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA
| | - Irish Del Rosario
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA
| | - Kyunghyun Sung
- Department of Radiological Sciences, University of California, Los Angeles, CA, 90095, USA
| | - Carla Janzen
- Department of Obstetrics & Gynecology, University of California, Los Angeles, CA, 90095, USA
| | - Sherin U Devaskar
- Department of Pediatrics, University of California, Los Angeles, CA, 90095, USA
| | | | - Beate Ritz
- Department of Epidemiology, University of California, Los Angeles, CA, 90095, USA.
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White A, Pruszynski J, Williams R, Duryea EL. Transfusion and hematologic indices in cases of stillbirth due to placental abruption. Am J Obstet Gynecol 2023; 229:677.e1-677.e10. [PMID: 37364802 DOI: 10.1016/j.ajog.2023.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Stillbirth because of placental abruption is often associated with maternal hemorrhage and coagulopathy. OBJECTIVE This study aimed to describe blood product requirements, hematologic indices, and the overall clinical picture of patients experiencing abruption demise. STUDY DESIGN This retrospective cohort included patients with abruption demise at an urban hospital from 2010 to 2020. Outcome data from patients who delivered stillborn infants ≥500 g or with gestational age of ≥24 weeks were included. Abruption was a clinical diagnosis made by a multidisciplinary stillbirth review committee. The overall number and type of blood products given were analyzed. Patients with a stillbirth who required blood transfusion were compared with those that did not. In addition, the hematologic indices of these 2 populations were analyzed and compared with one another. Finally, the overall clinical characteristics of the 2 populations were analyzed. The analysis of data included chi-square, t test, and logistic and negative binomial regression models. RESULTS Of 128,252 deliveries, 615 patients (0.48%) experienced a stillbirth, with 76 cases (12%) caused by abruption. Of note, 42 patients (55.2%) required blood transfusion; all received either packed red blood cells or whole blood with a median 3.5 units (2.0-5.5) received. The total units ranged from 1 to 59, with 12 of 42 patients (29%) requiring ≥10 units. Maternal age, gestational age, and mode of delivery were not different, with most (61/76 [80%]) delivering vaginally. Hematocrit level on arrival (odds ratio, 0.80; 95% confidence interval, 0.68-0.91; P=.002) and vaginal bleeding on arrival (odds ratio, 3.73; 95% confidence interval, 1.15-13.40; P=.033) were associated with blood transfusion, as was a diagnosis of preeclampsia (odds ratio, 8.40; 95% confidence interval, 2.49-33.41; P=.001). Those that required a blood transfusion often presented with lower hematologic indices and were more likely to develop disseminated intravascular coagulation (28% vs 0%; P<.001). CONCLUSION Most patients experiencing stillbirth because of abruption required blood transfusion, with almost 1 in 3 of those patients consuming ≥10 units of blood products. Hematocrit level on arrival, vaginal bleeding, and preeclampsia were all predictors of the need for blood transfusion. Those requiring blood transfusion were more likely to develop disseminated intravascular coagulation. Blood transfusion should be prioritized when abruption demise is suspected.
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Affiliation(s)
- Alesha White
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX.
| | - Jessica Pruszynski
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
| | - Rachel Williams
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
| | - Elaine L Duryea
- Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Parkland Health System, Dallas, TX
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18
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Nawsherwan, Liu Z, Le Z, Mubarik S, Sun Y, Naeem S, Li H. The adverse effect of gestational diabetes mellitus and hypertensive disorders of pregnancy on maternal-perinatal outcomes among singleton and twin pregnancies: a retrospective cohort study (2011-2019). Front Endocrinol (Lausanne) 2023; 14:1267338. [PMID: 38098860 PMCID: PMC10720659 DOI: 10.3389/fendo.2023.1267338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are the predominant pregnancy complications among singleton and twin pregnancies worldwide. Our primary objective was to explore the adverse effect of GDM and HDP on maternal-perinatal outcomes compared with non-GDM and non-HDP in singleton and twin pregnancies. The secondary objective was to find the risk of adverse maternal-perinatal outcomes in twin pregnancies compared with singleton pregnancies complicated with GDM and HDP in Hubei, China. Methods A tertiary hospital-based retrospective study was conducted at Wuhan University Renmin Hospital, Hubei Province, China, from 2011 to 2019. A chi-square test was used to determine the difference in adverse maternal-perinatal outcomes between singleton and twin pregnancies. A multiple binary logistic regression model and a joinpoint regression model were used to determine the association of GDM and HDP with adverse maternal-perinatal outcomes and GDM and HDP temporal trend among singleton and twin pregnancies. Results The trend of HDP [average annual percentage change (AAPC) 15.1% (95% confidence interval (95%CI): 5.3, 25.7)] among singleton pregnancies and GDM [AAPC 50.4% (95%CI: 19.9, 88.7)] among twin pregnancies significantly increased from 2011 to 2019. After adjusting for confounding factors, GDM is associated with an increased risk of C-section (adjusted odds ratio (aOR), 1.5; 95%CI: 1.3, 1.6) and macrosomia (aOR, 1.3; 95%CI: 1.1, 1.6) in singleton and preterm birth (PTB) (aOR, 2.1; 95%CI: 1.2, 3.3) in twin pregnancies compared with non-GDM. HDP was associated with a higher risk of C-section, PTB, perinatal mortality, and low birth weight (LBW) in both singleton and twin pregnancies compared with the non-HDP. Compared with singleton pregnancies complicated with GDM and HDP, twin pregnancies showed higher odds of C-section [(aOR, 1.7; 95%CI: 1.1, 2.7), (aOR, 4.6; 95%CI: 2.5, 8.7), respectively], PTB [(aOR, 22.9; 95%CI: 14.1, 37.3), (aOR, 8.1; 95%CI: 5.3, 12.3), respectively], LBW [(aOR, 12.1; 95%CI: 8.2, 18.1), (aOR, 5.1; 95%CI: 3.6, 7.4), respectively], and low Apgar score [(aOR, 8.2; 95%CI: 4.4, 15.1), (aOR, 3.8; 95%CI: 2.4, 5.8), respectively] complicated with GDM and HDP. Conclusion In conclusion, GDM showed an increased risk of a few adverse maternal-perinatal outcomes and HDP is associated with a higher risk of several adverse maternal-perinatal outcomes in singleton and twin pregnancies compared to non-GDM and non-HDP. Moreover, twin pregnancies complicated with GDM and HDP showed higher odds of adverse maternal-neonatal outcomes compared with singleton pregnancies complicated with GDM and HDP.
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Affiliation(s)
- Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Zhiyi Liu
- Clinical College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Hubei, China
| | - Zhang Le
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Sumaira Mubarik
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Yanmei Sun
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Shafaq Naeem
- Department of Preventive Medicine, School of Public Health, Wuhan University, Wuhan, China
| | - Hui Li
- Department of Medicine, Taixing People Hospital, Taizhou, Jiangsu, China
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19
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Pearce G, Bell L, Pezaro S, Reinhold E. Childbearing with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6957. [PMID: 37887695 PMCID: PMC10606623 DOI: 10.3390/ijerph20206957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
One in 20 births could be affected by hypermobile Ehlers-Danlos syndrome or Hypermobility Spectrum Disorders (hEDS/HSD); however, these are under-diagnosed and lacking research. This study aimed to examine outcomes and complications in people childbearing with hEDS/HSD. A large online international survey was completed by women with experience in childbearing and a diagnosis of hEDS/HSD (N = 947, total pregnancies = 1338). Data were collected on demographics, pregnancy and birth outcomes and complications. Participants reported pregnancies in the UK (N = 771), USA (N = 364), Australia (N = 106), Canada (N = 60), New Zealand (N = 23) and Ireland (N = 14). Incidences were higher in people with hEDS/HSD than typically found in the general population for pre-eclampsia, eclampsia, pre-term rupture of membranes, pre-term birth, antepartum haemorrhage, postpartum haemorrhage, hyperemesis gravidarum, shoulder dystocia, caesarean wound infection, postpartum psychosis, post-traumatic stress disorder, precipitate labour and being born before arrival at place of birth. This potential for increased risk related to maternal and neonatal outcomes and complications highlights the importance of diagnosis and appropriate care considerations for childbearing people with hEDS/HSD. Recommendations include updating healthcare guidance to include awareness of these possible complications and outcomes and including hEDS/HSD in initial screening questionnaires of perinatal care to ensure appropriate consultation and monitoring can take place from the start.
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Affiliation(s)
- Gemma Pearce
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Lauren Bell
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
- Coventry City Council, Coventry CV1 2GN, UK
| | - Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, Coventry CV1 5FB, UK; (L.B.); (S.P.)
| | - Emma Reinhold
- Patient and Public Involvement and Medical Advisor, Coventry University, Coventry CV1 5FB, UK;
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20
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Singh N, Sabo J, Crane DA, Doody DR, Schiff MA, Mueller BA. Birth Outcomes and Rehospitalizations Among Pregnant Women With Rheumatoid Arthritis and Systemic Lupus Erythematosus and Their Offspring. Arthritis Care Res (Hoboken) 2023; 75:2022-2031. [PMID: 36625100 DOI: 10.1002/acr.25087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/20/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare obstetric/birth outcomes and rehospitalization among women with and without rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and their infants. METHODS This population-based retrospective cohort study identified women with RA (n = 1,223) and SLE (n = 1,354) and unexposed women with singleton births 1987-2014 in Washington State in linked vital hospital discharge records. Outcomes, including cause-specific hospitalizations <2 years postpartum, were compared by estimating adjusted relative risks (RRs) and cause-specific rehospitalization hazard ratios (HRs) with 95% confidence intervals (95% CIs). RESULTS We observed increased risks of several adverse outcomes; RRs were often greatest for SLE. Women with RA/SLE more often required rehospitalization, most notably at <6 months postpartum (RA: 4% versus 2%; RR 2.22 [95% CI 1.62-3.04]; SLE: 6% versus 2%; RR 2.78 [95% CI 2.15-3.59]). Maternal postpartum rehospitalization was greatest for musculoskeletal conditions (RA: HR 19.1 [95% CI 13.6-26.8]; SLE: HR 29.8 [95% CI 22.1-40.1]). Infants of women with SLE more often had malformations (9% versus 6%; RR 1.46 [95% CI 1.21-1.75]), and increased mortality at <2 years (RR 2.11 [95% CI 1.21-3.67]). Infants of women with SLE also experienced more frequent rehospitalizations in their first year of life. CONCLUSION Women with RA or SLE and their infants experienced adverse outcomes, particularly infants of women with SLE. Maternal/infant rehospitalization was more common; most marked in the early months postpartum. Close follow-up during these time periods is crucial to minimize adverse outcomes.
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Affiliation(s)
| | | | | | - David R Doody
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Melissa A Schiff
- University of New Mexico, Albuquerque, and University of Washington School of Public Health, Seattle
| | - Beth A Mueller
- Fred Hutchinson Cancer Research Center and University of Washington School of Public Health, Seattle
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21
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Unar A, Bertolino L, Patauner F, Gallo R, Durante-Mangoni E. Pathophysiology of Disseminated Intravascular Coagulation in Sepsis: A Clinically Focused Overview. Cells 2023; 12:2120. [PMID: 37681852 PMCID: PMC10486945 DOI: 10.3390/cells12172120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/07/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023] Open
Abstract
Sepsis is a major global health problem that results from a dysregulated and uncontrolled host response to infection, causing organ failure. Despite effective anti-infective therapy and supportive treatments, the mortality rate of sepsis remains high. Approximately 30-80% of patients with sepsis may develop disseminated intravascular coagulation (DIC), which can double the mortality rate. There is currently no definitive treatment approach for sepsis, with etiologic treatment being the cornerstone of therapy for sepsis-associated DIC. Early detection, diagnosis, and treatment are critical factors that impact the prognosis of sepsis-related DIC. Over the past several decades, researchers have made continuous efforts to better understand the mechanisms of DIC in sepsis, as well as improve its quantitative diagnosis and treatment. This article aims to provide a comprehensive overview of the current understanding of sepsis-related DIC, focusing on common causes and diagnoses, with the goal of guiding healthcare providers in the care of patients with sepsis.
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Affiliation(s)
- Ahsanullah Unar
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Lorenzo Bertolino
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Fabian Patauner
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Raffaella Gallo
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
| | - Emanuele Durante-Mangoni
- Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, 80138 Naples, Italy; (A.U.); (L.B.); (F.P.); (R.G.)
- Unit of Infectious and Transplant Medicine, AORN Ospedali dei Colli-Monaldi Hospital, 80131 Naples, Italy
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22
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Schreiber H, Cohen G, Shalev-Ram H, Farladansky-Gershnabel S, Weitzner O, Biron-Shental T, Kovo M, Arnon S, Markovitch O. Bloody Amniotic Fluid and Neonatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1208. [PMID: 37508705 PMCID: PMC10378302 DOI: 10.3390/children10071208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Information on the effect of bloody amniotic fluid during labor at term is scarce. This study assessed risk factors and adverse outcomes in labors with bloody amniotic fluid. During the six years of this study, all nulliparas in our institution, with a trial of labor, were included. Multiple pregnancies and preterm deliveries were excluded. Outcomes were compared between the bloody amniotic fluid group and the clear amniotic fluid group. Overall, 11,252 women were included. Among them, 364 (3.2%) had bloody amniotic fluid and 10,888 (96.7%) had clear amniotic fluid. Women in the bloody amniotic fluid group were characterized by shorter duration of the second stage and higher rate of cesarean section due to non-reassuring fetal heart rate. In addition, there were higher rates of low cord pH (<7.1) and NICU admissions in the bloody amniotic fluid group. In multivariate logistic regression analysis, cesarean delivery, cord blood pH < 7.1, and NICU admission were independently associated with increased odds ratio for bloody amniotic fluid. Bloody amniotic fluid at term is associated with adverse outcomes and must be considered during labor.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Shmuel Arnon
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
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Amikam U, Hochberg A, Shenhav M, Haj L, Hochberg-Klein S, Hiersch L, Yogev Y. Anti-Phospholipid Antibodies in Women with Placenta-Mediated Complications Delivered at >34 Weeks of Gestation. J Clin Med 2023; 12:4516. [PMID: 37445549 DOI: 10.3390/jcm12134516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/21/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To determine the prevalence of positive antiphospholipid (aPL) antibodies among pregnant women with placenta-mediated complications delivered at >340/7 weeks of gestation. METHODS This was a single-center retrospective observational study conducted between 2017 and 2022. Inclusion criteria included pregnant or post-partum women, >18 years, diagnosed with any of the following placenta-mediated complications and delivered at >340/7 weeks of gestation: small-for-gestational-age neonate (SGA ≤ 5th percentile according to local birthweight charts), preeclampsia with severe features, and placental abruption. The primary outcome was the prevalence of positive aPL antibodies: Lupus anticoagulant, Anticardiolipin, or Anti-ß2glycoprotein1. RESULTS Overall, 431 women met the inclusion criteria. Of them, 378(87.7%) had an SGA neonate, 30 had preeclampsia with severe features (7%), 23 had placental abruption (5.3%), and 21 patients had multiple diagnoses(4.9%). The prevalence of aPL antibodies in the cohort was 4.9% and was comparable between the three subgroups (SGA-3.9%; PET with severe features-3.3%; and placental abruption-13% (p = 0.17)). CONCLUSION aPL antibodies prevalence in women with placenta-mediated complications > 34 weeks of gestation was 4.9%, with comparable prevalence rates among the three subgroups. Future prospective studies are needed to delineate the need for treatment in those who tested positive for aPL antibodies and do not meet Anti-Phospholipid Antibody Syndrome clinical criteria.
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Affiliation(s)
- Uri Amikam
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Alyssa Hochberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
- Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Michael Shenhav
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Lilian Haj
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Sarit Hochberg-Klein
- Palmerston North Hospital, Te Whatu Ora Health NZ, Palmerston North 4442, New Zealand
| | - Liran Hiersch
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Yariv Yogev
- Lis Hospital for Women, Sourasky Medical Center, Tel Aviv 6423906, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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24
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Parsapour H, Shafie N, Salehi AM, Assareh Z. Report of a Complicated Case of Couvelaire Uterus. Case Rep Med 2023; 2023:6668328. [PMID: 37408702 PMCID: PMC10319456 DOI: 10.1155/2023/6668328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/13/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023] Open
Abstract
Couvelaire uterus (CU) is a rare complication in the life-threatening placental abruption (PA) that consists of a state of blood infiltration of the uterine myometrium and serosa. The incidence is around 1% and the treatment of choice is obstetric hysterectomy, however, in some cases, close monitoring and timely decision-making can prevent hysterectomy. Herein, we present a rare and serious case of CU with uterus preservation in a young multiparous with a high-risk pregnancy.
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Affiliation(s)
- Hamideh Parsapour
- Clinical Research Development Unit of Fatemieh Hospital, Department of Gynecology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Neda Shafie
- Clinical Research Development Unit of Fatemieh Hospital, Department of Gynecology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Mohammad Salehi
- Student Research Committee, Hamadan University of Medical Sciences, School of Medicine, Hamadan, Iran
| | - Zeinab Assareh
- Student Research Committee, Hamadan University of Medical Sciences, School of Medicine, Hamadan, Iran
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25
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Tweddell SM, Bahr TM, Henry E, Page JM, Ilstrup SJ, Ohls RK, Christensen RD. Placental abruption and neonatal anemia. J Perinatol 2023; 43:782-786. [PMID: 36650233 DOI: 10.1038/s41372-023-01603-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Placental abruption can cause maternal blood loss and maternal anemia. It is less certain whether abruption can cause fetal blood loss and neonatal anemia. STUDY DESIGN Retrospective multi-hospital 24-month analysis of women with placental abruption and their neonates. RESULTS Of 55,111 births, 678 (1.2%) had confirmed abruption; 83% of these neonates (564) had one or more hemoglobins recorded in the first day. Four-hundred-seventy (83.3%) had a normal hemoglobin (≥5th% reference interval) while 94 (16.7%) had anemia, relative risk 3.26 (95% CI, 2.66-4.01) vs. >360,000 neonates from previous reference interval reports. The relative risk of severe anemia (<1st% interval) was 4.96 (3.44-7.16). When the obstetrician identified the abruption as "small" or "marginal" the risk of anemia was insignificant. CONCLUSIONS Most abruptions do not cause neonatal anemia but approximately 16% do. If an abruption is not documented as small, it is important to surveille the neonate for anemia.
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Affiliation(s)
- Sarah M Tweddell
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Timothy M Bahr
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Erick Henry
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Jessica M Page
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
| | - Sarah J Ilstrup
- Transfusion Medicine, Intermountain Medical Center, Murray, UT, USA
| | - Robin K Ohls
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Robert D Christensen
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
- Obstetric and Neonatal Operations, Intermountain Healthcare, Salt Lake City, UT, USA
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26
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Singh J, Kaur M, Rasane P, Kaur S, Kaur J, Sharma K, Gulati A. Nutritional management and interventions in complications of pregnancy: A systematic review. Nutr Health 2023:2601060231172545. [PMID: 37128673 DOI: 10.1177/02601060231172545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background: Pregnancy, also known as the "gestation period" which lasts for 37-40 weeks, has been marked as the period of "physiological stress" in a woman's life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.
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Affiliation(s)
- Jyoti Singh
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Mansehaj Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Jaspreet Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Kartik Sharma
- International Center of Excellence in Seafood Science and Innovation (ICE-SSI), Faculty of Agro-Industry, Prince of Songkla University, Hat Yai, Thailand
| | - Amisha Gulati
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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27
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Brandt JS, Ananth CV. Placental abruption at near-term and term gestations: pathophysiology, epidemiology, diagnosis, and management. Am J Obstet Gynecol 2023; 228:S1313-S1329. [PMID: 37164498 PMCID: PMC10176440 DOI: 10.1016/j.ajog.2022.06.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 05/12/2023]
Abstract
Placental abruption is the premature separation of the placenta from its uterine attachment before the delivery of a fetus. The clinical manifestations of abruption typically include vaginal bleeding and abdominal pain with a wide variety of abnormal fetal heart rate patterns. Clinical challenges arise when pregnant people with this condition present with profound vaginal bleeding, necessitating urgent delivery, especially when there is a concern for maternal and fetal compromise and coagulopathy. Abruption occurs in 0.6% to 1.2% of all pregnancies, with nearly half of abruption occurring at term gestations. An exposition of abruption at near-term (defined as the late preterm period from 34 0/7 to 36 6/7 weeks of gestation) and term (defined as ≥37 weeks of gestation) provides unique insights into its direct effects, as risks associated with preterm birth do not impact outcomes. Here, we explore the pathophysiology, epidemiology, and diagnosis of abruption. We discuss the interaction of chronic processes (decidual and uteroplacental vasculopathy) and acute processes (shearing forces applied to the abdomen) that underlie the pathophysiology. Risk factors for abruption and strengths of association are summarized. Sonographic findings of abruption and fetal heart rate tracings are presented. In addition, we propose a management algorithm for acute abruption that incorporates blood loss, vital signs, and urine output, among other factors. Lastly, we discuss blood component therapy, viscoelastic point-of-care testing, disseminated intravascular coagulopathy, and management of abruption complicated by fetal death. The review seeks to provide comprehensive, clinically focused guidance during a gestational age range when neonatal outcomes can often be favorable if rapid and evidence-based care is optimized.
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Affiliation(s)
- Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ; Cardiovascular Institute of New Jersey and Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
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28
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Wenzhi X, Xin X, Ping Z, Hanglin W, Xiaona L. A meta-analysis of obstetric and neonatal outcomes in patients after treatment of hysteroscopic adhesiolysis. Front Endocrinol (Lausanne) 2023; 14:1126740. [PMID: 37033233 PMCID: PMC10080075 DOI: 10.3389/fendo.2023.1126740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Hysteroscopic adhesiolysis is widely performed in women with intrauterine adhesions. Small observational studies have reported the obstetric and neonatal outcomes, but studies with larger sample sizes are few. The aim of this study is to evaluate the obstetric and neonatal outcomes in women after hysteroscopic adhesiolysis. Methods We conducted a literature search in July 2022 using the PubMed, Embase, the Cochrane Library, and Web of Science databases, and finally, 32 studies (N = 3812) were included. We did a meta-analysis to estimate the prevalence of placenta-related disorders, including placenta previa, placental abruption, placenta accreta, placenta increta, and retained placenta. We also included other obstetric and neonatal outcomes like postpartum hemorrhage, ectopic pregnancy, oligohydramnios, gestational hypertension, gestational diabetes mellitus, and intrauterine growth restriction. The results were presented as odds ratios (ORs) with 95% confidence intervals (CIs) in studies with a control group, but otherwise as prevalence (%) with 95% confidence intervals (CIs). Results The overall pregnancy and live birth rates were 58.97% and 45.56%, respectively. The prevalence of placenta previa differed in pregnant women who underwent hysteroscopic adhesiolysis compared with those who did not (OR, 3.27; 95% CI, 1.28-8.36). In studies without a comparative group, the pooled rate of placenta accreta was 7% (95% CI, 4-11) in 20 studies; placenta increta was 1% (95% CI, 0-4) in 5 studies; a retained placenta was 11% (95% CI, 5-24) in 5 studies; postpartum hemorrhage was 12% (95% CI, 8-18) in 12 studies; ectopic pregnancy was 1% (95% CI, 0-2) in 13 studies; oligohydramnios was 3% (95% CI, 1-6) in 3 studies; intrauterine growth restriction was 3% (95% CI, 1-8) in 3 studies; gestational hypertension was 5% (95% CI, 2-11) in 4 studies; and diabetes mellitus was 4% (95% CI, 2-7) in 3 studies. Discussion Due to the paucity of good quality comparative data, the question of whether there is an increased prevalence of obstetric and neonatal complications in women after hysteroscopic adhesiolysis compared with the general population remains unanswered. The findings from this review will provide a basis for more well-designed studies in the future. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=364021, identifier [CRD42022364021].
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Affiliation(s)
- Xu Wenzhi
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu Xin
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhou Ping
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wu Hanglin
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital, Hangzhou, China
| | - Lin Xiaona
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
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Atallah A, Piccin G, Dubernard G, Abdul-Hay MJ, Cortet M, Huissoud C. Fibrinogen for the prediction of severe maternal complications in placental abruption with fetal death after 24 weeks of gestation. Int J Gynaecol Obstet 2023; 160:900-905. [PMID: 35986606 PMCID: PMC10087485 DOI: 10.1002/ijgo.14417] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/15/2022] [Accepted: 08/09/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the correlation between standard laboratory indicators at admission and severe maternal complications due to placental abruption (PA) with intrauterine fetal death (IUFD) after 24 weeks. METHODS Retrospective study in three French tertiary referral hospitals. Correlation of laboratory indicators at admission (platelet count, prothrombin, activated partial thromboplastin time, fibrinogen) and severe maternal complications (massive transfusion, multiple organ failure, hysterectomy, or maternal deaths) in patients with PA and IUFD. RESULTS Over 12 years, we identified 27/344 (7.8%) pregnant women presenting PA with IUFD. No patient had coagulopathy at admission. Fifteen individuals (55.5%) underwent delivery by cesarean section before or during labor. Fifteen individuals (55.5%) presented severe complications, and 17/27 (63%) lost more than 1 L of blood during delivery. Fibrinogen level was shown to be the laboratory indicator most correlated with severe complications (r = -0.52, P = 0.01). The receiver operating characteristic curve of fibrinogen less than 1.9 g/L in the prediction of severe complications (area under the curve = 0.80, 95% confidence interval [CI] 0.54-0.97) showed both a sensitivity and specificity of 83% (95% CI 54%-96%). CONCLUSIONS In cases of IUFD with PA, fibrinogen levels at admission had a prognostic value for the prediction of severe maternal complications.
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Affiliation(s)
- Anthony Atallah
- Femme Mère Enfant University Hospital, Department of Maternal-Fetal Medicine and Obstetric Emergency Department, Hospices Civils de Lyon, Bron, France.,Claude Bernard University Lyon 1, Lyon, France
| | - Gaelle Piccin
- Department of Obstetrics and Gynecology, North-West Hospital of Villefranche-sur-Saône, Gleize, France
| | - Gil Dubernard
- Claude Bernard University Lyon 1, Lyon, France.,Croix Rousse University Hospital - Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Lyon, France
| | | | - Marion Cortet
- Claude Bernard University Lyon 1, Lyon, France.,Croix Rousse University Hospital - Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Lyon, France
| | - Cyril Huissoud
- Femme Mère Enfant University Hospital, Department of Maternal-Fetal Medicine and Obstetric Emergency Department, Hospices Civils de Lyon, Bron, France.,Claude Bernard University Lyon 1, Lyon, France
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30
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Collis R, Bell S. The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application. Semin Thromb Hemost 2023; 49:145-161. [PMID: 36318958 DOI: 10.1055/s-0042-1757895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.
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Affiliation(s)
- Rachel Collis
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
| | - Sarah Bell
- Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
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31
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Surgical Emergencies in the Pregnant Patient. Curr Probl Surg 2023; 60:101304. [PMID: 37169419 DOI: 10.1016/j.cpsurg.2023.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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32
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Meena S, Gaikwad HS, Nath B. Plasma Homocysteine, Folic Acid and Vitamin B12 in Abruptio Placentae: A Cross-Sectional Study of Their Role and Feto-Maternal Outcome. Cureus 2023; 15:e35664. [PMID: 37012959 PMCID: PMC10065975 DOI: 10.7759/cureus.35664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Background Out of the many causes of abruptio placentae, the micronutrient association with its occurrence and severity has not been researched extensively till now. We aim to measure the serum levels of homocysteine, folic acid and vitamin B12 in patients with abruptio placentae in the third trimester of pregnancy and compare the levels with those without the complication. We also propose to compare the feto-maternal outcome between the groups. Methods The cross-sectional study was undertaken in 50 pregnant women with abruption before or during delivery and 50 controls with uncomplicated pregnancy over 28 weeks of gestation. Serum levels of homocysteine, folic acid, and vitamin B12 were determined and feto-maternal outcome was compared between the groups Results Mean age of the cases and controls are 26.82 ± 5.5 and 28.82 ± 4.88 years respectively. Obstetric characteristics have significant difference between the groups in terms of gravidity, mode of delivery, timing of delivery, proportion of stillbirths and blood transfusion. The mean concentration of homocysteine and vitamin B12 between the groups also have a significant difference . The serum level of homocysteine is significantly correlated with serum vitamin B12 level (Pearson correlation= -0.601, P=0.000). However, folic acid concentration between the groups remains comparable. Conclusion Hence we conclude that vitamin B12 and homocysteine are significant determinants of abruptio placentae in pregnant women. Supplementation with the vitamin in the high-risk Indian population can avert a number of obstetric complications occurring due to raised homocysteine.
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Kawamura H, Takahashi N, Miyazaki Y, Tsuyoshi H, Orisaka M, Yoshida Y. Impact of maternal late hospital arrival on adverse outcome of offspring affected by placental abruption: A regional multicenter nested case-control study in Japan. J Obstet Gynaecol Res 2023; 49:1341-1347. [PMID: 36808792 DOI: 10.1111/jog.15579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/28/2023] [Indexed: 02/20/2023]
Abstract
AIMS To elucidate the influence of the time-intervals between the onset and arrival (TIME 1), onset and delivery (TIME 2), and the decision to deliver and delivery (TIME 3) on severe adverse outcomes of offspring born to mothers complicated by placental abruption outside the hospital. METHODS This is a multicenter nested case-control study about placental abruption at Fukui Prefecture, a regional area in Japan, through 2013 to 2017. Multiple pregnancy, fetal or neonatal congenital abnormality, and unknown detailed information at onset of placental abruption were excluded. A composite of perinatal death and cerebral palsy or death at 18-36 months of corrected age was defined as the adverse outcome. The relationship between time-intervals and the adverse outcome was analyzed. RESULTS The 45 subjects for analysis were divided into two groups, including a group with and without adverse outcome (poor, n = 8; and good, n = 37). TIME 1 was longer in the poor group (150 vs. 45 min, p < 0.001). A subgroup analysis targeted to 29 cases with preterm birth at the third trimester indicates that TIME 1 and TIME 2 were longer in the poor group (185 vs. 55 min, p = 0.02; and 211 vs. 125 min, p = 0.03), while TIME 3 was shorter in the poor group (21 vs. 53 min, p = 0.01). CONCLUSIONS Long time-intervals between onset and arrival or onset and delivery may be correlated with perinatal death or cerebral palsy in surviving infants affected by placental abruption.
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Affiliation(s)
- Hiroshi Kawamura
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Nozomu Takahashi
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Yumiko Miyazaki
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Hideaki Tsuyoshi
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Makoto Orisaka
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
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Automated placental abruption identification using semantic segmentation, quantitative features, SVM, ensemble and multi-path CNN. Heliyon 2023; 9:e13577. [PMID: 36852023 PMCID: PMC9957707 DOI: 10.1016/j.heliyon.2023.e13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The placenta is a fundamental organ throughout the pregnancy and the fetus' health is closely related to its proper function. Because of the importance of the placenta, any suspicious placental conditions require ultrasound image investigation. We propose an automated method for processing fetal ultrasonography images to identify placental abruption using machine learning methods in this paper. The placental imaging characteristics are used as the semantic identifiers of the region of the placenta compared with the amniotic fluid and hard organs. The quantitative feature extraction is applied to the automatically identified placental regions to assign a vector of optical features to each ultrasonographic image. In the first classification step, two methods of kernel-based Support Vector Machine (SVM) and decision tree Ensemble classifier are elaborated and compared for identification of the abruption cases and controls. The Recursive Feature Elimination (RFE) is applied for optimizing the feature vector elements for the best performance of each classifier. In the second step, the deep learning classifiers of multi-path ResNet-50 and Inception-V3 are used in combination with RFE. The resulting performances of the algorithms are compared together to reveal the best classification method for the identification of the abruption status. The best results were achieved for optimized ResNet-50 with an accuracy of 82.88% ± SD 1.42% in the identification of placental abruption on the testing dataset. These results show it is possible to construct an automated analysis method with affordable performance for the detection of placental abruption based on ultrasound images.
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Tugrul Ersak D, Kara Ö, Yakut K, Tokmak A, Sanhal CY, Yücel A, Şahin D. The Association between Placental Abruption and Platelet Indices. Fetal Pediatr Pathol 2023; 42:367-375. [PMID: 36715068 DOI: 10.1080/15513815.2023.2166798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: Placental abruption (PA) is an obstetric emergency. This study investigated the use of platelet indices in PA in its early stages to determine if it could aid in diagnosis. Materials and Methods: Sixty-two pregnant women with PA and 130 pregnant women who delivered due to idiopathic preterm delivery were included in this case-control study. Blood samples including platelet indices, biochemical, and coagulation parameters were obtained before cesarean section. Maternal and neonatal outcomes were recorded. Results: There was no significant difference between the groups as to hemoglobin, hematocrit, and white blood count. Platelet, mean platelet volume (MPV), and platelet to lymphocyte ratio (PLR) were significantly lower, platelet distribution width (PDW) was significantly higher in the PA patients. Conclusion: In the current study, MPV and PLR were lower and PDW was higher in PA patients. These parameters may be useful in assessment of PA.
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Affiliation(s)
- Duygu Tugrul Ersak
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Özgür Kara
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Kadriye Yakut
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Aytekin Tokmak
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Cem Yaşar Sanhal
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
| | - Dilek Şahin
- Ankara Dr. Zekai Tahir Burak Women's Health Training Research Hospital, Ankara, Turkey
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Altendahl M, Mok T, Adimkpayah E, Goldstein J, Lin J, Afshar Y. Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk. Sci Rep 2023; 13:1439. [PMID: 36697426 PMCID: PMC9876959 DOI: 10.1038/s41598-023-28011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Congenital heart disease (CHD) in pregnancy is associated with an increased risk of adverse maternal, obstetric, and neonatal outcomes, plausibly through mechanisms involving abnormal placental development and function. This retrospective study aims to elucidate how maternal CHD influences placental health. Demographic and clinical information were collected via electronic medical record review, and placentas underwent histopathological evaluation. Fifty-three singleton pregnancies were included: 35 participants (66%) were classified as lower cardiovascular risk (modified World Health Organization Classification (mWHO) I, II, II-III), and 18 (34%) were classified as higher cardiovascular risk (mWHO III, IV). 12 participants (23%) had a fetus with small for gestational age (SGA). Maternal vascular malperfusion (53%) and placental abruption (11.6%) were common in this cohort, with prevalence above baseline risk. Participants at higher cardiovascular risk had higher rates of SGA (p = 0.04), subchorionic hematomas (p = 0.01) and birth weight:placental weight < 10th percentile (p = 0.04), but did not differ in rates of maternal vascular malperfusion (p = 0.15) compared to those at lower cardiovascular risk. In pregnancies with maternal CHD, SGA and histologic evidence of maternal vascular malperfusion and placental abruption were common, though patients at higher cardiovascular risk did not show evidence of worsened placental health compared to those at lower risk.
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Affiliation(s)
- Marie Altendahl
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thalia Mok
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ekene Adimkpayah
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey Goldstein
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeannette Lin
- Division of Cardiology, Department of Medicine, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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杨 旻, 汪 吉. [Perinatal risk factors for the occurrence of singleton apparently stillborn infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:18-24. [PMID: 36655659 PMCID: PMC9893824 DOI: 10.7499/j.issn.1008-8830.2207108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants. METHODS This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants. RESULTS The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (P<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (P<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (OR=34.520), decreased antenatal fetal movement (OR=28.168),placental abruption (OR=15.641), grade III meconium-stained amniotic fluid (OR=6.365), abnormal antenatal fetal heart monitoring (OR=5.739), and breech presentation (OR=2.614) were risk factors for the occurrence of apparently stillborn infants (P<0.05), while higher gestational age was a protective factor (OR=0.686, P<0.05). CONCLUSIONS Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.
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Nkwabong E, Tchomguie Moussi OS, Fouedjio J. Risk factors for placental abruption. Trop Doct 2023; 53:37-40. [PMID: 35903928 DOI: 10.1177/00494755221116716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means, folic acid consumption, smoking, past-history of infertility, number of antenatal visits done, presence of pre-eclampsia and umbilical cord insertion. Significant risk factors for PA were frequent transportation by motorbikes, consumption of haematinic preparation not containing folic acid, passive smoking, past-history of infertility, pre-eclampsia and marginal cord insertion. Pregnant women should be counselled about the above-mentioned risk factors.
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Affiliation(s)
- Elie Nkwabong
- Department of Obstetrics and Gynecology; Faculty of Medicine and Biomedical Sciences & University Teaching Hospital, University of Yaoundé I, Yaoundé, Cameroon
| | - Olive Stella Tchomguie Moussi
- Department of Obstetrics and Gynecology; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Jeanne Fouedjio
- Department of Obstetrics and Gynecology; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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Parc E, Benin A, Lecarpentier E, Goffinet F, Lepercq J. Risk factors for hypoxic-ischemic encephalopathy or neonatal death in placental abruption. J Gynecol Obstet Hum Reprod 2023; 52:102498. [PMID: 36336280 DOI: 10.1016/j.jogoh.2022.102498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify risk factors for moderate or severe hypoxic-ischemic encephalopathy (HIE), or neonatal death in clinical placental abruption. MATERIAL AND METHODS A nested case-control study within a cohort of singleton pregnancies complicated by placental abruption with a live born infant at two academic reference centers in France, from 2006 to 2019. Cases were patients who gave birth to an infant with moderate or severe HIE or death within 28 days (HIE/death group), and controls were patients whose infant did not have any of these outcomes (no-HIE group). Independent risk factors were identified by logistic regression. Binary decision tree discriminant (CART) analysis was performed to define high-risk subgroups of HIE or death. RESULTS Among 152 patients, the infants of 44 (29%) had HIE or death. Out-of-hospital placental abruption and fetal bradycardia at admission were more frequent in cases than in controls: 39 (89%) vs 61 (56%), p < .01 and 24 (59%) vs 19 (18%), p < .01, respectively. In multivariate analysis, out-of-hospital placental abruption (aOR, 7.05; 95% CI, 1.94-25.66) and bradycardia at admission (aOR, 8.60; 95% CI, 2.51-29.42) were independently associated with an increased risk of HIE or death. The combination of out-of-hospital placental abruption and bradycardia was the highest risk situation associated with HIE or death (67%). The decision-to-delivery interval was 15 [12-20] minutes among cases. CONCLUSION Out-of-hospital placental abruption combined with bradycardia at admission was associated with a major risk of moderate or severe HIE or death. An optimal decision-to-delivery interval does not guarantee the absence of an adverse neonatal outcome.
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Affiliation(s)
- Enora Parc
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Amelie Benin
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France
| | - Edouard Lecarpentier
- Department of Obstetrics Gynecology and Reproductive Medicine, University Paris Est Créteil, Centre Hospitalier Inter-Communal de Créteil, Créteil, France
| | - François Goffinet
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France; Obstetrical, Perinatal and Pediatric Epidemiology (Epopé) Research Team, Center for Epidemiology and Statistics (CRESS), INSERM U1153, Paris, France
| | - Jacques Lepercq
- Department of Obstetrics and Gynecology of Port Royal, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris University, Paris, France.
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Santana EFM, Castello RG, Passos MET, Ribeiro GCF, Araujo Júnior E. How to Reach the Best Ultrasound Performance in the Delivery Room. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1070-1077. [PMID: 36580951 PMCID: PMC9800070 DOI: 10.1055/s-0042-1759773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Ultrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
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Affiliation(s)
- Eduardo Félix Martins Santana
- Medical Course, Albert Einstein Medical School, São Paulo, SP, Brazil.,Fetal Medicine Unit, Albert Einstein Hospital, São Paulo, SP, Brazil.
| | | | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of Sao Paulo, São Paulo, SP, Brazil.,Medical Course, Municipal University of Sao Caetano do Sul, São Paulo, SP, Brazil.,Address for correspondence Edward Araujo Junior, PhD Rua Borges Lagoa, 1341, 04038-034, Vila Clementino, São Paulo, SPBrazil
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Kanervo MM, Tupola SJ, Nikkola EM, Rantakari KM, Kahila HK. Buprenorphine-naloxone, buprenorphine, and methadone throughout pregnancy in maternal opioid use disorder. Acta Obstet Gynecol Scand 2022; 102:313-322. [PMID: 36562462 PMCID: PMC9951318 DOI: 10.1111/aogs.14497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/14/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Current WHO guidelines recommend using methadone or buprenorphine as maintenance treatments for maternal opioid use disorder. However, buprenorphine-naloxone, with a lower abuse risk than buprenorphine monotherapy or methadone, offers a potentially beneficial alternative, but scientific evidence on its effects on pregnancies, fetuses, and newborns is scarce. This paper compares the outcomes of the pregnancies, deliveries, and newborns of women on buprenorphine-naloxone, buprenorphine, or methadone maintenance treatments. According to the hypothesis, as a maintenance treatment, buprenorphine-naloxone does not have more adverse effects than buprenorphine, whereas methadone is more complicated. MATERIAL AND METHODS In this population-based study, 172 pregnant women on medical-assisted treatments were followed-up at Helsinki University Women's Hospital (Finland). Women receiving the same opioid maintenance treatment from conception to delivery and their newborns were included. Consequently, 67 mother-child dyads met the final inclusion criteria. They were divided into three groups based on their opioid pharmacotherapy. The outcomes were compared among the groups and, where applicable, with the Finnish population. RESULTS The buprenorphine-naloxone and buprenorphine groups showed similar outcomes and did not significantly differ from each other in terms of maternal health during pregnancies, deliveries, or newborns. Illicit drug use during the pregnancy was common in all groups, but in the methadone group it was most common (p = 0.001). Most neonates (96%) were born full-term with good Apgar scores. They were of relatively small birth size, with those in the methadone group tending to be the smallest. Of the neonates 63% needed pharmacological treatment for neonatal opioid withdrawal syndrome. The need was lower in the buprenorphine-based groups than in the methadone group (p = 0.029). CONCLUSIONS Buprenorphine-naloxone seems to be as safe for pharmacotherapy for maternal opioid use disorder as buprenorphine monotherapy for both mother and newborn. Hence it could be a choice for oral opioid maintenance treatment during pregnancy, but larger studies are needed before changing the official recommendations. Women on methadone treatment carry multifactorial risks and require particularly cautious follow up. Furthermore, illicit drug use is common in all treatment groups and needs to be considered for all patients with opioid use disorder.
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Affiliation(s)
- Minna M. Kanervo
- Children's Hospital, Pediatric Research CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland,Doctoral Program in Clinical ResearchUniversity of HelsinkiHelsinkiFinland
| | - Sarimari J. Tupola
- Children's Hospital, Pediatric Research CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Eeva M. Nikkola
- Children's Hospital, Pediatric Research CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Krista M. Rantakari
- Children's Hospital, Pediatric Research CenterHelsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Hanna K. Kahila
- Gynecology and ObstetricsHelsinki University Hospital and University of HelsinkiHelsinkiFinland
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Risk-factor model for postpartum hemorrhage after cesarean delivery: a retrospective study based on 3498 patients. Sci Rep 2022; 12:22100. [PMID: 36543795 PMCID: PMC9772352 DOI: 10.1038/s41598-022-23636-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the risk factors of patients with postpartum hemorrhage (PPH) after cesarean delivery (CD) and to develop a risk-factor model for PPH after CD. Patients were selected from seven affiliated medical institutions of Chongqing Medical University from January 1st, 2015, to January 1st, 2020. Continuous and categorical variables were obtained from the hospital's electronic medical record systems. Independent risk factors were identified by univariate analysis, least absolute shrinkage and selection operator and logistic regression. Furthermore, logistic, extreme gradient boosting, random forest, classification and regression trees, as well as an artificial neural network, were used to build the risk-factor model. A total of 701 PPH cases after CD and 2797 cases of CD without PPH met the inclusion criteria. Univariate analysis screened 28 differential indices. Multi-variable analysis screened 10 risk factors, including placenta previa, gestational age, prothrombin time, thrombin time, fibrinogen, anemia before delivery, placenta accreta, uterine atony, placental abruption and pregnancy with uterine fibroids. Areas under the curve by random forest for the training and test sets were 0.957 and 0.893, respectively. The F1 scores in the random forest training and test sets were 0.708. In conclusion, the risk factors for PPH after CD were identified, and a relatively stable risk-factor model was built.
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Association of Endometriosis and Severe Maternal Morbidity. Obstet Gynecol 2022; 140:1008-1016. [PMID: 36357981 DOI: 10.1097/aog.0000000000004969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the association between endometriosis and risk of severe maternal morbidity (SMM). METHODS We conducted a population-based retrospective cohort study of 2,412,823 deliveries at hospitals in Quebec, Canada, between 1989 and 2019. The exposure was surgically confirmed endometriosis. Patients were classified as having active endometriosis during pregnancy, inactive endometriosis during pregnancy, a diagnosis of endometriosis postpregnancy, or no endometriosis. The outcome was SMM, including by a range of life-threatening maternal conditions during pregnancy or up to 42 days postdelivery. We computed rates of SMM and used log binomial regression to assess the association with endometriosis (risk ratio [RR]; 95% CI), adjusted for maternal characteristics. RESULTS Severe maternal morbidity occurred in 46.2 of 1,000 patients with endometriosis, compared with 30.7 of 1,000 patients without endometriosis. Relative to no exposure, endometriosis was associated with 1.43 times the risk of SMM (95% CI 1.36-1.51). Patients with endometriosis that was active during pregnancy had a greater risk of SMM (RR 1.93; 95% CI 1.76-2.11). Active endometriosis was associated with the risk of severe preeclampsia and eclampsia, severe hemorrhage, hysterectomy, cardiac complications, embolism, shock, sepsis, and intensive care unit admission. Inactive endometriosis was less strongly associated with these outcomes. CONCLUSION Pregnant patients with endometriosis, especially active endometriosis, have a greater risk of SMM and may benefit from closer follow-up to prevent severe complications of pregnancy.
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Lueth A, Blue N, Silver RM, Allshouse A, Hoffman M, Grobman WA, Simhan HN, Reddy U, Haas DM. Prospective evaluation of placental abruption in nulliparous women. J Matern Fetal Neonatal Med 2022; 35:8603-8610. [PMID: 34814777 PMCID: PMC9678005 DOI: 10.1080/14767058.2021.1989405] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Because most data on placental abruption are derived from retrospective studies, multiple sources of bias may have affected the results. Thus, we aimed to characterize risk factors and outcomes for placental abruption in a large prospective cohort of nulliparous women. METHODS This was a secondary analysis of women enrolled in the Nulliparous Pregnancy Outcomes Study Monitoring-to-be (nuMom2b) study, a prospective observational cohort. Participants were recruited in their first trimester of pregnancy from 8 sites and had 4 study visits, including at delivery. Placental abruption was defined by confirmed clinical criteria. The primary analysis was restricted to abruption identified antepartum and intrapartum. As a secondary analysis, we examined antepartum and intrapartum abruptions separately. We compared risk factors (maternal demographic and clinical characteristics) and outcomes in women with and without placental abruption using univariable and multivariable analyses as appropriate. RESULTS 9450 women were included in the primary analysis. Abruption was identified in 0.66% (n = 62), of which 35 (56%) were antepartum and 27 (44%) intrapartum. For women with abruption, the mean gestational age at delivery was 35.6 ± 4.4 weeks and 38.8 ± 2.2 weeks for women without abruption. Gravidity was associated with abruption (OR 3.1, 95% CI: 1.6-6.0). In univariate analysis, abruption was associated with cesarean delivery (OR 3.7, 95% CI: 2.2-6.0), blood transfusion (OR 3.8, 95% CI: 1.4-10.7), PPROM (OR 9.0, 95% CI: 5.4-15.1), preterm birth (OR 8.5, 95% CI: 5.1-14.2), SGA (OR 4.0, 95% CI: 2.3-6.95), RDS (OR 5.5, 95% CI: 2.6-11.2), IVH 20.2 (OR 20.2, 95% CI: 5.9-68.8) and ROP (OR 12.2, 95% CI: 2.8-52.6). However, after adjustment for confounders including gestational age, abruption was only associated with increased odds of cesarean delivery and blood transfusion. Results were similar when restricted to antepartum and intrapartum abruptions. CONCLUSION Abruption was identified in <1% of nulliparous women. However, few maternal risk factors were identified. Neonatal morbidities were associated with an abruption and were primarily driven by gestational age due to preterm birth.
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Affiliation(s)
- Amir Lueth
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Nathan Blue
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Robert M Silver
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Amanda Allshouse
- Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, UT, USA
| | - Matthew Hoffman
- Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE, USA
| | - William A Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL, USA
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital of UPMC, Pittsburgh, PA, USA
| | - Uma Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
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AKTÜRK E, EMEKLİOGLU CN, CINGILLIOĞLU B, GENÇ S, YURCİ A, MİHMANLI V. Risk factors and maternal/fetal outcomes of pregnant women with abruptio placenta: a retrospective, descriptive study. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1161262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Abruptio placenta is one of the most important causes of antepartum bleeding and is linked to the major (unpleasant) obstetrics consequences leading to the increased risks of fetal and maternal morbidity and mortality. The aim of our study is to establish a prevalence in our tertiary hospital and find out the fetal and maternal outcomes, along with the patient’s demographic characteristics and risk factors of abruptio placenta.
Material and Method: This trial was carried out in Profesör Doktor Cemil Taşçıoğlu State Hospital, between January 2018 and March 2022. Patient data were extracted from computer system, and files were retrospectively evaluated. We established the fetal and maternal outcomes, along with the demographic characteristics and risk factors of abruptio placenta. All analysis was performed using SPSS software (Statistical Package for the Social Sciences, version 25.0, SPSS Inc., Chicago, IL, USA).
Results: Within the review period there were 7126 deliveries. And 112 cases with abruptio placenta were seen out of the total deliveries. In our population, prevalence of the abruptio placenta was calculated as 1.5%. Because of the incomplete data in certain files, only a total of 102 cases (91%) were eligible for the study.
Conclusion: In conclusion, since the abruptio placenta is highly associated with maternal and fetal morbidity and mortality, timely diagnosis is crucial to prevent devastating consequenuces.
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Affiliation(s)
- Erhan AKTÜRK
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL OKMEYDANI HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
| | - Cagdas Nurettin EMEKLİOGLU
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL OKMEYDANI HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
| | - Başak CINGILLIOĞLU
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL OKMEYDANI HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
| | - Simten GENÇ
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL OKMEYDANI HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
| | - Arzu YURCİ
- Bahcelievler Memorial Hospital, Clinic of Obstetrics and Gynecology, In Vitro Fertilization Unit
| | - Veli MİHMANLI
- UNIVERSITY OF HEALTH SCIENCES, İSTANBUL OKMEYDANI HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
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Goldbart A, Pariente G, Sheiner E, Wainstock T. Identifying risk factors for placental abruption in subsequent pregnancy without a history of placental abruption. Int J Gynaecol Obstet 2022; 161:406-411. [PMID: 36083780 DOI: 10.1002/ijgo.14446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To identify first pregnancy risk factors for placental abruption in subsequent pregnancy. METHODS In a population-based nested case-control study, cases were defined as women with placental abruption in their second pregnancy, and controls as women without abruption. A total of 43,328 women were included in the study, 0.4%(n=186) of second pregnancies had placental abruption. Multivariable logistic models were used to study the association between first pregnancy complications and placental abruption in subsequent pregnancy. RESULTS Having either small for gestational age, preterm delivery, preeclampsia or caesarian delivery during first pregnancy were independently associated with increased risk for placental abruption, and the risk was higher with any additional complication (age adjusted OR=2.00; 95%CI 1.46-2.74, adjusted OR=3.61; 95%CI 2.23-5.86, and adjusted OR=3.86; 95%CI 1.56-9.56, for 1, 2 and ≥3 complications, respectively). CONCLUSION First pregnancy may serve as a window of opportunity to identify women at risk for future placental abruption.
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Affiliation(s)
- Adi Goldbart
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Garr Barry V, Johnson TN, Herrick C, Lindley K, Carter EB. Adverse Pregnancy Outcomes and Postpartum Care as a Pathway to Future Health. Clin Obstet Gynecol 2022; 65:632-647. [PMID: 35708966 PMCID: PMC9339503 DOI: 10.1097/grf.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Adverse pregnancy outcomes (APOs) collectively represent the leading causes of maternal and neonatal morbidity and mortality. Beyond the potentially devastating impact of APOs during pregnancy and the puerperium, women diagnosed with APOs have a 2-fold to 4-fold increased risk of future cardiovascular disease. Fortunately, APOs occur at an opportune time, in early-adulthood to mid-adulthood, when primary and secondary prevention strategies can alter the disease trajectory and improve long-term health outcomes. This chapter takes a life-course approach to (1) the epidemiology of APOs, (2) evidence-based strategies for clinicians to manage APOs, and (3) future directions for APO research and clinical practice.
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Affiliation(s)
- Valene Garr Barry
- Division of Clinical Research, Department of Obstetrics and Gynecology
| | - Traci N Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | | | | | - Ebony B Carter
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022278.03232022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
| | - Ila Rocha Falcão
- Universidade Federal da Bahia, Brazil; Fundação Oswaldo Cruz, Brazil
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49
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Rocha ADS, Falcão IR, Teixeira CSS, Alves FJO, Ferreira AJF, Silva NDJ, Almeida MFD, Ribeiro-Silva RDC. Determinants of preterm birth: proposal for a hierarchical theoretical model. CIENCIA & SAUDE COLETIVA 2022; 27:3139-3152. [PMID: 35894325 DOI: 10.1590/1413-81232022278.03232022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/05/2022] [Indexed: 11/22/2022] Open
Abstract
Preterm birth (PB) is a syndrome resulting from a complex relationship between multiple factors which do not have fully understood relationships and causality. This article discusses a hierarchical theoretical model of PB determinants, considering maternal characteristics such as sociodemographic, psychosocial, nutritional, behavioral and biological aspects, traditionally associated with increased risk of PB. The variables were distributed in six dimensions within three hierarchical levels (distal, intermediate and proximal). In this model, the socioeconomic determinants of the mother, family, household and neighborhood play indirect effects on PB through variables at the intermediate level, which in turn affect biological risk factors at the proximal level that have a direct effect on PB. The study presents a hierarchical theoretical model of the factors involved in the PB determination chain and their interrelationships. Understanding these interrelationships is an important step in trying to break the causal chain that makes some women vulnerable to preterm birth.
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Affiliation(s)
- Aline Dos Santos Rocha
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Ila Rocha Falcão
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
| | - Camila Silveira Silva Teixeira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Flávia Jôse Oliveira Alves
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Andrêa Jacqueline Fortes Ferreira
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
| | - Natanael de Jesus Silva
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. Instituto de Saúde Global de Barcelona, Hospital Clínic. Barcelona Espanha
| | | | - Rita de Cássia Ribeiro-Silva
- Escola de Nutrição, Universidade Federal da Bahia, Salvador. Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz. R. Mundo 121, ed. Tecnocentro, sl. 315, Trobogy. 41745-715 Salvador BA Brasil.
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The Importance of Post-Mortem Investigations in Stillbirths: Case Studies and a Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148817. [PMID: 35886672 PMCID: PMC9318112 DOI: 10.3390/ijerph19148817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022]
Abstract
Stillbirth has an important economic and social impact, though it remains “inexplicable” in many cases. We report the analysis of 11 cases of intrauterine fetal death carried out through a retrospective study conducted in the period between 2014 and 2017. The purpose of the study is to quantify the contribution of the autopsy and placental examination in identifying the cause of stillbirths. For each case, the medical record was analyzed with the relative maternal and partner data, the results of the external fetal and autopsy examination as well as the macroscopic and histological placental examination. The peak of stillbirth was found in a maternal age group between 30 and 39 years, below the 32nd week and above the 37th week of gestation. The results obtained from the clinical history and external fetal examination make it possible to trace the cause of death in only 18.2% of cases. By adding to these data, the results of the fetal autopsy and the placental examination, it is possible to establish the cause of death in 90.9% of cases. The most frequent abnormalities found in the placenta and cord were short or hypercoiled cord, umbilical cord vascular thrombosis, turns around the neck or stretching of the funiculus, placental infarction and placental insufficiency; also, amniotic fluid abnormalities, such as suspected oligohydramnios and chorioamniositi, were found. The accurate analysis of post-mortem placental and fetal examination is essential to reduce the number of unresponsive intrauterine fetal deaths. Determining the cause of fetal death must help clinicians and parents in better management and care in future pregnancies.
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