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Laoreti A, Sala V, Casati D, Faiola S, Spaccini L, Cetin I, Lanna MM. Amnioreduction for Polyhydramnios in a Consecutive Series at a Single Center: Indications, Risks and Perinatal Outcomes. Children (Basel) 2024; 11:502. [PMID: 38671719 PMCID: PMC11048928 DOI: 10.3390/children11040502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024]
Abstract
Pregnancies complicated by severe polyhydramnios are associated with a high rate of underlying fetal anomaly. Amnioreduction may be offered to alleviate maternal symptoms. This is a retrospective study of amnioreductions performed on singleton and twin gestations complicated by symptomatic polyhydramnios between 2010 and 2023 at our tertiary referral center. The indications, procedural techniques and pregnancy and neonatal outcomes were retrieved from an archive database and reviewed with the use of the maternal and child medical record chart, the hospital electronic clinical discharge report and telephone recalls. Our study comprised 86 pregnancies, 65 singletons and 21 twin pregnancies. Fetal anomalies were identified in 79% of cases, mainly gastrointestinal obstructive anomalies; 9.3% of cases were idiopathic. The median gestational age at first amnioreduction was 32.5 weeks, and peri-procedural complications were rare (1 case of placental abruption and 2 cases of preterm delivery). The median gestational age at delivery was 36.5 weeks, with a median prolongation of the pregnancy from the time of first drain until birth of 30 days. Preterm labor < 37 weeks occurred in 48.8% of procedures, with 26.7% of patients delivering before 34 weeks and pPROM < 36 weeks recorded in 23.2% of cases. In conclusion, amnioreduction offered to alleviate maternal symptoms is a reasonably safe procedure with a low complication rate. These pregnancies necessitate management in a tertiary referral center because of their need for a multidisciplinary approach both prenatally and postnatally.
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Affiliation(s)
- Arianna Laoreti
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Valentina Sala
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Daniela Casati
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Stefano Faiola
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
| | - Luigina Spaccini
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
- Clinical Genetic Service, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy
| | - Irene Cetin
- Fondazione IRCCS Ca’ Granda, Hospital Maggiore Policlinico, University of Milan, 20122 Milan, Italy;
| | - Mariano M. Lanna
- Fetal Therapy Unit “U. Nicolini”, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (D.C.); (S.F.); (M.M.L.)
- Department of Woman, Mother and Neonate, Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy (L.S.)
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Martínez-Varea A, Prasad S, Domenech J, Kalafat E, Morales-Roselló J, Khalil A. Association of fetal growth restriction and stillbirth in twin compared with singleton pregnancies. Ultrasound Obstet Gynecol 2024. [PMID: 38642338 DOI: 10.1002/uog.27661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/02/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Twin pregnancies are at an increased risk of stillbirth compared to singletons. Fetal growth restriction (FGR) is a leading cause of perinatal mortality and morbidity, in both singleton and multiple pregnancies. Whether the contribution of FGR to stillbirth in twin pregnancies differs from that in singletons is yet to be determined. The main aim of this study was to determine the association between FGR and stillbirth in twin compared to singleton pregnancies. The secondary objectives include an assessment of the contribution of FGR to stillbirths, stratified by gestational age at delivery. Furthermore, we aimed to compare the association between FGR and stillbirth in twin pregnancies using the twin-specific versus singleton birthweight charts, stratified by chorionicity. METHODS This was a cross-sectional study including pregnancies receiving obstetric care and birth at St George's Hospital, London. The exclusion criteria included triplet and higher order pregnancies, those resulting in miscarriage or livebirths at or prior to 23+6 weeks, or had a termination of pregnancy, or with missing data on the gestational age at birth. FGR and small for gestational age (SGA) were defined as birthweight <5th and <10th centile, respectively. While standard logistic regression was used for singleton pregnancies, the association of FGR and SGA designation with stillbirth in twin pregnancies was investigated with mixed-effects logistic regression models. For twin pregnancies, intercepts were allowed to vary for twin pairs to account for inter-twin dependency. Analyses were stratified by gestational age at delivery and chorionicity. RESULTS The study included 95,342 singleton and 3,576 twin pregnancies. There were 494 (0.52%) stillbirths in singleton and 41 (1.15%) stillbirths in twin pregnancies (17 dichorionic and 24 monochorionic). FGR and SGA were significantly associated with stillbirth in singleton pregnancies, across all gestational ages at delivery (before 32 weeks- SGA: OR 2.36; 95% CI 1.78-3.13, p<0.001 and FGR: OR 2.67; 95% CI 2.02- 3.55, p<0.001; between 32-36 weeks- SGA: OR 2.70; 95% CI 1.71-4.31, p<0.001 and FGR: OR 2.82; 95% CI 1.78- 4.47, p<0.001; above 36 weeks- SGA: OR 3.85; 95% CI 2.83 - 5.21, p<0.001 and FGR: OR 4.43; 95% CI 3.16 - 6.12, p<0.001) A greater proportion of fetuses from twin pregnancies were diagnosed as SGA and FGR when singleton compared to the twin-specific chart was used (48.43% vs. 9.12%, and 36.73% vs. 6.23%, respectively). When stratified by gestational age at delivery, both SGA and FGR determined by the twin-specific charts were associated with significantly increased odds of having a stillbirth for those delivered before 32 weeks (SGA: OR 3.87; 95% CI 1.56-9.50, p=0.003 and FGR: OR 5.26; 95% CI 2.11-13.01, p<0.001), those delivered between 32-36 weeks (SGA: OR 6.67; 95% CI 2.11-20.41, p=0.001 and FGR: OR 9.54; 95% CI 3.01-29.40, p<0.001) and those delivered beyond 36 weeks (SGA: OR 12.68 95% CI 2.47-58,15, p=0.001 and FGR: OR 23.84; 95% CI 4.62-110.25, p<0.001), whereas the association of stillbirth with either SGA or FGR was inconsistent when analysed using singleton charts (before 32 weeks- SGA: p=0.014 and FGR: p=0.005; between 32-36 weeks- SGA: p=0.036 and FGR: p=0.008; above 36 weeks- SGA: p=0.080 and FGR: p=0.063). For dichorionic twins delivered before 32 weeks, the odds of an SGA or FGR fetus having a stillbirth was increased when analysed using twin-specific charts. In contrast, monochorionic twins delivered before 32 weeks showed lower and non-significant associations with stillbirth for both SGA and FGR cases using either twin-specific or singleton charts. In dichorionic twin pregnancies delivered between 32-36 weeks, the OR for stillbirth of SGA using twin birthweight chart was 6.70 (95% CI 0.80-56.46, p=0.059), and using singleton chart was 0.92 (95% CI 0.11-7.71, p=0.934) and statistically non-significant. Similarly, the OR for stillbirth of FGR using twin birthweight chart and singleton chart was 9.59 (95% CI 1.14-81.06, p=0.025), and 1.40 (95% CI 0.17-11.76, p=0.735), respectively. On the other hand, in monochorionic twin pregnancies delivered between 32-36 weeks, the OR for stillbirth of SGA and FGR using twin birthweight chart was 9.37 (95% CI 2.20- 37.72, p=0.001), and 13.55 (95% CI 3.12 - 55.94 p < 0.001) respectively. CONCLUSIONS Our study demonstrates a significant association between SGA, particularly for FGR, with increased odds of stillbirths in singleton pregnancies across all gestational ages. For twin pregnancies, when twin-specific charts were used, SGA and in particular FGR were associated with a significantly increased risk of stillbirth, across all gestational ages at delivery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - S Prasad
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J Domenech
- Department of Economics and Social Sciences, Universitat Politecnica de Valencia, Valencia, Spain
| | - E Kalafat
- Department of Obstetrics and Gynecology, Koc University Hospital, Istanbul, Turkey
| | - J Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twin and Multiple Pregnancy Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
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Bezerra NDA, dos Santos CNS, da Silva ATCSG, Linhares FMP, Morais SCRV. Nursing care for parents who have experienced fetal demise: integrative review. Rev Bras Enferm 2024; 77:e20220811. [PMID: 38511784 PMCID: PMC10941679 DOI: 10.1590/0034-7167-2022-0811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/02/2023] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES to identify scientific evidence regarding nursing care for parents who have experienced grief following fetal demise. METHODS an integrative review of original studies was conducted across six databases. The studies were classified according to the level of evidence. RESULTS the qualitative analysis of the nine studies comprising the sample involved thematic categories, exploring the impact of perinatal loss on families, inadequate communication by healthcare professionals, and the importance of a holistic approach in care. The role of the nurse is highlighted in making a positive contribution to the team, emphasizing participation in training and the provision of essential information. FINAL CONSIDERATIONS grieving affects not only family dynamics but also the social environment, emphasizing the urgency of a more empathetic and comprehensive approach. Care should be holistic, going beyond technical nursing assistance, and addressing the biopsychosocial context of the parents.
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Espinoza J, Agarwal N, Johnson A, Hernandez-Andrade E, Backley S, Papanna R, Bergh EP. Risk stratification for donor twin fetal death by evaluating middle cerebral artery in twin-to-twin transfusion syndrome in absence of twin anemia polycythemia sequence. Ultrasound Obstet Gynecol 2024. [PMID: 38437460 DOI: 10.1002/uog.27629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/29/2024] [Accepted: 02/18/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To determine the association of high middle cerebral artery peak systolic velocity (MCA-PSV) with fetal demise in donor twins among pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) in the absence of twin anemia polycythemia sequence (TAPS). METHODS This prospective cohort study included TTTS cases that underwent laser surgery between 2011 and 2022 at a single center. TAPS cases were excluded from the study. The primary objective was to explore the association of high MCA-PSV (>1.5 multiples of the median) with fetal demise of the donor twin among pregnancies complicated by TTTS. Secondary objectives were: 1) to evaluate if donor or recipient MCA-PSV is associated with an increased risk for their corresponding fetal death using receiving operator characteristic curve analysis; and 2) to compare the proportion of fetuses with low MCA pulsatility index among donor twins with high MCA-PSV and in those with normal MCA-PSV to evaluate the contribution of blood flow redistribution to high MCA-PSV. Multivariable and Poisson regression analysis were performed to explore the association of isolated high donor MCA-PSV and fetal demise, adjusted for TTTS stage, selective fetal growth restriction (sFGR), and other confounders. p<0.05 was considered significant. RESULTS Out of 660 TTTS cases, donor MCA-PSV was unavailable in 48 (7.3%) cases. Of the remaining 612 patients, 9 (1.5%) were lost to follow-up, and 96 TAPS cases were excluded. High donor MCA-PSV was seen in 6.5% (33/507) of the study population. High donor MCA-PSV was an independent risk factor for donor fetal demise (adjusted relative risk (aRR) of 4.52; 95% CI: 2.72-7.50), adjusted for confounders. Regression analysis restricted to each Quintero TTTS stage demonstrated that high donor MCA-PSV was an independent risk factor for donor fetal demise in Quintero stage II (aRR of 14.21; 95% CI: 1.09-186.2) and Quintero stage III (aRR of 3.41; 95% CI: 1.82-6.41). Donor MCA-PSV was associated with donor fetal demise (AUC: 0.69; p<0.001), but recipient MCA-PSV was not associated with its corresponding fetal demise (AUC: 0.54; p=0.44). A higher proportion of donor twins in the group with high MCA-PSV had a low MCA pulsatility index than in those with normal MCA-PSV (33.3% vs. 15.5%; p=0.016). CONCLUSIONS Elevated donor MCA-PSV without TAPS prior to laser surgery is associated with a 4-fold increased risk for donor fetal demise, adjusted for sFGR, TTTS stage, and other confounders. Doppler evaluation of donor MCA-PSV prior to laser surgery can further stratify TTTS staging to evaluate the risk for donor fetal demise. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Lerner Y, Peled T, Yehushua M, Rotem R, Weiss A, Sela HY, Grisaru-Granovsky S, Rottenstreich M. Labor Induction in Women with Isolated Polyhydramnios at Term: A Multicenter Retrospective Cohort Analysis. J Clin Med 2024; 13:1416. [PMID: 38592253 PMCID: PMC10932132 DOI: 10.3390/jcm13051416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Background: With the increasing popularity of elective induction after 39 + 0 weeks, the question of whether induction of labor (IOL) is safe in women with isolated polyhydramnios has become more relevant. We aimed to evaluate the pregnancy outcomes associated with IOL among women with and without isolated polyhydramnios. Methods: This was a multicenter retrospective cohort that included women who underwent induction of labor at term. The study compared women who underwent IOL due to isolated polyhydramnios to low-risk women who underwent elective IOL due to gestational age only. The main outcome measure was a composite adverse maternal outcome, while the secondary outcomes included maternal and neonatal adverse pregnancy outcomes. Results: During the study period, 1004 women underwent IOL at term and met inclusion and exclusion criteria; 162 had isolated polyhydramnios, and 842 had a normal amount of amniotic fluid. Women who had isolated polyhydramnios had higher rates of the composite adverse maternal outcome (28.7% vs. 20.4%, p = 0.02), prolonged hospital stay, perineal tear grade 3/4, postpartum hemorrhage, and neonatal hypoglycemia. Multivariate analyses revealed that among women with IOL, polyhydramnios was significantly associated with adverse composite maternal outcome [aOR 1.98 (1.27-3.10), p < 0.01]. Conclusions: IOL in women with isolated polyhydramnios at term was associated with worse perinatal outcomes compared to low-risk women who underwent elective IOL. Our findings suggest that the management of women with polyhydramnios cannot be extrapolated from studies of low-risk populations and that clinical decision-making should take into account the individual patient's risk factors and preferences.
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Affiliation(s)
- Yael Lerner
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Tzuria Peled
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Morag Yehushua
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Reut Rotem
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Ari Weiss
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Hen Y. Sela
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
| | - Misgav Rottenstreich
- Department of Obstetrics & Gynecology, Shaare Zedek Medical Center, Faculty of Medicine, Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
- Department of Nursing, Jerusalem College of Technology, Jerusalem 9548301, Israel
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Pares DBDS, Pacheco GHAS, Lobo GAR, Araujo Júnior E. Intrauterine Transfusion for Rhesus Alloimmunization: A Historical Retrospective Cohort from A Single Reference Center in Brazil. J Clin Med 2024; 13:1362. [PMID: 38592667 PMCID: PMC10931764 DOI: 10.3390/jcm13051362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
Objective: This study aimed to describe the historical experience of a single reference center in Brazil with intrauterine transfusion (IUT) for Rhesus (Rh) alloimmunization, evaluating the major complications and the perinatal outcomes of this procedure. Methods: This retrospective cohort study evaluated data from medical records of pregnant women between 20 and 34 weeks of gestation whose fetuses underwent IUT by cordocentesis between January 1991 and June 2021. The same experienced examiner performed all procedures. Univariate and multivariate logistic regression was used to assess the effect of fetal hydrops, duration of IUT, post-transfusion cord bleeding time, and bradycardia on death (fetal or neonatal). Results: We analyzed data from 388 IUTs in 169 fetuses of alloimmunized pregnant women with a mean age of 29.3 ± 5.1 years. Death and fetal hydrops were significantly associated at first IUT (p < 0.001). We had two cases of emergency cesarean section (mean of 0.51% per IUT) and three cases of premature rupture of the ovular membranes (mean of 0.77% per procedure). Thirty-six deaths were recorded, including 14 intrauterine and 22 neonatal. A higher percentage of neonatal deaths was observed in the group with post-transfusion cord bleeding time > 120 s (45.8%). The odds of neonatal death were 17.6 and 12.9 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. The odds of death (fetal and neonatal) were 79.9 and 92.3 times higher in cases with hydrops and bradycardia than in cases without hydrops and bradycardia, respectively. Conclusions: The most common complications of IUT for Rh alloimmunization were post-transfusion cord bleeding, fetal bradycardia, premature rupture of ovular membranes, and emergency cesarean section. The IUT complication most associated with death (fetal and neonatal) was bradycardia, and the perinatal outcomes were worse in fetuses with hydrops.
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Affiliation(s)
| | | | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo 04023-062, SP, Brazil; (D.B.d.S.P.); (G.H.A.S.P.); (G.A.R.L.)
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Young BK, Florine Magdelijns P, Chervenak JL, Chan M. Amniotic fluid embolism: a reappraisal. J Perinat Med 2024; 52:126-135. [PMID: 38082418 DOI: 10.1515/jpm-2023-0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/20/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES Using cases from our own experience and from the published literature on amniotic fluid embolism (AFE), we seek to improve on existing criteria for diagnosis and discern associated risk factors. Additionally, we propose a novel theory of pathophysiology. METHODS This retrospective case review includes eight cases of AFE from two hospital systems and 21 from the published literature. All cases were evaluated using the modified criteria for research reporting of AFE by Clark et al. in Am J Obstet Gynecol, 2016;215:408-12 as well as our proposed criteria for diagnosis. Additional clinical and demographic characteristics potentially correlated with a risk of AFE were included and analyzed using descriptive analysis. RESULTS The incidence of AFE was 2.9 per 100,000 births, with five maternal deaths in 29 cases (17.2 %) in our series. None of the cases met Clark's criteria while all met our criteria. 62.1 % of patients were over the age of 32 years and two out of 29 women (6.9 %) conceived through in-vitro fertilization. 6.5 % of cases were complicated by fetal death. Placenta previa occurred in 13.8 %. 86.2 % of women had cesarean sections of which 52.0 % had no acute maternal indication. CONCLUSIONS Our criteria identify more patients with AFE than others with a low likelihood of false positives. Clinical and demographic associations in our review are consistent with those previously reported. A possible relationship between cesarean birth and risk of AFE was identified using our criteria. Additionally, we propose a new hypothesis of pathophysiology.
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Affiliation(s)
- Bruce K Young
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York City, USA
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
| | | | - Judith L Chervenak
- Department of Obstetrics and Gynecology, Bellevue Medical Center, New York City, USA
| | - Michael Chan
- Department of Obstetrics and Gynecology, NYU Langone Medical Center, New York City, USA
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8
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Tóth EL, Orbán-Kálmándi R, Bagoly Z, Lóczi L, Deli T, Török O, Molnár S, Baráth S, Singh P, Hevessy Z, Katona É, Fagyas M, Szabó AÁ, Molnár S, Krasznai ZT. Case report: Complex evaluation of coagulation, fibrinolysis and inflammatory cytokines in a SARS-CoV-2 infected pregnant woman with fetal loss. Front Immunol 2024; 15:1329236. [PMID: 38449857 PMCID: PMC10915050 DOI: 10.3389/fimmu.2024.1329236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 03/08/2024] Open
Abstract
Background SARS-CoV-2 infection during pregnancy increases the risk of severe obstetrical complications. Detailed evaluation of COVID-19-associated coagulopathy in a pregnancy with stillbirth hasn't been described so far. Besides knowledge gaps in the pathomechanism leading to stillbirth in COVID-19 pregnancies, currently, no prognostic biomarker is available to identify pregnant patients who are at imminent risk of COVID-19-associated maternal and fetal complications, requiring immediate medical attention. Case Here we report the case of a 28-year-old SARS-CoV-2 infected pregnant patient, admitted to our hospital at 28 weeks of gestation with intrauterine fetal loss. The presence of SARS-CoV-2 placentitis was confirmed by immunohistological evaluation of the placenta. She had only mild upper respiratory symptoms and her vital signs were within reference throughout labor and postpartum. The stillborn infant was delivered per vias naturales. Fibrinogen concentrate was administered before and after labor due to markedly decreased fibrinogen levels (1.49 g/l) at admission and excessive bleeding during and after delivery. Although coagulation screening tests were not alarming at admission, the balance of hemostasis was strikingly distorted in the patient. As compared to healthy age- and gestational age-matched pregnant controls, increased D-dimer, low FVIII activity, low FXIII level, marked hypocoagulability as demonstrated by the thrombin generation assay, together with shortened clot lysis and decreased levels of fibrinolytic proteins were observed. These alterations most likely have contributed to the increased bleeding observed during labor and in the early postpartum period. Interestingly, at the same time, only moderately altered inflammatory cytokine levels were found at admission. Serum ACE2 activity did not differ in the patient from that of age- and gestational age-matched healthy controls, suggesting that despite previous speculations in the literature, ACE2 may not be used as a potential biomarker for the prediction of COVID-19 placentitis and threatening fetal loss in SARS-CoV-2-infected pregnancies. Conclusions Although based on this case report no prognostic biomarker could be identified for use in pregnant patients with imminent risk of fetal loss associated with COVID-19 placentitis, the above-described hemostasis alterations warrant awareness of postpartum hemorrhagic complications and could be helpful to identify patients requiring intensified medical attention.
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Affiliation(s)
- Eszter Lilla Tóth
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Molecular Medicine, University of Debrecen, Debrecen, Hungary
| | - Rita Orbán-Kálmándi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Bagoly
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Linda Lóczi
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Tamás Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Olga Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sarolta Molnár
- Department of Pathology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Sándor Baráth
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Parvind Singh
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsanna Hevessy
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Éva Katona
- Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Miklós Fagyas
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Ádám Szabó
- Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Szabolcs Molnár
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoárd Tibor Krasznai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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9
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Sweeney LC, Reddy UM, Campbell K, Xu X. Postpartum readmission risk: a comparison between stillbirths and live births. Am J Obstet Gynecol 2024:S0002-9378(24)00089-9. [PMID: 38367754 DOI: 10.1016/j.ajog.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Stillbirth occurs more commonly among pregnant people with comorbid conditions and obstetrical complications. Stillbirth also independently increases maternal morbidity and imparts a psychosocial hazard when compared with live birth. These distinct needs and burden may increase the risk for postpartum readmission after stillbirth. OBJECTIVE This study aimed to examine the risk for maternal postpartum readmission after stillbirth in comparison with live birth and to identify indications for readmission and the associated risk factors. STUDY DESIGN This was a retrospective cohort of patients with singleton stillbirths or live births, delivered at ≥20 weeks' gestation, who were identified from the 2019 Nationwide Readmissions Database. The primary outcome was all-cause readmission within 6 weeks of discharge from the childbirth hospitalization. The association between stillbirth (vs live birth) and risk for readmission was assessed using multivariable regression models with adjustment for maternal age, sociodemographic characteristics, maternal and obstetrical conditions, and delivery characteristics. Within the stillbirth group, risk factors for readmission were further examined using multivariable regression. The secondary outcomes included principal indication for readmission (categorized based on principal diagnosis code of the readmission hospitalization) and timing of readmission (number of weeks after childbirth hospitalization). Differences in these secondary outcomes were compared between the stillbirth and live birth groups using chi-square tests. All analyses accounted for the complex sample design to generate nationally representative estimates. RESULTS Postpartum readmission occurred in 2.7% of 16,636 patients with stillbirths, whereas it occurred in 1.6% of 2,870,677 patients with live births (unadjusted risk ratio, 1.65; 95% confidence interval, 1.47-1.86). The higher risk for readmission after stillbirth (vs live birth) persisted after adjusting for maternal, obstetrical, and delivery characteristics (adjusted risk ratio, 1.27; 95% confidence interval, 1.11-1.46). The distribution of principal indication for readmission differed after stillbirth and after live birth and included hypertension (30.2% vs 39.5%; unadjusted risk ratio, 0.76; 95% confidence interval, 0.63-0.93), mental health or substance use disorders (6.8% vs 3.6%; unadjusted risk ratio, 1.90; 95% confidence interval, 1.15-3.16), and venous thromboembolism (5.8% vs 2.0%; unadjusted risk ratio, 2.87; 95% confidence interval, 1.60-5.17). Among patients with stillbirths, 56.0% of readmissions occurred within 1 week, 71.8% within 2 weeks, and 88.1% within 4 weeks; the timing of readmission did not differ significantly between the stillbirth and live birth cohorts. Pregestational diabetes (adjusted risk ratio, 1.87; 95% confidence interval, 1.20-2.93), gestational diabetes (adjusted risk ratio, 1.67; 95% confidence interval, 1.03-2.71), hypertensive disorders of pregnancy (adjusted risk ratio, 1.80; 95% confidence interval, 1.31-2.47), obesity (adjusted risk ratio, 1.46; 95% confidence interval, 1.01-2.12), and primary cesarean delivery (adjusted risk ratio, 1.74; 95% confidence interval, 1.17-2.58) were associated with a higher risk for readmission after stillbirth, whereas higher household income was associated with a lower risk for readmission (eg, adjusted risk ratio for income ≥$82,000 vs $1-$47,999, 0.48; 95% confidence interval, 0.30-0.77). CONCLUSION When compared with live births, the risk for postpartum readmission was higher after stillbirths, even after adjustment for differences in the patient demographic and clinical characteristics. Readmission for mental health or substance use disorders and venous thromboembolism is more common after stillbirths than after live births.
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Affiliation(s)
- Lena C Sweeney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
| | - Uma M Reddy
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Katherine Campbell
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT; Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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10
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Reeves EL, Neelam V, Carlson JM, Olsen EO, Fox CJ, Woodworth KR, Nestoridi E, Mobley E, Montero Castro S, Dzimira P, Sokale A, Sizemore L, Hall AJ, Ellington S, Cohn A, Gilboa SM, Tong VT. Pregnancy and infant outcomes following SARS-CoV-2 infection in pregnancy during delta variant predominance - Surveillance for Emerging Threats to Pregnant People and Infants. Am J Obstet Gynecol MFM 2024; 6:101265. [PMID: 38135220 DOI: 10.1016/j.ajogmf.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, stillbirth, and maternal and infant complications. Previous research suggests an increased risk of severe COVID-19 illness and stillbirth in pregnant people during delta variant predominance in 2021; however, those studies did not assess timing of infection during pregnancy, and few of them described COVID-19 vaccination status. OBJECTIVE Using a large population-based cohort, this study compared pregnancy and infant outcomes and described demographic and clinical characteristics of pregnant people with SARS-CoV-2 infection prior to and during the delta variant period. STUDY DESIGN This retrospective cohort analysis included persons with confirmed SARS-CoV-2 infection in pregnancy from 6 US jurisdictions reporting to the Surveillance for Emerging Threats to Pregnant People and Infants Network. Data were collected through case reports of polymerase chain reaction-positive pregnant persons and linkages to birth certificates, fetal death records, and immunization records. We described clinical characteristics and compared frequency of spontaneous abortion (<20 weeks of gestation), stillbirth (≥20 weeks), preterm birth (<37 weeks), small for gestational age, and term infant neonatal intensive care unit admission between the time periods of pre-delta and delta variant predominance. Study time periods were determined by when variants constituted more than 50% of sequences isolated according to regional SARS-CoV-2 genomic surveillance data, with time periods defined for pre-delta (March 3, 2020-June 25, 2021) and Delta (June 26, 2021-December 25, 2021). Adjusted prevalence ratios were estimated for each outcome measure using Poisson regression and were adjusted for continuous maternal age, race and ethnicity, and insurance status at delivery. RESULTS Among 57,563 pregnancy outcomes, 57,188 (99.3%) were liveborn infants, 65 (0.1%) were spontaneous abortions, and 310 (0.5%) were stillbirths. Most pregnant persons were unvaccinated at the time of SARS-CoV-2 infection, with a higher proportion in pre-delta (99.4%) than in the delta period (78.4%). Of those with infections during delta and who were previously vaccinated, the timing from last vaccination to infection was a median of 183 days. Compared to pre-delta, infections during delta were associated with a higher frequency of stillbirths (0.7% vs 0.4%; adjusted prevalence ratio, 1.55; 95% confidence interval, 1.14-2.09) and preterm births (12.8% vs 11.9%; adjusted prevalence ratio, 1.14; 95% confidence interval, 1.07-1.20). The delta period was associated with a lower frequency of neonatal intensive care unit admission (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.67-0.82) than in the pre-delta period. During the delta period, infection during the third trimester was associated with a higher frequency of preterm birth (adjusted prevalence ratio, 1.41; 95% confidence interval, 1.28-1.56) and neonatal intensive care unit admission (adjusted prevalence ratio, 1.21; 95% confidence interval, 1.01-1.45) compared to the first and second trimester combined. CONCLUSION In this US-based cohort of persons with SARS-CoV-2 infection in pregnancy, the majority were unvaccinated, and frequencies of stillbirth and preterm birth were higher during the delta variant predominance period than in the pre-delta period. During the delta period, frequency of preterm birth and neonatal intensive care unit admission was higher among infections occurring in the third trimester vs those earlier in pregnancy. These findings demonstrate population-level increases of adverse fetal and infant outcomes, specifically in the presence of a COVID-19 variant with more severe presentation.
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Affiliation(s)
- Emily L Reeves
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox).
| | - Varsha Neelam
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Jeffrey M Carlson
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Emily O Olsen
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Charise J Fox
- Eagle Global Scientific, LLC, Atlanta, GA (Ms Reeves, Dr Carlson, and Ms Fox)
| | - Kate R Woodworth
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Eirini Nestoridi
- Massachusetts Department of Public Health, Boston, MA (Dr Nestoridi)
| | - Evan Mobley
- Missouri Department of Health and Senior Services, Jefferson City, MO (Mr Mobley)
| | | | - Paula Dzimira
- Pennsylvania Department of Health, Pittsburgh, PA (Ms Dzimira)
| | - Ayomide Sokale
- Philadelphia Department of Public Health, Philadelphia, PA (Ms Sokale)
| | | | - Aron J Hall
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Hall)
| | - Sascha Ellington
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA (Dr Ellington)
| | - Amanda Cohn
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Suzanne M Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
| | - Van T Tong
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA (Ms Neelam; Drs Olsen, Woodworth, Cohn, and Gilboa; and Ms Tong)
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11
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McDonough MR, Leone-Sheehan D. Lived Experience of the Dyad and Their Relationships Following a Fetal Death: A Hermeneutic Phenomenological Study. J Fam Nurs 2024; 30:41-49. [PMID: 38014518 DOI: 10.1177/10748407231213085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Little is known about the lived experience of the dyad following a fetal death and the impact on relationships. The purpose of this paper is to explore the dyadic relationship between partners, with health care providers, and with the baby's memory after birth. This qualitative study utilized hermeneutic phenomenology. The sample included 10 heterosexual dyads from the United States and Canada. All experienced a fetal death between 6 months and 7 years prior to their interviews. The data revealed three themes: (a) The Dyad Relationship: Moving Through the Experience Together; (b) Keeping the Memory Alive: Memorializing the Baby; and (c) Relationships With Health Care Providers: A Spectrum of Caring. The findings from this study provide the beginning knowledge needed to improve the care of dyads who have experienced a fetal death and for future studies to improve care delivery for dyads as their relationships change after fetal death.
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12
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Garland CE, Geller SE, Koch AR. Adverse Delivery and Neonatal Outcomes Among Women with Severe Maternal Morbidity in Illinois, 2018-2019. J Womens Health (Larchmt) 2024; 33:163-170. [PMID: 37972060 DOI: 10.1089/jwh.2023.0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Objective: To examine adverse delivery outcomes from 2018 to 2019 severe maternal morbidity (SMM) cases that were reviewed by facility-level review committees in Illinois (n = 666) and describe the burden of adverse delivery outcomes among demographic subgroups, SMM etiology, and whether the SMM event was potentially preventable. Materials and Methods: This is a descriptive analysis of the SMM review cohort. Consistent with expert recommendations to identify SMM for hospital quality review, SMM was defined as any intensive care or critical care unit admission and/or transfusion of four or more units of packed red blood cells from conception to 42 days postpartum. Adverse delivery outcomes were fetal death, low birthweight, preterm birth, neonatal intensive care unit admission, and 5-minute Apgar score <7. Chi square and Fisher's exact tests compared maternal demographic and delivery characteristics between the SMM sample and 2018-2019 deliveries in Illinois. Logistic regression modeled the associations between primary cause of morbidity, maternal race/ethnicity, adverse delivery outcomes, and opportunities to alter the outcome to assess whether the burden of adverse birth outcomes was distributed evenly across subcategories of the cohort. Results: Overall, 53.9% of women with SMM had at least one adverse delivery outcome. SMM events owing to preeclampsia/eclampsia (adjusted odds ratio [aOR] = 4.41, 95% confidence interval [CI] = 2.37-8.24) and infection/sepsis (aOR = 4.40, 95% CI = 1.79-11.04) were more likely to be accompanied by adverse delivery outcomes compared with hemorrhage-related SMM. Non-Hispanic Black women with SMM were more likely to have an adverse delivery outcome compared with non-Hispanic White women with SMM (aOR = 1.74, 95% CI = 1.01-3.02). Conclusion: A greater proportion of the SMM review cohort experienced adverse delivery outcomes compared with the overall birthing population in the state. Non-Hispanic Black women with SMM were almost twice as likely to have an adverse delivery outcome compared with non-Hispanic White women.
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Affiliation(s)
- Caitlin E Garland
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Stacie E Geller
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
- Departments of Obstetrics and Gynecology and Medicine, Chicago College of Medicine, University of Illinois, Chicago, Illinois, USA
| | - Abigail R Koch
- Center for Research on Women and Gender, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
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13
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Czeiger S, Weissbach T, Zloto K, Wiener A, Nir O, Massarwa A, Weisz B, Bartal MF, Ulman RY, Bart Y, Achiron R, Kivilevitch Z, Mazaki-Tovi S, Kassif E. Umbilical-portal-systemic venous shunt and intrauterine growth restriction: an inquiry from a prospective study. Am J Obstet Gynecol 2024:S0002-9378(24)00011-5. [PMID: 38218510 DOI: 10.1016/j.ajog.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/22/2023] [Accepted: 01/01/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND The investigation of the fetal umbilical-portal venous system is based on the premise that congenital anomalies of this system may be related to adverse perinatal outcomes. Several small retrospective studies have reported an association between umbilical-portal-systemic venous shunts and intrauterine growth restriction. However, the prevalence of portosystemic shunts in the fetal growth restricted population is yet to be determined. OBJECTIVE The aims of this study were (1) to determine the prevalence of fetal umbilical-portal-systemic venous shunts in pregnancies complicated by intrauterine growth restriction and (2) to compare the perinatal and neonatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts. STUDY DESIGN This was a prospective, cross-sectional study of pregnancies diagnosed with intrauterine growth restriction, as defined by the Society for Maternal-Fetal Medicine intrauterine growth restriction guidelines. All participants underwent a detailed anomaly scan, supplemented with a targeted scan of the fetal portal system. Venous shunts were diagnosed using color Doppler mode. The perinatal outcomes of pregnancies with intrauterine growth restriction with and without umbilical-portal-systemic venous shunts were compared. RESULTS A total of 150 cases with intrauterine growth restriction were recruited. The prevalence of umbilical-portal-systemic venous shunts in our cohort was 9.3% (n=14). When compared with the control group (intrauterine growth restriction without umbilical-portal-systemic venous shunts, n=136), the study group had a significantly lower mean gestational age at the time of intrauterine growth restriction diagnosis (29.7±5.6 vs 32.47±4.6 weeks of gestation; P=.036) and an earlier gestational age at delivery (33.50±6.0 vs 36.13±2.8; P=.005). The study group had a higher rate of fetal death (21.4% vs 0.7%; P<.001) and, accordingly, a lower rate of live births (71.4% vs 95.6%; P=.001). Additional associated fetal vascular anomalies were significantly more prevalent in the study group than in the control group (35.7% vs 4.4%; P≤.001). The rate of other associated anomalies was similar. The study group had a significantly lower rate of abnormal uterine artery Doppler indices (0% vs 40.4%; P=.011) and a higher rate of abnormal ductus venosus Doppler indices (64.3% vs 23%; P=.001). There were no cases of hypertensive disorders of pregnancy in the study group, whereas the control group had an incidence of 12.5% (P=.16). Other perinatal and neonatal outcomes were comparable. CONCLUSION Umbilical-portal-systemic venous shunt is a relatively common finding among fetuses with growth restriction. When compared with pregnancies with intrauterine growth restriction with a normal portal system, these pregnancies complicated by intrauterine growth restriction and an umbilical-portal-systemic venous shunt are associated with a different Doppler flow pattern, an increased risk for fetal death, earlier presentation of intrauterine growth restriction, a lower gestational age at delivery, additional congenital vascular anomalies, and a lower rate of pregnancy-induced hypertensive disorders. Meticulous sonographic evaluation of the portal system should be considered in the prenatal workup of intrauterine growth restriction, as umbilical-portal-systemic venous shunts may affect perinatal outcomes.
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Affiliation(s)
- Shelly Czeiger
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Mayanei HaYeshuha Medical Center, Bnei-Brak, Israel.
| | - Tal Weissbach
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Zloto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariella Wiener
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Nir
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Fishel Bartal
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rakefet Yoeli Ulman
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Bart
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zvi Kivilevitch
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shali Mazaki-Tovi
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kassif
- Obstetrics and Gynecology Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Kalafat E, Liu B, Barratt I, Bhate R, Papageorghiou A, Khalil A. Risk factors associated with stillbirth and adverse perinatal outcomes in dichorionic twin pregnancies complicated by selective fetal growth restriction: a cohort study. BJOG 2024; 131:189-198. [PMID: 37308720 DOI: 10.1111/1471-0528.17564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/18/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR). DESIGN Retrospective cohort study. SETTING Tertiary reference centre. POPULATION Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital. METHODS Regression analyses were performed using generalised linear models and mixed-effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed-effects Cox regression models. MAIN OUTCOME MEASURES Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins. RESULTS A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane-Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval [CI] 0.55-0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47-0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89-0.99) and 0.83 (95% CI 0.73-0.92) for stillbirth and composite adverse perinatal outcomes, respectively. CONCLUSION In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z-scores were associated with both intrauterine death and adverse perinatal outcomes.
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Affiliation(s)
- Erkan Kalafat
- Department of Obstetrics and Gynaecology, School of Medicine, Koc University, Istanbul, Turkey
- Department of Statistics, Faculty of Arts and Sciences, Middle East Technical University, Ankara, Turkey
| | - Becky Liu
- Fetal Medicine Unit, St George's University Hospitals, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospitals, London, UK
| | - Imogen Barratt
- Fetal Medicine Unit, St George's University Hospitals, London, UK
| | - Rohan Bhate
- Fetal Medicine Unit, St George's University Hospitals, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospitals, London, UK
| | | | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals, London, UK
- Twins Trust Centre for Research and Clinical Excellence, St George's University Hospitals, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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15
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Mukherjee A, Di Stefano L, Blencowe H, Mee P. Determinants of stillbirths in sub-Saharan Africa: A systematic review. BJOG 2024; 131:140-150. [PMID: 37272228 DOI: 10.1111/1471-0528.17562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/07/2023] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Sub-Saharan African (SSA) countries have high stillbirth rates compared with high-income countries, yet research on risk factors for stillbirth in SSA remain scant. OBJECTIVES To identify the modifiable risk factors of stillbirths in SSA and investigate their strength of association using a systematic review. SEARCH STRATEGY CINAHL Plus, EMBASE, Global Health and MEDLINE databases were searched for literature. SELECTION CRITERIA Observational population- and facility-level studies exploring stillbirth risk factors, published in 2013-2019 were included. DATA COLLECTION AND ANALYSIS A narrative synthesis of data was undertaken and the potential risk factors were classified into subgroups. MAIN RESULTS Thirty-seven studies were included, encompassing 20 264 stillbirths. The risk factors were categorised as: maternal antepartum factors (0-4 antenatal care visits, multiple gestations, hypertension, birth interval of >3 years, history of perinatal death); socio-economic factors (maternal lower wealth index and basic education, advanced maternal age, grand multiparity of ≥5); intrapartum factors (direct obstetric complication); fetal factors (low birthweight and gestational age of <37 weeks) and health systems factors (poor quality of antenatal care, emergency referrals, ill-equipped facility). The proportion of unexplained stillbirths remained very high. No association was found between stillbirths and body mass index, diabetes, distance from the facility or HIV. CONCLUSIONS The overall quality of evidence was low, as many studies were facility based and did not adjust for confounding factors. This review identified preventable risk factors for stillbirth. Focused programmatic strategies to improve antenatal care, emergency obstetric care, maternal perinatal education, referral and outreach systems, and birth attendant training should be developed. More population-based, high-quality research is needed.
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Affiliation(s)
- Ankita Mukherjee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Monitoring, Evaluation and Research, New Delhi, India
| | | | - Hannah Blencowe
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Mee
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Lincoln International Institute for Rural Health, College of Social Science, University of Lincoln, Lincoln, UK
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16
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Hugh O, Cowan J, Butler E, Gardosi J. Fetal size vs growth: comparative analysis of 3 models of growth velocity based on third trimester estimated fetal weights for identifying stillbirth risk. Am J Obstet Gynecol 2023:S0002-9378(23)02188-9. [PMID: 38151221 DOI: 10.1016/j.ajog.2023.12.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Fetal growth velocity is being recognized as an important parameter by which to monitor fetal wellbeing, in addition to assessment of fetal size. However, there are different models and standards in use by which velocity is being assessed. OBJECTIVE We wanted to investigate 3 clinically applied methods of assessing growth velocity and their ability to identify stillbirth risk, in addition to that associated with small for gestational age. STUDY DESIGN Retrospective analysis of prospectively recorded routine-care data of pregnancies with 2 or more third trimester scans in New Zealand. Results of the last 2 scans were used for the analysis. The models investigated to define slow growth were (1) 50+ centile drop between measurements, (2) 30+ centile drop, and (3) estimated fetal weight below a projected optimal weight range, based on predefined, scan interval specific cut-offs to define normal growth. Each method's ability to identify stillbirth risk was assessed against that associated with small-for-gestational age at last scan. RESULTS The study cohort consisted of 71,576 pregnancies. The last 2 scans in each pregnancy were performed at an average of 32+1 and 35+6 weeks of gestation. The 3 models defined "slow growth" at the following differing rates: (1) 50-centile drop 0.9%, (2) 30-centile drop 5.1%, and (3) below projected optimal weight range 10.8%. Neither of the centile-based models identified at-risk cases that were not also small for gestational age at last scan. The projected weight range method identified an additional 79% of non-small-for-gestational-age cases as slow growth, and these were associated with a significantly increased stillbirth risk (relative risk, 2.0; 95% CI, 1.2-3.4). CONCLUSION Centile-based methods fail to reflect adequacy of fetal weight gain at the extremes of the distribution. Guidelines endorsing such models might hinder the potential benefits of antenatal assessment of fetal growth velocity. A new, measurement-interval-specific projection model of expected fetal weight gain can identify fetuses that are not small for gestational age, yet at risk of stillbirth because of slow growth. The velocity between scans can be calculated using a freely available growth rate calculator (www.perinatal.org.uk/growthrate).
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Affiliation(s)
- Oliver Hugh
- Perinatal Institute, Birmingham, United Kingdom
| | - Joyce Cowan
- Auckland University of Technology, Auckland, New Zealand
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Chen X, Zhang Y, Chen H, Dou Y, Wang Y, He W, Ma X, Sheng W, Yan W, Huang G. Association Between Serum Glycated Hemoglobin Levels at Early Gestation and the Risk of Subsequent Pregnancy Loss in Pregnant Women Without Diabetes Mellitus: Prospective Cohort Study. JMIR Public Health Surveill 2023; 9:e46986. [PMID: 38085559 PMCID: PMC10751628 DOI: 10.2196/46986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 09/27/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND As a severe morbidity during pregnancy, the etiology of spontaneous pregnancy loss (SPL) remains largely unknown. Serum glycated hemoglobin (HbA1c) level is an established predictor of SPL risk among women with diabetes, but little is known about whether such an association exists among pregnant women without diabetes when glycemic levels are within the normal range. OBJECTIVE This study aimed to quantify the association between maternal HbA1c levels in early pregnancy and subsequent SPL risk in a cohort of pregnant women without diabetes. METHODS This prospective cohort study involved 10,773 pregnant women without diabetes enrolled at their first antenatal care visit at a hospital's early pregnancy clinic from March 2016 to December 2018 in Shanghai, China. HbA1c and fasting blood glucose (FBG) levels were examined at enrollment. Participants with diabetes before or pregnancy or those diagnosed with gestational diabetes were excluded. Diagnosis of SPL, defined as fetal death occurring before 28 gestational weeks, was derived from medical records and confirmed via telephone interviews. We used generalized linear models to quantify the associations of continuous and dichotomized maternal HbA1c levels with SPL risk and reported crude and adjusted risk ratios (RRs) and 95% CIs. A restricted cubic spline (RCS) regression model was used to assess the potential nonlinear dose-response relationship. Adjusted covariates included maternal age, education level, preconception BMI, gestational weeks, gravidity, history of adverse pregnancy outcomes, family history of diabetes, folic acid supplementation, and smoking and drinking during the periconception period. RESULTS In total, 273 (2.5%) SPL cases occurred. Every 0.5% increase in HbA1c levels was linearly associated with a 23% increase in SPL risk (adjusted RR [aRR] 1.23; 95% CI 1.01-1.50). The RCS model revealed that this association was linear (P=.77 for the nonlinearity test). Analyses based on dichotomized HbA1c levels showed a significantly increased risk of SPL when HbA1c levels were ≥5.9% (aRR 1.67; 95% CI 0.67-3.67), and the significance threshold was ≥5.6% (aRR 1.60; 95% CI 1.01-2.54). Sensitivity analyses showed similar results when including the participants with missing SPL records or HbA1c data. Linear associations of HbA1c levels remained significant even in the subgroups without overweight, alcohol consumption, and a family history of diabetes and adverse pregnancy outcomes. Every 1 mmol/L increment in maternal FBG levels was associated with a >2-fold higher risk of SPL (aRR 2.12; 95% CI 1.61-2.80; P<.001). CONCLUSIONS Higher HbA1c levels in early pregnant women without diabetes are associated with an increased SPL risk in a dose-response manner. Pregnant women with an HbA1c level above 5.6% at early gestation need attention for its potentially increased risk for SPL. Our findings support the need to monitor HbA1c levels to identify individuals at high risk of subsequent SPL in the general population of pregnant women. TRIAL REGISTRATION ClinicalTrials.gov NCT02737644; https://clinicaltrials.gov/study/NCT02737644.
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Affiliation(s)
- Xiaotian Chen
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yi Zhang
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Hongyan Chen
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yalan Dou
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yin Wang
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wennan He
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaojing Ma
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Wei Sheng
- Shanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Weili Yan
- Department of Clinical Epidemiology & Clinical Trial Unit, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
| | - Guoying Huang
- Pediatric Heart Center, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
- Shanghai Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
- Research Unit of Early Intervention of Genetically Related Childhood Cardiovascular Diseases (2018RU002), Chinese Academy of Medical Sciences, Shanghai, China
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Albertini L, Ezekian J, Care M, Silversides C, Sermer M, Gollob MH, Spears D. Assessment of Severity of Long QT Syndrome Phenotype and Risk of Fetal Death. J Am Heart Assoc 2023; 12:e029407. [PMID: 38014677 PMCID: PMC10727344 DOI: 10.1161/jaha.122.029407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND It has been postulated that long QT syndrome (LQTS) can cause fetal loss through putative adverse effects of the channelopathy on placenta and myometrial function. The authors aimed to describe the fetal death rate in a population of pregnant women with long QT syndrome and investigate whether women with more severe phenotype had worse fetal outcomes. METHODS AND RESULTS The authors retrospectively evaluated fetal outcomes of 64 pregnancies from 23 women with long QT syndrome followed during pregnancy in a tertiary pregnancy and heart disease program. Thirteen of 64 pregnancies (20%) resulted in a fetal loss, 12 miscarriages (19%), and 1 stillbirth (1.6%). Baseline maternal characteristics, including age and use of β-blockers, did not differ between women who experienced a fetal death or not. Maternal corrected QT interval (QTc) was significantly longer in pregnancies that resulted in fetal death compared with live births (median, 518 ms [interquartile range (IQR), 482-519 ms] versus 479 ms [IQR, 454-496 ms], P<0.001). Mothers treated with β-blockers had babies born at term with lower birth weight compared with untreated women (2973±298 g versus 3470±338 g, P=0.002). In addition, the birth weight of babies born at term to treated women with QTc >500 ms was significantly lower compared with women with QTc <500 ms (2783±283 g versus 3084±256 g, P=0.029). CONCLUSIONS Women with long QT syndrome with more severe phenotypes have a higher incidence of fetal death. Maternal QTc is longer in pregnancies that result in fetal loss, and the birth weight of babies born to patients taking β-blockers with a QTc >500 ms is lower, suggesting that patients with more marked phenotype may experience worse fetal outcomes.
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Affiliation(s)
- Lisa Albertini
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Jordan Ezekian
- Division of CardiologyThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Melanie Care
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Candice Silversides
- Department of Medicine, Division of CardiologyUniversity of Toronto Pregnancy and Heart Disease Program and Obstetric Medicine Program, Mount Sinai and Toronto General HospitalsTorontoOntarioCanada
| | - Mathew Sermer
- Department of Obstetrics and GynaecologyMount Sinai HospitalTorontoOntarioCanada
| | - Michael H. Gollob
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
| | - Danna Spears
- Division of Cardiology, Electrophysiology, Toronto General HospitalUniversity Health Network TorontoTorontoOntarioCanada
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Nkobetchou M, Leruez-Ville M, Guilleminot T, Roux N, Petrilli G, Guimiot F, Saint-Frison MH, Deryabin I, Ville Y, Faure-Bardon V. SARS-CoV-2 infection as cause of in-utero fetal death: regional multicenter cohort study. Ultrasound Obstet Gynecol 2023; 62:867-874. [PMID: 37519281 DOI: 10.1002/uog.27439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Placental infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to placental insufficiency and in-utero fetal death (IUFD). The objective of this study was to confirm and quantify the extent to which fetoplacental infection with SARS-CoV-2 is a cause of fetal death. METHODS This was a multicenter retrospective cohort study of fetal deaths that underwent postmortem examination between January 2020 and January 2022 in three fetal pathology units in Paris, France. All cases of IUFD and termination of pregnancy (TOP) occurring in 31 maternity hospitals in the Paris region undergo detailed placental pathological examination in these units. Databases were searched for cases of IUFD and TOP. Cases with fetal malformation or cytogenetic abnormality were excluded to avoid bias. We included cases of IUFD with a placental or undetermined cause and cases of TOP in the context of severe intrauterine growth restriction (IUGR). Placentas were sent to a single virology unit for reverse-transcription polymerase chain reaction (RT-PCR) testing by a single laboratory technician blinded to the initial postmortem examination report. Our primary endpoint was the proportion of positive placental SARS-CoV-2 RT-PCR tests in the cohort. RESULTS Among 147 722 deliveries occurring over 2 years, 788 postmortem examinations for IUFD and TOP for severe IUGR were recorded, of which 462 (58.6%) were included. A total of 13/462 (2.8%) placentas tested positive for SARS-CoV-2 by RT-PCR. Wild-type virus and alpha and delta variants were identified. All positive cases had histological lesions consistent with placental dysfunction. There was a strong correlation between SARS-CoV-2 placentitis and the presence of chronic intervillositis and/or massive fibrin deposits in the placenta. When both lesion types were present, the specificity and negative predictive value for the diagnosis of placental SARS-CoV-2 infection were 0.99 (95% CI, 0.98-1.00) and 0.96 (95% CI, 0.94-0.98), respectively. CONCLUSIONS At the height of the SARS-CoV-2 pandemic, the cause of more than half of fetal deaths in the Paris area was determined by postmortem analysis to be of placental or undetermined origin. Of these cases, 2.8% were due to placental SARS-CoV-2 infection with a specific pattern of histological involvement. This study highlights the need for SARS-CoV-2 screening in stillbirth assessment. The impact of vaccination coverage remains to be established. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Nkobetchou
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
| | - M Leruez-Ville
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Virology Department, Necker University Hospital, Paris, France
| | - T Guilleminot
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Virology Department, Necker University Hospital, Paris, France
| | - N Roux
- Histopathology Department, Necker University Hospital, Paris, France
| | - G Petrilli
- Histopathology Department, Necker University Hospital, Paris, France
| | - F Guimiot
- Histopathology Department, Robert Debré Hospital, Paris, France
| | | | - I Deryabin
- Histopathology Department, Trousseau Hospital, Paris, France
| | - Y Ville
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
| | - V Faure-Bardon
- EA 73-28, Paris Cité University, Necker University Hospital, Paris, France
- Maternity Department, Necker University Hospital, Paris, France
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20
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Krumb E, Mehta N, Hutchinson C, Jradeh B, Jaslowska E, Gomez K, Abdul-Kadir R. Postmortem diagnosis of severe factor X deficiency in a fetus with intracranial hemorrhage resulting in intrauterine death. J Thromb Haemost 2023; 21:3501-3507. [PMID: 37678549 DOI: 10.1016/j.jtha.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
In patients with severe congenital factor X deficiency, spontaneous intracranial hemorrhage (ICH) is particularly frequent in early childhood. We describe a case of fetal death at 26 weeks due to massive ICH. Gene panel analysis of postmortem samples revealed homozygosity for a pathologic F10 gene variant (c.1210T>C, p.Cys404Arg), which impedes correct folding of the catalytic serine protease domain and, therefore, causes a significant reduction in FX levels. The parents, not consanguineous but of the same ethnic community, were found to be heterozygous for this variant and did not have any personal or family history of abnormal bleeding. To the best of our knowledge, this is the first reported case of severe FX deficiency resulting in ICH diagnosed through postmortem genetic analysis. It illustrates the importance of exploring the etiology of fetal or neonatal ICH, which may impact future pregnancies, and the treatment of a potential coagulopathy in the child.
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Affiliation(s)
- Evelien Krumb
- Haemostasis and Thrombosis Unit, Division of Adult Haematology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
| | - Nishita Mehta
- Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation Hospital, London, United Kingdom
| | - Ciaran Hutchinson
- Great Ormond Street Hospital Institute of Child Health, London, United Kingdom
| | - Bilal Jradeh
- Health Services Laboratories, London, United Kingdom
| | - Ewa Jaslowska
- Health Services Laboratories, London, United Kingdom
| | - Keith Gomez
- Katharine Dormandy Haemophilia and Thrombosis Centre, The Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Rezan Abdul-Kadir
- Department of Obstetrics and Gynaecology, The Royal Free NHS Foundation Hospital, London, United Kingdom; Katharine Dormandy Haemophilia and Thrombosis Centre, The Royal Free London NHS Foundation Trust, London, United Kingdom; Institute for Women's Health, University College London, London, United Kingdom
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21
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Dasgupta S, Dasgupta J, Goswami B, Mondal J. Randomized controlled trial comparing efficacy of a combination regime containing two cervical sensitizers (mifepristone + Foley's catheter) versus single agent mifepristone or Foley's catheter for labor induction in women attempting TOLAC at late third trimester with a dead fetus in utero. J Obstet Gynaecol Res 2023; 49:2671-2679. [PMID: 37678840 DOI: 10.1111/jog.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Randomized controlled trial comparing efficacy of a combination regime containing two cervical sensitizers (mifepristone + Foley's catheter) versus single agent mifepristone or Foley's catheter for labor induction in women attempting TOLAC at late third trimester with a dead fetus in utero. AIM To compare efficacy and safety of a new combination regime comprising of two cervical sensitizers used simultaneously with single agents, for labor induction in women attempting TOLAC at ≥34 weeks' gestation with a dead fetus. METHOD This was a multiarm randomized controlled trial (RCT) where participants received one of the three regimes-single agent oral Mifepristone 200 mg, intracervical Foley's catheter (16 Fr size, filled with 40 mL normal saline after intracervical instillation), and combination regime consisting of both used simultaneously. Number of women undergoing vaginal birth within 48 h of induction (VB48 ) was the primary outcome compared between groups. RESULTS VB48 was higher in participants on combination regime in comparison to participants on Foley's catheter (54 vs. 42). Total vaginal births were higher in participants on combination regime compared to both single agents (58 vs. 48 and 44). Duration and dose of oxytocin augmentation was lower in participants on combination regime compared to both single agents. Induction birth interval was short in participants on combination regime compared to those on Foley's catheter. Maternal complications between groups were similar. CONCLUSION Combination of cervical sensitizers for labor induction in late third trimester among women with dead fetus attempting TOLAC resulted in higher proportion of vaginal births and might reduce risk of scar dehiscence due to requirement of a lower dose of oxytocin for augmentation.
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Affiliation(s)
- Subhankar Dasgupta
- Department of Obstetrics and Gynecology, Rampurhat Government Medical College &Hospital, Birbhum, West Bengal, India
| | - Jija Dasgupta
- AILABS, Adani Enterprises LTD, Kolkata, West Bengal, India
| | - Barnali Goswami
- Department of Obstetrics and Gynecology, College of Obstetrics Gynecology and Child Health, CRSS, Kolkata, West Bengal, India
| | - Joyeeta Mondal
- Department of obstetrics and gynecology, Diamond harbor government medical college and hospital, Diamond Harbor, West Bengal, India
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22
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Madhuri MS, Jha N, Pampapati V, Chaturvedula L, Jha AK. Fetomaternal outcome of scarred uterine rupture compared with primary uterine rupture: a retrospective cohort study. J Perinat Med 2023; 51:1067-1073. [PMID: 37125850 DOI: 10.1515/jpm-2023-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/15/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Literature comparing maternal and perinatal outcomes among women with scarred and primary uterine rupture are limited. Therefore, the study aimed to compare maternal and perinatal outcomes and associated risk factors of uterine rupture among scarred and unscarred uterus. METHODS This retrospective cohort study was performed at a large tertiary care of India between July 1, 2011 and June 30, 2020. We analysed all the cases of complete uterine rupture beyond the 20th week of gestation. The outcome measures were live birth rate, perinatal mortality, maternal mortality and morbidity. RESULTS A total of 115 complete uterine ruptures were noted in 148,102 pregnancies. Of those 115 uterine ruptures, 89 (77.3 %) uterine ruptures occurred in women with a history of caesarean delivery, and 26 (22.6 %) uterine ruptures occurred in primary uterine rupture. The primary uterine rupture group had a significantly higher incidence of lower parity, breech presentation and mean birth weight. The live birth rate (68.18% vs. 42.85 %; p=0.04) was significantly higher in the scarred group, and the stillbirth rate (57.14% vs. 31.86 %; p=0.009) was significantly higher in the primary uterine rupture group. Hypoxic ischemic encephalopathy, APGAR score, and neonatal intensive care unit admission were comparable. Postpartum haemorrhage, blood transfusion, severe acute maternal morbidity and intensive care unit stay were more frequently reported in the primary uterine rupture group. CONCLUSIONS The maternal and perinatal outcomes appear less favourable among women with primary uterine rupture than scarred uterine rupture.
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Affiliation(s)
- Makkam S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Veena Pampapati
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Latha Chaturvedula
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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McDonough MR, Leone-Sheehan D. "You're on a Rollercoaster, Just Hold On": The Lived Experience of the Dyad Following a Fetal Death. Res Theory Nurs Pract 2023:RTNP-2023-0037.R1. [PMID: 37848222 DOI: 10.1891/rtnp-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Purpose: Pregnancy and birth is often a joyous period for a dyad. In the instance of fetal death, however, dyads are met with a devastating loss of their child, the hope for the future, and the new reality of becoming a bereaved parent. The purpose of this qualitative study was to investigate the lived experience of the dyad following a fetal death and capture the essence of the grief journey. Study design and methods: A hermeneutic phenomenological study was performed using van Manen's method for data collection and analysis. Semi-structured interviews were conducted via Zoom. Participants were recruited from national and local agencies providing education and resources about perinatal loss. Data analysis utilized the Dedoose software platform to track qualitative coding. Results: Ten dyads (20 individuals) from the United States and Canada participated. The data revealed four major themes with several subthemes. The major themes were as follows: "The child I'll never really know": Pregnancy loss grief; "You're on a rollercoaster, just hold on": The emotional journey; Climbing uphill: Barriers to healing; and Resurfacing from grief: Healing after loss Clinical implications: The death of a fetus over 20 weeks gestation provides a unique experience of grief. The findings support the need for additional resources needed beyond the hospital by nurses or other providers to facilitate healing and minimize complicated grief. Furthermore, the findings support the need for increasing awareness among healthcare providers and peers about how to communicate and care for dyads experiencing fetal death.
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Affiliation(s)
- Mary Rose McDonough
- Community Nursing Department, UMASS Dartmouth College of Nursing and Health Sciences, Dartmouth, MA, USA
| | - Danielle Leone-Sheehan
- School of Nursing and Health Sciences, Merrimack College North Andover, North Andover, MA, USA
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24
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DuBose B, Tembunde Y, Goodman KE, Pineles L, Nadimpalli G, Baghdadi JD, Parchem JG, Harris AD, Pineles BL. Delivery outcomes in a cohort of pregnant patients with COVID-19 with and without viral pneumonia. Am J Obstet Gynecol MFM 2023; 5:101077. [PMID: 37399892 PMCID: PMC11018246 DOI: 10.1016/j.ajogmf.2023.101077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/18/2023] [Accepted: 06/29/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Among pregnant people, COVID-19 can lead to adverse outcomes, but the specific pregnancy outcomes that are affected by the disease are unclear. In addition, the effect of the severity of COVID-19 on pregnancy outcomes has not been clearly identified. OBJECTIVE This study aimed to evaluate the associations between COVID-19 with and without viral pneumonia and cesarean delivery, preterm delivery, preeclampsia, and stillbirth. STUDY DESIGN We conducted a retrospective cohort study (April 2020-May 2021) of deliveries between 20 and 42 weeks of gestation from US hospitals in the Premier Healthcare Database. The primary outcomes were cesarean delivery, preterm delivery, preeclampsia, and stillbirth. We used a viral pneumonia diagnosis (International Classification of Diseases -Tenth-Clinical Modification codes J12.8 and J12.9) to categorize patients by severity of COVID-19. Pregnancies were categorized into 3 groups: NOCOVID (no COVID-19), COVID (COVID-19 without viral pneumonia), and PNA (COVID-19 with viral pneumonia). Groups were balanced for risk factors by propensity-score matching. RESULTS A total of 814,649 deliveries from 853 US hospitals were included (NOCOVID: n=799,132; COVID: n=14,744; PNA: n=773). After propensity-score matching, the risks of cesarean delivery and preeclampsia were similar in the COVID group compared with the NOCOVID group (matched risk ratio, 0.97; 95% confidence interval, 0.94-1.00; and matched risk ratio, 1.02; 95% confidence interval, 0.96-1.07; respectively). The risks of preterm delivery and stillbirth were greater in the COVID group than in the NOCOVID group (matched risk ratio, 1.11; 95% confidence interval, 1.05-1.19; and matched risk ratio, 1.30; 95% confidence interval, 1.01-1.66; respectively). The risks of cesarean delivery, preeclampsia, and preterm delivery were higher in the PNA group than in the COVID group (matched risk ratio, 1.76; 95% confidence interval, 1.53-2.03; matched risk ratio, 1.37; 95% confidence interval, 1.08-1.74; and matched risk ratio, 3.33; 95% confidence interval, 2.56-4.33; respectively). The risk of stillbirth was similar in the PNA and COVID group (matched risk ratio, 1.17; 95% confidence interval, 0.40-3.44). CONCLUSION Within a large national cohort of hospitalized pregnant people, we found that the risk of some adverse delivery outcomes was elevated in people with COVID-19 with and without viral pneumonia, with much higher risks in the group with viral pneumonia.
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Affiliation(s)
- Brianna DuBose
- University of Maryland School of Medicine, Baltimore, MD (Mses DuBose and Tembunde)
| | - Yazmeen Tembunde
- University of Maryland School of Medicine, Baltimore, MD (Mses DuBose and Tembunde)
| | - Katherine E Goodman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Gita Nadimpalli
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Jonathan D Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Jacqueline G Parchem
- Department of Obstetrics, Gynecology and Reproductive Sciences, John P. and Kathrine G. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX (Dr Parchem)
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (Dr Goodman, Ms L Pineles, and Drs Nadimpalli, Baghdadi, and Harris)
| | - Beth L Pineles
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Dr B Pineles).
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Hansen DN, Kahr HS, Torp-Pedersen C, Feifel J, Uldbjerg N, Sinding M, Sørensen A. The Danish newborn standard and the International Fetal and Newborn Growth Consortium for the 21st Century newborn standard: a nationwide register-based cohort study. Am J Obstet Gynecol 2023; 229:290.e1-290.e8. [PMID: 36907534 DOI: 10.1016/j.ajog.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/16/2023] [Accepted: 02/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND It is a matter of debate whether 1 universal standard, such as the International Fetal and Newborn Growth Consortium for the 21st Century standard, can be applied to all populations. OBJECTIVE The primary objective was to establish a Danish newborn standard based on the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard to compare the percentiles of these 2 standards. A secondary objective was to compare the prevalence and risk of fetal and neonatal deaths related to small for gestational age defined by the 2 standards when used in the Danish reference population. STUDY DESIGN This was a register-based nationwide cohort study. The Danish reference population included 375,318 singletons born at 33 to 42 weeks of gestation in Denmark between January 1, 2008, and December 31, 2015. The Danish standard cohort included 37,811 newborns who fulfilled the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard. Birthweight percentiles were estimated using smoothed quantiles for each gestational week. The outcomes included birthweight percentiles, small for gestational age (defined as a birthweight of 3rd percentile), and adverse outcomes (defined as either fetal or neonatal death). RESULTS At all gestational ages, the Danish standard median birthweights at term were higher than the International Fetal and Newborn Growth Consortium for the 21st Century standard median birthweights: 295g for females and 320 g for males. Therefore, the estimates of the prevalence rate of small for gestational age within the entire population were different: 3.9% (n=14,698) using the Danish standard vs 0.7% (n=2640) using the International Fetal and Newborn Growth Consortium for the 21st Century standard. Accordingly, the relative risk of fetal and neonatal deaths among small-for-gestational-age fetuses differed by SGA status defined by the different standards (4.4 [Danish standard] vs 9.6 [International Fetal and Newborn Growth Consortium for the 21st Century standard]). CONCLUSION Our finding did not support the hypothesis that 1 universal standard birthweight curve can be applied to all populations.
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Affiliation(s)
- Ditte N Hansen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.
| | - Henriette S Kahr
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Jan Feifel
- Institute of Statistics, Ulm University, Ulm, Germany
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marianne Sinding
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
| | - Anne Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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Haataja A, Kokki H, Uimari O, Kokki M. Non-obstetric surgery during pregnancy and the effects on maternal and fetal outcomes: A systematic review. Scand J Surg 2023; 112:187-205. [PMID: 37329286 DOI: 10.1177/14574969231175569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes. METHODS A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates. RESULTS We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0). CONCLUSIONS The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.
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Affiliation(s)
- Anna Haataja
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Outi Uimari
- PEDEGO Research Unit, Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland
| | - Merja Kokki
- Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
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Cannarella R, Kaiyal RS, Marino M, La Vignera S, Calogero AE. Impact of COVID-19 on Fetal Outcomes in Pregnant Women: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:1337. [PMID: 37763105 PMCID: PMC10533032 DOI: 10.3390/jpm13091337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Coronavirus disease (COVID-19) is a pandemic causing respiratory symptoms, taste alterations, olfactory disturbances, and cutaneous, cardiovascular, and neurological manifestations. Recently, research interest has shifted to reproductive health to understand the factors predisposing to COVID-19 infection in pregnancy, the consequences of the infection on the fetus and on the mother, and possible vertical transmission through the placenta. Pregnancy does not increase the risk of SARS-CoV-2 infection, according to studies. However, contrary to non-pregnant women, pregnancy worsens the clinical outcome of COVID-19. Studies investigating the effects of COVID-19 on pregnancy women are heterogeneous, and the results are often conflicting. Objectives: The goal of the current work was to offer a thorough and up-to-date systematic review of, and meta-analysis on, the impact of COVID-19 on ovarian function, pregnancy, and fetal outcomes. Search strategy: This meta-analysis (PROSPERO n. CRD42023456904) was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. The search for relevant material was conducted using PubMed, Scopus, Cochrane, and Embase databases, through to 15 December 2022. Selection criteria: Original articles on fertile pregnant women or women attempting to become pregnant, with an active case of, or history of, SARS-CoV-2 infection were included, and reproductive function was compared to that of uninfected women. Data collection and analysis: The effects of COVID-19 on female reproductive function, particularly ovarian function, the profile of female sex hormones, pregnancy outcomes and fetal outcomes were the focus of our search. Quantitative analysis was performed with Comprehensive Meta-Analysis Software. The standard difference of the mean was calculated for the statistical comparison between cases and controls. Cochran's Q test and heterogeneity (I2) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed. Main Results: Twenty-eight articles met our inclusion criteria, for a total of 27,383 patients pregnant or looking to have offspring, with active or anamnestic COVID-19, and 1,583,772 uninfected control women. Our study revealed that there was no significant difference between COVID-19 patients and the control group in terms of maternal characteristics such as age, body mass index (BMI) and comorbidities that could affect pregnancy and fetal outcomes. The risk of a miscarriage or Cesarean delivery was significantly lower, while the risk of fetal death or premature delivery was significantly higher in COVID-19 patients than in the controls. None of the included studies evaluated hormonal profiles or investigated the presence of infertility. Conclusions: Maternal comorbidities, age, and BMI do not raise the risk of COVID-19. However, pregnant women with COVID-19 had a lower risk of miscarriage and Cesarean delivery, possibly because of better prenatal care and high levels of observation during labor. COVID-19 during pregnancy increases the risk of fetal death and premature delivery.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (M.M.); (S.L.V.); (A.E.C.)
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Raneen Sawaid Kaiyal
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Marta Marino
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (M.M.); (S.L.V.); (A.E.C.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (M.M.); (S.L.V.); (A.E.C.)
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia 78, 95123 Catania, Italy; (M.M.); (S.L.V.); (A.E.C.)
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Parry M, Torvaldsen S, Nippita TA, Bowen J, Morris JM, Ibiebele I. Trends in early gestation stillbirths and neonatal deaths in New South Wales, Australia 2002-2019. Aust N Z J Obstet Gynaecol 2023; 63:541-549. [PMID: 37062902 DOI: 10.1111/ajo.13685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Little research has focused on understanding trends in early gestation (20-27 weeks) stillbirths and neonatal deaths. AIMS To examine trends in early gestation stillbirths and neonatal deaths in New South Wales (NSW), Australia. MATERIALS AND METHODS Population-based cohort study of all births ≥20 weeks gestation among female NSW residents during 2002 to 2019, induced pregnancy terminations excluded. Stillbirth rates by gestational age and birth year were calculated per 1000 fetuses-at-risk (FAR). Neonatal death rates by gestational age and birth year were calculated per 1000 live births. Linear regression was used to examine trends in stillbirth and neonatal death rates among all, singleton and twin births. RESULTS Declining trends in early gestation stillbirth and neonatal death rates were found. Stillbirth rates decreased from 1.9 and 0.9/1000 FAR in 2002 to 1.6 and 0.7 in 2019 for 20-23 and 24-27 week groups, respectively. Neonatal rates decreased from 940 and 315/1000 live births in 2002 to 925 and 189 in 2019 for the 20-23 and 24-27 week groups, respectively. Among singleton births, declining trends in stillbirth and neonatal death rates across all age groups were observed, except for 37-38 week stillbirths. No trends in twin stillbirth rates were found across gestational age groups, although a decreasing trend was observed for 20-23 week twin neonatal deaths. CONCLUSIONS Trends in early gestation stillbirth and neonatal deaths have declined in recent decades in NSW but further efforts are needed to reduce both early and late gestation stillbirth rates among twin births.
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Affiliation(s)
- Marissa Parry
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
| | - Siranda Torvaldsen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Tanya A Nippita
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jennifer Bowen
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Neonatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jonathan M Morris
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Clinical Excellence Commission, New South Wales Ministry of Health, Sydney, New South Wales, Australia
| | - Ibinabo Ibiebele
- Faculty of Medicine and Health, Reproduction and Perinatal Centre, Women and Babies Research, The University of Sydney, Sydney, New South Wales, Australia
- Northern Sydney Local Health District, Kolling Institute, Sydney, New South Wales, Australia
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Lee HS, Abbasi N, Van Mieghem T, Mei-Dan E, Audibert F, Brown R, Coad S, Lewi L, Barrett J, Ryan G. Guideline No. 440: Management of Monochorionic Twin Pregnancies. J Obstet Gynaecol Can 2023; 45:587-606.e8. [PMID: 37541734 DOI: 10.1016/j.jogc.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
OBJECTIVE This guideline reviews the evidence-based management of normal and complicated monochorionic twin pregnancies. TARGET POPULATION Women with monochorionic twin or higher order multiple pregnancies. BENEFITS, HARMS, AND COSTS Implementation of these recommendations should improve the management of both complicated and uncomplicated monochorionic (and higher order multiple) twin pregnancies. They will help users monitor monochorionic twin pregnancies appropriately and identify and manage monochorionic twin complications optimally in a timely manner, thereby reducing perinatal morbidity and mortality. These recommendations entail more frequent ultrasound monitoring of monochorionic twins compared to dichorionic twins. EVIDENCE Published literature was retrieved through searches of PubMed and the Cochrane Library using appropriate MeSH headings (Twins, Monozygotic; Ultrasonography, Prenatal; Placenta; Fetofetal Transfusion; Fetal Death; Fetal Growth Retardation). Results were restricted to systematic reviews, randomized controlled clinical trials, and observational studies. There were no date limits, but results were limited to English or French language materials. VALIDATION METHODS The content and recommendations were drafted and agreed upon by the principal authors. The Board of the SOGC approved the final draft for publication. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE Maternal-fetal medicine specialists, obstetricians, radiologists, sonographers, family physicians, nurses, midwives, residents, and other health care providers who care for women with monochorionic twin or higher order multiple pregnancies. TWEETABLE ABSTRACT Canadian (SOGC) guidelines for the diagnosis, ultrasound surveillance and management of monochorionic twin pregnancy complications, including TTTS, TAPS, sFGR (sIUGR), acardiac (TRAP), monoamniotic twins and intrauterine death of one MC twin. SUMMARY STATEMENTS RECOMMENDATIONS.
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Pels A, Ganzevoort W, Kenny LC, Baker PN, von Dadelszen P, Gluud C, Kariya CT, Leemhuis AG, Groom KM, Sharp AN, Magee LA, Jakobsen JC, Mol BWJ, Papageorghiou AT. Interventions affecting the nitric oxide pathway versus placebo or no therapy for fetal growth restriction in pregnancy. Cochrane Database Syst Rev 2023; 7:CD014498. [PMID: 37428872 PMCID: PMC10332237 DOI: 10.1002/14651858.cd014498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND Fetal growth restriction (FGR) is a condition of poor growth of the fetus in utero. One of the causes of FGR is placental insufficiency. Severe early-onset FGR at < 32 weeks of gestation occurs in an estimated 0.4% of pregnancies. This extreme phenotype is associated with a high risk of fetal death, neonatal mortality, and neonatal morbidity. Currently, there is no causal treatment, and management is focused on indicated preterm birth to prevent fetal death. Interest has risen in interventions that aim to improve placental function by administration of pharmacological agents affecting the nitric oxide pathway causing vasodilatation. OBJECTIVES The objective of this systematic review and aggregate data meta-analysis is to assess the beneficial and harmful effects of interventions affecting the nitric oxide pathway compared with placebo, no therapy, or different drugs affecting this pathway against each other, in pregnant women with severe early-onset FGR. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (16 July 2022), and reference lists of retrieved studies. SELECTION CRITERIA We considered all randomised controlled comparisons of interventions affecting the nitric oxide pathway compared with placebo, no therapy, or another drug affecting this pathway in pregnant women with severe early-onset FGR of placental origin, for inclusion in this review. DATA COLLECTION AND ANALYSIS We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. MAIN RESULTS We included a total of eight studies (679 women) in this review, all of which contributed to the data and analysis. The identified studies report on five different comparisons: sildenafil compared with placebo or no therapy, tadalafil compared with placebo or no therapy, L-arginine compared with placebo or no therapy, nitroglycerin compared with placebo or no therapy and sildenafil compared with nitroglycerin. The risk of bias of included studies was judged as low or unclear. In two studies the intervention was not blinded. The certainty of evidence for our primary outcomes was judged as moderate for the intervention sildenafil and low for tadalafil and nitroglycerine (due to low number of participants and low number of events). For the intervention L-arginine, our primary outcomes were not reported. Sildenafil citrate compared to placebo or no therapy (5 studies, 516 women) Five studies (Canada, Australia and New Zealand, the Netherlands, the UK and Brazil) involving 516 pregnant women with FGR were included. We assessed the certainty of the evidence as moderate. Compared with placebo or no therapy, sildenafil probably has little or no effect on all-cause mortality (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.80 to 1.27, 5 studies, 516 women); may reduce fetal mortality (RR 0.82, 95% CI 0.60 to 1.12, 5 studies, 516 women), and increase neonatal mortality (RR 1.45, 95% CI 0.90 to 2.33, 5 studies, 397 women), although the results are uncertain for fetal and neonatal mortality as 95% confidence intervals are wide crossing the line of no effect. Tadalafil compared with placebo or no therapy (1 study, 87 women) One study (Japan) involving 87 pregnant women with FGR was included. We assessed the certainty of the evidence as low. Compared with placebo or no therapy, tadalafil may have little or no effect on all-cause mortality (risk ratio 0.20, 95% CI 0.02 to 1.60, one study, 87 women); fetal mortality (RR 0.11, 95% CI 0.01 to 1.96, one study, 87 women); and neonatal mortality (RR 0.89, 95% CI 0.06 to 13.70, one study, 83 women). L-Arginine compared with placebo or no therapy (1 study, 43 women) One study (France) involving 43 pregnant women with FGR was included. This study did not assess our primary outcomes. Nitroglycerin compared to placebo or no therapy (1 studies, 23 women) One study (Brazil) involving 23 pregnant women with FGR was included. We assessed the certainty of the evidence as low. The effect on the primary outcomes is not estimable due to no events in women participating in both groups. Sildenafil citrate compared to nitroglycerin (1 study, 23 women) One study (Brazil) involving 23 pregnant women with FGR was included. We assessed the certainty of the evidence as low. The effect on the primary outcomes is not estimable due to no events in women participating in both groups. AUTHORS' CONCLUSIONS Interventions affecting the nitric oxide pathway probably do not seem to influence all-cause (fetal and neonatal) mortality in pregnant women carrying a baby with FGR, although more evidence is needed. The certainty of this evidence is moderate for sildenafil and low for tadalafil and nitroglycerin. For sildenafil a fair amount of data are available from randomised clinical trials, but with low numbers of participants. Therefore, the certainty of evidence is moderate. For the other interventions investigated in this review there are insufficient data, meaning we do not know whether these interventions improve perinatal and maternal outcomes in pregnant women with FGR.
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Affiliation(s)
- Anouk Pels
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Louise C Kenny
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Philip N Baker
- College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Christian Gluud
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Chirag T Kariya
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| | - Aleid G Leemhuis
- Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, Netherlands
| | - Katie M Groom
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Andrew N Sharp
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, King's College London, London, UK
| | - Janus C Jakobsen
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ben Willem J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medial Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Manjee K, Price E, Ernst LM. Comparison of the Autopsy and Placental Findings in Second vs Third Trimester Stillbirth. Pediatr Dev Pathol 2023; 26:345-351. [PMID: 37082921 DOI: 10.1177/10935266231165854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND The pathology of second trimester fetal loss is not well-characterized due to lack of comprehensive autopsy studies. The purpose of this study is to compare autopsy pathology of second trimester and third trimester stillbirth. METHODS In this retrospective cohort study, fetal autopsies performed in-house with complete placental examination were included. From autopsy reports, maternal demographics, gestational age, sex, body and placental weight, congenital anomalies, and cause of death (COD) were obtained. Immediate COD was coded "probable" or "possible" according to Initial Causes of Fetal Death (INCODE). RESULTS Among 68 second trimester and 54 third trimester fetal autopsies, at least 1 probable COD was identified in 59/68 (87%) second trimester and 44/54 (81%) third trimester cases. 42/68 (62%) second trimester and 28/54 (52%) third trimester fetuses had probable COD secondary to placental pathology. Among placental causes, 29/42 (69%) second trimester and 14/28 (50%) third trimester stillbirths were related to compromised fetal microcirculation with umbilical cord abnormality. CONCLUSIONS Among stillborn first and second trimester fetuses who undergo autopsy, the most prevalent COD is pathologic placental conditions, particularly those associated with umbilical cord obstruction. This study stresses the importance of placenta examination for establishing COD in both second and third trimester fetuses.
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Affiliation(s)
- Kiran Manjee
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erica Price
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL, USA
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Vlachadis N, Vrachnis D, Antonakopoulos N, Tigka M, Loukas N, Parthenis C, Metallinou D, Nanou C, Stavros S, Vrachnis N. Temporal Trends in Stillbirth in Greece: A Longitudinal Population-Based Study. Cureus 2023; 15:e37154. [PMID: 37034145 PMCID: PMC10081855 DOI: 10.7759/cureus.37154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Stillbirths are a major public health issue and a key population health indicator. The aim of this study was to comprehensively investigate and present time trends in stillbirth in Greece. METHODS Data on all live births and stillbirths were derived from the Hellenic Statistical Authority, covering a 65-year period from 1957 to 2021 and the annual stillbirth rate (SBR) was calculated, defined as the number of stillbirths per 1,000 live births and stillbirths (total births). Trends in the SBR were assessed using joinpoint regression analysis with calculation of the annual percent change (APC) with a 95% confidence interval (95% CI) and level of statistical significance p<0.05. RESULTS The SBR in Greece, after an initial increasing trend (1957-1965: APC=2.6, 95% CI: 0.5 to 4.7, p=0.016), and an all-time high of 15.8 per 1,000 births in 1966, recorded a four decades period of continuous improvement (1965-2003: APC=3.0, 95% CI: -3.2 to -2.8, p<0.001) and reached a historic low in 2008 (3.3 per 1,000 births) (a decrease by 79%). However, the SBR stagnated at an elevated level during the decade 2006-2016 and showed a steeply upward trend during the most recent period 2016-2021 (APC=7.4, 95% CI: 3.0 to 12.1, p=0.001). In 2021, the SBR was 5.3 per 1,000 births, 60% up from 2008. It was estimated that the SBR improvement for the 1967-2021 period resulted in 50,914 stillbirths averted (7.9 per 1,000 births), but the recent increase in the SBR has led to 1,200 additional fetal deaths (1.0 per 1,000 births) during 2009-2021. CONCLUSION After an impressive decline for almost four decades the SBR gradually deteriorated during the economic crisis and finally showed an alarming rising trend after 2015, resulting in an increasing burden of fetal deaths in Greece. Further public health interventions are needed to address preventable risk factors and ensure access to optimized antenatal monitoring.
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Affiliation(s)
| | - Dionysios Vrachnis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, GRC
| | - Nikolaos Antonakopoulos
- Department of Obstetrics and Gynecology, University of Patras, Rio University Hospital, Patras, GRC
| | - Maria Tigka
- Department of Midwifery, University of West Attica, Athens, GRC
| | - Nikolaos Loukas
- Department of Obstetrics and Gynecology, Tzaneio Hospital, Piraeus, GRC
| | - Christos Parthenis
- Department of Maternal Fetal Medicine, Elena Venizelou Hospital, Athens, GRC
| | | | - Christina Nanou
- Department of Midwifery, University of West Attica, Athens, GRC
| | - Sofoklis Stavros
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attiko Hospital, Athens, GRC
| | - Nikolaos Vrachnis
- Third Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Attiko Hospital, Athens, GRC
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thompson RA, Thompson JMD, Wilson J, Cronin RS, Mitchell EA, Raynes-Greenow CH, Li M, Stacey T, Heazell AEP, O'Brien LM, McCowan LME, Anderson NH. Risk factors for late preterm and term stillbirth: A secondary analysis of an individual participant data meta-analysis. BJOG 2023. [PMID: 36852504 DOI: 10.1111/1471-0528.17444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/14/2022] [Accepted: 01/09/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Identify independent and novel risk factors for late-preterm (28-36 weeks) and term (≥37 weeks) stillbirth and explore development of a risk-prediction model. DESIGN Secondary analysis of an Individual Participant Data (IPD) meta-analysis investigating modifiable stillbirth risk factors. SETTING An IPD database from five case-control studies in New Zealand, Australia, the UK and an international online study. POPULATION Women with late-stillbirth (cases, n = 851), and ongoing singleton pregnancies from 28 weeks' gestation (controls, n = 2257). METHODS Established and novel risk factors for late-preterm and term stillbirth underwent univariable and multivariable logistic regression modelling with multiple sensitivity analyses. Variables included maternal age, body mass index (BMI), parity, mental health, cigarette smoking, second-hand smoking, antenatal-care utilisation, and detailed fetal movement and sleep variables. MAIN OUTCOME MEASURES Independent risk factors with adjusted odds ratios (aOR) for late-preterm and term stillbirth. RESULTS After model building, 575 late-stillbirth cases and 1541 controls from three contributing case-control studies were included. Risk factor estimates from separate multivariable models of late-preterm and term stillbirth were compared. As these were similar, the final model combined all late-stillbirths. The single multivariable model confirmed established demographic risk factors, but additionally showed that fetal movement changes had both increased (decreased frequency) and reduced (hiccoughs, increasing strength, frequency or vigorous fetal movements) aOR of stillbirth. Poor antenatal-care utilisation increased risk while more-than-adequate care was protective. The area-under-the-curve was 0.84 (95% CI 0.82-0.86). CONCLUSIONS Similarities in risk factors for late-preterm and term stillbirth suggest the same approach for risk-assessment can be applied. Detailed fetal movement assessment and inclusion of antenatal-care utilisation could be valuable in late-stillbirth risk assessment.
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Affiliation(s)
- R A Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J M D Thompson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - J Wilson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - R S Cronin
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - E A Mitchell
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - C H Raynes-Greenow
- Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia
| | - M Li
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
- Women's Health Division, Counties Manukau Health, Auckland, New Zealand
| | - T Stacey
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - A E P Heazell
- University of Manchester, Manchester, UK
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M O'Brien
- University of Michigan, Ann Arbor, Michigan, USA
| | - L M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - N H Anderson
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
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Redline RW, Roberts DJ, Parast MM, Ernst LM, Morgan TK, Greene MF, Gyamfi-Bannerman C, Louis JM, Maltepe E, Mestan KK, Romero R, Stone J. Placental pathology is necessary to understand common pregnancy complications and achieve an improved taxonomy of obstetrical disease. Am J Obstet Gynecol 2023; 228:187-202. [PMID: 35973475 PMCID: PMC10337668 DOI: 10.1016/j.ajog.2022.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 01/28/2023]
Abstract
The importance of a fully functioning placenta for a good pregnancy outcome is unquestioned. Loss of function can lead to pregnancy complications and is often detected by a thorough placental pathologic examination. Placental pathology has advanced the science and practice of obstetrics and neonatal-perinatal medicine by classifying diseases according to underlying biology and specific patterns of injury. Many past obstacles have limited the incorporation of placental findings into both clinical studies and day-to-day practice. Limitations have included variability in the nomenclature used to describe placental lesions, a shortage of perinatal pathologists fully competent to analyze placental specimens, and a troubling lack of understanding of placental diagnoses by clinicians. However, the potential use of placental pathology for phenotypic classification, improved understanding of the biology of adverse pregnancy outcomes, the development of treatment and prevention, and patient counseling has never been greater. This review, written partly in response to a recent critique published in a major obstetrics-gynecology journal, reexamines the role of placental pathology by reviewing current concepts of biology; explaining the most recent terminology; emphasizing the usefulness of specific diagnoses for obstetrician-gynecologists, neonatologists, and patients; previewing upcoming changes in recommendations for placental submission; and suggesting future improvements. These improvements should include further consideration of overall healthcare costs, cost-effectiveness, the clinical value added of placental assessment, improvements in placental pathology education and practice, and leveraging of placental pathology to identify new biomarkers of disease and evaluate novel therapies tailored to specific clinicopathologic phenotypes of both women and infants.
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Affiliation(s)
- Raymond W Redline
- Department of Pathology and Reproductive Biology, Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center and Cleveland, OH.
| | - Drucilla J Roberts
- Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Mana M Parast
- Department of Pathology, Sanford Consortium for Regenerative Medicine, University of California San Diego, La Jolla, CA
| | - Linda M Ernst
- Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL
| | - Terry K Morgan
- Department of Pathology and Obstetrics and Gynecology, Center for Developmental Health, Oregon Health Sciences University, Portland, OR
| | - Michael F Greene
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Cynthia Gyamfi-Bannerman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA
| | - Judette M Louis
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University South Florida, Tampa, FL
| | - Emin Maltepe
- Department of Pediatrics, University California, San Francisco, San Francisco, CA
| | - Karen K Mestan
- Department of Pediatrics and Neonatology, University of California, San Diego, School of Medicine and Rady Children's Hospital, San Diego, CA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI
| | - Joanne Stone
- Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
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Kashyap N, Islam M, Kaur H, Tiwari D, Begum A, Bose M, Das CR, Saikia AK, Kalita P, Bose PD, Bose S. Oxidative stress-A key determinant of complications and negative outcome in hepatitis E virus infected pregnancies: A comprehensive account involving cases from northeast India. J Med Virol 2023; 95:e28576. [PMID: 36779361 DOI: 10.1002/jmv.28576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/14/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
Regulated oxidative stress (OS) is important during pregnancy. Sporadic studies suggest the significance of deregulated OS in hepatitis E virus (HEV) infected pregnancy, but with limited reactive oxygen species (ROS) or antioxidant markers. The present novel study, therefore, aimed to evaluate the significance of ROS-antioxidant imbalance and resulting altered OS in HEV infected pregnancy complications like preterm delivery (PTD) and outcome. Difference in serum levels of ROS and antioxidant panel of markers were evaluated by ELISA for HEV immunoglobulin M RNA positive genotype 1 cases (including acute [acute viral hepatitis, AVH] and fulminant [fulminant hepatic failure, FHF] cases) and healthy term delivery subjects, and analyzed statistically. Direct ROS marker H2 O2 levels and indirect OS marker for DNA damage 8-hydroxy-2'-deoxyguanosine was significantly increased in HEV-cases compared to controls, and was associated and prognostic factor for PTD and fetal death in HEV cases. A comparatively lower total serum antioxidant capacity was observed in the FHF cases compared to the control subjects and the AVH cases. Glutathione (GSH) levels and superoxide dismutase (SOD) activity were significantly associated with PTD in the FHF sub-cohorts (p = 0.017) and AVH sub-cohorts (p < 0.001), respectively, and was associated with poor prognosis in HEV cases. The serum H2 O2 levels were found to be negatively correlated with SOD activity (p = 0.016) and GSH levels (p = 0.001) in the HEV-AVH cases; and positively correlated with the viral load in HEV cases (p = 0.023). The ROS-antioxidant imbalance resulting OS plays a detrimental associative role in HEV infected pregnancy complications like PTD and adverse pregnancy outcomes; and holds therapeutic significance.
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Affiliation(s)
- Natasha Kashyap
- Department of Molecular Biology and Biotechnology, Cotton University, Guwahati, Assam, India.,Department of Biotechnology, Gauhati University, Guwahati, Assam, India
| | - Mafidul Islam
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
| | - Harpreet Kaur
- Division of Epidemiology and Communicable Diseases (ECD), Indian Council of Medical Research Headquarters, New Delhi, India
| | - Diptika Tiwari
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
| | - Anjuma Begum
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
| | - Moumita Bose
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
| | - Chandana Ray Das
- Department of Obstetrics and Gynaecology, Gauhati Medical College & Hospital (GMCH), Guwahati, Assam, India
| | - Anjan Kumar Saikia
- Department of Gastroenterology & Hepatology, Guwahati Neurological Research Center (GNRC) Hospitals, Guwahati, Assam, India
| | - Pankaj Kalita
- Department of Ayurveda, SMO (Ayurveda), ESIC Model Hospital, Guwahati, Assam, India
| | - Purabi Deka Bose
- Department of Molecular Biology and Biotechnology, Cotton University, Guwahati, Assam, India
| | - Sujoy Bose
- Department of Biotechnology, Gauhati University, Guwahati, Assam, India
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Xie A, Cui Y, Luo G, Chen X, Zhang X, Han J, Tong L, Ren Y, Wei X. Determining the cause of intrauterine fetal death in monochorionic twins: A case report. Front Med (Lausanne) 2023; 9:1055275. [PMID: 36687412 PMCID: PMC9846037 DOI: 10.3389/fmed.2022.1055275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
Background Determining the cause of intrauterine fetal death is essential for patients to manage their next pregnancy. However, in the majority of cases of fetal death, the cause remains unexplained despite comprehensive evaluation, especially in the cases of twins. Among twin pregnancies, conditions of monochorionic twinning, commonly regarded as monozygotic, are more complicated than dichorionic ones. Case summary We systematically evaluated the cause of fetal death for a Han Chinese woman with monochorionic twinning following in vitro fertilization/embryo transfer. Discrepant karyotypes were unexpectedly discovered between the twins. One fetus had an aneuploid male karyotype (46, XY), dup (9) (p24.3-q13), and the other had a normal female karyotype (46, XX). We considered that the male died of aberration of chromosome 9 and the female died of subsequent acute exsanguination through vascular anastomosis. Conclusion This study demonstrated the importance of recognizing the presence of monochorionic dizygotic twinning and the challenges of clinical management for twins following in vitro fertilization/double embryo transfer.
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Affiliation(s)
- Anxia Xie
- Research Center for High Altitude Medicine, Qinghai University, Xining, China,Medical College, Qinghai University, Xining, China,Department of Obstetrics, Qinghai Provincial People’s Hospital, Xining, China
| | - Yan Cui
- Department of Gynecology, Qinghai Provincial People’s Hospital, Xining, China
| | - Gang Luo
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Xianxia Chen
- Department of Ultrasonography, Qinghai Provincial People’s Hospital, Xining, China
| | - Xuecheng Zhang
- Department of Pathology, Qinghai Provincial People’s Hospital, Xining, China
| | - Jie Han
- Department of Gynecology, Qinghai Provincial People’s Hospital, Xining, China
| | - Li Tong
- Medical College, Qinghai University, Xining, China,Qinghai Provincial Key Laboratory of Traditional Chinese Medicine Research for Glucolipid Metabolic Diseases, Xining, China
| | - Yanming Ren
- Medical College, Qinghai University, Xining, China,*Correspondence: Yanming Ren,
| | - Xiaoxing Wei
- Research Center for High Altitude Medicine, Qinghai University, Xining, China,Medical College, Qinghai University, Xining, China,Xiaoxing Wei,
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Tong M, Li P, Wang M, Sun Y, Han Y, Liu H, Li J, Li J, Wu F, Guan T, Xue T. Time-varying association between fetal death and gestational exposure to ambient fine particles: a nationwide epidemiological study of 49 million fetuses in the contiguous US from 1989 to 2004. Int J Epidemiol 2022; 51:1984-1999. [PMID: 35586940 DOI: 10.1093/ije/dyac103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/27/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Gestational exposure to fine particulate matter (PM2.5) has been reported to be associated with an increased risk of fetal death in recent studies, but earlier studies in the past century have usually reported a non-significant association. As such, it remains unknown whether this adverse effect of PM2.5 exposure varies with time. METHODS Nearly 49.2 million eligible birth and fetal death records from 1989 to 2004 were selected from the United States (US) birth and fetal death certificate datasets. For each record, the level of prenatal exposure to PM2.5 was taken as the average concentration in the mother's residential county during the entire gestational period, according to well-established estimates of monthly levels across the contiguous US. We first stratified the dataset by the month of the last menstrual period (LMP) and then independently evaluated the nationwide association between PM2.5 exposure and fetal death within each stratum using five typical logit models: unadjusted, covariate-adjusted, propensity-score, double robust, and diagnostic-score models. Finally, we conducted a meta-analysis to pool estimated LMP-specific associations and explored how the overall association varied by LMP month. RESULTS Different models showed temporal heterogeneity in the estimated association between PM2.5 exposure and fetal death. According to the meta-analysis, double robust model estimates were more homogeneous than the rest, and thus the model outcome was recognized as the main result. For each 1-µg/m3 increase in prenatal exposure to PM2.5, the pooled odds ratio (OR) of fetal death was estimated to be 1.08 [95% confidence interval (CI): 1.05, 1.10]. The LMP-specific ORs exhibited a slightly increasing trend and a significant seasonal pattern. Compared with the pooled OR among samples with the LMP in spring, the estimates for summer, fall and winter were higher by 11.1% (95% CI: 6.2%, 16.3%), 27.8% (95% CI: 22.1%, 33.8%) and 28.8% (95% CI: 23.7%, 34.1%), respectively. We also found that temporal patterns in the association between PM2.5 exposure and fetal death could be explained by several population-level indicators or modifiers (i.e. ethnicity, maternal age, gestational weight gain, previous pregnancy of abnormal termination and diabetes). CONCLUSIONS Prenatal exposure to PM2.5 can increase the risk of fetal death. The effects of PM2.5 exposure may be modified by complex factors, which leads to a time-varying association.
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Affiliation(s)
- Mingkun Tong
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Pengfei Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.,Advanced Institute of Information Technology, Peking University, Beijing, China
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Yilun Sun
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Yiqun Han
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Hengyi Liu
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jiajianghui Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jiwei Li
- Department of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Fei Wu
- Department of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Tianjia Guan
- Department of Health Policy, School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Xue
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
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Wondemagegn AT, Tsehay B, Mebiratie AL, Negesse A. Effects of dietary diversification during pregnancy on birth outcomes in east Gojjam, northwest Ethiopia: A prospective cohort study. Front Public Health 2022; 10:1037714. [PMID: 36544806 PMCID: PMC9760662 DOI: 10.3389/fpubh.2022.1037714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/08/2022] [Indexed: 12/08/2022] Open
Abstract
Introduction Adequate nutrient intake during pregnancy is an important key factor affecting fetal growth and birth outcomes, as well as maternal health, as demonstrated by experimental animal studies. However, the few human studies available, especially those conducted in the least developed countries (LDCs), are much less consistent. Therefore, this study aimed to investigate the association between dietary diversification during pregnancy and birth outcomes in Gojjam, Ethiopia. Methodology A facility-based prospective cohort study was conducted on 416 pregnant mothers (exposed and non-exposed) from December 2019 to January 2020. Information about the Women's Dietary Diversity Score (WDDS) was collected using the Food and Agricultural Organization's guidelines. Data were collected through interviewer-administered questionnaires and measurements. Log-binomial regression analysis was performed to estimate the relative risk of adverse birth outcomes. Energy, macronutrient, and micronutrient amounts were calculated using the nutrition survey software version 2007. The differences between groups were noticed using analysis of variance. Eta squared was estimated in the current study. Results The overall magnitude of low birth weight, preterm birth, and stillbirth in the study area, respectively, was 41%, 38%, and 4%. After adjustment for baseline characteristics, this study revealed that pregnant women in the inadequate WDDS group were at increased risk of LBW (ARR = 6.4; 95% CI: 3.4, 12) and PTD (ARR = 6.3; 95% CI: 3.3, 11.95) as compared with their counterparts but no difference in the occurrence of stillbirth (ARR = 1.08; 95% CI: 0.20, 5.79). Conclusion Overall, this study found a large magnitude of low birth weight and preterm birth. Inadequate intake of dietary diversity during pregnancy significantly increased the rate of low birth weight and preterm birth. Thus, we recommend the concerned body to work on improving the feeding practices of pregnant mothers in the study area.
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Affiliation(s)
- Amsalu Taye Wondemagegn
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia,*Correspondence: Amsalu Taye Wondemagegn
| | - Binalfew Tsehay
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Akiloge Lake Mebiratie
- Department of Obstetrics and Gynecology, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Ayenew Negesse
- Department of Human Nutrition and Food Sciences, Health Science College, Debre Markos University, Debre Markos, Ethiopia
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Jaiman S, Romero R, Gotsch F, Gowrishankar S, Mohiuddin K, Gallo DM, Jung E, Suksai M, Fernandez E. Fetal sepsis: a cause of stillbirth. J Matern Fetal Neonatal Med 2022; 35:9966-9970. [PMID: 35647781 PMCID: PMC9976197 DOI: 10.1080/14767058.2022.2079404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/21/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
Abstract
Infection is considered a leading cause of fetal death, responsible for approximately 20% of cases. Such estimates are derived from the frequency of acute histological chorioamnionitis and funisitis in cases of fetal death rather than direct detection of microorganisms in the fetal compartment. We report a case of clinically unexplained fetal death at 38 weeks of gestation in an uncomplicated pregnancy resulting in delivery of an appropriate-for-gestational-age fetus. The mother did not have any clinical signs of infection. Overwhelming bacterial invasion in multiple fetal organs, including the heart, liver, spleen, and kidneys, was observed despite the lack of evidence of maternal clinical infection. The bacteria were visualized by using standard histologic techniques (e.g. H&E/ tissue Gram stain) highlighting the value of autopsy in determining the cause of death.
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Affiliation(s)
- Sunil Jaiman
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Detroit Medical Center, Detroit, Michigan, USA
| | - Francesca Gotsch
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Kashif Mohiuddin
- Department of Pathology, KIMS Hospitals, Begumpet, Secunderabad, India
| | - Dahiana M. Gallo
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eunjung Jung
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Manaphat Suksai
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
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Souza RT, Brasileiro M, Ong M, Delaney L, Vieira MC, Dias MAB, Pasupathy D, Cecatti JG. Investigation of stillbirths in Brazil: A systematic scoping review of the causes and related reporting processes in the past decade. Int J Gynaecol Obstet 2022; 161:711-725. [PMID: 36373189 DOI: 10.1002/ijgo.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recognizing the causes of stillbirths and their associated conditions is essential to reduce its occurrence. OBJECTIVE To describe information on stillbirths in Brazil during the past decade. SEARCH STRATEGY A literature search was performed from January 2010 to December 2020. SELECTION CRITERIA Original observational studies and clinical trials. DATA COLLECTION AND ANALYSIS Data were manually extracted to a spreadsheet and descriptive analysis was performed. RESULTS A total of 55 studies were included; 40 studies (72.2%) used the official data stored by national public health systems. Most articles aimed to estimate the rate and trends of stillbirth (60%) or their causes (55.4%). Among the 16 articles addressing the causes of death, 10 (62.5%) used the International Classification of Diseases; most of the articles only specified the main cause of death. Intrauterine hypoxia was the main cause reported (ranging from 14.3% to 54.9%). CONCLUSION Having a national system based on compulsory notification of stillbirths may not be sufficient to provide quality information on occurrence and, especially, causes of death. Further improvements of the attribution and registration of causes of deaths and the implementation of educational actions for improving reporting systems are advisable. Finally, expanding the investigation of contributing factors associated with stillbirths would create an opportunity for further development of prevention strategies in low- and middle-income countries such as Brazil.
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Affiliation(s)
- Renato T Souza
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Mariana Brasileiro
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
| | - Melissa Ong
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Louisa Delaney
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Matias C Vieira
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK
| | - Marcos A B Dias
- Fernandes Figueira Institute, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Dharmintra Pasupathy
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, Women's Health Academic Centre KHP, London, UK.,Westmead Reproduction and Perinatal Medicine Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - José G Cecatti
- Department of Obstetrics and Gynaecology, University of Campinas (UNICAMP), School of Medical Sciences, Cidade Universitaria, Campinas, Brazil
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Gudipally M, Farooq F, Basany K, Haggerty CL, Tang G, Kusneniwar GN, Jammy GR, Bunker CH, Reddy PS. Impact of prepregnancy body mass index on adverse pregnancy outcomes: analysis from the Longitudinal Indian Family hEalth cohort study. AJOG Glob Rep 2023; 3:100134. [PMID: 36691397 DOI: 10.1016/j.xagr.2022.100134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Both high and low maternal prepregnancy body mass index can lead to suboptimal fetal growth and risk of pregnancy complications. In developed countries, nearly half of all women of childbearing age are either overweight or obese, and most data linking maternal body mass index and adverse pregnancy complications are limited to these populations. OBJECTIVE This study aimed to prospectively evaluate the relationships between prepregnancy body mass index and adverse pregnancy outcomes using the Longitudinal Indian Family hEalth (LIFE) study. STUDY DESIGN We modeled the relationships between prepregnancy body mass index and adverse pregnancy outcomes such as low birthweight, preterm birth, cesarean delivery, intrauterine growth restriction, miscarriage, and fetal death among 675 women aged 15 to 35 years with singleton pregnancies in the Longitudinal Indian Family hEalth study, a population-based prospective pregnancy cohort study conducted in Telangana, India. Prepregnancy body mass index was calculated as weight in kilograms divided by height in meters squared and was classified into 4 categories using the World Health Organization recommendations for Asian adults. Prepregnancy body mass index was assessed at a mean of 12.3 months before pregnancy. Odds ratios and 95% confidence intervals of adverse pregnancy outcomes were modeled and adjusted for confounders. RESULTS Obese women had a 3-fold increased risk of cesarean delivery (odds ratio, 3.13; 95% confidence interval, 1.56-6.29) compared with normal-weight women. Those who were overweight also had a marginally increased risk of cesarean delivery, albeit not statistically significant (odds ratio, 1.17; 95% confidence interval, 0.61-2.24). Underweight women had a modestly increased risk of low birthweight, compared with normal-weight women (odds ratio, 1.12; 95% confidence interval, 0.71-1.77), although results were not significant. Conversely, obese (odds ratio, 0.71; 95% confidence interval, 0.28-1.77) and overweight (odds ratio, 0.61; 95% confidence interval, 0.24-1.51) women had a marginally decreased risk of low birthweight. CONCLUSION Our data suggest that women with elevated prepregnancy body mass index may have a higher risk of adverse pregnancy outcomes, especially cesarean delivery. Although this study has limited generalizability, our findings are generalizable to rural to periurban regions of India. Further studies exploring the translatability of these findings to other populations are needed. In addition, targeted prepregnancy intervention studies and programs that include counseling on optimization of preconception health and lifestyle modification for improvement of subsequent pregnancy outcomes among overweight and obese women are needed.
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Viano DC, Parenteau CS. Fetal deaths and maternal injury in motor-vehicle crashes using NASS-CDS and CISS field data. Traffic Inj Prev 2022; 24:14-20. [PMID: 36318877 DOI: 10.1080/15389588.2022.2140409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/17/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE This study determined the risk for fetal death and maternal injury in the same sample of motor-vehicle crashes. The frequency and risk of serious injury (MAIS 3 + F) were also assessed by sex, pregnancy, seating position and crash type. METHOD The 2008-2015 NASS-CDS and 2017-2020 CISS are representative samples that were analyzed for the risk of fetal death and the risk of maternal injury grouped by MAIS 0-2, MAIS 3 + F and death (F) in 2000+ model year (MY) light vehicles. All electronic cases involving fetal mortality were reviewed for mechanism of injury. Separately, the 2000-2015 NASS-CDS and 2017-2020 CISS data was analyzed for the risk of serious injury for male, female and pregnant female occupants by seating position and crash type in 2000+ MY light vehicles. All calculations are made with weighted data. The significance of differences in risk was determined by the Rao-Scott chi-square test in SAS and z-test for differences in proportions. RESULTS There were 2,467 ± 1,407 fetal deaths in light vehicle crashes from 2008-2015 and 2016-2020 with an annual occurrence of 206/yr. The risk for fetal death was 1.25% ± 0.74% of exposed pregnant females. There were 127 ± 67 deaths of pregnant females, or 11/yr in the same sample. The fatality risk was 0.065% ± 0.035%. The difference in proportions was statistically significant (z = 46.1, p < 0.0001). Fetal deaths occurred 19.4-times more often than deaths of pregnant females. In 82.9% of the crashes with a fetal death, the pregnant female was not seriously injured (MAIS 3 + F). The most common mechanism of fetal death was a minor crash, in 80.1% of the weighted cases based on review of photos of the case vehicle and observing very minor structural damage to the vehicle. The minor crash involved either yaw of the occupant compartment with side loading of the pregnant female or her displacement into the restraint system and side interior in 71.7% of the crashes. A severe crash with intrusion at the seating position of the pregnant female occurred in only 11.5% of cases. It usually caused serious injury to the pregnant female and fetal death. CONCLUSIONS Fetal deaths occurred 19.4-times more often than deaths of pregnant females in a 12-year sample of motor-vehicle crashes. The most common mechanism was a minor crash that resulted in a fetal death without serious injury to the pregnant female and involved side or oblique loading of the pregnant female.
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Cozzi GD, Jauk VC, Szychowski JM, Tita AT, Battarbee AN, Subramaniam A. Participation in obstetrical studies is associated with improved pregnancy outcomes. Am J Obstet Gynecol MFM 2022; 4:100729. [PMID: 35995368 PMCID: PMC10577523 DOI: 10.1016/j.ajogmf.2022.100729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The association between pregnant patients participating in obstetrical studies and pregnancy outcomes is understudied. OBJECTIVE This study aimed to evaluate the association between participation in obstetrical studies and maternal and neonatal outcomes. STUDY DESIGN This was a retrospective cohort study of all patients delivering at a single center from 2013 to 2018. Patients with pregnancy loss at <13 weeks of gestation or major fetal anomalies were excluded. Patients who enrolled in one or more obstetrical studies were categorized as "study participants" and were compared with patients who did not enroll in an obstetrical study, that is, "study nonparticipants." The primary outcome was a composite of maternal morbidity diagnosed up to 6 weeks after delivery. The secondary outcomes included composite neonatal morbidity and other perinatal outcomes. Bivariate analyses compared baseline demographics and outcomes between groups. Multivariable logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals. Subgroup analyses by study design (trial or observational) were planned. RESULTS Of 19,569 patients included in this analysis, 3848 (19.7%) were study participants, and 15,721 (80.3%) were study nonparticipants. Among study participants, 3023 (78.6%) enrolled in a trial, and 825 (21.4%) enrolled in an observational study. The study participants had higher body mass index and were more likely to be younger, non-Hispanic Black, publicly insured, nulliparous, and undergo cesarean delivery than study nonparticipants. Compared with study nonparticipants, the study participants had significantly lower odds of composite maternal morbidity (9.2% vs 8.7%; adjusted odds ratio, 0.83; 95% confidence interval, 0.73-0.95) and composite neonatal morbidity (27.5% vs 18.6%; adjusted odds ratio, 0.53; 95% confidence interval, 0.48-0.58). In addition, the odds of fetal death, 5-minute Apgar score of <5, neonatal death, maternal and neonatal intensive care unit admissions, and lengths of stay were lower for study participants than for study nonparticipants. In stratified analyses, maternal morbidity was only significantly decreased among trial participants; however, there was a significantly reduced odds of neonatal morbidity, regardless of study design (trial or observational vs no study). CONCLUSION Participation in obstetrical studies was associated with decreased maternal and neonatal morbidities after adjusting for potential confounders. This underscored the importance of pregnant patients enrolling in obstetrical clinical studies and potentially benefiting from the additional surveillance. Further study of how study participation exerts this effect on pregnancy outcomes is warranted.
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Affiliation(s)
- Gabriella D Cozzi
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam).
| | - Victoria C Jauk
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam)
| | - Jeff M Szychowski
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam); Biostatistics (Dr Szychowski), University of Alabama at Birmingham, Birmingham, AL
| | - Alan T Tita
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
| | - Ashley N Battarbee
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
| | - Akila Subramaniam
- Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL (Dr Cozzi, Ms Jauk, and Drs Szychowski, Tita, Battarbee, and Subramaniam); Departments of Obstetrics and Gynecology (Drs Cozzi, Szychowski, Tita, Battarbee, and Subramaniam)
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Winterstein AG, Thai TN, Nduaguba S, Smolinski NE, Wang X, Sahin L, Krefting I, Gelperin K, Bird ST, Rasmussen SA. Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy. Am J Obstet Gynecol 2022; 228:465.e1-465.e11. [PMID: 36241080 DOI: 10.1016/j.ajog.2022.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concerns have been raised about prenatal exposure to magnetic resonance imaging with gadolinium-based contrast agents because of nonclinical findings of gadolinium retention in fetal tissue and 1 population-based study reporting an association with adverse pregnancy outcomes. OBJECTIVE This study aimed to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death and neonatal intensive care unit admission. STUDY DESIGN We constructed a retrospective cohort of >11 million Medicaid-covered pregnancies between 1999 and 2014 to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death (primary endpoint) and neonatal intensive care unit admissions (secondary endpoint). Medicaid claims data were linked to medical records, Florida birth and fetal death records, and the National Death Index to validate the outcomes and gestational age estimates. Pregnancies with multiples, concurrent cancer, teratogenic drug exposure, magnetic resonance imaging focused on fetal or pelvic evaluation, undetermined gadolinium-based contrast agent use, or those preceded by or contemporaneous with congenital anomaly diagnoses were excluded. We adjusted for potential confounders with standardized mortality ratio weighting using propensity scores. RESULTS Among 5991 qualifying pregnancies, we found 11 fetal or neonatal deaths in the gadolinium-based contrast agent magnetic resonance imaging group (1.4%) and 73 in the non-gadolinium-based contrast agent magnetic resonance imaging group (1.4%) with an adjusted relative risk of 0.73 (95% confidence interval, 0.34-1.55); the neonatal intensive care unit admission adjusted relative risk was 1.03 (0.76-1.39). Sensitivity analyses investigating the timing of magnetic resonance imaging or repeat magnetic resonance imaging exposure during pregnancy and simulating the impact of exposure misclassification corroborated these results. CONCLUSION This study addressed the safety concerns related to prenatal exposure to gadolinium-based contrast agents used in magnetic resonance imaging and the risk thereof on fetal and neonatal death or the need for neonatal intensive care unit admission. Although the results on fatal or severe acute effects are reassuring, the impact on subacute outcomes was not evaluated.
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Affiliation(s)
- Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL.
| | - Thuy N Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Leyla Sahin
- Division of Pediatrics and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, MD
| | - Ira Krefting
- Division of Imaging and Radiation Medicine, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Kate Gelperin
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Steven T Bird
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Sonja A Rasmussen
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL; Departments of Pediatrics, College of Medicine, University of Florida, Gainesville, FL; Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL
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Romero R, Jung E, Chaiworapongsa T, Erez O, Gudicha DW, Kim YM, Kim JS, Kim B, Kusanovic JP, Gotsch F, Taran AB, Yoon BH, Hassan SS, Hsu CD, Chaemsaithong P, Gomez-Lopez N, Yeo L, Kim CJ, Tarca AL. Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology. Am J Obstet Gynecol 2022; 227:615.e1-615.e25. [PMID: 36180175 PMCID: PMC9525890 DOI: 10.1016/j.ajog.2022.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The major challenge for obstetrics is the prediction and prevention of the great obstetrical syndromes. We propose that defining obstetrical diseases by the combination of clinical presentation and disease mechanisms as inferred by placental pathology will aid in the discovery of biomarkers and add specificity to those already known. OBJECTIVE To describe the longitudinal profile of placental growth factor (PlGF), soluble fms-like tyrosine kinase-1 (sFlt-1), and the PlGF/sFlt-1 ratio throughout gestation, and to determine whether the association between abnormal biomarker profiles and obstetrical syndromes is strengthened by information derived from placental examination, eg, the presence or absence of placental lesions of maternal vascular malperfusion. STUDY DESIGN This retrospective case cohort study was based on a parent cohort of 4006 pregnant women enrolled prospectively. The case cohort of 1499 pregnant women included 1000 randomly selected patients from the parent cohort and all additional patients with obstetrical syndromes from the parent cohort. Pregnant women were classified into six groups: 1) term delivery without pregnancy complications (n=540; control); 2) preterm labor and delivery (n=203); 3) preterm premature rupture of the membranes (n=112); 4) preeclampsia (n=230); 5) small-for-gestational-age neonate (n=334); and 6) other pregnancy complications (n=182). Maternal plasma concentrations of PlGF and sFlt-1 were determined by enzyme-linked immunosorbent assays in 7560 longitudinal samples. Placental pathologists, masked to clinical outcomes, diagnosed the presence or absence of placental lesions of maternal vascular malperfusion. Comparisons between mean biomarker concentrations in cases and controls were performed by utilizing longitudinal generalized additive models. Comparisons were made between controls and each obstetrical syndrome with and without subclassifying cases according to the presence or absence of placental lesions of maternal vascular malperfusion. RESULTS 1) When obstetrical syndromes are classified based on the presence or absence of placental lesions of maternal vascular malperfusion, significant differences in the mean plasma concentrations of PlGF, sFlt-1, and the PlGF/sFlt-1 ratio between cases and controls emerge earlier in gestation; 2) the strength of association between an abnormal PlGF/sFlt-1 ratio and the occurrence of obstetrical syndromes increases when placental lesions of maternal vascular malperfusion are present (adjusted odds ratio [aOR], 13.6 vs 6.7 for preeclampsia; aOR, 8.1 vs 4.4 for small-for-gestational-age neonates; aOR, 5.5 vs 2.1 for preterm premature rupture of the membranes; and aOR, 3.3 vs 2.1 for preterm labor (all P<0.05); and 3) the PlGF/sFlt-1 ratio at 28 to 32 weeks of gestation is abnormal in patients who subsequently delivered due to preterm labor with intact membranes and in those with preterm premature rupture of the membranes if both groups have placental lesions of maternal vascular malperfusion. Such association is not significant in patients with these obstetrical syndromes who do not have placental lesions. CONCLUSION Classification of obstetrical syndromes according to the presence or absence of placental lesions of maternal vascular malperfusion allows biomarkers to be informative earlier in gestation and enhances the strength of association between biomarkers and clinical outcomes. We propose that a new taxonomy of obstetrical disorders informed by placental pathology will facilitate the discovery and implementation of biomarkers as well as the prediction and prevention of such disorders.
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI; Detroit Medical Center, Detroit, MI.
| | - Eunjung Jung
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Offer Erez
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Faculty of Health Sciences, Division of Obstetrics and Gynecology, Maternity Department "D," Soroka University Medical Center, School of Medicine, Ben-Gurion University of the Negev, Beersheba, Israel; Department of Obstetrics and Gynecology, HaEmek Medical Center, Afula, Israel
| | - Dereje W Gudicha
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Yeon Mee Kim
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung-Sun Kim
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI; Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Bomi Kim
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI; Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; División de Obstetricia y Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Centro de Investigación e Innovación en Medicina Materno-Fetal, Unidad de Alto Riesgo Obstétrico, Hospital Sotero Del Rio, Santiago, Chile
| | - Francesca Gotsch
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Andreea B Taran
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Bo Hyun Yoon
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Physiology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, University of Arizona, College of Medicine - Tucson, Tucson, AZ
| | - Piya Chaemsaithong
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Faculty of Medicine, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nardhy Gomez-Lopez
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI
| | - Lami Yeo
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI
| | - Chong Jai Kim
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Pathology, Wayne State University School of Medicine, Detroit, MI; Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Adi L Tarca
- Perinatology Research Branch, Divisions of Obstetrics and Maternal-Fetal Medicine and Intramural Research, US Department of Health and Human Services, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Computer Science, Wayne State University College of Engineering, Detroit, MI
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47
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Cassidy PR. Beyond emotional support: predictors of satisfaction and perceived care quality following the death of a baby during pregnancy. J Perinat Med 2022; 50:832-843. [PMID: 35468664 DOI: 10.1515/jpm-2021-0489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/27/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate which objective (actions/interventions) and subjective (perceptions of care quality) outcomes of care following stillbirth or termination of pregnancy predict perceived care quality. METHODS A cross-sectional descriptive study using an anonymous online survey. The population was women who had experienced a stillbirth or termination of pregnancy from ≥16 weeks of gestation, in the Spanish health system. Multiple sequential regression analysis was used to identify predictors of perceived care quality (satisfaction, willingness to recommend, competence and ability to provide loss-focused care). RESULTS Results from 610 women were analysed. A significant regression equation (p<0.001) was found in each of the objective only and objective-subjective models. In the case of overall care (satisfaction-recommend composite), 72.0% of variance (adj. R2) was explained. In general, subjective evaluations of care are more potent predictors of perceived care quality than objective care interventions (e.g. autopsy performed). Feeling free to 'express emotions', 'teamwork between doctors and nurses/midwives', and 'being well-informed of all steps and procedures' were the three strongest predictors, followed by perception of 'medical negligence'. Information provision and loss-focused interventions had the weakest influence, except in the specific 'loss-focused' model. CONCLUSIONS The results indicate that the 'atmosphere' of care is a transversal dimension related to the context of loss and trauma and has the single greatest influence on perceptions of care quality. It is necessary to use a specific 'loss-focused' care variable to adequately capture perceptions of the quality of bereavement care and a custom scale to measure the influence of care interventions on perceived quality.
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Affiliation(s)
- Paul Richard Cassidy
- Complutense University of Madrid, Umamanita (Stillbirth and Neonatal Death Charity), Carrer Major 3, 17133, Girona, Spain
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48
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Blix E, Eskild A, Skau I, Grytten J. The impact of the introduction of intrapartum fetal ECG ST segment analysis. A population study. Acta Obstet Gynecol Scand 2022; 101:809-818. [PMID: 35288935 DOI: 10.1111/aogs.14347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION ST segment analysis (STAN) of the fetal electrocardiogram was introduced as an adjunct to cardiotocography for intrapartum fetal monitoring 30 years ago. We examined the impact of the introduction of STAN on changes in the occurrence of fetal and neonatal deaths, Apgar scores of <7 at 5 min, intrapartum cesarean sections, and instrumental vaginal deliveries while controlling for time- and hospital-specific trends and maternal risk factors. MATERIAL AND METHODS Data were retrieved from the Medical Birth Registry of Norway from 1985 to 2014. Individual data were linked to the Education Registry and the Central Person Registry. The study sample included 1 132 022 singleton births with a gestational age of 36 weeks or beyond. Information about the year of STAN introduction was collected from every birth unit in Norway using a questionnaire. Our data structure consisted of a hospital-year panel. We applied a linear probability model with hospital-fixed effects and with adjustment for potentially confounding factors. The prevalence of the outcomes before and after the introduction of STAN were compared within each birth unit. RESULTS In total, 23 birth units, representing 76% of all births in Norway, had introduced the STAN technology. During the study period, stillbirths declined from 2.6 to 1.9 per 1000 births, neonatal deaths declined from 1.7 to 0.7 per 1000 live births, babies with Apgar score <7 at 5 min after birth increased from 7.4 to 9.5 per 1000 births, intrapartum cesarean sections increased from 6.4% to 9.5%, and instrumental vaginal deliveries increased from 7.8% to 10.9%. Our analyses found that the introduction of STAN was not associated with the decline in proportion of stillbirths (p =0.76) and neonatal deaths (p =0.76) or with the increase in intrapartum cesarean sections (p =0.92) and instrumental vaginal deliveries (p =0.78). However, it was associated with the increased occurrence of Apgar score <7 at 5 min (p =0.01). CONCLUSIONS There is no evidence that the introduction of STAN contributed to changes in the rates of stillbirths, neonatal deaths, intrapartum cesarean sections, or instrumental vaginal deliveries. There was an association between the introduction of STAN and a small increase in neonates with low Apgar scores.
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Affiliation(s)
- Ellen Blix
- Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Anne Eskild
- Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Irene Skau
- Department of Community Dentistry, University of Oslo, Oslo, Norway
| | - Jostein Grytten
- Department of Community Dentistry, University of Oslo, Oslo, Norway
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Johnson JE, Price AB, Sikorskii A, Key KD, Taylor B, Lamphere S, Huff C, Cinader M, Zlotnick C. Protocol for the Healing After Loss (HeAL) Study: a randomised controlled trial of interpersonal psychotherapy (IPT) for major depression following perinatal loss. BMJ Open 2022; 12:e057747. [PMID: 35440458 PMCID: PMC9020310 DOI: 10.1136/bmjopen-2021-057747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This protocol describes a study testing the efficacy of interpersonal psychotherapy (IPT) for major depressive disorder following perinatal loss (early and late fetal death and early neonatal death). Perinatal loss is associated with elevated risk of major depressive disorder and post-traumatic stress disorder (PTSD). Perinatal loss conveys specific treatment needs. The trial will be the first fully powered randomised trial of treatment for any psychiatric disorder following perinatal loss. METHODS AND ANALYSIS A sample of 274 women in Flint and Detroit areas in Michigan who experience a major depressive episode following a perinatal loss will be randomised to group IPT for perinatal loss or to group coping with depression. We anticipate that 50% of the sample will have co-occurring PTSD. Assessments occur at baseline, mid-treatment (8 weeks), post-treatment (16 weeks) and follow-up (28 weeks). Clinical outcomes include time to recovery from major depressive episode (primary), depressive symptoms, PTSD symptoms and time to recovery from PTSD. Additional outcomes include social support, social role functioning (including parental functioning for those with living children), well-being, grief (including complicated grief and fault beliefs) and fear of subsequent pregnancies. Social support and grief are hypothesised mediators of IPT effects on time to recovery from major depressive episode. ETHICS AND DISSEMINATION The trial was approved by Michigan State University's Biomedical Institutional Review Board. It has a data and safety monitoring board and has been submitted to the community-based organisation partners community ethics review board. Written operating procedures outline methods for protecting confidentiality, monitoring and recording adverse events, and safeguarding participants. We will share study results with research and clinical communities, community organisations through which we recruited, and will offer results to study participants. Deidentified datasets will be available through the National Institute of Mental Health Data Archive and to qualified investigators on request. TRIAL REGISTRATION NUMBER NCT04629599.
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Affiliation(s)
- Jennifer E Johnson
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, Flint, Michigan, USA
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Ann B Price
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Kent D Key
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Brandon Taylor
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Susan Lamphere
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Christine Huff
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Morgan Cinader
- Division of Public Health, Michigan State University College of Human Medicine, Flint, Michigan, USA
| | - Caron Zlotnick
- Department of Psychiatry, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
- Women and Infants Hospital of Rhode Island, Providence, Rhode Island, USA
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50
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Baschat AA, Galan HL, Lee W, DeVore GR, Mari G, Hobbins J, Vintzileos A, Platt LD, Manning FA. The role of the fetal biophysical profile in the management of fetal growth restriction. Am J Obstet Gynecol 2022; 226:475-486. [PMID: 35369904 DOI: 10.1016/j.ajog.2022.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/01/2022]
Abstract
Growth-restricted fetuses are at risk of hypoxemia, acidemia, and stillbirth because of progressive placental dysfunction. Current fetal well-being, neonatal risks following delivery, and the anticipated rate of fetal deterioration are the major management considerations in fetal growth restriction. Surveillance has to quantify the fetal risks accurately to determine the delivery threshold and identify the testing frequency most likely to capture future deterioration and prevent stillbirth. From the second trimester onward, the biophysical profile score correlates over 90% with the current fetal pH, and a normal score predicts a pH >7.25 with a 100% positive predictive value; an abnormal score on the other hand predicts current fetal acidemia with similar certainty. Between 30% and 70% of growth-restricted fetuses with a nonreactive heart rate require biophysical profile scoring to verify fetal well-being, and an abnormal score in 8% to 27% identifies the need for delivery, which is not suspected by Doppler findings. Future fetal well-being is not predicted by the biophysical profile score, which emphasizes the importance of umbilical artery Doppler and amniotic fluid volume to determine surveillance frequency. Studies with integrated surveillance strategies that combine frequent heart rate monitoring with biophysical profile scoring and Doppler report better outcomes and stillbirth rates of between 0% and 4%, compared with those between 8% and 11% with empirically determined surveillance frequency. The variations in clinical behavior and management challenges across gestational age are better addressed when biophysical profile scoring is integrated into the surveillance of fetal growth restriction. This review aims to provide guidance on biophysical profile scoring in the in- and outpatient management of fetal growth restriction.
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