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Vivod G, Merlo S, Kovacevic N. High-Grade Serous Ovarian Cancer during Pregnancy: From Diagnosis to Treatment. Curr Oncol 2024; 31:1920-1935. [PMID: 38668047 PMCID: PMC11048790 DOI: 10.3390/curroncol31040144] [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: 02/02/2024] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Due to the rarity of ovarian cancer diagnosed during pregnancy, the literature on the treatment of subtypes of epithelial ovarian cancer in pregnancy is sparse. The aim of our review was to analyze cases of high-grade serous ovarian cancer in pregnancy. METHODS The PubMed and Scopus databases were searched for relevant articles published in English between January 2000 and December 2023. The references of all the relevant reviews found were also checked to avoid omitting eligible studies. Information on the all retrieved cases was extracted and reviewed in detail. The most important detail was the subtype of high-grade serous ovarian cancer, which was referred to as serous adenocarcinoma (grade 2 or grade 3) in older cases. RESULTS We found eleven cases with relevant details of high-grade serous ovarian cancer diagnosed in pregnancy. Despite the small number of cases we found, our study demonstrated the importance of an accurate initial vaginal ultrasound at the first examination in pregnancy and the safety of diagnostic surgery and chemotherapy in pregnancy. CONCLUSIONS There have not been long-term follow-ups of patients' oncologic and obstetric outcomes. As patients should be comprehensively informed, more detailed case reports or series with longer follow-up periods are needed.
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Affiliation(s)
- Gregor Vivod
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sebastjan Merlo
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
| | - Nina Kovacevic
- Department of Gynecological Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (G.V.); (S.M.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Health Care Angela Boskin, 4270 Jesenice, Slovenia
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Le Guévelou J, Selleret L, Laas E, Lecuru F, Kissel M. Cervical Cancer Associated with Pregnancy: Current Challenges and Future Strategies. Cancers (Basel) 2024; 16:1341. [PMID: 38611019 PMCID: PMC11011172 DOI: 10.3390/cancers16071341] [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: 02/19/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer during pregnancy is defined as a tumor diagnosed in a pregnant woman or up to 1-year post-partum. While being a rare disease, cervical cancer is probably one of the most challenging medical conditions, with the dual stake of treating the cancer without compromising its chances for cure, while preserving the pregnancy and the health of the fetus and child. To date, guidelines for gynecological cancers are provided through international consensus meetings with expert panels, giving insights on both diagnosis, treatment, and obstetrical care. However, these expert guidelines do not discuss the various approaches than can be found within the literature, such as alternative staging modalities or innovative surgical approaches. Also, the obstetrical care of women diagnosed with cervical cancer during pregnancy requires specific considerations that are not provided within our current standard of care. This systematic review aims to fill the gap on current issues with regards to the management of cervical cancer during pregnancy and provide future directions within this evolving landscape.
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Affiliation(s)
- Jennifer Le Guévelou
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Radiation Oncology, Centre Eugène Marquis, 35000 Rennes, France
| | - Lise Selleret
- Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Sorbonne University, 75005 Paris, France
- Cancer Associé à La Grossesse (CALG), French CALG Network, 75005 Paris, France
| | - Enora Laas
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
| | - Fabrice Lecuru
- Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, 75005 Paris, France
- Université de Paris, 75006 Paris, France
| | - Manon Kissel
- Department of Radiation Oncology, Institut Curie, 75005 Paris, France
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Goto A, Fujita C, Horiguchi H, Iyama S, Kobune M. Successful Pregnancy and Fetal Outcomes Following Brentuximab Vedotin for Early Relapsed Classic Hodgkin Lymphoma After Autologous Stem Cell Transplant. Cureus 2024; 16:e57291. [PMID: 38690456 PMCID: PMC11058904 DOI: 10.7759/cureus.57291] [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: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
Brentuximab vedotin (BV), an anti-CD30 antibody with monomethyl auristatin E conjugate, has shown clinical effects against relapsed/refractory classic Hodgkin lymphoma (cHL) and hence is widely used in the clinical setting. We report a special clinical case of successful pregnancy and fetal outcome in a patient with cHL who achieved long-term remission with BV for early relapse after an autologous stem cell transplant (auto-SCT). A 27-year-old woman with advanced cHL achieved complete response (CR) after six cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) regimen. Embryos obtained from intracytoplasmic sperm injection were cryopreserved before the initiation of induction chemotherapy. Despite achieving a second CR following intensive salvage chemotherapy, auto-SCT, and radiotherapy, she relapsed again six months after transplantation. BV monotherapy was administered as salvage therapy. She completed 16 cycles of BV and achieved CR. Six months after BV completion, she expressed her desire to bear a child. She achieved pregnancy through third in vitro fertilization and embryo transfer and delivered a healthy baby. BV may provide a potentially curative treatment for patients with cHL relapsed after auto-SCT. Pregnancy should be avoided during BV administration up to a certain period after the end of administration. Fertility preservation is important for adolescent and young adult cancer survivors, and patients should be informed of cancer-related infertility and fertility preservation options prior to the initiation of cancer treatment.
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Affiliation(s)
- Akari Goto
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Chisa Fujita
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Hiroto Horiguchi
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Satoshi Iyama
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
| | - Masayoshi Kobune
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, JPN
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Pathak J, Goel N, Jha SK, Rani S, Kumari K, Ranjana R. Comparing Feto-Maternal Outcomes in Pregnant Women With Normal and Abnormal Liver Function Tests: A Prospective Observational Study. Cureus 2024; 16:e56811. [PMID: 38654811 PMCID: PMC11036451 DOI: 10.7759/cureus.56811] [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: 03/23/2024] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION Pregnant women with abnormal liver function tests (LFTs) require proper evaluation and timely management to reduce maternal and fetal morbidity and mortality. OBJECTIVE The present study was done with the objective of determining feto-maternal outcomes in antenatal women with abnormal LFTs and comparing them with antenatal women having normal liver function. The prevalence and possible causes of derangements in LFT were also identified. METHOD Pregnant women referred to an antenatal clinic for several reasons pertaining to abnormal liver functions, and those admitted to the labor room for delivery with abnormal LFTs were included in the study. The pregnant women with abnormal LFT were studied prospectively, and they were compared with pregnant women having normal LFT. The fetal and maternal outcomes were also noted. RESULTS The pregnant women attending the antenatal clinic with a history of pruritus, abdominal pain, jaundice, nausea/vomiting, hypertension ascites, etc. and delivered at our facility were evaluated. One hundred and eight women had abnormal LFT defined by criteria laid down in material and methods. Eighty-seven women with normal LFT were taken for comparison. In the abnormal LFT, the main cause was intrahepatic cholestasis of pregnancy (IHCP). There were 6 (5.5%) maternal deaths in this group and none in the normal LFTs. There were 6 (5.6%) fetal deaths and 4 (4.6%) in the other group (p-value=1). The prevalence of abnormal LFT was 9.11% throughout pregnancy. Increased bilirubin and alkaline phosphatase (ALP) were significantly correlated with maternal mortality, while gestational age at birth, presence of meconium, appearance, pulse, grimace, activity, and respiration (APGAR) score, maternal mortality, and raised alkaline phosphatase level were found to be significantly associated with fetal mortality. CONCLUSION Patients with abnormal LFT were significantly associated with maternal morbidity and mortality. However, fetal outcomes in patients with abnormal and normal LFT were similar. Hyperbilirubinemia and raised alanine aminotransferase (ALT) were significant predictors of maternal mortality.
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Affiliation(s)
- Jyotsna Pathak
- Obstetrics and Gynecology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Neeru Goel
- Obstetrics and Gynecology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Sanjeev Kumar Jha
- Gastroenterology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Sweety Rani
- Obstetrics and Gynecology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Kanchan Kumari
- Obstetrics and Gynecology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
| | - Ranjana Ranjana
- Obstetrics and Gynecology, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, IND
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Johal D, Kale M, Brar S. Maternal and Fetal Outcomes in Pregnancy in the Fifth Decade of Life and Beyond. J Obstet Gynaecol Can 2024; 46:102418. [PMID: 38423466 DOI: 10.1016/j.jogc.2024.102418] [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: 10/23/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (AMA) (over age 50 years) in Calgary. The secondary objective is to determine if there is a role in protocolizing complex care plans for patients at extreme AMAs. METHODS A retrospective chart review was conducted of all pregnancies ≥20 weeks gestation in patients over the age of 50 years that delivered in Calgary between January 2007 and December 2021. Pregnancy data were collected, including maternal age, pre-existing medical conditions, mode and timing of delivery, neonatal outcomes, neonatal intensive care unit (NICU) and adult intensive care unit (ICU) admissions, postpartum complications, and maternal or neonatal death. Data were extracted for maternity patients as well as neonatal ICU databases. Maternal and neonatal outcomes were assessed until discharge from hospital. RESULTS All 23 pregnancies identified were achieved through assisted reproductive technologies. Comorbidities varied, but the most common comorbidities included hypertension and gestational diabetes. Cesarean delivery was the most common form of delivery. Three cases involved postpartum maternal ICU admission. Neonatal outcomes included gestational ages of 22-39 weeks and birth weights of 486-3593 g, with 8 confirmed NICU admissions. The most common neonatal complications were jaundice and small for gestational age. CONCLUSIONS Extremely AMA patients are more likely to have pre-existing comorbidities and develop comorbidities during pregnancy. The potential for adverse maternal and fetal outcomes is greater for these pregnancies; however, the complications are diverse and developing a universal complex care plan is difficult.
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Affiliation(s)
- Dildar Johal
- Department of Biological Sciences, University of Calgary, Calgary, AB.
| | - Mruganka Kale
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB
| | - Simrit Brar
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, AB
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Dixit S, Dixit NA, Rawat A, Bajpai A, Alelyani M, Sabah ZU, Raghuwanshi S. Color Doppler ultrasound in high-low risk pregnancies and its relationship to fetal outcomes: a cross-sectional study. Front Pediatr 2024; 11:1221766. [PMID: 38444769 PMCID: PMC10912586 DOI: 10.3389/fped.2023.1221766] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/26/2023] [Indexed: 03/07/2024] Open
Abstract
Objective To calculate the multivessel color Doppler indices in high-risk and low-risk pregnancies and relate these to fetal outcomes. Methods The investigation involved 60 patients who were pregnant. The patients were separated into groups according to assessment of low and high risk. The patients underwent color Doppler ultrasonography to detect the maternal and fetal blood vessels, and the measured Doppler indices were then analyzed for any association with fetal outcomes. Results The gestational stages (in weeks) of the participants at the respective times of investigation and delivery were 32.06 ± 2.98 and 36.2 ± 1.78 in the low-risk group and 29.21 ± 1.95 and 29.83 ± 1.86 in the high-risk group. The pulsatility index (PI), resistive index (RI), and systolic/diastolic ratio (SD) decreased with gestation length in the low-risk group, whereas in the high-risk group, these values increased in the uterine and umbilical arteries. With increased gestational stage, MCA-PSV (peak systolic velocity) in the middle cerebral artery (MCA) increased, while PI decreased. Pulsatile and reversal flow of the uterine vein, the vein of Galen, and the umbilical vein were noted in high-risk pregnancies, and these negatively affected the fetal outcome. The fetal venous parameters were more specific and sensitive for predicting an unfavorable fetal outcome than the arterial factors, with a greater negative predictive value. Conclusion The results of our study indicate that abnormal Doppler indices of the blood vessels in high-risk pregnant patients will result in adverse clinical outcomes. Therefore, the patients can be monitored and managed accordingly using Doppler ultrasonography.
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Affiliation(s)
- Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Nitin Arun Dixit
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Anil Rawat
- Department of Radiodiagnosis, King George Medical University, Lucknow, India
| | - Akanksha Bajpai
- Department of Radiodiagnosis, Career Institute of Medical Sciences, Lucknow, India
| | - Magbool Alelyani
- Department of Radiological Sciences, College of Applied Medical Science, King Khalid University, Abha, Saudi Arabia
| | - Zia Ul Sabah
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
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Wander G, Breviario S, Krishnathasan K, Patel RR, Habibi H, Li W, Johnson MR, Gatzoulis MA, Dimopoulos K, Rafiq I. Multifaceted Fontan Patients and Their Response to Pregnancy. JACC Case Rep 2023; 28:102136. [PMID: 38204530 PMCID: PMC10774892 DOI: 10.1016/j.jaccas.2023.102136] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 01/12/2024]
Abstract
We present 4 patients with Fontan circulation who underwent successful pregnancies, albeit with complications that required close monitoring and timely intervention. Each Fontan patient presents with a unique clinical picture, making risk stratification challenging but all the more important.
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Affiliation(s)
- Gurleen Wander
- Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Susanna Breviario
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Kaushiga Krishnathasan
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roshni R. Patel
- Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Hajar Habibi
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Wei Li
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Mark R. Johnson
- Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Michael A. Gatzoulis
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Konstantinos Dimopoulos
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Isma Rafiq
- Royal Brompton Hospital, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
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D'Ambrosio V, Vena F, Scopelliti A, D'Aniello D, Savastano G, Brunelli R, Giancotti A. Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review. J Matern Fetal Neonatal Med 2023; 36:2253956. [PMID: 38092425 DOI: 10.1080/14767058.2023.2253956] [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: 04/28/2022] [Accepted: 08/26/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid. METHODS Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI). RESULTS Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment. CONCLUSIONS The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.
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Affiliation(s)
- Valentina D'Ambrosio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Flaminia Vena
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Annalisa Scopelliti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Debora D'Aniello
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Giovanna Savastano
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Umberto I Hospital, Rome, Italy
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Vaajala M, Liukkonen R, Ponkilainen V, Kekki M, Mattila VM, Kuitunen I. Delivery mode and fetal outcome in attempted vaginal deliveries after previous cesarean section: a nationwide register-based cohort study in Finland. J Matern Fetal Neonatal Med 2023; 36:2198062. [PMID: 37031969 DOI: 10.1080/14767058.2023.2198062] [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: 04/11/2023]
Abstract
PURPOSE Even though the risks and advantages of repeat Cesarean sections (CSs) and vaginal births after cesarean section (VBACs) are well studied, there is a scarcity of information on the effects of previous CS on maternal and fetal outcomes during subsequent deliveries. The aim of this study is to evaluate delivery mode and fetal outcomes in a trial of labor after cesarean section (TOLAC). METHODS In this nationwide retrospective cohort study, data from the National Medical Birth Register (MBR) were used to evaluate the outcomes of TOLACs. TOLACs were compared to the outcomes of the trial of labor after previous successful vaginal delivery. A multivariable logistic regression model was used to assess the primary outcomes (delivery mode, neonatal intensive care unit, and perinatal/neonatal mortality). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used for comparison. RESULTS A total of 29 352 (77.0%) women attempted vaginal delivery in the TOLAC group. In the control group, 169 377 (97.2%) women attempted vaginal delivery. The adjusted odds for urgent CS (aOR 13.05, CI 12.59-13.65) and emergency CS (aOR 3.65, CI 3.26-4.08) were notably higher in the TOLAC group when compared to the control group. The odds for neonatal intensive care unit treatment (aOR 2.05, CI 1.98-2.14), perinatal mortality (aOR 2.15, CI 1.79-2.57), and neonatal mortality (aOR 1.75, CI 1.20-2.49) were higher in the TOLAC group. CONCLUSIONS The odds for emergency CS were higher among women who underwent TOLAC. The odds for neonatal intensive care and perinatal mortality were also higher, and further research is needed to identify those expecting women who are better suited for TOLAC to minimize the risk for a neonate. The results of this study should be acknowledged by the mother and the clinician when considering the possibility of vaginal births after cesarean section.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Rasmus Liukkonen
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
- Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland
- Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Kleuskens DG, Van Veen CMC, Groenendaal F, Ganzevoort W, Gordijn SJ, Van Rijn BB, Lely AT, Schuit E, Kooiman J. Prediction of fetal and neonatal outcomes after preterm manifestations of placental insufficiency: systematic review of prediction models. Ultrasound Obstet Gynecol 2023; 62:644-652. [PMID: 37161550 DOI: 10.1002/uog.26245] [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: 12/19/2022] [Revised: 03/31/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES To identify all prediction models for fetal and neonatal outcomes in pregnancies with preterm manifestations of placental insufficiency (gestational hypertension, pre-eclampsia, HELLP syndrome or fetal growth restriction with its onset before 37 weeks' gestation) and to assess the quality of the models and their performance on external validation. METHODS A systematic literature search was performed in PubMed, Web of Science and EMBASE. Studies describing prediction models for fetal/neonatal mortality or significant neonatal morbidity in patients with preterm placental insufficiency disorders were included. Data extraction was performed using the CHARMS checklist. Risk of bias was assessed using PROBAST. Literature selection and data extraction were performed by two researchers independently. RESULTS Our literature search yielded 22 491 unique publications. Fourteen were included after full-text screening of 218 articles that remained after initial exclusions. The studies derived a total of 41 prediction models, including four models in the setting of pre-eclampsia or HELLP, two models in the setting of fetal growth restriction and/or pre-eclampsia and 35 models in the setting of fetal growth restriction. None of the models was validated externally, and internal validation was performed in only two studies. The final models contained mainly ultrasound (Doppler) markers as predictors of fetal/neonatal mortality and neonatal morbidity. Discriminative properties were reported for 27/41 models (c-statistic between 0.6 and 0.9). Only two studies presented a calibration plot. The risk of bias was assessed as unclear in one model and high for all other models, mainly owing to the use of inappropriate statistical methods. CONCLUSIONS We identified 41 prediction models for fetal and neonatal outcomes in pregnancies with preterm manifestations of placental insufficiency. All models were considered to be of low methodological quality, apart from one that had unclear methodological quality. Higher-quality models and external validation studies are needed to inform clinical decision-making based on prediction models. © 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)
- D G Kleuskens
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - C M C Van Veen
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - F Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B B Van Rijn
- Department of Obstetrics and Fetal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A T Lely
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - E Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Kooiman
- Department of Obstetrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
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Eltayeb MM, Mohamad RMA, Alhawiti IS, Alsulami GM, Buraei SSEM, Mohammed SSH, Awaji HH. Neonatal Outcome of Mothers With COVID-19 in King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia. Cureus 2023; 15:e45257. [PMID: 37842358 PMCID: PMC10576630 DOI: 10.7759/cureus.45257] [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] [Accepted: 09/07/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES This study was conducted to assess the neonatal outcome of mothers with COVID-19 in King Salman Armed Forces Hospital, Tabuk, Saudi Arabia. METHODS This was a hospital record-based, retrospective cohort study. The case group included neonates born to mothers who were positive for the COVID-19 virus during pregnancy, whereas the control group included neonates born to mothers who were not infected with the COVID-19 virus during pregnancy. The data were collected from the records and were analyzed using the Statistical Package for the Social Sciences software (IBM Corp., Armonk, NY, USA). RESULTS This study covered the hospital records of 342 women (114 cases and 228 control). The rates of cesarean sections and small for gestational age were significantly higher among the cases compared to the controls (71.1% versus 43.4%, p < 0.001 and 24.6% versus 11.8%, p = 0.003; respectively). The mean birth weight was significantly lower among the cases group (3.0 ± 0.6 versus 3.3 ± 0.6 kg, p = 0.022). Only the case group reported the occurrence of neonatal COVID-19 infection (7.9%, p < 0.001). The study reported only a single case of intrauterine fetal death and one stillbirth in the cases group, but no neonatal deaths (p > 0.05). CONCLUSIONS Maternal COVID-19 may be associated with undesirable neonatal outcomes. There is a possibility of vertical transmission of COVID-19 from the mother to the neonate, but this cannot be confirmed.
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Affiliation(s)
| | | | | | | | | | | | - Hosam Hadi Awaji
- Preventive Medicine Department, King Salman Armed Forces Hospital, Tabuk, SAU
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12
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Momoh R, Kent O, Lambourne J, Fernandes R. Ruptured splenic artery aneurysm in pregnancy. Int J Gynaecol Obstet 2023; 162:1106-1107. [PMID: 37269112 DOI: 10.1002/ijgo.14908] [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: 12/12/2022] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 06/04/2023]
Abstract
SynopsisA rare case of a massive hemorrhage from a ruptured splenic artery aneurysm (SAA) in pregnancy that resulted in an emergency laparotomy, splenectomy, and cesarean section with maternal survival, but fetal loss, is presented. The development of protocols or guidelines for the early identification or prevention of SAA rupture in pregnancy would be of greater importance than reactive measures to control acute SAA bleeds.
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Affiliation(s)
- Rabiu Momoh
- Department of Intensive Care Medicine, William Harvey Hospital, Ashford, Kent, UK
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13
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Al-Marhabi BD, Fahim WA, Katooa NE, Al-Nujaydi AA. Maternal and Fetal Outcomes Among Pregnant Women Exposed to Violence. Cureus 2023; 15:e44715. [PMID: 37809198 PMCID: PMC10552788 DOI: 10.7759/cureus.44715] [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] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Domestic violence against women is now widely recognized as a public health issue and a major human rights violation on a global scale. It is a significant risk factor for women's health problems. Pregnancy places a woman under significant physical and psychological pressure, even without additional stressors like abuse. This pressure can have a negative impact on both the mother's and the child's health. This study aims to assess the prevalence of violence among pregnant women and to determine the maternal and fetal outcomes among pregnant women exposed to violence. Materials and methods This cross-sectional study was conducted among 347 postpartum women to assess maternal and fetal outcomes among those who were exposed to violence during their pregnancy. A face-to-face interview was done using one tool with three parts to collect the necessary data. Part one included socio-demographic characteristics and reproductive history for participants, part two included safe and validated dates-physical violence victimization scale, and part three included maternal and fetal outcomes. Result The findings of this study showed that the prevalence of victimization occurred one to three times (28.8%), while 11.5% of victimization occurred four to nine times, and 2.6% of victimization occurred 10 times or more. Many factors play a role in violence, including family income, husband's jobs, husband smoking, being forced into marriage, a higher number of children, and parity. Additionally, it was discovered that adverse pregnancy and fetal outcomes include preterm birth (PTB), early onset of labor, low birth weight (LBW), and neonatal admission to the intensive care unit. Conclusion The result indicates that violence against pregnant women is at a significant rate. Their findings show that there are several factors that may have caused this percentage. Among the factors that contributed to violence in this study were family income, smoking, husbands' work, forced marriage, the number of pregnancies, and the number of children. To reduce violence during pregnancy, it is crucial to empower women, especially those without a source of income of their own. It is also critical to educate partners and foster healthy relationships between partners.
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Affiliation(s)
| | - Wafaa A Fahim
- Faculty of Nursing, King Abdulaziz University, Jeddah, SAU
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14
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Wanyonyi S, Nyagaka F, Okiro P, Ogutu L, Nyaichowa A, Oindi F, Sequeira E. Umbilical cord hemangioma and pseudocyst with favorable fetal outcome. Clin Case Rep 2023; 11:e7656. [PMID: 37415590 PMCID: PMC10319952 DOI: 10.1002/ccr3.7656] [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: 04/05/2023] [Revised: 05/19/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023] Open
Abstract
Key Clinical Message There is a high association between umbilical cord hemangiomas or cysts with fetal mortality. However, favorable outcome is possible with proper prenatal monitoring and care. Abstract Umbilical cord hemangiomas are rare neoplasms of vascular origin, commonly found in the free section of the umbilical cord proximal to placental insertion. They are associated with an increased risk of fetal mortality. We present a rare co-occurrence of an umbilical cord hemangioma and a pseudocyst managed conservatively, with favorable fetal outcome despite the interval increase in size, decreased caliber of the umbilical arteries, and fetal chest compression.
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Affiliation(s)
- Sikolia Wanyonyi
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Felix Nyagaka
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | | | - Lilian Ogutu
- Department of PathologyAga Khan UniversityNairobiKenya
| | - Alice Nyaichowa
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Felix Oindi
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
| | - Evan Sequeira
- Department of Obstetrics and GynecologyAga Khan UniversityNairobiKenya
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15
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Kale RM, Tirupathi RG, Sheela SR. Role of Ultrasonography and Color Doppler in the Assessment of High-Risk Pregnancies and Their Accuracy in Predicting Fetal Outcome. Cureus 2023; 15:e39017. [PMID: 37323339 PMCID: PMC10265127 DOI: 10.7759/cureus.39017] [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: 04/22/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Various methods are employed to evaluate the well-being of the fetus in high-risk pregnancies which consists of a biophysical profile (BPP), a non-stress test (NST), and daily fetal movements. Detection of aberrant blood flow in fetoplacental beds has been revolutionized by recent developments in ultrasound technology, such as color Doppler flow velocimetry. The cornerstone of maternal and fetal care is lowering maternal and perinatal mortality and morbidity is antepartum fetal surveillance. Doppler ultrasound is a non-invasive way of obtaining a qualitative and quantitative evaluation of maternal and fetal circulation and is utilized to investigate complications like fetal growth restriction (FGR) and fetal distress. Thus, it is useful in making distinctions between fetuses that are truly growth restricted and small for gestational age and healthy fetuses. The aim of the current study was to determine the role of Doppler indices in high-risk pregnancies and their accuracy in predicting fetal outcomes. Material and methods This prospective cohort study included 90 high-risk pregnancies in the III trimester (after 28 weeks of gestation) on whom ultrasonography and Doppler were performed. Ultrasonography was performed using PHILIPS EPIQ 5, a curvilinear probe of frequency 2-5MHz. Gestational age was determined with a biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femoral length (FL). Placental grading and position were noted. Estimated fetal weight and the amniotic fluid index were calculated. BPP scoring was done. Doppler study was conducted and the findings of Doppler indices that is pulsatility index (PI) and resistive index (RI) of the middle cerebral artery (MCA), umbilical artery (UA), and uterine artery (UTA), and cerebroplacental (CP) ratio in these high-risk pregnancies were documented and compared with standard. The flow patterns in MCA, UA, and UTA were also assessed. These findings were correlated with fetal outcomes. Results Among 90 cases, the common high-risk factor in pregnancy was preeclampsia without severe features (30%). Growth lag was present in 43 (47.8%) participants. Among the study population, HC/AC ratio was increased in 19 (21.1%) participants which indicates asymmetrical intrauterine growth restriction. Adverse fetal outcomes were seen in 59 (65.6%) of the subjects. CP ratio and UA PI had better sensitivity (83.05% and 79.66%, respectively) and positive predictive value (PPV) (87.50% and 90.38%, respectively) in identifying the adverse fetal outcomes. Diagnostic accuracy of CP ratio and UA PI (Accuracy=81.11%) was highest in predicting adverse outcomes than all the other parameters. Conclusion CP ratio and UA PI had better sensitivity, PPV, and diagnostic accuracy in identifying adverse fetal outcomes than other parameters. The study's findings support that the use of color Doppler imaging in high-risk pregnancies will help in the early identification of adverse fetal outcomes and aid in early intervention. This study is non-invasive, simple, safe, and reproducible. This study can also be performed bedside in high risk and unstable patients. This study is required to accurately assess fetal well-being in all high-risk pregnancies in order to improve fetal outcomes and to incorporate this procedure as a part of the protocol for the assessment of fetal well-being in these patients.
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Affiliation(s)
- R Mahima Kale
- Department of Radiodiagnosis, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - Rajeswari G Tirupathi
- Department of Radiodiagnosis, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
| | - S R Sheela
- Department of Obstetrics and Gynecology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND
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16
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Sarno L, Neola D, Carbone L, Saccone G, Carlea A, Miceli M, Iorio GG, Mappa I, Rizzo G, Girolamo RD, D'Antonio F, Guida M, Maruotti GM. Use of artificial intelligence in obstetrics: not quite ready for prime time. Am J Obstet Gynecol MFM 2023; 5:100792. [PMID: 36356939 DOI: 10.1016/j.ajogmf.2022.100792] [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: 07/18/2022] [Revised: 10/18/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
Abstract
Artificial intelligence is finding several applications in healthcare settings. This study aimed to report evidence on the effectiveness of artificial intelligence application in obstetrics. Through a narrative review of literature, we described artificial intelligence use in different obstetrical areas as follows: prenatal diagnosis, fetal heart monitoring, prediction and management of pregnancy-related complications (preeclampsia, preterm birth, gestational diabetes mellitus, and placenta accreta spectrum), and labor. Artificial intelligence seems to be a promising tool to help clinicians in daily clinical activity. The main advantages that emerged from this review are related to the reduction of inter- and intraoperator variability, time reduction of procedures, and improvement of overall diagnostic performance. However, nowadays, the diffusion of these systems in routine clinical practice raises several issues. Reported evidence is still very limited, and further studies are needed to confirm the clinical applicability of artificial intelligence. Moreover, better training of clinicians designed to use these systems should be ensured, and evidence-based guidelines regarding this topic should be produced to enhance the strengths of artificial systems and minimize their limits.
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Affiliation(s)
- Laura Sarno
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida).
| | - Luigi Carbone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Gabriele Saccone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Annunziata Carlea
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Marco Miceli
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida); CEINGE Biotecnologie Avanzate, Naples, Italy (Dr Miceli)
| | - Giuseppe Gabriele Iorio
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (Dr Mappa and Dr Rizzo)
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rome Tor Vergata, Rome, Italy (Dr Mappa and Dr Rizzo)
| | - Raffaella Di Girolamo
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Francesco D'Antonio
- Center for Fetal Care and High Risk Pregnancy, Department of Obstetrics and Gynecology, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy (Dr D'Antonio)
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Sarno, Dr Neola, Dr Carbone, Dr Saccone, Dr Carlea, Dr Miceli, Dr Iorio, Dr Girolamo, and Dr Guida)
| | - Giuseppe Maria Maruotti
- Gynecology and Obstetrics Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy (Dr Maruotti)
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Muacevic A, Adler JR, Mujalda A, Mujalda J, Yadav S, Kundal RK. The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre. Cureus 2023; 15:e34318. [PMID: 36865957 PMCID: PMC9971241 DOI: 10.7759/cureus.34318] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. OBJECTIVES The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. MATERIAL AND METHODS The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. RESULTS Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications were sickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. CONCLUSION In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCD vigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.
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Wang L, Zhou D, Long B, Wang J, Li L, Peng Y, Zhou Q, Zeng S. The abnormal umbilical venous-arterial index in the second half of pregnancy is associated with fetal outcome: A retrospective cross-sectional study. Front Pediatr 2023; 11:1036359. [PMID: 36969267 PMCID: PMC10036777 DOI: 10.3389/fped.2023.1036359] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/17/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study aims to observe the changes of the umbilical venous-arterial index (VAI) and investigate its predictive power for fetal outcome during the second half of pregnancy. Methods Fetuses with gestational age (GA) at 24-39 weeks were collected. According to the outcome score, neonates with outcome scores of 0, 1, or 2 were assigned to the control group, whereas those with scores of 3-12 were assigned to the compromised group. VAI was calculated as the ratio of normalized umbilical vein blood flow volume and umbilical artery pulsatility index. Regression analysis was performed to obtain the best-fitting curves between VAI and GA in the controls. Doppler parameters and perinatal outcomes were compared in both groups. Receiver operating characteristic analysis was used to assess the diagnostic performance of the VAI. Results A total of 833 (95%) fetuses had Doppler parameters and pregnancy outcomes documented. Compared with the controls, the VAI was significantly lower in the compromised group (83.2 vs. 184.8 ml/min/kg, p < 0.001). The sensitivity and specificity of VAI to predict compromised neonates were 95.15% (95% Cl, 89.14 to 97.91%) and 99.04% (95% CI: 98.03 to 99.53%), respectively at a cutoff value of 120 ml/min/kg. Conclusions VAI presents better diagnostic performance than umbilical vein blood flow volume and umbilical artery pulsatility index. A cutoff value of 120 ml/min/kg might be used as the warning value for predicting the fetal outcome.
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Affiliation(s)
- Ling Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Dan Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
- Correspondence: Dan Zhou
| | - Baiguo Long
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Jiqing Wang
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Lingling Li
- Department of Ultrasound, Women and Children Healthcare Hospital of Changsha, Changsha, China
| | - Yang Peng
- Department of Ultrasound, Women and Children Healthcare Hospital of Zhu Zhou, Zhuzhou, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha, China
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Abstract
OBJECTIVE In the setting of RhD-alloimmunized pregnancy, laboratory variations in critical titer (CT) of anti-D antibody may result in needless referrals or a compromised fetal outcome. METHODS RhD-alloimmunized pregnant women were included. Fetal outcome was categorized based on cord hemoglobin and interventions required. For 3 commonly used CTs of 8, 16, and 32, sensitivity and specificity as well as positive and negative predictive values were computed. RESULTS When compared with CTs of 16 and 32, we detected 6.9% and 19.4% more cases of moderate-severe hemolytic disease of the fetus and newborn by using 8 as the CT. However, this leads to greater rate of unnecessary referral (12.1%, 10/82) than a CT of 16 (8.2%, 6/73) and 32 (4.9%, 3/61). A CT of 8 demonstrated 100% sensitivity, but 12.1% (10/82) of patients were referred needlessly. CONCLUSION Because of its 100% sensitivity, we advocate decreasing the CT to 8. However, this may lead to unwarranted referrals.
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Affiliation(s)
- Bharat Singh
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajendra Chaudhary
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Katharia
- Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Muacevic A, Adler JR, Punshi H, Dengani M, Agrawal S, Jain K, Verma N, Naik S. The Outcome of Pregnancy Among Tobacco Users in Tertiary Care Hospital of Chhattisgarh Province of India. Cureus 2022; 14:e32877. [PMID: 36699785 PMCID: PMC9870601 DOI: 10.7759/cureus.32877] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Tobacco use is responsible for numerous adverse pregnancy outcomes for females and their infants. The aim of this study was to explore the adverse outcome of tobacco use among pregnant females. METHOD A cross-sectional study was conducted on 1250 females in the third trimester of pregnancy from April to June 2022, which were exposed to tobacco use in the form of gudaku, tobacco chewing, gutka, or smoking. Complications and outcomes during and after pregnancy were recorded based on self-administered questionnaires. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY) software version 20.0 for categorical data, frequencies (n) and percentages (%) were calculated, and the chi-square test was used for determining intergroup differences. RESULTS Out of 1250 females, tobacco exposure was present among 429 (34.3%), and 821 (65.7%) had no tobacco exposure. Of 429, 36.10% of females complained about complications such as abortion (1.60%), antepartum hemorrhage (0.90%), congenital anomaly (0.20%), infertility (1.20%), intrauterine fetal death (IUFD) (0.50%), intrauterine growth restriction (IUGR) (0.90%), oligohydramnios (OLIGO) (3.30%), preterm labor (18.40%), premature rupture of membrane (6.30%), and anemia (2.80%), which were slightly higher than the females with no tobacco exposure. In tobacco users, obstructive complications were found to be significant with a p value of 0.0036. CONCLUSION Our study concluded that tobacco use could have an adverse effect on their fetus and infants, as well as the pregnant females themselves. Policymakers need to ensure effective strategies that pregnant females, their partners, and close relatives need to have enough knowledge to avoid potential risks.
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de Jong MF, van Hamersvelt HW, van Empel IW, Nijkamp EJ, Lely AT. Summary of the Dutch Practice Guideline on Pregnancy Wish and Pregnancy in CKD. Kidney Int Rep 2022; 7:2575-2588. [PMID: 36506226 PMCID: PMC9727525 DOI: 10.1016/j.ekir.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Margriet F.C. de Jong
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, the Netherlands,Correspondence: Margriet F. C. de Jong, Department of Internal Medicine, division of Nephrology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | | | - Inge W.H. van Empel
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ellen J.W. Nijkamp
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, the Netherlands
| | - A. Titia Lely
- Department of Obstetrics and Gynecology, Utrecht University Medical Center, Utrecht, the Netherlands
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Springer S, Karner E, Worda C, Grabner MM, Seidl-Mlczoch E, Laccone F, Neesen J, Scharrer A, Ulm B. Outcome after Prenatal Diagnosis of Trisomy 13, 18, and 21 in Fetuses with Congenital Heart Disease. Life (Basel) 2022; 12:life12081223. [PMID: 36013402 PMCID: PMC9410270 DOI: 10.3390/life12081223] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Abstract
Fetal congenital heart disease (CHD) is often associated with chromosomal abnormalities. Our primary aim was to assess stillbirth and neonatal mortality rates for pregnancies complicated by trisomies 13, 18, and 21 in the presence of CHD, from a single tertiary referral center during 2000-2020 in a retrospective cohort study. The secondary aims were to investigate maternal morbidity in these pregnancies, and to study the gestational or neonatal age when mortality occurred. Inclusion criteria were the prenatal diagnosis of at least one structural CHD, together with prenatally diagnosed fetal trisomy 13, 18, or 21. One-hundred and sixty patients with fetal trisomy 13 (14.4%), fetal trisomy 18 (28.8%), and fetal trisomy 21 (56.9%) were evaluated. In total, 98 (61.3%) families opted for the termination of pregnancy (TOP). Of the remaining 62 (38.8%) pregnancies, 16 (25.8%) resulted in intrauterine fetal death/death during delivery. Ten out of twenty-one (47.6%) infants with trisomy 13 or 18 were born alive. The livebirth rate was 87.8% (36/41) for infants with trisomy 21. Early neonatal death was observed in nine (19.6%) infants. Thirty-one (86.1%) infants with trisomy 21 survived the first year of life. These data may be helpful for counseling affected parents when the decision to terminate or continue the pregnancy should be considered.
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Affiliation(s)
- Stephanie Springer
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Eva Karner
- Department of Internal Medicine, Saint Josef Hospital, 1130 Vienna, Austria
| | - Christof Worda
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Maria Magdalena Grabner
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Seidl-Mlczoch
- Department of Pediatric and Adolescent Medicine, Division for Pediatric Cardiology, Medical University of Vienna, 1090 Vienna, Austria
| | - Franco Laccone
- Institute of Medical Genetics, Medical University of Vienna, 1090 Vienna, Austria
| | - Jürgen Neesen
- Institute of Medical Genetics, Medical University of Vienna, 1090 Vienna, Austria
| | - Anke Scharrer
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria
| | - Barbara Ulm
- Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-140400-28210
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23
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Rajan M, Sachan S, Abhinay A, Yadav DP, Verma B. Maternal and neonatal outcomes of COVID-19 co-infection in pregnant women with chronic hepatitis B virus infection: A prospective cohort study. Int J Gynaecol Obstet 2022; 158:221-222. [PMID: 35212394 PMCID: PMC9087504 DOI: 10.1002/ijgo.14154] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/23/2022] [Indexed: 11/07/2022]
Abstract
Co‐infection with COVID‐19 in pregnant women with pre‐existing HBV infection led to a higher proportion of preterm deliveries and lower mean birth weight.
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Affiliation(s)
- Mamta Rajan
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, BHU, Varanasi, India
| | - Shikha Sachan
- Department of Obstetrics and Gynecology, Institute of Medical Sciences, BHU, Varanasi, India
| | - Abhishek Abhinay
- Department of Pediatrics, Institute of Medical Sciences, BHU, Varanasi, India
| | - Dawesh Prakash Yadav
- Department of Gastroenterology, Institute of Medical Sciences, BHU, Varanasi, India
| | - Bhupendra Verma
- Department of Cardiology, Institute of Medical Sciences, BHU, Varanasi, India
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24
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Abstract
Gestational diabetes mellitus is a frequently diagnosed glucose metabolic disorder during pregnancy. Diabetes mellitus has been found to pose important health risks to the developing fetus, mother, and offspring. Here, we investigated the protective effects of S14G-humanin, a potent humanin analogue, against maternal and neonatal adverse outcomes in mice with diabetes mellitus. The results show that S14G-humanin administration reduced the blood glucose levels and elevated the serum insulin levels in diabetes mellitus mice. The parameters of serum lipid metabolism including low-density lipoprotein, total cholesterol, and high-density lipoprotein in diabetes mellitus mice were also decreased after S14G-humanin administration. Intervention with S14G-humanin also increased the fetus alive ratio and fetal length, as well as decreased fetal and placenta weights. In addition, we demonstrate that S14G-humanin elevated the activity of the anti-oxidative enzymes catalase, glutathione peroxidase, and superoxide dismutase and reduced the inflammatory cytokines levels in the placentas of diabetes mellitus mice. The significantly increased endoplasmic reticulum stress in the placentas of diabetes mellitus mice was also attenuated by S14G-humanin administration. Taken together, S14G-humanin exerted protective roles in improving maternal and neonatal outcomes. Our findings indicate that S14G-humanin might be an effective intervention approach for women with diabetes mellitus.
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Affiliation(s)
- Huiling Jiang
- Department of Obstetrics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Ying Xu
- Department of Obstetrics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
| | - Liqiong Cao
- Department of Obstetrics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China
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25
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AlJahdali EA, AlSinani NS. Pregnancy outcomes at advanced maternal age in a tertiary Hospital, Jeddah, Saudi Arabia. Saudi Med J 2022; 43:491-499. [PMID: 35537719 PMCID: PMC9280590 DOI: 10.15537/smj.2022.43.5.20220023] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/18/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives: To evaluate obstetrical and fetal outcomes among advanced maternal age (AMA) women. Methods: Retrospective cohort study carried out at a teaching hospital, Jeddah, Saudi Arabia, during 18 years period (from January 2003 until December 2020). A total of 79095 women gave birth, and randomized block was used to include 4318 singleton pregnancy women (>28 gestational weeks), of them 2162 age ≥40 years. Associations between AMA and obstetrical and fetal parameters were assessed. Results: Advanced maternal age independently associated with non-Saudi national, mother’s weights 80-99 kg, diabetes mellitus, and hypertension. Advanced maternal age mothers were more liable to premature rupture of membranes (PROM), caesarean (CS) deliveries, and postpartum hemorrhage. Newborn of AMA women were at high risk of birth weight <2500 g, birth weight 3600-4500 g, decline Apgar score at 5 minutes, and neonatal intensive care unit (NICU) admissions. Conclusion: Advanced maternal age is an independent risk factor for adverse obstetric hazards as CS, antepartum haemorrhage, diabetes mellitus, hypertension, PROM, postpartum hemmorage, and fetal complications as low birth weight, macrosomia, NICU admission, congenital anomalies, and low Apgar score. These results must be carefully considered by maternal care providers to effectively improve clinical surveillance.
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Affiliation(s)
- Ettedal A. AlJahdali
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.
- Address correspondence and reprint request to: Dr. Ettedal A. AlJahdali, Associate Professor, Department of Obstetrics and Gynecology, Faulty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail: ORCID ID: https://orcid.org/0000-0002-9858-8417
| | - Nawal S. AlSinani
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia.
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26
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Al Khalaf S, Bodunde E, Maher GM, O'Reilly ÉJ, McCarthy FP, O'Shaughnessy MM, O'Neill SM, Khashan AS. Chronic kidney disease and adverse pregnancy outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2022; 226:656-670.e32. [PMID: 34736915 DOI: 10.1016/j.ajog.2021.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 06/30/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Limited evidence exists on the role that the cause of chronic kidney disease plays in determining pregnancy outcomes. The aim of this systematic review and meta-analysis was to examine the association between chronic kidney disease and adverse pregnancy outcomes by the cause and severity of chronic kidney disease where reported. The protocol was registered under the International Prospective Register of Systematic Reviews (CRD42020211925). DATA SOURCES PubMed, Embase, and Web of Science were searched until May 24, 2021, supplemented with reference list checking. STUDY ELIGIBILITY CRITERIA Studies that compared the pregnancy outcomes in women with or without chronic kidney disease were included. Two reviewers independently screened titles, abstracts, and full-text articles according to a priori defined inclusion criteria. METHODS Data extraction and quality appraisal were performed independently by 3 reviewers. The grading of recommendations, assessment, development, and evaluation approach was used to assess the overall certainty of the evidence. Random-effects meta-analyses were used to calculate the pooled estimates using the generic inverse variance method. The primary outcomes included preeclampsia, cesarean delivery, preterm birth (<37 weeks' gestation), and small for gestational age babies. RESULTS Of 4076 citations, 31 studies were included. Prepregnancy chronic kidney disease was significantly associated with a higher odds of preeclampsia (pooled crude odds ratio, 8.13; [95% confidence interval, 4.41-15], and adjusted odds ratio, 2.58; [1.33-5.01]), cesarean delivery (adjusted odds ratio, 1.65; [1.21-2.25]), preterm birth (adjusted odds ratio, 1.73; [1.31-2.27]), and small for gestational age babies (adjusted odds ratio, 1.93; [1.06-3.52]). The association with stillbirth was not statistically significant (adjusted odds ratio, 1.67; [0.96-2.92]). Subgroup analyses indicated that different causes of chronic kidney disease might confer different risks and that the severity of chronic kidney disease is associated with a risk of adverse pregnancy outcomes, as pregnancies with later stages of chronic kidney disease had higher odds of preeclampsia, preterm birth, and small for gestational age babies than those at earlier stages. The grading of recommendations, assessment, development, and evaluation certainty of the evidence overall was "very low". CONCLUSION This meta-analysis quantified the associations between prepregnancy chronic kidney disease and adverse pregnancy outcomes, both overall and according to the cause and severity of the disease. These findings might support the clinicians aiming to counsel women having chronic kidney disease by allowing them to tailor their advice according to cause and severity of the chronic kidney disease. We identified the gaps in the literature, and further studies examining the effect of specific kidney diseases and other clinical characteristics (eg, proteinuria, hypertension) on adverse pregnancy outcomes are warranted.
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Affiliation(s)
- Sukainah Al Khalaf
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.
| | - Elizabeth Bodunde
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland
| | - Éilis J O'Reilly
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fergus P McCarthy
- The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, Cork University Hospital, Cork, Ireland
| | | | | | - Ali S Khashan
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research, University College Cork, Cork, Ireland.
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27
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Sanches APV, de Oliveira JL, Ferreira MS, Lima BDS, Miyamoto JÉ, Simino LADP, Torsoni MA, Torsoni AS, Milanski M, Ignácio-Souza LM. Obesity phenotype induced by high-fat diet leads to maternal-fetal constraint, placental inefficiency, and fetal growth restriction in mice. J Nutr Biochem 2022; 104:108977. [PMID: 35248701 DOI: 10.1016/j.jnutbio.2022.108977] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 05/25/2021] [Revised: 11/20/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate certain parameters regarding the maternal-fetal outcomes in a diet-induced obesity model. Obese, glucose-intolerant females who were exposed to a high-fat diet prior to pregnancy had lower placental efficiency and lower birth weight pups compared to the controls. Simple linear regression analyses showed that maternal obesity disrupts the proportionality between maternal and fetal outcomes during pregnancy. Maternal obesity is correlated with fetal outcomes, perhaps because of problems with hormonal signaling and exacerbation of inflammation in the maternal metabolic environment. The maternal obese phenotype altered the thickness of the placental layer, the transport of fatty acids, and the expression of growth factors. For example, lower expression of epidermal growth factor receptor (EGFR) mRNA in the obesity-prone group may have contributed to the rupture of the placental layers, leading to adverse fetal outcomes. Furthermore, maintenance of maternal glucose homeostasis and overexpression of placental growth factor (PGF) in the obesity-resistant group likely protected the placenta and fetuses from morphological and functional damage.
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Affiliation(s)
- Ana Paula Varela Sanches
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Josilene Lopes de Oliveira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Maíra Schuchter Ferreira
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Bruna de Souza Lima
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Josiane Érica Miyamoto
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Laís Angélica de Paula Simino
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil
| | - Márcio Alberto Torsoni
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Adriana Souza Torsoni
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Marciane Milanski
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil
| | - Letícia Martins Ignácio-Souza
- Laboratory of Metabolic Disorders, School of Applied Sciences, University of Campinas - UNICAMP, Limeira, São Paulo, Brazil; Obesity and Comorbidities Research Center, University of Campinas, Campinas, Brazil.
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28
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Brodowski L, Rochow N, Yousuf EI, Kohls F, von Kaisenberg CS, Berlage S, Voigt M. The impact of parity and maternal obesity on the fetal outcomes of a non-selected Lower Saxony population. J Perinat Med 2022; 50:167-175. [PMID: 34695308 DOI: 10.1515/jpm-2020-0614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/31/2020] [Accepted: 10/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Maternal obesity during pregnancy is associated with adverse intrauterine events and fetal outcomes and may increase the risk of obesity and metabolic disease development in offspring. Higher parity, regardless of socioeconomic status, is associated with increased maternal body mass index (BMI). In this study, we examined the relationship between parity, maternal obesity, and fetal outcomes in a large sample of mother-neonate pairs from Lower Saxony, Germany. METHODS This retrospective cohort study examined pseudonymized data of a non-selected singleton cohort from Lower Saxony's statewide quality assurance initiative. 448,963 cases were included. Newborn outcomes were assessed in relation to maternal BMI and parity. RESULTS Maternal obesity was associated with an increased risk of placental insufficiency, chorioamnionitis, and fetal distress while giving birth. This effect was present across all parity groups. Fetal presentation did not differ between BMI groups, except for the increased risk of high longitudinal position and shoulder dystocia in obese women. Maternal obesity was also associated with an increased risk of premature birth, low arterial cord blood pH and low 5-min APGAR scores. CONCLUSIONS Maternal obesity increases the risk of adverse neonatal outcomes. There is a positive correlation between parity and increased maternal BMI. Weight-dependent fetal risk factors increase with parity, while parity-dependent outcomes occur less frequently in multipara. Prevention and intervention programs for women planning to become pregnant can be promising measures to reduce pregnancy and birth complications.
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Affiliation(s)
- Lars Brodowski
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Niels Rochow
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany.,Department of Pediatrics, Univesity Hospital Rostock, Rostock, Germany.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Efrah I Yousuf
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Fabian Kohls
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | | | - Silvia Berlage
- Center for Quality and Management in Health Care, Ärztekammer Niedersachsen, Hannover, Germany
| | - Manfred Voigt
- Faculty of Medicine, Department of Obstetrics and Gynecology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Biological Anthropology, Medical Faculty, University of Freiburg, Freiburg, Germany
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29
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Guidi S, Berghella V, Scambia G, Fagotti A, Vidiri A, Restaino S, Vizzielli G, Inzani F, Cavaliere AF. Adult Granulosa Cell Tumor in Pregnancy: A New Case and a Review of the Literature. Healthcare (Basel) 2021; 9:healthcare9111455. [PMID: 34828500 PMCID: PMC8622987 DOI: 10.3390/healthcare9111455] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/26/2022] Open
Abstract
Granulosa cell tumors are rare ovarian tumors that can arise during pregnancy. We present a new case of recurrent adult granulosa cell tumor (AGCT) in pregnancy and a systematic review of the literature. The new case described is a 41-year-old woman G5P1122 with a prior history of AGCT that was referred to our center at 29 weeks because of a symptomatic abdominal mass, compatible with a possible recurrence of AGCT. At 36 + 3 weeks, she underwent a cesarean delivery for preterm labor and a total hysterectomy with a radical surgical staging. A healthy female infant was delivered. The patient received a platinum-based chemotherapy, with a 26-month follow-up negative for recurrence. Analyzing our case with the four identified by the literature review, three were recurrent and two were primary AGCT. Only one required surgery for AGCT at 15 weeks, while another underwent chemotherapy in pregnancy. In the other three cases, surgery for AGCT was done at the time of cesarean delivery. There were three cases of preterm delivery. All five pregnancies resulted in the birth of live babies with weight adequate for gestational age. In conclusion, AGCT diagnosed in pregnancy is rare, reported in only five cases. All gave birth to live babies in the third trimester, and maternal outcome at up to 18 months showed no recurrence.
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Affiliation(s)
- Sofia Guidi
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (G.S.); (A.F.); (A.V.); (G.V.)
- Correspondence: ; Tel.: +39-33-3446-0214
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (G.S.); (A.F.); (A.V.); (G.V.)
| | - Anna Fagotti
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (G.S.); (A.F.); (A.V.); (G.V.)
| | - Annalisa Vidiri
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (G.S.); (A.F.); (A.V.); (G.V.)
| | - Stefano Restaino
- Department of Obstetrics, Gyneacology and Pediatrics, Udine University Hospital, DAME, 33100 Udine, Italy;
| | - Giuseppe Vizzielli
- Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy; (G.S.); (A.F.); (A.V.); (G.V.)
- Department of Obstetrics, Gyneacology and Pediatrics, Udine University Hospital, DAME, 33100 Udine, Italy;
| | - Frediano Inzani
- Gynecopathology and Breast Pathology Unit, Department of Woman’s Health Science, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy;
| | - Anna Franca Cavaliere
- Azienda USL Toscana Centro, Gynecology and Obstetrics Department, Santo Stefano Hospital, 59100 Prato, Italy;
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30
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Chen Y, Li K, Zhang H, Liu Z, Chen D, Yang L, Hu W. Good pregnancy outcomes in lupus nephritis patients with complete renal remission. Nephrol Dial Transplant 2021; 37:1888-1894. [PMID: 34610132 DOI: 10.1093/ndt/gfab289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/15/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To investigate pregnancy outcomes and risk factors in patients with lupus nephritis (LN). METHODS A total of 158 pregnancies in 155 women with LN were divided into a remission group and a control group according to whether they achieved complete renal remission (CRR) prior to pregnancy. The adverse pregnancy outcomes and risk factors were retrospectively analyzed. RESULTS In the remission group, 130 LN patients with 133 pregnancies (two twin pregnancies) delivered 127 live births; 25 LN patients with 25 pregnancies delivered 19 live births in the control group. Compared with the control group, the remission group had significantly lower incidence of LN relapse, fetal loss, and premature birth. For LN patients in the remission group, a CRR duration < 18 months (odds ratio (OR) 11.24, 95% confidence interval (CI) 2.95-42.80, P < 0.001) and anti-C1q antibody positivity before pregnancy (OR 7.2, 95% CI 1.38-37.41, P = 0.019) were independent risk factors for LN relapse; anti-phospholipid antibody positivity (OR 9.32, 95% CI 1.27-68.27, P = 0.028) and prednisone dosage during pregnancy ≥ 12.5 mg/d (OR 3.88, 95% CI 1.37-10.99, P = 0.011) were independent risk factors for fetal loss and premature birth, respectively; and age > 30 years was an independent risk factor for preeclampsia and premature birth. CONCLUSION LN patients with a complete renal remission duration greater than 18 months were associated with good pregnancy outcomes and lower LN relapse. Age, anti-C1q and anti-phospholipid antibodies, and prednisone dosage during pregnancy were risk factors for adverse pregnancy outcomes.
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Affiliation(s)
- Yinghua Chen
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | | | - Haitao Zhang
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Zhengzhao Liu
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Duqun Chen
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Liu Yang
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China
| | - Weixin Hu
- National Clinical Research Centre for Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, China.,The First School of Clinical Medicine, Southern Medical University, China
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31
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Al Khalaf SY, O'Reilly ÉJ, McCarthy FP, Kublickas M, Kublickiene K, Khashan AS. Pregnancy outcomes in women with chronic kidney disease and chronic hypertension: a National cohort study. Am J Obstet Gynecol 2021; 225:298.e1-298.e20. [PMID: 33823152 DOI: 10.1016/j.ajog.2021.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/20/2020] [Revised: 03/04/2021] [Accepted: 03/19/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Maternal chronic kidney disease and chronic hypertension have been linked with adverse pregnancy outcomes. We aimed to examine the association between these conditions and adverse pregnancy outcomes over the last 3 decades. OBJECTIVE We conducted this national cohort study to assess the association between maternal chronic disease (CH, CKD or both conditions) and adverse pregnancy outcomes with an emphasis on the effect of parity, maternal age, and BMI on these associations over the last three decades. We further investigated whether different subtypes of CKD had differing effects. STUDY DESIGN We used data from the Swedish Medical Birth Register, including 2,788,490 singleton births between 1982 and 2012. Women with chronic kidney disease and chronic hypertension were identified from the Medical Birth Register and National Patient Register. Logistic regression models were performed to assess the associations between maternal chronic disease (chronic hypertension, chronic kidney disease, or both conditions) and pregnancy outcomes, including preeclampsia, in-labor and prelabor cesarean delivery, preterm birth, small for gestational age, and stillbirth. RESULTS During the 30-year study period, 22,397 babies (0.8%) were born to women with chronic kidney disease, 13,279 (0.48%) to women with chronic hypertension and 1079 (0.04%) to women with both conditions. Associations with chronic hypertension were strongest for preeclampsia (adjusted odds ratio, 4.57; 95% confidence interval, 4.33-4.84) and stillbirth (adjusted odds ratio, 1.65; 95% confidence interval, 1.35-2.03) and weakest for spontaneous preterm birth (adjusted odds ratio, 1.07; 95% confidence interval, 0.96-1.20). The effect of chronic kidney disease varied from (adjusted odds ratio, 2.05; 95% confidence interval, 1.92-2.19) for indicated preterm birth to no effect for stillbirth (adjusted odds ratio, 1.16; 95% confidence interval, 0.95-1.43). Women with both conditions had the strongest associations for in-labor cesarean delivery (adjusted odds ratio, 1.86; 95% confidence interval, 1.49-2.32), prelabor cesarean delivery (adjusted odds ratio, 2.68; 95% confidence interval, 2.18-3.28), indicated preterm birth (adjusted odds ratio, 9.09; 95% confidence interval, 7.61-10.7), and small for gestational age (adjusted odds ratio, 4.52; 95% confidence interval, 3.68-5.57). The results remained constant over the last 3 decades. Stratified analyses of the associations by parity, maternal age, and body mass index showed that adverse outcomes remained independently higher in women with these conditions, with worse outcomes in multiparous women. All chronic kidney disease subtypes were associated with higher odds of preeclampsia, in-labor cesarean delivery, and medically indicated preterm birth. Different subtypes of chronic kidney disease had differing risks; strongest associations of preeclampsia (adjusted odds ratio, 3.98; 95% confidence interval, 2.98-5.31) and stillbirth (adjusted odds ratio, 2.73; 95% confidence interval, 1.13-6.59) were observed in women with congenital kidney disease, whereas women with diabetic nephropathy had the most pronounced increase odds of in-labor cesarean delivery (adjusted odds ratio, 3.54; 95% confidence interval, 2.06-6.09), prelabor cesarean delivery (adjusted odds ratio, 7.50; 95% confidence interval, 4.74-11.9), and small for gestational age (adjusted odds ratio, 4.50; 95% confidence interval, 2.92-6.94). In addition, women with renovascular disease had the highest increased risk of preterm birth in both spontaneous preterm birth (adjusted odds ratio, 3.01; 95% confidence interval, 1.57-5.76) and indicated preterm birth (adjusted odds ratio, 8.09; 95% confidence interval, 5.73-11.4). CONCLUSION Women with chronic hypertension, chronic kidney disease, or both conditions are at an increased risk of adverse pregnancy outcomes which were independent of maternal age, body mass index, and parity. Multidisciplinary management should be provided with intensive clinical follow-up to support these women during pregnancy, particularly multiparous women. Further research is needed to evaluate the effect of disease severity on adverse pregnancy outcomes.
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Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Éilis J O'Reilly
- School of Public Health, University College Cork, Cork, Ireland; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland; Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Marius Kublickas
- Department of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Karolina Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
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Çakır Ç, Ceylan Y, Karagöz A, Ökten MŞ, Kaya Y. Percutaneous mitral commissurotomy in women with asymptomatic severe mitral stenosis before pregnancy. Acta Cardiol 2021; 76:754-759. [PMID: 32594839 DOI: 10.1080/00015385.2020.1783778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/24/2022]
Abstract
OBJECTIVES Performing percutaneous mitral commissurotomy (PMC) in the women with asymptomatic severe mitral stenosis (MS) who plan a pregnancy is recommended. However the data regarding this recommendation is limited in the literature. We aimed to investigate maternal and fetal outcomes of women with asymptomatic severe MS who underwent PMC before a planned pregnancy. METHODS We retrospectively analysed the procedural, pregnancy related, and fetal outcomes of 33 consecutive women with severe asymptomatic MS, age 27.97 ± 2.86 years, who underwent PMC before a planned pregnancy between 2014 and 2019. The control group comprised of 66 pregnant women, age 29.09 ± 3.00 years, without a cardiac disease. RESULTS The PMC procedure was successful in all patients and no major complication occurred. There were no deaths, pulmonary oedema, heart failure, atrial fibrillation, and thromboembolism during pregnancy. Maternal arrhythmia (p < .001), deterioration in NYHA class (p = .08), and use of cardiovascular medication (p < .001) was significantly higher in the study group. Maternal hospitalisation (p = .435), preeclampsia (p = 1), abortus (p = 1), fetal death (p = 1), and preterm delivery (p = .746) was similar between groups. Birth weight was significantly lower in the PMC group 2890 g (229) vs 3120 g (255) <0.001, however small for gestational age newborns were similar between groups (p = .12). CONCLUSIONS PMC is safe in asymptomatic women with severe MS planning a future pregnancy. In selected patients with favourable valve anatomy PMC may improve maternal and fetal outcomes.
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Affiliation(s)
- Çayan Çakır
- Department of Cardiology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Yemlihan Ceylan
- Department of Cardiology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Ali Karagöz
- Department of Cardiology, University of Health Sciences Kartal Koşuyolu High Specialization Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Şefa Ökten
- Department of Cardiology, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Yüksel Kaya
- Department of Cardiology, Yüzüncü Yıl University, Van, Turkey
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Štimjanin H, Iriškić R, Hodžić J, Štimjanin E. A one-year review of macrosomic births at the Cantonal Hospital Zenica, Bosnia and Herzegovina. Med Glas (Zenica) 2020; 17:141-4. [PMID: 31719508 DOI: 10.17392/1063-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/05/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022]
Abstract
Aim To identify a rate of macrosomic births in a one-year review, associated maternal characteristics and pregnancy outcome. Methods This one-year retrospective review included all macrosomic deliveries at the Department of Obstetrics and Gynaecology at the Cantonal Hospital Zenica between 1 January 2018 and 31 December 2018. The data were collected from maternal and newborn medical records. A total of 361 singleton normal birth weight term newborns (birth weight <4000 g, but not small for gestational age) who were delivered in the same period, represented the control group. Results Among the total of 2758 women who gave birth, 360 (13.05%) macrosomic infants (birth weight more than 4000 g) were delivered. Mean birth weight was 4258.90 g (maximum 5460g); nine (0.33%) were >5000g. Male macrosomic infants were more frequently represented, 245 (68,1%) comparing to the control group (p<0.01); in the control group female infants were more frequently represented (p<0.01). The overall Cesarean section rate, including elective Cesarean delivery was 23.2%, and 76.1% underwent an attempt of labour delivered vaginally. Conclusion Macrosomia represents a risk for adverse outcome for the mother and neonate, with a higher risk for the operative mode of delivery.
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Abstract
Cancer diagnosis and treatment in pregnant women is a challenging situation. A multidisciplinary network of specialists is required to guide both, the expecting mother and the unborn child through the diagnostic workup and the cytotoxic therapy, by balancing the respective risks and benefits. Tumor entity, stage, biology and gestational week at diagnosis determine the appropriate approach. As premature delivery emerged as one of the main risk factors for adverse long-term outcome of the progeny, it should be avoided, if reasonable from the oncological perspective. This article offers a comprehensive review with respect to the various aspects of cancer in pregnancy.
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Affiliation(s)
- Roxana Schwab
- Department of Obstetrics and Women’s Health, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (K.A.); (A.H.)
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Nnaji HC, Asimadu EE, Aniebue UU. The effect of short interpregnancy interval on birthweight and other pregnancy outcomes in Enugu, Southeast Nigeria. J OBSTET GYNAECOL 2021; 42:244-247. [PMID: 34027820 DOI: 10.1080/01443615.2021.1904230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/21/2022]
Abstract
The time interval between one pregnancy and the next is a modifiable risk factor, and has an effect on pregnancy outcomes. This study compared the effects of short interpregnancy interval (IPI) on fetal birthweight and selected pregnancy outcomes amongst parturients in Enugu, Nigeria. Group A (Subjects) consisted of parturients with short IPI (IPI < 18 months), while group B (Controls) consisted of parturients with normal IPI (IPI ≥ 18 months). Relevant obstetric data were collected at delivery. Mean birthweight was 2664.13 ± 339.25g vs 3670.63 ± 452.69g in women with short IPI and normal IPI respectively (p < .0001). Women with short IPI were more likely to have low birthweight babies compared to those with normal IPI (OR = 7.331, p < .001). Maternal anaemia, preeclampsia and caesarean delivery were significantly more associated with short IPI. Women with short IPI are at greater risk of delivering newborn babies with significantly lower mean birthweight and other associated pregnancy complications than women with normal IPI.Impact StatementWhat is already known on this subject? Short interpregnancy interval has an adverse effect on pregnancy outcomes as shown in studies from Europe and the Americas.What do the results of this study add? This study adds to the body of evidence of the deleterious effects of inadequately spaced pregnancies and draws attention to this in West Africa, sub-Saharan Africa, and an area with low contribution to studies on the effect of short IPI on pregnancy outcomes.What are the implications of these findings for clinical practice and/or further research? With evidence from our own environment, it will further boost evidence for proper education of our mothers on the need for adequate birth spacing to avoid the adverse effects of a short IPI on the next pregnancy.
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Affiliation(s)
- Henry C Nnaji
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Eric E Asimadu
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Uzochukwu U Aniebue
- Institute of Maternal and Child Health, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.,Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Rosen H, Bart Y, Zlatkin R, Ben-Sira L, Ben Bashat D, Amit S, Cohen C, Regev-Yochay G, Yinon Y. Fetal and Perinatal Outcome Following First and Second Trimester COVID-19 Infection: Evidence from a Prospective Cohort Study. J Clin Med 2021; 10:2152. [PMID: 34065646 DOI: 10.3390/jcm10102152] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 04/23/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
A novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of coronavirus causing coronavirus disease 2019 (COVID-19) disease, which emerged as a global pandemic. Data regarding the implications of COVID-19 disease at early gestation on fetal and obstetric outcomes is scarce. Thus, our aim was to investigate the effect of first and second trimester maternal COVID-19 disease on fetal and perinatal outcomes. This was a prospective cohort study of pregnant women with a laboratory-proven SARS-COV-2 infection contracted prior to 26 weeks gestation. Women were followed at a single tertiary medical center by serial sonographic examinations every 4-6 weeks to assess fetal well-being, growth, placental function, anatomic evaluation and signs of fetal infection. Amniocentesis was offered to assess amniotic fluid SARS-COV-2-PCR (polymerase chain reaction) and fetal brain magnetic resonance imaging (MRI) was offered at 30-32 weeks gestation. Demographic, obstetric and neonatal data were collected from history intake, medical charts or by telephone survey. Perinatal outcomes were compared between women infected at first vs. second trimester. 55 women with documented COVID-19 disease at early gestation were included and followed at our center. The mean maternal age was 29.6 ± 6.2 years and the mean gestational age at viral infection was 14.2 ± 6.7 weeks with 28 (51%) women infected at the first trimester and 27 (49%) at the second trimester. All patients but one experienced asymptomatic to mild symptoms. Of 22 patients who underwent amniocentesis, none had evidence of vertical transmission. None of the fetuses exhibited signs of central nervous system (CNS) disease, growth restriction and placental dysfunction on serial ultrasound examinations and fetal MRI. Pregnancies resulted in perinatal survival of 100% to date with mean gestational age at delivery of 38.6 ± 3.0 weeks and preterm birth <37 weeks rate of 3.4%. The mean birthweight was 3260 ± 411 g with no cases of small for gestational age infants. The obstetric and neonatal outcomes were similar among first vs. second trimester infection groups. We conclude SARS-CoV-2 infection at early gestation was not associated with vertical transmission and resulted in favorable obstetric and neonatal outcomes.
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Wang Y, Liu C, Yin A, Zhao X, He W, Xiong Y, Fang L, Wu J. Prenatal diagnosis of fetal right ventricular diverticulum with massive pericardial effusion in one of monochorionic diamniotic twins: a case report with a favorable outcome following in utero pericardiocentesis. J Int Med Res 2021; 49:300060520986668. [PMID: 33478307 PMCID: PMC7841867 DOI: 10.1177/0300060520986668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Congenital ventricular diverticulum is a rare abnormality that may occur as an isolated malformation. Most cases are accompanied by pericardial effusion. Prenatal counseling can be difficult because the prognosis is uncertain and there is no consensus approach to prenatal management. Case presentation: We describe a case of congenital cardiac diverticulum complicated by large pericardial effusion in one of monochorionic diamniotic twins. The case was diagnosed by ultrasonography at 21 weeks of gestation. Therapeutic pericardiocentesis at 22 weeks resulted in complete resolution of the effusion and led to a favorable fetal outcome. We summarize the interventions and pregnancy outcomes in cases of cardiac diverticula reported in the literature. Conclusions Better awareness of clinical features, in utero therapies, and pregnancy outcomes could help define and improve prenatal management of congenital ventricular diverticula.
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Affiliation(s)
- Yunan Wang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chang Liu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Aihua Yin
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xin Zhao
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Wei He
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Ying Xiong
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Liyuan Fang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jing Wu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China.,Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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Getachew A, Wakgari N, Gishille T. Feto-Maternal Outcomes of Obstructed Labor and Associated Factors among Mothers Who Gave Birth in Public Hospitals of West Shoa Zone, Central Ethiopia: Cross-Sectional Study. Ethiop J Health Sci 2021; 31:467-474. [PMID: 34483603 PMCID: PMC8365494 DOI: 10.4314/ejhs.v31i3.3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Obstructed labor the major cause of adverse feto-maternal outcomes. Hence, the study assessed adverse fetomaternal outcomes of obstructed labor and associated factors among women who gave birth in public Hospitals of West Shoa Zone. METHODS Cross-sectional study design was conducted among 277 respondents. The required data were extracted from the mothers' chart by using a systematic random sampling method. Checklists were used to collect data. Bivariable and multivariable logistic regression was used to identify factors associated with feto-maternal outcomes. The odds ratio with 95%CI and p-value were used to identify the significant variables. RESULTS In this study, 145(52.3%) and 157(56.7%) of the respondents had adverse maternal and fetal outcomes respectively. Mothers who were referred from the health center (AOR: 3.96, 95%CI: 1.61-9.8) and who had a trial of labor at the health center and home had a more likelihood of adverse maternal outcomes than those who were referred and had trial of labor at hospital respectively. In addition, mothers who were not followed by partograph and in labor for >24hrs had also a more likelihood of adverse maternal outcomes than their counterparts. Likewise, newborns whom their mothers were not followed by partograph and mothers in labor for >24 hrs had also a more likelihood of adverse fetal outcomes than their counterparts. Hence, health professionals should give special attention to early diagnosis and referral of obstructed labor to higher facilities.
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Affiliation(s)
- Alem Getachew
- Dire Incini Health Center, West Shoa Zone, Oromia Region, Central Ethiopia
| | - Negash Wakgari
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Tolosa Gishille
- Department of Obstetrics and Gynecology, Ambo University Referral Hospitals, Ambo, Ethiopia
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Degu Ayele A, Getnet Kassa B, Nibret Mihretie G, Yenealem Beyene F. Decision to Delivery Interval, Fetal Outcomes and Its Factors Among Emergency Caesarean Section Deliveries at South Gondar Zone Hospitals, Northwest Ethiopia: Retrospective Cross-Sectional Study, 2020. Int J Womens Health 2021; 13:395-403. [PMID: 33953613 PMCID: PMC8089467 DOI: 10.2147/ijwh.s295348] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/28/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Although its fetal outcomes and practicality are unclear time interval between decision-to-delivery ≤30 minutes in emergency caesarean section (CS) is the internationally accepted standard of practice. This study aimed to determine whether a decision to delivery interval (DDI) of approximately 30 minutes was achieved in daily practice, its fetal outcomes, and associated factors among emergency caesarean section delivery at South Gondar Zone Hospitals, Northwest Ethiopia. PATIENTS AND METHODS Retrospective cross-sectional study was carried out from August 1-30/2020 among emergency caesarean sections. Information was collected from the birth register book and individual files of standardized facility booking forms. The data was encoded and entered into Epi-Data version 4.2 and exported to SPSS version 23 for analysis. A bivariable and multivariable logistic regression analysis was conducted and a significant association was recorded at p<0.05. RESULTS Only 17.5% of parturients attained a decision-to-delivery interval ≤30 minutes. The average median of decision to delivery interval was 54 minutes with interquartile range (IQR) of 48-80 minutes. Time taken to collect material with Adjusted odds ratio (AOR=10.3, 95% CI 5.87-45.7), time of decision (AOR=0.32, 95% CI, 0.15-0.67), and time taken from decision to delivery to delivery of anesthesia (AOR=4.74, 95% CI, 1.30-17.3) were the predictors of prolonged delivery time interval. Significant fetal adverse outcomes were not observed in a decision to delivery interval higher than 30 minutes. CONCLUSION In most cases, delivery was not completed within the prescribed ≤30-minutes interval, particularly in developing countries with infrastructural challenges, however, fetal outcomes were not directly correlated. Despite lack of substantial linkage between the delivery time declaration and fetal events, an unreasonable gap from the decision-making to birth of the child is not appropriate and should be discouraged.
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Affiliation(s)
- Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentahun Yenealem Beyene
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Al Khalaf SY, O'Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS. Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e018494. [PMID: 33870708 PMCID: PMC8200761 DOI: 10.1161/jaha.120.018494] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Maternal chronic hypertension is associated with adverse pregnancy outcomes. Previous studies examined the association between either chronic hypertension or antihypertensive treatment and adverse pregnancy outcomes. We aimed to synthesize the evidence on the effect of chronic hypertension/antihypertensive treatment on adverse pregnancy outcomes. Methods and Results Medline/PubMed, EMBASE, and Web of Science were searched; we included observational studies and assessed the effect of race/ethnicity, where possible, following a registered protocol (CRD42019120088). Random-effects meta-analyses were used. A total of 81 studies were identified on chronic hypertension, and a total of 16 studies were identified on antihypertensive treatment. Chronic hypertension was associated with higher odds of preeclampsia (adjusted odd ratio [aOR], 5.43; 95% CI, 3.85-7.65); cesarean section (aOR, 1.87; 95% CI, 1.6-2.16); maternal mortality (aOR, 4.80; 95% CI, 3.04-7.58); preterm birth (aOR, 2.23; 95% CI, 1.96-2.53); stillbirth (aOR, 2.32; 95% CI, 2.22-2.42); and small for gestational age (SGA) (aOR, 1.96; 95% CI, 1.6-2.40). Subgroup analyses indicated that maternal race/ethnicity does not influence the observed associations. Women with chronic hypertension on antihypertensive treatment (versus untreated) had higher odds of SGA (aOR, 1.86; 95% CI, 1.38-2.50). Conclusions Chronic hypertension is associated with adverse pregnancy outcomes, and these associations appear to be independent of maternal race/ethnicity. In women with chronic hypertension, those on treatment had a higher risk of SGA, although the number of studies was limited. This could result from a direct effect of the treatment or because severe hypertension during pregnancy is a risk factor for SGA and women with severe hypertension are more likely to be treated. The effect of antihypertensive treatment on SGA needs to be further tested with large randomized controlled trials.
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Affiliation(s)
- Sukainah Y Al Khalaf
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | - Éilis J O'Reilly
- School of Public Health University College Cork Cork Ireland.,Department of Nutrition Harvard T.H. Chan School of Public Health Boston MA
| | - Peter M Barrett
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
| | | | - Lauren C Pawley
- Department of Anatomy and Neuroscience University College Cork Cork Ireland
| | - Fergus P McCarthy
- INFANT Research Centre University College Cork Ireland.,Department of Obstetrics and Gynaecology University College Cork Cork Ireland
| | - Ali S Khashan
- School of Public Health University College Cork Cork Ireland.,INFANT Research Centre University College Cork Ireland
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Abstract
Introduction: Fanconi anemia (FA) is a rare congenital disease that belongs to the family of congenital trilinear bone marrow failure. Most FA patients will suffer bone marrow failure and the main treatment relies on supportive measures or more recently on the use of hematopoietic stem cell transplant. The improvements seen in the management of FA has led women to reach childbearing age and have successful pregnancies. However, these pregnancies are associated with increased complications such as preterm delivery, cesarean delivery, eclampsia and others.Areas covered: This review highlights on the outcome of pregnancies in FA patients reported in the literature along with practical recommendations.Expert opinion: Multidisciplinary efforts are required to optimize the management of pregnancy in FA patients. Moreover, the development of a set of recommendations to optimize the treatment is highly necessary.
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Affiliation(s)
- Charbel F Matar
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou-Fakhredin
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roberta Russo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnology, Naples, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnology, Naples, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy.,CEINGE Advanced Biotechnology, Naples, Italy
| | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Gbotolorun SC, Ezeife CC, Ogunlade B. Prenatal exposure of bonny light crude oil induces embryotoxicity, impaired cognitive functions and cortico-hippocampal neurodegeneration on fetal outcomes of pregnant sprague-dawley rats. Drug Chem Toxicol 2021; 45:1978-1985. [PMID: 33719803 DOI: 10.1080/01480545.2021.1894721] [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: 10/21/2022]
Abstract
The low Sulfur level, heavy metals and easy production rate of Bonny Light Crude Oil (BLCO) makes it one of Nigeria's most explored oil. This study investigated the memory impairments, embryotoxicity and cortico-hippocampal neurodegeneration induced by prenatal exposure to BLCO of pregnant Sprague-Dawley (S-D) rats. Twenty pregnant rats were divided into 4 groups (A-D) of 5 rats each. Group A received normal saline as placebo. Group B-D received oral doses of BLCO at 0.73 ml/kg, 2 ml/kg and 3.8 ml/kg on pregnancy day 8-12.5 respectively. The pregnant rats were allowed to litter and nurse their pups. At 6 weeks postnatal life, twelve (12) selected young rats (n = 12) were accessed for behavioral study (Y-maze) and then sacrificed for biochemical and histological analysis. The results showed spontaneous abortion, still births and significantly reduced number of live births in the high dose group of BLCO compared to control. Length of gestation was significantly increased in the high dose group when compared to the control. CAT levels reduced significantly with concomitant increase in 8-OHdG among BLCO treated groups compared to control. Spontaneous alteration and number of arm entries decreased in the BLCO groups in comparison to control. Histological observation showed reduced cellular size, chromatolysis and presence of extracellular senile plaques in the prefrontal cortex and mild histological changes in the hippocampus architecture in the BLCO treated groups compared to the control. BLCO is capable of inducing embryotoxicity, impair cognition and cortico-hippocampal neurodegeneration.
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Affiliation(s)
- S C Gbotolorun
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria
| | - C C Ezeife
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria
| | - B Ogunlade
- Anatomy Department, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Nigeria.,Human Anatomy Department, Federal University of Technology Akure, Akure, Nigeria
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Lu Y, Yu Y, Xia W, Chen D, Wu X, Cheng T. Pregnancy outcomes in different stages of systemic lupus erythematosus among Chinese women - a retrospective cohort study. Ginekol Pol 2021; 92:365-370. [PMID: 33751514 DOI: 10.5603/gp.a2020.0151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/19/2020] [Revised: 01/15/2021] [Accepted: 09/09/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To analyze the outcomes of pregnancies and risk factors in Chinese women with different stages of systemic lupus erythematosus (SLE). MATERIAL AND METHODS A total of 55 conceptions in 52 patients with SLE between Jan 2007 and Jan 2019 were retrospected systematically from a general hospital graded 3A in China. Medical records provided us a good way to retrieve the clinical parameters and lab data of patients. RESULTS Pregnant women with SLE activity had significant hyperimmunoglobulin, hypocomplement, low platelet counts, high erythrocyte sedimentation rate, C-reactive protein and 24-h urine protein. Hydroxychloroquine had been used to reduce the rates of SLE activity in pregnant women. Logistic regression analysis showed low platelet counts, hypocomplement and 24-h urine protein were significantly correlated with fetal loss. Compared to those in stable stage, the active SLE patients have more risks of hypertensive disorders of pregnancy, thrombocytopenia, lupus nephritis and placental infarction, and have worse fetal outcomes, including the higher rate of fetal loss, preterm and asphyxia neonatorum. CONCLUSIONS Different stages of SLE during pregnancy are closely related to maternal and fetal outcomes. It is imperative to provide SLE women with pregnancy consultation and regular multispecialty care.
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Affiliation(s)
- Yaping Lu
- Department of Obstetrics and Gynecology, Maternal and Child Health Care of Shandong Province, Jinan, China.
| | - Yinghua Yu
- Department of Obstetrics and Gynecology, Zhongda Hospital Lishui Branch, affiliated to Southeast University, Nanjing, China
| | - Weilan Xia
- Department of Obstetrics and Gynecology, Lishui People's Hospital, affiliated Hospital 6 to Wenzhou Medical University, Lishui, China
| | - Diwen Chen
- Department of Obstetrics and Gynecology, Lishui People's Hospital, affiliated Hospital 6 to Wenzhou Medical University, Lishui, China
| | - Xingmei Wu
- Department of Obstetrics and Gynecology, Lishui People's Hospital, affiliated Hospital 6 to Wenzhou Medical University, Lishui, China
| | - Tingting Cheng
- Department of Obstetrics and Gynecology, Lishui People's Hospital, affiliated Hospital 6 to Wenzhou Medical University, Lishui, China
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Salem D, Katranji F, Bakdash T. COVID-19 infection in pregnant women: Review of maternal and fetal outcomes. Int J Gynaecol Obstet 2020; 152:291-298. [PMID: 33305352 PMCID: PMC9087662 DOI: 10.1002/ijgo.13533] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 01/22/2023]
Abstract
Pregnant women, their fetuses, and newborns are likely to represent a high‐risk population during the current coronavirus disease 2019 (COVID‐19) pandemic caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). Literature on the outcomes of COVID‐19 infections during pregnancy is slowly building up. The aim of the present review was to gather evidence from relevant articles published in English from January to August 2020 in Medline and Google Scholar. The review revealed that pregnant women who become COVID‐19‐positive are usually either asymptomatic or mild‐to‐moderately symptomatic, similar to non‐pregnant women. Pneumonia is one of the most common outcomes in pregnant women with COVID‐19. However, it cannot be conclusively said that SARS‐CoV‐2 infection increases the risk of maternal, fetal, and neonatal complications. Pregnant women with COVID‐19 with co‐morbidities have increased risks of complications: there are regional variations in the rates of adverse outcomes reported. Though uncommon, the review shows that vertical transmission is possible. Additionally, the third trimester seems to be the most vulnerable period of infection. This aspect needs to be researched further to activate surveillance programs at the end of second trimester. Overall, it is necessary to monitor pregnant women before and after delivery, and their infants, during this pandemic.
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Affiliation(s)
- Deemah Salem
- Department of Obstetrics and Gynecology, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.,Department of Obstetrics and Gynecology, Genesis Healthcare Center, Dubai, UAE
| | - Fawzi Katranji
- Department of Pulmonary Medicine, Michigan State University School of Osteopathic Medicine, East Lansing, MI, USA
| | - Talah Bakdash
- School of Medicine, University of Kansas, Kansas City, KS, USA
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Sharma TS, Amin S, Sapre S, Golani P, Zala S. Unilateral Pulmonary Fibrosis in Pregnancy: A Post-Tubercular Sequelae. Cureus 2020; 12:e11864. [PMID: 33409098 PMCID: PMC7781547 DOI: 10.7759/cureus.11864] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pulmonary tuberculosis (TB) is one of the top 10 leading causes of death in the world. Multi-drug resistant TB can lead to short-term and long-term sequelae causing clinical, psychosocial, and financial burden on the diseased. Pregnancy in a woman with compromised pulmonary function is a challenge for the treating obstetrician. A multidisciplinary approach involving a respiratory physician, pre-conceptional counseling, and delivery at a tertiary care center can reduce maternal morbidity and mortality. Compliance with anti-tubercular treatment with regular follow-up can minimize the long term effects of pulmonary TB. We report a case of unilateral lung collapse due to multidrug-resistant pulmonary TB in pregnancy with good maternal and fetal outcomes.
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Affiliation(s)
| | - Shivang Amin
- Obstetrics and Gynaecology, Pramukhswami Medical College, Anand, IND
| | - Shilpa Sapre
- Obstetrics and Gynaecology, Pramukhswami Medical College, Anand, IND
| | - Palak Golani
- Obstetrics and Gynaecology, Pramukhswami Medical College, Anand, IND
| | - Sheetalba Zala
- Obstetrics and Gynaecology, Pramukhswami Medical College, Anand, IND
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Rezk M, Emarh M, Masood A, Dawood R, El-Shamy E, Gamal A, Badr H. Methyldopa versus labetalol or no medication for treatment of mild and moderate chronic hypertension during pregnancy: a randomized clinical trial. Hypertens Pregnancy 2020; 39:393-398. [PMID: 32697618 DOI: 10.1080/10641955.2020.1791902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 07/04/2019] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE to assess the maternal and fetal outcome in women with mild to moderate chronic hypertension on antihypertensive drug (methyldopa or labetalol) therapy compared to no medication. METHODS This multicenter randomized clinical study was conducted at Menoufia University hospital, Shibin El-kom Teaching hospital at Menoufia governorate, Egypt.486 pregnant women with mild to moderate chronic hypertension were randomized into three groups; methyldopa group (n = 164), labetalol group (n = 160), and control or no medication group (n = 162) who were followed from the beginning of pregnancy till the end of puerperium to record maternal and fetal outcome. RESULTS There was a highly significant difference between treatment groups (methyldopa and labetalol) and control group regarding the development of maternal severe hypertension, development of preeclampsia, renal impairment, presence of ECG changes, placental abruption, and repeated admission to hospital for blood pressure control (p < 0.001) with higher occurrence in the control (no treatment) group. Neonates in the labetalol group were more prone for the development of small for gestational age (SGA), neonatal hypotension, neonatal hyperbilirubinemia, and admission to NICU than their counterparts in the methyldopa and control groups (p < 0.001). The rate of prematurity was significantly higher in the control group than the treatment groups (p < 0.05). CONCLUSION Treatment of mild to moderate chronic hypertension during pregnancy is beneficial in decreasing both maternal and fetal morbidity. The use of labetalol was associated with higher rates of SGA, neonatal hypotension, and neonatal hyperbilirubinemia compared to methyldopa or no medication.
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Affiliation(s)
- Mohamed Rezk
- Department of Obstetrics and Gynecology, Menoufia University , Shibin Al Kawm, Egypt
| | - Mohamed Emarh
- Department of Obstetrics and Gynecology, Menoufia University , Shibin Al Kawm, Egypt
| | - Alaa Masood
- Department of Obstetrics and Gynecology, Menoufia University , Shibin Al Kawm, Egypt
| | - Ragab Dawood
- Department of Obstetrics and Gynecology, Menoufia University , Shibin Al Kawm, Egypt
| | - Elsayed El-Shamy
- Department of Obstetrics and Gynecology, Menoufia University , Shibin Al Kawm, Egypt
| | - Awni Gamal
- Department of Cardiology, Menoufia University , Shibin Al Kawm, Egypt
| | - Hassan Badr
- Department of Pediatrics, Menoufia University , Shibin Al Kawm, Egypt
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47
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Javaid A, Majid A, Aslam S, Ali L, Razaq MK, Bukhari SNI, Shaikh A, Rizwan A. Maternal and Fetal Outcome of Pregnant Patients Having Preexisting Cardiovascular Disease. Cureus 2020; 12:e9563. [PMID: 32905531 PMCID: PMC7473608 DOI: 10.7759/cureus.9563] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Cardiovascular disease is common in woman of all age, including child bearing age. In this study, we aim to compare maternal and fetal outcome in pregnant woman with and without preexisting cardiovascular disease. Methods This case control single center study was conducted by Obstetrics & Gynecology department and Cardiology department Shaikh Zayed Medical College/Hospital Rahimyar Khan from 1st March 2020 to 30th June 2020. Results Pregnant woman with preexisting cardiovascular disease had more preterm births and newborn with lower birth weight. Maternal and fetal deaths were numerical higher in pregnant women with preexisting cardiovascular disease but statistically non-significant compared to woman without preexisting cardiovascular disease. Conclusion It is important to identify underlying cardiovascular disease in pregnant woman. Proper counselling throughout pregnancy is needed and efforts should be made to minimize risk of maternal and fetal complications.
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Affiliation(s)
- Aamir Javaid
- Cardiology, Shaikh Zayed Medical College, Rahimyar Khan, PAK
| | - Abdul Majid
- Cardiology, Shaikh Zayed Medical College, Rahimyar Khan, PAK
| | - Shahida Aslam
- Cardiology, Shaikh Zayed Medical College, Rahimyar Khan, PAK
| | - Liaquat Ali
- Cardiology, Nishtar Hospital Medical University, Multan, PAK
| | | | | | - Anam Shaikh
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Amber Rizwan
- Family Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
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48
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Janardana R, Haridas V, Priya V, Bhat V, Singh Y, Rao VK, Jois R, Srikantiah C, Pinto B, Shobha V. Maternal and fetal outcomes of lupus pregnancies: A collective effort by Karnataka Rheumatologists. Lupus 2020; 29:1397-1403. [PMID: 32741300 DOI: 10.1177/0961203320944503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 02/02/2023]
Abstract
INTRODUCTION Identifying factors predicting adverse pregnancy outcomes involving systemic lupus erythematosus (SLE) is a research priority. The aims of this study were to investigate (a) the maternal and fetal outcomes of pregnant lupus patients and the factors associated with adverse pregnancy outcomes, and (b) the effect of pregnancy on lupus disease activity of these patients. METHODS This was an ambi-directional study collecting information from five multi-specialist referral centres across the state of Karnataka, India over 5 years (2013-2018). Clinical details of pregnancies and outcomes that were temporally associated with lupus disease were recorded using a structured pro forma. The Safety of Estrogen in SLE National Assessment-SLE Disease Activity Index (SELENA-SLEDAI) was used to assess lupus activity during the 6 months prior to pregnancy and the intra- and post-partum periods. Modifications suggested in the SLE Pregnancy Disease Activity Index were considered while scoring. RESULTS A total of 121 pregnancies in 80 SLE patients with a mean age of 27.1 (±4.5) years and with a mean disease duration of 4.6 (±4.1) years were reviewed. Largely patients were in clinical remission (109/121; 90.1%). Antiphospholipid antibody positivity was seen in 45/121 (37.2%) patients. A history of lupus nephritis was noted in 29/121 (24%) patients. Maternal complications (32%) were mainly due to hypertensive disorders of pregnancy (HDP; 19/121; 15.7%). Adverse fetal outcomes (58%) were mainly in the form of spontaneous first-trimester abortions (21/121; 16%), stillbirth (14/121; 11.6%) and prematurity (24/121; 20%). HDP is strongly associated with stillbirth and prematurity and is independent of active lupus. Disease activity was associated with a three-fold increased risk of adverse fetal outcome in univariate analysis. The risk of major flare during pregnancy is low (4.1%) when conception occurs during stable disease. Hydroxychloroquine (HCQ) use was associated with reduced risk of flare (p = 0.001) in patients in remission at the time of conception. CONCLUSIONS The risk of major flare during pregnancy is low when conception happens during stable disease. HCQ use was associated with reduced risk of flare in patients in remission at the time of conception. HDP was strongly associated with stillbirth and prematurity and are independent of active lupus in our cohort.
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Affiliation(s)
- Ramya Janardana
- Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, Bengaluru, India
| | - Vikram Haridas
- Department of Obstetrics and Gynecology, St John's Medical College Hospital, Bengaluru, India
| | | | - Vasudha Bhat
- Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, Bengaluru, India
| | | | | | | | | | - Benzeeta Pinto
- Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, Bengaluru, India
| | - Vineeta Shobha
- Department of Clinical Immunology and Rheumatology, St John's Medical College Hospital, Bengaluru, India
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Yu H, Liao H, Wang X, Tong Y. Outcome of twin pregnancy in a patient with Gitelman syndrome: a case report and literature review. Ann Palliat Med 2020; 9:2361-2366. [PMID: 32692195 DOI: 10.21037/apm-19-299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/27/2020] [Indexed: 11/06/2022]
Abstract
Gitelman syndrome (GS) is a rare autosomal-recessive disease characterized by hypokalemia, hypomagnesemia, metabolic alkalosis and hypocalciuria. The impact of GS to pregnant and fetus is not wellknown, with few reports until now and no report about twin pregnancy and GS. We report the successful outcome of monochorionic twin pregnancy in a patient with GS. Oral or intravenously potassium chloride and magnesium citrate were prescribed. The course of the pregnancy was uneventful and the patient remained asymptomatic despite persistent hypokalemia. At 36+4 weeks of gestation, two female babies were delivered, weighing 2,380 and 2,210 g respectively. SLC12A3 gene analysis in mother and two babies revealed heterozygous mutations at 988 ATA codon in exon 26, which convert isoleucine to threonine (I988T). The mother and the twins are all in good health condition during three years follow-up. Close fetal serial surveillance, frequent electrolyte evaluation and adequately supplement with potassium and magnesium should be required to prevent obstetrical and fetal complications in a patient with GS. Management by multidisciplinary team is critical to optimizing outcomes for mother and fetus.
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Affiliation(s)
- Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| | - Yu Tong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China; Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
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Uzunov AV, Bohiltea RE, Munteanu O, Nemescu D, Cirstoiu MM. A retrospective study regarding the method of delivery of adolescents in a Romanian Hospital. Exp Ther Med 2020; 20:2444-2448. [PMID: 32765731 DOI: 10.3892/etm.2020.8835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/17/2020] [Accepted: 05/19/2020] [Indexed: 11/06/2022] Open
Abstract
Adolescent pregnancies are associated with a high number of risks for the newborn and mother. Hence, an increased number of emergency caesarean extractions are performed in this group of patients. The aim of this study was to analyze the pregnancy-related conditions, the way of delivery and the neonatal outcome of all the patients who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, a tertiary unit in Romania in a period of 5 years. An observational, retrospective study was performed on a group of 686 patients, aged 12 to 19 years, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, between January 1, 2014 and December 31, 2018. The pregnant women were divided into two age groups. In the first group were pregnant patients aged under 18 years, and in the second group pregnant adolescents between 18 and 19 years. Whether the patients underwent prenatal screening was analyzed. Furthermore, the age of the patients, the rate of caesarean extraction and vaginal birth and the obstetrical complications were evaluated and compared. The outcome of the newborns was assessed based on Apgar score at 1 min and birth weight. Regarding the results, 464 of the 686 patients did not undergo any medical visits during pregnancy. In total, 52.76% of the patients delivered by caesarean section. The most frequent indications for caesarean extraction, in both analyzed groups, were Cephalo-pelvic disproportion, fetal distress and uterine scar after caesarean section. The lack of specific protocols regarding the ante-, peri- and post-natal management of adolescents is probably the cause of the alarmingly increasing number of patients pertaining to the group who deliver by caesarean section.
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Affiliation(s)
- Ana Veronica Uzunov
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy Doctoral School, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Octavian Munteanu
- Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Dragos Nemescu
- Department of Obstetrics and Gynecology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Monica Mihaela Cirstoiu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
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