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Weiss E, Eshkoli T, Baumfeld Y, Rotem R, Kaur G, Weintraub AY. Maternal and fetal outcomes among women with GDMA1 before and post-date. Eur J Obstet Gynecol Reprod Biol 2024; 293:44-49. [PMID: 38104393 DOI: 10.1016/j.ejogrb.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/13/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To investigate adverse pregnancy outcomes in patients complicated with GDMA1 who delivered at term before or after 40 weeks of gestation. STUDY DESIGN A population-based cohort study including all women with GDMA1 during pregnancy was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. RESULTS During the study period, 11,765 women with GDMA1 met the inclusion criteria. Of these, 1303 (11 %) delivered after 40 weeks (post-date, study group), while 10,462 (89 %) delivered at term before 40 weeks of gestation (before date, control group). Those who delivered after 40 weeks of gestation (the study group) had a significantly lower percent of cesarean deliveries (CD), higher rates of spontaneous vaginal deliveries and induction of labor in comparison to those who delivered before 40 weeks of gestation (the control group). The control group had significantly higher rates of preeclampsia and intrauterine growth restriction than the study group. Using a multivariable logistic regression model, delivery after 40 weeks was noted as an independent protective factor for CD (adjusted OR = 0.78, 95 %CI 0.66-0.92, p value = 0.001). Delivery after 41 + 0 weeks had a significantly higher rate of CD and LGA. CONCLUSION No significant increase in adverse pregnancy outcomes at term post-date pregnancies complicated with GDMA1 was demonstrated. Furthermore, there was no increase in the rate of CD with the increase in gestational age until 41 weeks of gestation.
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Affiliation(s)
- Eyal Weiss
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Eshkoli
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yael Baumfeld
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel
| | - Gurkamaljot Kaur
- Medical School for International Health, Ben-Gurion University of the Negev, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Chellamma J, Jayakumar RV, Nair A, Nirmala C, Khadar JP, Vijayan CP, Babu A, Gopi A. Reference range for glycated haemoglobin in full term non diabetic pregnant women: a multicentric cross sectional study. Arch Gynecol Obstet 2023:10.1007/s00404-023-07231-1. [PMID: 37794248 DOI: 10.1007/s00404-023-07231-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND There are no large studies to define the normal value of glycated haemoglobin (HbA1c) measured in full term pregnant women measured at the time of delivery. RESEARCH DESIGN AND METHODS The study was conducted at three government hospitals in South India. Clinical data, maternal blood sample and foetal cord blood sample were collected from women admitted for safe confinement. Mean (± SD) of HbA1c in participants with no known diabetes (gestational or pregestational) or any complications (maternal or fetal) is described, 2.5th-97.5th centile reference range was derived. RESULTS From 3 centres, 2004 women participated in the study. Data from 1039 participants who had no history of diabetes or any maternal or fetal complication were used to determine the reference range for HbA1c at term pregnancy. The mean HbA1c in subjects devoid of diabetes and its known complications was 5.0 (± 0.39) %. The reference range for normal HbA1c at term in these women was found to be 4.3-5.9%. Maternal HbA1c at term pregnancy in non-diabetic pregnant women is associated with pre-pregnancy BMI, maternal age and 2-h plasma glucose level of 2nd trimester oral glucose tolerance test (OGTT). CONCLUSIONS The mean HbA1c at term pregnancy in non-diabetic women admitted for safe confinement is 5.00 (± 0.39) %. An HbA1c of 5.9% or more at term should be considered abnormal and women with such a value may be kept at a close surveillance for development of diabetes.
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Affiliation(s)
| | - R V Jayakumar
- Indian Institute of Diabetes, Thiruvananthapuram, India
| | - Abilash Nair
- Indian Institute of Diabetes, Thiruvananthapuram, India.
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India.
| | - C Nirmala
- Department of Obstetrics and Gynaecology, Government Medical College, Thiruvananthapuram, India
| | - Jabbar Puthiyaveettil Khadar
- Indian Institute of Diabetes, Thiruvananthapuram, India
- Department of Endocrinology and Metabolism, Government Medical College, Thiruvananthapuram, India
| | - C P Vijayan
- Department of Obstetrics and Gynaecology, Government Medical College, Kottayam, India
| | - Asha Babu
- Department of Obstetrics and Gynaecology, W&C Hospital, Thycaud, Thiruvananthapuram, India
| | - Anjana Gopi
- Department of Paediatrics, ESIC Model Super Specialty Hospital, Kollam, India
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Luo R, Wen W, Corsi DJ, Fell DB, Taljaard M, Wen SW, Walker MC. Comparison of adverse maternal and perinatal outcomes between induction and expectant management among women with gestational diabetes mellitus at term pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:509. [PMID: 37438706 DOI: 10.1186/s12884-023-05779-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Induction at 38-40 weeks of gestation has been broadly suggested for women with gestational diabetes mellitus (GDM), yet its benefits and risks remain unclear. This study aimed to systematically review and meta-analyze existing evidence on the effect of induction at term gestation among women with GDM. METHODS We searched MEDLINE, EMBASE, Cochrane Libraries, and Web of Science from inception to June 2021. We included randomized controlled trials (RCTs) and observational studies comparing induction with expectant management among GDM term pregnancies. Primary outcomes included caesarean section (CS) and macrosomia. All screening and extraction were conducted independently and in duplicates. Meta-analyses with random-effects models were conducted to generate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the Mantel-Haenszel method. Methodological quality was assessed independently by two reviewers using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. RESULTS Of the 4,791 citations, 11 studies were included (3 RCTs and 8 observational studies). Compared to expectant management, GDM women with induction had a significantly lower odds for macrosomia (RCTs 0.49 [0.30-0.81]); observational studies 0.64 [0.54-0.77]), but not for CS (RCTs 0.95 [0.64-1.43]); observational studies 1.03 [0.79-1.34]). Induction was associated with a lower odds of severe perineal lacerations in observational studies (0.59 [0.39-0.88]). No significant difference was observed for other maternal or neonatal morbidities, or perinatal mortality between groups. CONCLUSIONS For GDM women, induction may reduce the risk of macrosomia and severe perineal lacerations compared to expectant management. Further rigorous studies with large sample sizes are warranted to better inform clinical implications.
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Affiliation(s)
- Rong Luo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Wendy Wen
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
- International and Global Health Office, University of Ottawa, Ottawa, Canada.
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Sah SK, Sunuwar DR, Baral JR, Singh DR, Chaudhary NK, Gurung G. Maternal hemoglobin and risk of low birth weight: A hospital-based cross-sectional study in Nepal. Heliyon 2022; 8:e12174. [PMID: 36578405 PMCID: PMC9791333 DOI: 10.1016/j.heliyon.2022.e12174] [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: 01/31/2022] [Revised: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
Background Maternal hemoglobin during pregnancy is an important predictor of neonatal outcomes such as birth weight. The newborn weight of an infant is considered a crucial factor for morbidity and mortality. This study aimed to assess the association between maternal hemoglobin concentration and newborn weight at term pregnancy. Methods A hospital-based cross-sectional study was conducted at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from 14th April 2018 to 13th April 2019. Term singleton pregnant women who were admitted for delivery in the labor room of TUTH were included in this study. Maternal characteristics such as age, parity, birth space, ethnicity, education level, dietary habit, body mass index (BMI), and hemoglobin level were recorded. The newborn weight was taken immediately after delivery. The main outcome of this study was the birth weight. The association between hemoglobin level and newborn weight was analyzed using bivariate and multivariable logistic regression analysis. Results Of 2,418 term pregnant women, the prevalence of low hemoglobin and high hemoglobin levels were 24% (95% CI: 22-25.4), and 17% (95% CI: 15.7-18.7), respectively. The prevalence of low birth weight (LBW) was 12.9% (95% CI: 11.7-14.4). Multivariable logistic regression analysis showed that those mothers who had low hemoglobin concentration (adjusted Odds Ratio/aOR = 3.77, 95% CI: 2.84-5.01), and high hemoglobin concentration (aOR = 3.07, 95% CI: 2.23-4.24) had higher odds of having LBW compared to mothers having normal hemoglobin level. Mothers with both young age pregnancy (aged 16-20 years) and older pregnancy (aged ≥31 years) (aOR = 1.60, 95% CI: 1.01-2.52) and (aOR = 1.60, 95% CI: 1.06-2.41), respectively had higher odds of LBW compared to mothers aged 21-25 years. Those mothers who attended a primary level of education had higher odds of (aOR = 1.93, 95% CI: 1.05-3.55) LBW compared to those mothers with a higher level of education. Moreover, mothers who belonged to Janajati ethnic group (aOR = 0.47, 95% CI: 0.34-0.65) compared to the Brahmin/Chhetri ethnic group, and mothers with a birth space of more than three years (aOR = 0.63, 95% CI: 0.41-0.97) compared to those who had less than three years of birth spacing and mothers who were overweight/obese (aOR = 0.74, 95% CI: 0.55-0.99) compared to normal nutritional status had lower odds of having LBW. Conclusions Our study concludes that both low and high hemoglobin had an increased risk of having low birth weight. Policies and programs can benefit by adopting the findings of this study. More empirical research is critical to understanding the impact of hemoglobin levels on birth weight.
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Affiliation(s)
- Sandeep Kumar Sah
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Dev Ram Sunuwar
- Department of Nutrition and Dietetics, Nepal Armed Police Force Hospital, Kathmandu, Nepal,Corresponding author.
| | - Josie R. Baral
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, United Kingdom
| | | | - Geeta Gurung
- Department of Obstetrics and Gynecology, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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An H, Zheng W, Zhu Q, Wen H. Retrospective study of intrapartum fever in term pregnancies and adverse obstetric and neonatal outcomes. PeerJ 2022; 10:e14242. [PMID: 36320562 PMCID: PMC9618262 DOI: 10.7717/peerj.14242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background Intrapartum fever is a well-known predisposing factor for severe perinatal outcomes. Herein, we explored the intrapartum features, obstetric outcomes, and neonatal outcomes in relation to the extent of intrapartum fever via three group analyses. Methods A retrospective cohort analysis consisting of 575 term, singleton live births in one medical center from January 1st to December 31st, 2020 was carried out. Parturients who had experienced a maximal intrapartum fever of <38.0 °C were compared with two sub-groups of parturients who had experienced respective maximal fevers of 38.0-38.9 °C and ≥39.0 °C. We computed the adjusted risks for adverse perinatal outcomes via multiple logistic regression models to control for confounders. Results There were statistically remarkable differences among the three groups in 13 items including body mass index, epidural, and WBC before delivery (p < 0.05). In contrast with intrapartum fevers of 37.5-37.9 °C, intrapartum fevers of 38.0-38.9 °C were linked to an elevated risk of neonatal sepsis and neonatal intensive care unit admission with an odds ratio (OR) of 4.28 (95% CI 2.162-8.479) and 1.73 (95% CI 1.125-2.666), nonetheless, the relationship was remarkably higher for intrapartum fever ≥39.0 °C, with an OR of 6.40 (95% CI 2.450-16.725) and 2.23 (95% CI 1.021-4.854). Additionally, intrapartum fevers of 38.0-38.9 °C and ≥39.0 °C were related to remarkably higher risk for operative deliveries (OR 2.24, 95% CI 1.373-3.648; OR 3.59, 95% CI 1.398-9.226; respectively) and histological chorioamnionitis (OR 3.77, 95% CI 2.261-6.271; OR 19.24, 95% CI 7.385-50.111, respectively). Conclusions Intrapartum fever is an important indicator of adverse perinatal outcomes. The higher the temperature, the higher risk of histological chorioamnionitis, as well as the risk of neonatal sepsis and neonatal intensive care unit admission.
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Affiliation(s)
- Hongmin An
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
| | - Wei Zheng
- Department of Gastroenterology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, China
| | - Qinghua Zhu
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
| | - Haiyan Wen
- Obstetrics Department, Hangzhou Women’s Hospital, Hangzhou, China
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Wen C, Liu X, Wang Y, Wang J. Conventional versus modified application of COOK Cervical Ripening Balloon for induction of labor at term: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:739. [PMID: 36184583 DOI: 10.1186/s12884-022-05035-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background This study aims to evaluate the efficacy and safety of the modified application of COOK Cervical Ripening Balloon (CCRB) for induction of labor (IOL) at term in primipara. Methods A total of 227 singleton full-term pregnancies with indications of IOL were enrolled and randomly divided into the control and study groups in our hospital from January 2021 to December 2021. In the control group, a conventional method was used. Both the uterine and vaginal balloons were filled to 80 mL and removed after 12 h. In the study group, a modified method was used. The uterine and vaginal balloons were filled to 120 mL and 40 mL respectively. Light traction was given to help CCRB to be discharged after 12 h placement. Oxytocin was administered in both groups after CCRB was discharged before labor starting. The improved Bishop scores, duration of labor, and spontaneous delivery rate were evaluated in the two groups. Results The improved Bishop scores in the study group were 3.06 ± 0.97 at 12 h placement of CCRB and 4.37 ± 0.87 when CCRB was discharged, which were significantly higher compared to the control group (2.52 ± 0.79, p < 0.05). Duration of the first stage of labor and the full labor in the study group were significantly shorter than those in the control group ((6.17 ± 2.85) h vs. (7.27 ± 2.90) h, p = 0.010; (7.07 ± 3.18) h vs. (8.09 ± 3.11) h, p = 0.028). No difference in spontaneous delivery rate between the two groups was observed. But the delivery rate within 24 h between the two groups was significantly different (79.79% vs. 55.91%, p < 0.05). For the cases with initial Bishop scores ≤ 3, the improved score was significantly increased, the first stage of labor and the full labor were significantly shorter in the study group than those in the control group (p < 0.05). Those results were not observed in cases with initial Bishop scores of 4–6. Conclusions The modified application of CCRB could benefit cervical ripening, shorten the duration of labor, especially for cases with poor cervical maturity, and improve the delivery rate within 24 h. Trial registration Retrospectively registered: ChiCTR2200058270. Registered 04/04/2022.
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7
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Momtahan M, Kasraeean M, Faraji A, Moradi-Alamdarloo S, Moosaie M. Term Spontaneous Heterotopic Pregnancy (Abdominal and Intrauterine): A Case Report. Bull Emerg Trauma 2021; 9:201-203. [PMID: 34692872 PMCID: PMC8525693 DOI: 10.30476/beat.2021.86588.1153] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 12/01/2022] Open
Abstract
Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component outside the context of assisted reproduction and is difficult in diagnosis with very few cases reported in the literature. We report such a case in a 31-year-old primigravida with heterotopic pregnancy which is a fetus in the uterine cavity and the other in the abdominal cavity. Her pregnancy was initially misdiagnosed and managed as a di-amniotic di-chorionic gestation. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The patient was complicated with severe bleeding which led to disseminated intravascular coagulopathy and massive transfusion. Two other operations were imposed on the patient because of bleeding. The clinical risk factor for ectopic pregnancy was only previous pelvic inflammatory disease in this woman.
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Affiliation(s)
- Mozhde Momtahan
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Kasraeean
- Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azam Faraji
- Maternal-fetal medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mina Moosaie
- Student research committee, Shiraz University of Medical Sciences, Shiraz, Iran
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8
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Arabi A, Ayoola-Adeola M, Nguyen HQ, Brar H, Walker C. Pulmonary metastasis as a primary manifestation of gestational choriocarcinoma in a third trimester pregnancy. Gynecol Oncol Rep 2021; 36:100762. [PMID: 33869715 PMCID: PMC8042422 DOI: 10.1016/j.gore.2021.100762] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
Choriocarcinomas can follow molar, ectopic, or normal pregnancies. The early diagnosis and treatment of choriocarcinomas is imperative. Atypical symptoms in pregnancy should raise suspicion for choriocarcinoma. Choriocarcinoma must always be in the differential in uncomplicated term pregnancies.
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Affiliation(s)
- Ahmad Arabi
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
| | - Martins Ayoola-Adeola
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
| | - Huy Q Nguyen
- Wayne State University School of Medicine, Department of Pathology, Detroit, MI, USA
| | | | - Christopher Walker
- Wayne State University School of Medicine, Department of Obstetrics and Gynecology, 3980 John R, 7-Brush N, MB #165, Detroit, MI 48201, USA
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9
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Gu YZ, Duan NY, Cheng HX, Xu LQ, Meng JL. Fertility-sparing surgeries without adjuvant therapy through term pregnancies in a patient with low-grade endometrial stromal sarcoma: A case report. World J Clin Cases 2021; 9:983-991. [PMID: 33585648 PMCID: PMC7852628 DOI: 10.12998/wjcc.v9.i4.983] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/30/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Low-grade endometrial stromal sarcoma (LGESS) is a rare indolent tumor with a favorable prognosis. With the importance of improving quality of life recognized, fertility-sparing surgery may be an option for those young women. However, most of the reports suggested that stage IA patients might be candidates for fertility-sparing surgery, and adjuvant hormonal treatment was considered a feasible adjuvant therapy for reducing the recurrence risk of patients with LGESS and hysterectomy was recommended after the completion of pregnancy and delivery.
CASE SUMMARY A 28-year-old pregnant woman diagnosed with stage IB LGESS was treated by fertility-sparing surgery when term cesarean section delivery was performed. Without any adjuvant treatment, she had the other successful term pregnancy and cesarean section 45 mo after first fertility-sparing surgery. Moreover, only hysteroscopic resection was performed to retain fertility again even when the tumor recurred after 6 years. So far the patient’s fertility and disease-free status have remained for more than 8 years without any adjuvant therapy despite local resection of the sarcoma. And the two babies were in good health.
CONCLUSION For young patients with stage I LGESS, it seems that repeated fertility-sparing surgeries could be performed even after two term deliveries and the tumor recurrence, and it might be attempted without adjuvant therapy but the counseling should be considered as mandatory.
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Affiliation(s)
- Yong-Zhong Gu
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Ning-Ya Duan
- Department of Obstetrics and Gynecology, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Hong-Xia Cheng
- Department of Pathology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Lian-Qiong Xu
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
| | - Jin-Lai Meng
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
- Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong Province, China
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Bademkiran MH, Bademkiran C, Ege S, Peker N, Sucu S, Obut M, Demirel MO, Samanci S, Bagli I, Celik K. Explanatory variables and nomogram of a clinical prediction model to estimate the risk of caesarean section after term induction. J OBSTET GYNAECOL 2020; 41:367-373. [PMID: 33054454 DOI: 10.1080/01443615.2020.1798902] [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: 10/23/2022]
Abstract
The aims of this study were to identify the explanatory variables associated with failure of induction of labour (IOL) and to designate nomograms that predict probability. This retrospective study included 1328 singleton term pregnant women (37-42 weeks). The penalised maximum likelihood estimation (PMLE) method was used instead of traditional logistic regression. Of the 25,678 deliveries that occurred during the study period, 1328 (5.1%) women underwent term delivery. Of those, 1125 (84.7%) had successful vaginal deliveries and 203 (15.3%) had failed vaginal deliveries following use of a dinoprostone slow-release vaginal insert. Explanatory variables were discovered that were associated with delivery failure in term pregnancy undergoing induction of labour with an unfavourable cervix, and a nomogram that predicted probability was developed.IMPACT STATEMENTWhat is already known on this subject? The caesarean rate has continued to climb worldwide over the past decade. Most caesarean sections are performed because of suspected foetal distress or failure to progress. In absolute numbers, most caesarean deliveries are performed in women with a term pregnancy with a foetus in cephalic presentation. Despite these numbers, predicting the mode of delivery by which these women will deliver remains a challenge.What do the results of this study add? Five explanatory variables were strongly associated with failure of dinoprostone delivery of term pregnancies: nulliparity, induction time, premature rupture of membranes, Bishop score and foetal genderWhat are the implications of these findings for clinical practice and further research? The developed nomograms enable fast and easy implementation in clinical practice. After external validation and proof of generalisability, the present model could be used in obstetric clinical management.
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Affiliation(s)
- Muhammed Hanifi Bademkiran
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Cihan Bademkiran
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Serhat Ege
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Nurullah Peker
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Seyhun Sucu
- Department of Obstetrics and Gynaecology, Gaziantep University Medical School, Diyarbakır, Turkey
| | - Mehmet Obut
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Ozgur Demirel
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Serhat Samanci
- Department of Pediatric Disease, Diyarbakır Pediatric Hospital, Diyarbakır, Turkey
| | - Ihsan Bagli
- Department of Obstetrics and Gynaecology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Kiymet Celik
- Department of Neonatology, Health Sciences University Gaziyaşargil Education and Research Hospital, Diyarbakır, Turkey
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11
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Veronesi MC, Fusi J, Comin A, Ferrario PG, Bolis B, Prandi A. Effect of breed body-size on leptin amniotic fluid concentrations at term pregnancy in dogs. Theriogenology 2020; 149:1-5. [PMID: 32224377 DOI: 10.1016/j.theriogenology.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 01/22/2023]
Abstract
Because of the need to improve the knowledge about canine perinatology, and given the major role of fetal fluids in sustaining the course of pregnancy and fetal development, an in-depth analysis to better understand the role of some hormones in these compartments is essential. Among all, leptin is recognized to play a key role not only on the energetic homeostasis, but also at multiple levels, influencing the control of reproduction, food assumption and metabolism. Even if in humans and other species it is reported the presence of leptin receptors during fetal development, very little is known about the canine species, in which the role of leptin still needs to be fully understood. The present study aimed to assess the amniotic fluid leptin (AFL) concentrations at term pregnancy in healthy dogs, and to evaluate the possible influence played by breed body-size (after assessment of correlation with maternal bodyweight and placental weight), or other maternal (age, parity, and the so-called "litter effect") and neonatal (gender, birth weight, litter size) parameters on AFL concentrations, analyzed by ELISA test. The study was performed on 90 healthy, viable and normal weighted puppies, 39 small-sized (adult body weight < 10 kg) and 51 large-sized (adult body weight > 25 kg), born by 29 purebred, healthy bitches, submitted to elective Caesarean section because of breed-related or individual high risk for dystocia. The results showed that the mean AFL concentration in the small-sized puppies was significantly (p < 0.05) higher in comparison to large-sized puppies (867.48 vs 698.42 pg/ml), while all the other studied parameters did not show to influence AFL concentrations. In conclusions, the present study showed significant higher at term AFL concentrations in small-sized as compared to large-sized breeds, suggesting an influence of breed body-size on fetal metabolism, as previously reported for NEFA and IGF-I.
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Affiliation(s)
- M C Veronesi
- Department of Veterinary Medicine, Università degli Studi di Milano, Via dell'Università 6, Lodi, Italy.
| | - J Fusi
- Department of Veterinary Medicine, Università degli Studi di Milano, Via dell'Università 6, Lodi, Italy
| | - A Comin
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, Via Sondrio, 2/a, Udine, Italy
| | - P G Ferrario
- Max Rubner-Institut, Department of Physiology and Biochemistry of Nutrition, Haid-und-Neu-Str. 9, Karlsruhe, Germany
| | - B Bolis
- Department of Veterinary Medicine, Università degli Studi di Milano, Via dell'Università 6, Lodi, Italy
| | - A Prandi
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, Via Sondrio, 2/a, Udine, Italy
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12
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Abstract
Intraplacental choriocarcinoma is a rare type of gestational choriocarcinoma occurring in the placenta, of which only a small number of cases have been reported. Gestational choriocarcinoma rapidly metastasizes to organs such as the lung, brain, and liver; thus, early diagnosis and treatment are essential. In addition, intraplacental choriocarcinoma can affect fetal mortality. We present a case of a 33-year-old woman diagnosed with intraplacental choriocarcinoma based on placental biopsy performed after the pregnancy had reached term. The patient had pulmonary metastasis at the time of diagnosis, but after the combination chemotherapy with EMA-EP, complete remission is maintained.
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Affiliation(s)
- Eunhyun Lee
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Hyunjin Cho
- Department of Obstetrics and Gynecology, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
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13
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Madendag IC, Sahin ME. The effects of antenatal corticosteroid exposure on the rate of hyperbilirubinemia in term newborns. Pak J Med Sci 2019; 35:1582-1586. [PMID: 31777497 PMCID: PMC6861493 DOI: 10.12669/pjms.35.6.1218] [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: 11/15/2022] Open
Abstract
Objective Neonatal hyperbilirubinemia is a short-lasting benign condition that affects approximately 60% of infants born at term infants. This study aimed to evaluate the effects of antenatal corticosteroid (ACS) exposure on the rate of hyperbilirubinemia in term newborns. Methods This retrospective study was conducted at the Health Sciences University Kayseri Education and Research Hospital, Turkey from June 2017 to June 2018. A total of 6254 pregnant participants aged between 18 and 35 years with a singleton pregnancy were included in the study. The study group included 354 women with low-risk pregnancies (no perinatal risk except threatened preterm labor) who received ACS treatment and were hospitalized because of the threat of preterm labor before the 34th gestational week but delivered after 37 weeks of gestation. The control group was composed of 5900 women with low-risk pregnancies who did not receive ACS treatment throughout their pregnancy and delivered after 37 weeks of gestation. Results Maternal age, mean body mass index, gestational week at delivery, nulliparity, previous cesarean history, sex of the baby, fetal weight, labor induction, vaginal delivery, and five minutes. Apgar score were similar in both groups. The neonatal hyperbilirubinemia rate was 20/354 (5.6%) in the ACS treatment group and 564/5900 (9.6%) in the control group. Conclusions The neonatal hyperbilirubinemia was significantly decreased in term-born babies exposed to ACS before 34 weeks.
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Affiliation(s)
- Ilknur Col Madendag
- Ilknur Col Madendag, MD, Department of Obstetrics and Gynecology, Health Sciences University Kayseri, City Hospital, Kayseri, Turkey
| | - Mefkure Eraslan Sahin
- Mefkure Eraslan Sahin, MD, Department of Obstetrics and Gynecology, Health Sciences University Kayseri, City Hospital, Kayseri, Turkey
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14
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Dakwar Shaheen J, Hershkovitz R, Mastrolia SA, Charach R, Eshel R, Tirosh D, Shaheen N, Baron J. Estimation of fetal weight using Hadlock's formulas: Is head circumference an essential parameter? Eur J Obstet Gynecol Reprod Biol 2019; 243:87-92. [PMID: 31678760 DOI: 10.1016/j.ejogrb.2019.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To test the equivalence of two fetal weight estimation formulas generated by Hadlock, a formula that includes head circumference parameter (H1), and another (H2) which excludes this parameter. A secondary aim was to identify the patients in which H2 formula is less reliable to use. STUDY DESIGN This retrospective cohort study included a total of 1220 sonographic fetal weight estimations performed within seven days of delivery and recorded at a single medical center from January 2014 to December 2016. Estimated fetal weight was calculated using H1 and H2 formulas. Their accuracies were compared using percentage error, the proportion of weight estimations falling within ±15% error interval and by Bland-Altman analysis. Multivariate regression was performed to evaluate factors affecting weight estimation by H2 formula. RESULTS The mean birth weight was 3288.92 ± 641.27gr. The H2 formula presented with statistically significant higher value of systemic mean percent error comparing to H1 (3.19% vs. 1.87%, p < 0.001 respectively). H2 formula had a lower accuracy compared to H1 in predicting fetal weight within ±15% of birth weight (90.49% vs. 93.44%, p < 0.01 respectively). Using Bland-Altman analysis, the 95% limits of agreement between both formulas were (-142.03) to 231.79gr with a mean of 44.88gr. Factors found to influence significantly on H2 formula were long femur length (OR 1.144, p < 0.0001) and low maternal age (OR 0.947, p < 0.01). CONCLUSIONS H1formula was more accurate than H2 formula in predicting fetal weight at term. However, the accuracy difference was found to be small. Therefore, if ultrasonographic evaluation of HC is technically difficult, Hadlock formula that excludes head circumference can be used with confidence. Caution should be paid with higher values of femur length and lower maternal age.
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15
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Gutvirtz G, Wainstock T, Sheiner E, Landau D, Slutzky A, Walfisch A. Long-term pediatric hematological morbidity of the early-term newborn. Eur J Pediatr 2018; 177:1625-1631. [PMID: 30088135 DOI: 10.1007/s00431-018-3223-x] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
Abstract
Children born at early term (37 0/7 to 38 6/7 weeks' gestation) are at an increased risk for long-term respiratory, cardiovascular, neurological, and developmental morbidities as compared with children born at full term (39 0/7 to 40 6/7 weeks' gestation). In this population-based cohort analysis, we sought to evaluate the long-term hematological morbidity of early-term born children. The cohort consisted of 223,242 term singleton deliveries. Hospitalizations of the offspring up to 18 years of age involving hematological morbidity were evaluated, including hereditary and acquired anemias, immunodeficiency disorders, coagulation disorders, white blood cell disorders, cytopenias, polycythemia, and myelodysplastic syndrome. Hematological hospitalizations were significantly more common in children delivered at early term as compared with those born at later gestational ages. A Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of hematological-related hospitalizations in the early-term born group (logrank p < 0.001). Using a Cox regression model, early-term delivery was found to be an independent risk factor for childhood hematological morbidity with an adjusted hazard ratio of 1.15 (95%CI 1.01-1.30, p=0.027).Conclusion: Early-term delivery appears to be independently associated with pediatric long-term hematological morbidity of the offspring. What is Known? • It has been shown that children born at early term are at increased risk for short-term adverse outcomes including perinatal mortality. • Early-term infants are also at increased risk for long-term morbidity, mainly respiratory. What is New? • Early-term delivery is also independently associated with long-term hematological morbidity of the offspring.
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Affiliation(s)
- Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Slutzky
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center (SUMC), Ben-Gurion University of the Negev, 151 Izak Rager Ave., 84101, Beer-Sheva, Israel
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16
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Karamustafaoglu Balci B, Goynumer G. Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium. Arch Gynecol Obstet 2018; 297:915-918. [PMID: 29362926 DOI: 10.1007/s00404-018-4679-7] [Citation(s) in RCA: 3] [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: 05/23/2017] [Accepted: 01/15/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The presence of echogenic amniotic fluid at term gestation on sonography is uncommon. The aim of our study was to investigate the incidence of echogenic amniotic fluid at term pregnancy, and to determine how often echogenic amniotic fluid was associated with meconium. METHODS All singleton pregnant women at term who were admitted to our labor unit and who delivered within 24 h of the ultrasound scan were included in the study. For each woman, gestational age, maternal age, gravidity, parity, the character of the amniotic fluid on ultrasound at admission (clear or echogenic), birth weight, and the character of the amniotic fluid on artificial or spontaneous rupture of membranes or on cesarean section (clear/with vernix/meconium-stained) were recorded. RESULTS When amniotic fluid was assessed on ultrasound, among 278 patients, 9 (3.2%) patients' amniotic fluid was echogenic. When the amniotic fluid was assessed at delivery, the rates of meconium-stained amniotic fluid in women with and without echogenic amniotic fluid were 44.44% (4/9) and 9.3% (25/269), respectively; the difference was statistically significant (p = 0.035). We found a sensitivity and specificity of 13.79 and 97.99%, and a positive and negative predictive value of 44.44 and 90.7%, respectively, for echogenic amniotic fluid seen on ultrasound in identifying meconium-stained amniotic fluid. CONCLUSIONS The incidence of echogenic amniotic fluid at term gestation was found as 3.2 and 44.4% of cases of echogenic amniotic fluid was associated with meconium.
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Affiliation(s)
- Burcin Karamustafaoglu Balci
- Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, Istanbul, Turkey.
| | - Gokhan Goynumer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Düzce University, Duzce, Turkey
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17
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Chávez-Lizárraga D, Zárate-Segura P, Beltrán-Montoya J, Canchola-Sotelo C, Vadillo-Ortega F, Chavira-Suárez E. DNA Methylation Variability in a Single Locus of the RXRα Promoter from Umbilical Vein Blood at Term Pregnancy. Biochem Genet 2018; 56:210-24. [PMID: 29305749 DOI: 10.1007/s10528-017-9838-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/29/2017] [Indexed: 12/26/2022]
Abstract
DNA methylation status of RXRα gene promoter has been correlated with maternal diet during early pregnancy, and associated with offspring's adiposity and bone mineral content. In adult life, increased methylation of RXRα promoter region is associated with myocardium pathologies. Early growth response proteins (EGR) are zinc finger transcription factors associated with several cellular pathways such as inflammation, apoptosis, and cardiopathies. DNA-binding sequences of EGR proteins have been reported in the RXRα gene promoter using chromatin immunoprecipitation methods. Here, we used correlations between the maternal pre-pregnancy body mass index (p-BMI), gestational weight gain (GWG), and birth weight (BW) as indirect indicators of the maternal nutritional status as modifier of DNA methylation in the offspring. DNA methylation status from newborns' umbilical vein blood in full-term pregnancy was evaluated in a short sequence (116 pb) of the RXRα gene promoter that contains the elements of response sequence for EGR proteins. Fifty-three bisulfite-modified DNA samples were assessed through methyl-sensitive high-resolution melting (MS-HRM) analysis. To validate the results, we directly sequenced MS-HRM samples to confirm the presence of CpG-methylated positions. In addition, the RXRα protein levels in extracts of umbilical vein blood were evaluated by western blot. We found differential methylation in a specific locus of the RXRα promoter surrounding the EGR-binding sequence; however, no correlation was found with the level of RXRα protein expression. Variability in the methylation status of the RXRα promoter near the EGR transcription factor binding site in newborn cord blood provides controversial epigenetic insights into RXRα regulation via EGR proteins.
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18
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Wu X, Wang C, Li Y, Ouyang C, Liao J, Cai W, Zhong Y, Zhang J, Chen H. Cervical dilation balloon combined with intravenous drip of oxytocin for induction of term labor: a multicenter clinical trial. Arch Gynecol Obstet 2017; 297:77-83. [PMID: 29043436 DOI: 10.1007/s00404-017-4564-9] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aimed to investigate the effectiveness and safety of a method combining double-balloon catheter for cervical ripening and intravenous drip of oxytocin on the induction of term labor, providing the reference for clinical safety. METHODS A total of 120 pregnant women with a gestation between 37+0 and 41+6 weeks, indications of labor induction, singleton pregnancy with cephalic presentation were enrolled. The patients were divided into the research group receiving cervical dilation balloon combined with intravenous drip of oxytocin and the control group receiving an intravenous drip of oxytocin at a concentration of 0.5% for labor induction (n = 60 for each). The effectiveness and safety of labor induction were evaluated by the rates of successful cervical ripening promotion and labor induction, as well as the vaginal delivery rate, induced labor time, total duration of labor, the total amount of postpartum hemorrhage within 24 h after giving birth, the incidences of postpartum hemorrhage, cervical laceration, puerperal infection and neonatal outcomes. RESULTS There was no statistical difference in the basal demographic and clinical characteristics, including ages, gestational weeks, delivery times and Bishop scores at admission between two groups. The rate of successful cervical ripening promotion (research vs. control = 90.00% vs. 55.00%), the rate of successful induction (95.00% vs. 40.00%), the vaginal delivery rate (93.33% vs. 63.33%), the induced labor time (15.03 ± 5.40 vs. 30.68 ± 10.82 h), and the total duration of labor (8.12 ± 2.65 vs. 15.01 ± 6.06 h) were significantly different between two groups (all P < 0.05). There was no significant difference in the total amount of postpartum hemorrhage, incidences of postpartum hemorrhage, cervical laceration, puerperal infection as well as the neonatal outcomes, including neonatal weight, neonatal asphyxia and incidence of meconium aspiration syndrome between two groups. CONCLUSIONS Compared to labor induction of oxytocin, the method combining double-balloon catheter for cervical ripening and intravenous drip of oxytocin for the induction of term labor has a higher vaginal delivery rate, shorter total duration of labor, and does not increase the incidences of postpartum hemorrhage and neonatal infection, which is a more effective and safer method for induction of term labor.
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Affiliation(s)
- Xueqin Wu
- Department of Obstetrics, Longgang District Center Hospital, Shenzhen, Guangdong, China
| | - Chunxiang Wang
- Department of Obstetrics, Songgang People's Hospital, Shenzhen, Guangdong, China
| | - Yufang Li
- Department of Obstetrics, Longgang District Center Hospital, Shenzhen, Guangdong, China
| | - Chunmei Ouyang
- Department of Obstetrics, Longgang District Center Hospital, Shenzhen, Guangdong, China
| | - Jiaying Liao
- Department of Obstetrics, Longgang District Center Hospital, Shenzhen, Guangdong, China
| | - Weibin Cai
- Guangdong Engineering and Technology Research Center for Disease-Model Animals, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yilei Zhong
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang Road 107, Guangzhou, 510120, Guangdong, China
| | - Jianping Zhang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang Road 107, Guangzhou, 510120, Guangdong, China.
| | - Hui Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Yanjiang Road 107, Guangzhou, 510120, Guangdong, China.
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Rajagopala L, Satharasinghe RL, Karunarathna M. A rare case of dengue encephalopathy complicating a term pregnancy. BMC Res Notes 2017; 10:79. [PMID: 28148289 PMCID: PMC5288850 DOI: 10.1186/s13104-017-2391-5] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dengue fever has an expanded clinical spectrum ranging from an asymptomatic infection to life threatening dengue hemorrhagic fever and refractory shock. Dengue infection in pregnancy can be a diagnostic dilemma, particularly considering the physiological changes in pregnancy and the obstetric complications encountered in clinical practice. Hence the knowledge of its diagnosis and management in its atypical presentations is of paramount importance. Here we report an unusual case of uncomplicated dengue encephalopathy in a term mother, probably the first to be reported from the Indian subcontinent. CASE PRESENTATION A 28 year old woman, 37 weeks of pregnancy presented with fever of four days duration. She eventually developed irritability, altered sensorium, somnolence, and unresponsiveness to commands by the 5th day of febrile illness without any circulatory compromise. Physical examination and investigations including serology confirmed dengue fever. After excluding all other possible causes, the transient neurological deterioration was finally attributed to dengue encephalopathy which is an uncommon manifestation of the disease, particularly in pregnancy. Her deteriorated neurological status which had lasted for 6 days improved spontaneously with the convalescence of dengue infection. Cautious fluid management was carried out in correlation to clinical and hematological parameters. The pregnancy was continued uncomplicated till the platelet count had risen to more than 50,000 cells/cumm. She delivered vaginally a healthy male baby. CONCLUSIONS Dengue fever in pregnancy is increasingly being encountered due to its rising disease burden. Dengue encephalitis/encephalopathy must be suspected in the differential diagnosis of fever and altered sensorium, even in pregnancy, in the tropical countries where the infection is rampant. Management of dengue infection in term pregnancy is a challenge for both the clinician and obstetrician. Further discussion and research are mandatory to decide on optimal management of these patients, with regard to monitoring, fluid management, and the precise timing and mode of delivery in order to prevent fatal morbidity and mortality to both mother and fetus.
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Affiliation(s)
- Lavanya Rajagopala
- Sri Jayewardenepura General Hospital, Sri Jayewardenepura, Kotte, Sri Lanka.
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Bolis B, Prandi A, Rota A, Faustini M, Veronesi MC. Cortisol fetal fluid concentrations in term pregnancy of small-sized purebred dogs and its preliminary relation to first 24 hours survival of newborns. Theriogenology 2016; 88:264-269. [PMID: 28234232 DOI: 10.1016/j.theriogenology.2016.09.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 05/16/2016] [Revised: 08/31/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
Along the perinatal period, in mammals, cortisol (C) plays a pivotal role in the final intrauterine fetal maturation and in the early neonatal adaptation. Because of the scarce knowledge about canine perinatology, the present study was aimed to assess the C concentrations in amniotic and allantoic fluids collected, without invasiveness, from small-sized, purebred newborn puppies born by elective cesarean section, at term of pregnancy. Possible correlations between fetal fluid C concentrations and maternal parity, litter size, birth weight, Apgar score, were evaluated. In addition, the possible effect of fetal fluid C concentrations on newborn survival at 24 hours of age, and the effect of the litter or the newborn gender on fetal fluid C concentrations were also assessed. The results, obtained from 50 born alive, normal-weight puppies, without gross physical malformation, showed that C concentration was higher in allantoic than in amniotic fluid (P < 0.01), even if a strong positive correlation between the two fluids C concentration was found (P < 0.0001; R = 0.83). Neither amniotic nor allantoic C concentrations were correlated to maternal parity, litter size, birth weight, and Apgar score. Interestingly, higher amniotic (P < 0.05), but not allantoic, C concentrations were found in puppies not surviving at 24 hours after birth. Therefore, it could be suggested that this parameter may be useful for the recognition, at birth, of puppies needing special surveillance during the first day of age. A significant (P < 0.001) effect of the litter in both amniotic and allantoic C concentrations was found. In conclusion, the present results showed that in small-sized purebred puppies, born at term by elective cesarean section, the exact fetal, maternal, or placental source contributing to fetal fluid C concentrations remains to be clarified. From a clinical perspective, however, the evaluation of amniotic C concentration at birth seems useful for the detection of puppies that need special surveillance during the first 24 hours of age, and should be coupled to the early newborn evaluation by Apgar score. However, the small total number of newborns, and especially of the dead puppies enrolled in the present study, suggests that further, more-focused investigations on a large number of subjects are needed before the method could be considered for application in the clinical practices.
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Affiliation(s)
- B Bolis
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy; ECAR Resident Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy.
| | - A Prandi
- Department of Agricultural, Food, Environmental and Animal Sciences, University of Udine, Udine, Italy
| | - A Rota
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - M Faustini
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
| | - M C Veronesi
- Department of Veterinary Medicine, Università degli Studi di Milano, Milan, Italy
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21
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Konopka CK, Azzolin VF, Cadoná FC, Machado AK, Dornelles EB, Barbisan F, da Cruz IBM. Misoprostol modulates the gene expression prostaglandin E2 and oxidative stress markers in myometrial cells. Prostaglandins Other Lipid Mediat 2016; 126:38-45. [PMID: 27647508 DOI: 10.1016/j.prostaglandins.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/03/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Misoprostol, prostaglandin E1 analogue, used for labour induction. However, one-third of patients who have labour induced with prostaglandins do not reach vaginal delivery. The differential expression of prostaglandin receptors in myometrial cells could account for this differential response. Since delivery physiology also involves modulation of oxidative metabolism that can be potentially affected by pharmacological drugs, in the present investigation the role of misoprostol on expression of prostaglandin receptors, and oxidative markers of myometrial cells was evaluated. Samples of myometrial tissues procured from women with spontaneous (SL) and nonspontaneous (NSL) labours were cultured in vitro and exposed to different concentrations of misoprostol. Gene expression was evaluated by qRT-PCR and oxidative biomarkers were evaluated by spectrophotometric and fluorometric analysis. Cells from SL women presented greater responsiveness to misoprostol, since an upregulation of genes related to increased muscle contraction was observed. Otherwise, cells from NSL women had low responsiveness to misoprostol exposure or even a suppressive effect on the expression of these genes. Oxidative biomarkers that previously have been related to labour physiology were affected by misoprostol treatment: lipoperoxidation and protein carbonylation (PC). However, a decrease in lipoperoxidation was observed only in SL cells treated with low concentrations of misoprostol, whereas a decrease of PC occurred in all samples treated with different misoprostol concentrations. The results suggest a pharmacogenetic effect of misoprostol in labour induction involving differential regulation of EP receptor genes, as well as some minor differential modulation of oxidative metabolism in myometrial cells.
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Affiliation(s)
- Cristine Kolling Konopka
- Graduating Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 21, Zip code: 97105-900 Santa Maria-RS, Brazil; Department of Gynecology and Obstetrics, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 26, Zip code: 97105-900 Santa Maria, RS, Brazil.
| | - Verônica Farina Azzolin
- Graduating Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 21, Zip code: 97105-900 Santa Maria-RS, Brazil.
| | - Francine Carla Cadoná
- Graduating Program in Toxicological Biochemistry, Center of Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 18, Zip code: 97105-900 Santa Maria-RS, Brazil.
| | - Alencar Kolinski Machado
- Graduating Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 21, Zip code: 97105-900 Santa Maria-RS, Brazil.
| | - Eduardo Bortoluzzi Dornelles
- Graduating Program in Toxicological Biochemistry, Center of Natural and Exact Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 18, Zip code: 97105-900 Santa Maria-RS, Brazil.
| | - Fernanda Barbisan
- Graduating Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 21, Zip code: 97105-900 Santa Maria-RS, Brazil.
| | - Ivana Beatrice Mânica da Cruz
- Program in Pharmacology, Center of Health Sciences, Federal University of Santa Maria, Av. Roraima 1000, Prédio 21, Zip code: 97105-900 Santa Maria-RS, Brazil.
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Ahmed I, Chishti U, Akhtar M, Ismail H. Factors affecting mode of delivery in a nullipara at term with singleton pregnancy and vertex presentation (NTSV). Pak J Med Sci 2016; 32:314-8. [PMID: 27182230 PMCID: PMC4859013 DOI: 10.12669/pjms.322.9138] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: To analyse the factors associated with Caesarean Section (CS) of Nulliparous, Term and Singleton pregnancies with Vertex presentation (NTSV) at a tertiary care hospital. Methods: In this unmatched retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries (SVD) were taken as cases and controls. Results: The mean maternal age of cases (CS) was 26.64 (SD: 3.9) and of controls (SVD) was 26.7(SD: 3.9) years, whereas mean gestational age was 38.66±1.12 and 38.57±0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed ≤3kg were 45% and >3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant (p value 0.077). Labour was induced in 38% patients. The Odds of Induction of Labour (IOL) were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times (81%) if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery (MOD) in this study. Conclusion: Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section.
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Affiliation(s)
- Iffat Ahmed
- Dr. Iffat Ahmed, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Uzma Chishti
- Dr. Uzma Chishti, Assistant Professor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Munazza Akhtar
- Dr. Munazza Akhtar, Senior Instructor, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
| | - Humaira Ismail
- Ms. Humaira Ismail, Research Specialist, Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Karachi, Pakistan
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Walfisch A, Beharier O, Shoham-Vardi I, Sergienko R, Landau D, Sheiner E. Placenta previa and long-term morbidity of the term offspring. Eur J Obstet Gynecol Reprod Biol 2016; 203:1-4. [PMID: 27219201 DOI: 10.1016/j.ejogrb.2016.05.001] [Citation(s) in RCA: 4] [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: 01/06/2016] [Revised: 03/25/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The long-term impact of placenta previa on term infants is unknown. We aimed to investigate whether abnormal placentation increases the risk for long-term morbidity of the term offspring. STUDY DESIGN A population-based cohort study compared the incidence of long-term hospitalizations up to the age of 18 due to cardiovascular, endocrine, neurological, hematological, respiratory and urinary morbidity of children born at term in pregnancies diagnosed with placenta previa and those without. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence over time. A multivariable generalized estimating equation (GEE) logistic regression model analysis was used to control for confounders and for maternal clusters. RESULTS During the study period 233,123 term deliveries met the inclusion criteria; 0.2% (n=502) of the children were born to mothers with placenta previa. During the follow-up period, children born to mothers with placenta previa did not have an increased risk for long-term cardiovascular, endocrine, hematological, neurological, respiratory, and urinary morbidity. CONCLUSION Term offsprings of mothers diagnosed with placenta previa do not appear to be at an increased risk for long-term morbidity up to the age of 18.
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Affiliation(s)
- Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Ofer Beharier
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilana Shoham-Vardi
- Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Gutvirtz G, Walfisch A, Beharier O, Sheiner E. Isolated single umbilical artery is an independent risk factor for perinatal mortality and adverse outcomes in term neonates. Arch Gynecol Obstet 2016; 294:931-5. [PMID: 27048509 DOI: 10.1007/s00404-016-4088-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/24/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether an isolated single umbilical artery (iSUA) is an independent risk factor for perinatal mortality in term neonates with normal estimated fetal weight (EFW) prior to delivery. METHOD A population-based study was conducted, including all deliveries occurring between 1993 and 2013, in a tertiary medical center. Pregnancies with and without iSUA were compared. Multiple gestations, chromosomal, and structural abnormalities were excluded from the cohort. Only pregnancies delivered at term with normal EFW evaluated prior to delivery were included. Stratified analysis was performed using multiple logistic regression models to evaluate the risk of adverse outcomes and perinatal mortality for iSUA fetuses. RESULTS During the study period, 233,123 deliveries occurred at "Soroka" University Medical Center, out of which 786 (0.3 %) were diagnosed with iSUA. Different pregnancy complications were more common with iSUA fetuses including: placental abruption (OR = 3.4), true knot of cord (OR = 3.5) and cord prolapse (OR = 2.8). Induction of labor and cesarean delivery were also more common in these pregnancies (OR = 1.5 and OR = 1.9, respectively). iSUA neonates had lower Apgar scores at 1 and 5 min (OR = 1.8, OR = 1.9, respectively) compared to the control group and perinatal mortality rates were higher both antenatally (IUFD, OR = 8.1) and postnatally (PPD, OR = 6.1). CONCLUSION iSUA appears to be an independent predictor of adverse perinatal outcomes in term neonates.
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Abstract
PURPOSE Immediate neonatal outcome in pregnancies complicated by placenta previa is largely dependent on gestational age. We aimed to investigate whether placenta previa increases the risk for perinatal mortality and immediate morbidity of the offspring born at term. METHODS A population-based cohort study included all singleton pregnancies, with and without placenta previa, delivered at term. Maternal and pregnancy characteristics as well as immediate neonatal morbidity and mortality were compared. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. RESULTS During the study period 233,123 consecutive term deliveries met the inclusion criteria; 0.2 % of the babies were born to mothers diagnosed with placenta previa. Women with placenta previa were significantly older and more likely to have had a previous cesarean section. Pregnancies were more likely to be complicated with pathological presentations and cesarean hysterectomies. Babies born at term following pregnancies with placenta previa were more likely to weigh less than 2500 g (OR 2.78 CI 1.9-3.9, p < 0.001). However, 5 min Apgar score and perinatal mortality rates were comparable between the groups. Neonatal outcomes remained comparable between the groups in a sub-analysis of cesarean deliveries only. CONCLUSION Although placenta previa pregnancies involve higher maternal morbidity rates, term offsprings are not at an increased risk for immediate adverse outcome.
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Affiliation(s)
- Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Abstract
A case report of a live birth following a term pregnancy located in a non-communicating rudimentary horn of a unicornuate uterus in a rural hospital in Nigeria is presented. A 32-year-old primiparous woman registered for antenatal care at a rural missionary hospital at 28 weeks gestation. She had intermittent unexplained vaginal bleeding prior to booking and multiple ultrasound scans in different centers affirmed a viable intrauterine pregnancy. She had an elective cesarean section at 38 weeks gestational age on account of a persistent oblique breech presentation and “low lying placenta.” Intra-operatively, the pregnancy was found in a non-communicating pouch continuous with the left fallopian tube and separate from the uterine cavity. A female baby weighing 2.2 kg with no gross deformity was delivered. Resection of the rudimentary horn and repair were done. The possibility of a uterine anomaly should be considered by clinicians and sonographers in unexplained intermittent early pregnancy bleeding.
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Affiliation(s)
- Ca Iyoke
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Cn Okafor
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Go Ugwu
- Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - C Oforbuike
- Department of Obstetrics and Gynecology, Catholic Mission Hospital Moniyan, Ogoja, Nigeria
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