Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

Background and Aim: Delivery of a fetus with SGA is associated with increased risk of perinatal morbidity and mortality. Evidence is limited for the accuracy of Oligohydramnios to predict substantive perinatal morbidity and mortality in non–anomalous SGA fetuses monitored with normal Doppler studies. The aim of this study is to determine the association between amniotic fluid index and adverse perinatal outcomes in term SGA fetuses with normal Doppler studies. Method: This is a prospective observational study carried out by 340 pregnant women who were admitted to obstetrics unit, Sri Jayewardenepura from January 2019 to January 2023. Singleton pregnancies at term who were diagnosed with SGA (EFW 10th centile or AC 10th centile) with normal umbilical artery and middle cerebral artery Doppler studies were included. AFI was assessed predelivery and data were collected according to demographic details, mode of delivery, time of delivery, intrapartum events, and neonatal outcomes. Results: A total of 340 term pregnant women were studied. Out of them, 44% were in AFI more than 10 groups and 37% and 19% were in AFI 5 - 10 and less than 5 groups respectively. More obstetrics interventions were reported in AFI 5 groupa in terms of induction of labor (P 0.04) and emergency caesarean sections (P 0.003). No significant deference in immediate neonatal outcome was detected between each group. (Meconium-stained liquor (P 0.634), 1 minute APGAR (P 0.575) and 5-minute APGAR P 0.165)). Neonatal unit admission (P 0.001) and long-term neonatal complications were

Increased syndecan-1 and glypican-3 predict poor perinatal outcome and treatment resistance in intrahepatic cholestasis

Background:Intrahepatic cholestasis of pregnancy(ICP)increases the risk of adverse pregnancy outcomes.This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid(UDCA).Methods:This prospective,case control study included 88 pregnant women(44 women with ICP and 44 healthy controls).The primary end points were the perinatal outcome and the response to UDCA therapy.A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy.Results:Women with ICP had significantly higher serum syndecan-1(1.27±0.36 ng/m L vs.0.98±0.50 ng/m L;P=0.003),glypican-3(1.78±0.13 ng/m L vs.1.69±0.16 ng/m L;P=0.004),AST(128.59±1.44 vs.13.29±1.32 U/L;P<0.001),and ALT(129.84±1.53 vs.8.00±3.67 U/L;P<0.001)levels compared with the controls.The increased levels of syndecan-1(OR=4.715,95%CI:1.554–14.310;P=0.006),glypican-3(OR=8.465,95%CI:3.372–21.248;P=0.007),ALT(OR=1.382,95%CI:1.131–1.690;P=0.002),and postprandial bile acid(PBA)(OR=3.392,95%CI:1.003–12.869;P=0.026)were correlated to ICP.The adverse neonatal outcome was related to increased glypican-3(OR=4.275,95%CI:2.726–5.635;P=0.039),and PBA(OR=3.026,95%CI:1.069–13.569;P=0.037).Increases of syndecan-1(OR=7.464,95%CI:2.130–26.153,P=0.017)and glypican-3(OR=6.194,95%CI:2.951–13.002;P=0.025)were the risk factors of decreased response to UDCA treatment.Conclusion:Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP,and they can be used to predict the response to the UDCA treatment.

A Comparison of Amniotic Fluid Index versus Single Deepest Vertical Pocket Measurement at Term as a Predictor of Adverse Perinatal Outcome

Introduction: Oligohydramnios is an important sign of fetal jeopardy and amniotic fluid index (AFI) and single deepest vertical pocket (SDVP) have been used to detect it. Objective: To compare AFI vs. SDVP at term as a predictor of adverse perinatal outcomes. Methods: A prospective observational study was conducted in Teaching Hospital Kandy, Sri Lanka for eight months from July 2015 to March 2016. 448 Singleton pregnancies admitted after 37 completed weeks were included. AFI ≤ 5 cm and SDVP < 2 cm were the exposure variables, which were related to outcome variables. Results: Mean AFI was 11.35 cm (SD = 5.15) and Mean SDVP was 4.07 cm (SD = 1.88). AFI and SDVP values showed a significant positive correlation (r = 0.954;p < 0.001). A significant percentage with low AFI needed induction of labour (RR 2.14, 95% CI 1.85 - 2.49). Low AFI was also a significant risk factor for not having an uneventful birth outcome (RR 2.682, 95% CI 1.082 - 6.642). Low SDVP was a significant risk factor for induction of labour (RR 1.83, 95% CI 1.434 - 2.334), operative delivery (RR 1.714, 95% CI 1.292 - 2.280), meconium-stained liquor (RR 2.67, 95% CI 1.342 - 5.308), and Apgar < 7 (RR 17.74, 95% CI 7.96 - 40.924). SDVP had better predictability than AFI for adverse perinatal outcomes. Conclusion: AFI better predicted oligohydramnios and subsequent labour induction than SDVP. Low SDVP was a risk factor for adverse perinatal outcomes (such as induction of labour, meconium-stained liquor, operative delivery, 5-minute Apgar less < 7, admission to special care baby units or perinatal deaths). In predicting adverse perinatal events, a higher potential was noted in SDVP method than AFI method. To determine the most predictive cut-off values of SDVP and AFI for each perinatal outcome, an in-depth experimental analysis is required in future research.

Comparison of Perinatal Outcomes in Late Preterm Spontaneous and Indicated Preterm Birth Neonates

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.

Impacts of assisted reproductive technology on perinatal outcomes and offspring health

Assisted reproductive technology(ART)has evolved rapidly over the last 40 years,offering hope to individuals and couples struggling with infertility.As technology continues to evolve,simulating a realistic female reproductive system environment has become a common goal for all types of ARTs,thereby reducing the impact of the artificial microenvironment on perinatal and offspring health.In this review,we provide a brief history of the development of each major ART and discuss the impact of ART on perinatal and offspring health.We also explore how the negative consequences of ART may be overcome and how its benefits can be maximized.

Diagnosis of appendicitis during pregnancy and perinatal outcome in the late pregnancy

Background Appendicitis is the most common surgical problem in pregnancy, however the particular dangers of appendicitis in pregnancy lie in the varied presentation of symptoms and the higher chance of delayed diagnosis. The aim of this study was to determine the risk factors associated with prenatal outcome in acute appendicitis during second and third trimester pregnancies. Methods This was a retrospective single-center study that presented a descriptive analysis of the results. A total of 102 pregnant women who were diagnosed with acute appendicitis and operated upon in Peking University Third Hospital, China between January 1993 and December 2007 were presented. SPSS 12.0 for Windows was used for data analysis. Results Seventy-eight pregnant women who were diagnosed with acute appendicitis （sixteen patients had a perforated appendix, 62 patients had a non-perforated appendix） were operated upon during late pregnancy. The interval between symptom onset and surgery was the only predictive variable. A longer interval between symptom onset and surgery was associated with appendix perforation （（109.5±52.7） hours） than with no appendix perforation （（35.1±19.62） hours; P=-0.007）. There was a significant difference in the rate of preterm labor （5.1% vs 1.3%） and the rate of fetal mortality （25% vs 1.7%） between patients with and without a perforated appendix. Conclusions Delaying surgery correlates to more advanced disease with an increased risk of perforation. This contributes to an increased risk of further complications, including premature labor or abortion, and to higher maternal complication rates. Prompt diagnosis may improve the prenatal outcome.

Long interpregnancy interval and adverse perinatal outcomes: a retrospective cohort study

We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval(IPI)and adverse perinatal outcomes. With the 12–23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs(<12, 12–23, 24–59, 60–119, and ≥120 mon) and perinatal outcomes(gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia).Compared with the 12–23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture(adjusted odds ratio(OR) 1.76, 95% confidence interval(CI) 1.32–2.35 and adjusted OR 2.03, 95% CI 1.53–2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.

Prevalence, Risk Factors and Outcome of Preterm Premature Rupture of Membranes at the Bamenda Regional Hospital

Background: Preterm premature rupture of membranes (PPROM) is one of the most common complications of pregnancy. It is one of the leading identifiable cause of preterm deliveries, and an important cause of maternal and perinatal morbidity and mortality. The aim of this study was to determine the prevalence of PPROM, to identify its associated factors and to evaluate the early outcome (within 72 hrs after delivery) following PPROM at the Bamenda Regional Hospital (BRH). Methods: A cross-sectional study was conducted in March and April 2020. Three hundred and eighty-seven women who delivered at the labour room of the BRH were included in this study. Interviewer-administered questionnaires were used to obtain data. The cases of PPROM were women who had lost amniotic fluid continuously before hospitalisation and whose gestational age was between 28 weeks + 0 days and 36 weeks + 6 days. Descriptive statistics followed by logistic regression analyses were conducted with level of significance set at p-value <0.05. Results: Among the 387 participants included in the study, 19 had PPROM giving a prevalence of 4.91%. Of 57 preterm deliveries, PPROM accounted for 33.33% (n = 19). The statistically significant independent factors associated with lower odds of PPROM were the age groups 20 - 29 years (aOR = 0.07, 95% CI: 0.01 - 0.42, p = 0.003) and ≥30 years (aOR = 0.01, 95% CI: 0.001 - 0.14, p = 0.001), and attending ANC ≥ 4 times (aOR = 0.23, 95% CI: 0.06 - 0.84, p = 0.026). Whereas, having a multiple pregnancy (aOR = 39.72, 95% CI: 7.19 - 219.33, p < 0.001), urinary tract infection during pregnancy (aOR = 104.86, 95% CI: 12.25 - 897.90, p < 0.001), genital tract infections during pregnancy (aOR = 17.34, 95% CI: 2.67 - 112.56, p = 0.003), and having a history of preterm delivery (aOR = 27.65, 95% CI: 1.76 - 434.15, p = 0.018) were associated with a higher likelihood of PPROM. The study revealed that 10.53% (n = 2) of women who had PPROM had an unfavourable outcome. Babies born by mothers who had PPROM were more likely to have an unfavourable outcome (OR = 14.44, 95% CI: 5.42 - 38.48, p < 0.001). Conclusion: Preterm premature rupture of membranes considerably causes perinatal morbidity and mortality, and thus optimum obstetric and medical care is essential for the reduction of the complications related to it.

The Feto-Maternal Outcome in Instrumental Assisted Vaginal Delivery in Parapokar Maternity and Woman Hospital—A Retrospective Study

Aim: To determine maternal and neonatal morbidities associated with instrumental vaginal delivery. Methods: This retrospective study consisted of 233 women undergoing instrumental vaginal deliveries from April 2020 to March 2021 at Paropakar Maternity and Women Hospital, a tertiary care hospital in Kathmandu, Nepal. Neonatal and maternal complications were analyzed. Results: Of 233 women, 102 (43.7%) and 131 (56.2%) had vacuum and forceps deliveries, respectively. The use of instruments was more frequent in infants with higher birth weight and gestational age. There were no significant differences in Apgar scores between the two groups. Two main indications of instrumental deliveries were fetal distress and prolonged second stage labor. Forceps, compared with vacuum, more often caused 3rd/4th perineal tears, tear extending to fornices, and postpartum hemorrhage. Neonatal outcomes were similar in both types of instrumental deliveries. Conclusion: Instrumental vaginal delivery caused maternal morbidity and procedure/judgment training for it is essential.

Nuchal Cord at Delivery and Neonatal Outcomes: A Retrospective Cohort Study

Objective: The present study was aimed at evaluating the outcome of pregnancies with a nuchal cord. Methods: A retrospective population-based study of all deliveries during the years 2011-2020 in Philippe Maguilen SENGHOR Center was conducted. Perinatal outcome of patients with and without nuchal cord was compared. Results: Among 44,958 deliveries during the study period, 1.8% had a nuchal cord, documented at birth (n = 807). Higher rates of labor induction (9.1% vs. 3.2%;p 0.001) and non-reassuring fetal heart rate patterns (RR = 2.366;CI: 1.631 - 3.432) were noted among pregnancies with nuchal cord as compared with the control group. The cesarean delivery rate was significantly higher among pregnancies with a nuchal cord (39.5% vs. 21.8%;RR = 2333;CI: 2.023 - 2.692). Although 5 min Apgar scores lower than 7 were more common in pregnancies with a nuchal cord (7.8% vs. 3.8%;RR = 2.117;CI: 1.629 - 3.363). There was no statistical significance between the two groups for the perinatal mortality. Conclusion: Nuchal cord is associated with prolonged labor and adverse perinatal outcome.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

Perinatal Management and Outcomes of Pregnancy Following Sheehan Syndrome: A Case Report and Literature Review

Pregnancy is rare and difficult in Sheehan syndrome patients.With the help of assisted reproductive technology,the patients even with panhypopituitarism can get pregnant again.Moreover,women with hypopituitarism have increased risk of pregnancy complications.Here we report a patient who suffered acute and severe Sheehan syndrome with panhypopituitarism and central diabetes insipidus got pregnant again by in vitro fertilization and embryo transfer.A regular and careful antenatal care was given by the cooperation between obstetricians and endocrinologists.Finally,she delivered a healthy female baby at 37+6 weeks of gestation with Apgar scores of 10 and 10 at 1 and 5 minutes,respectively.The patient and her baby were doing well at postpartum follow-up.The related articles were also reviewed.This case report is aimed to help clinical practitioners to make better decisions on the management of Sheehan syndrome or other type of hypopituitarism during pregnancy.

Pregnancy,childbirth and neonatal outcomes associated with adolescent pregnancy

Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnant women were separated into two groups:(1)women aged 19 and younger;(2)women aged 20-34 years.Main outcome measures include preterm birth,maternal comorbidities,preeclampsia,eclampsia,low birth weight(LBW),intrauterine growth restriction(IUGR),placenta abnormalities,placenta abruption,cho-rioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacer-ations,postpartum hemorrhage,childbirth trauma,shoulder dystocia,congenital malformation,and unfavorable maternal and neonatal outcome.Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.Results:Of 7033 deliveries,92.4%of women were adults,and 7.6%were adolescents.Adolescents residing in rural districts were more common than adults(42.3%vs.33.7%).However,access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy.There was no difference in the risk of preeclampsia,placenta abruption,placenta previa,fetal distress,preterm labor,shoulder dystocia,perineal lacerations,childbirth trauma,congenital malformation,postpartum hemorrhage,intensive care unit admission,maternal death,and unfavorable neonatal outcome including stillbirth,neonatal intensive care unit admission,neonatal death in adolescent pregnancies compared to adults.Adolescents had a significantly higher risk of LBW(OR:1.47,95%CI:1.01-2.73),IUGR(OR:1.96,95%CI:1.31-2.45),and meconium fluid(OR:1.74,95%CI:1.41-2.32),however,there was no statistically significant difference after adjusting the confounding factors.Compared with adults,adolescents had a significantly lower risk of CS(aRR:0.67,95%CI:0.51-0.77)and a lower risk of gestational diabetes(aRR:0.78,95%CI:0.51-0.95).Conclusions:Although we found no serious consequences of adolescent pregnancy,more research is needed to reach a more accurate conclusion about teenage pregnancy.

Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes

Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated.The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.Methods:A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st,2011 to December 31st,2011.A total of 2756 singleton pregnancies complicated with PPROM were included.Adverse neonatal outcomes including early neonatal death,birth asphyxia,respiratory distress syndrome(RDS),pneumonia,infection,birth trauma,and 5-min/10-min Apgar scores were obtained from the hospital records.Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression.Numerical variables were compared by multiple linear regressions.Results:In total,2756 newborns were involved in the analysis.Among them,1166 newborns(42.31%)were delivered by CS and 1590 newborns belonged to vaginal delivery(VD)group.The CS proportion of PPROM obviously increased with the increase of gestational age(x2=5.014,P=0.025).Compared with CS group,VD was associated with a higher risk of total newborns mortality(odds ratio[OR],2.38;95%confidence interval[Cl],1.102-5.118;P=0.027),and a lower level of pneumonia(OR,0.32;95%Cl,0.126-0.811;P=0.016).However,after multivariable adjustment and stratification for gestational age,only pneumonia was significantly related with CS in 28 to 34 weeks group(OR,0.34;95%Cl,0.120-0.940;P=0.038).There were no differences regarding to other adverse outcomes in the two groups,including neonatal mortality,birth asphyxia,Apgar scores,RDS,pneumonia,and sepsis.Conclusions:The proportion of CS of pregnant women with PPROM was very high in China.The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.

Outcome and risk factors of early onset severe preeclampsia

Background Early onset severe preeclampsia is a specific type of severe preeclampsia, which causes high morbidity and mortality of both mothers and fetus. This study aimed to investigate the clinical definition, features, treatment, outcome and risk factors of early onset severe preeclampsia in Chinese women. Methods Four hundred and thirteen women with severe preeclampsia from June 2006 to June 2009 were divided into three groups according to the gestational age at the onset of preeclampsia as follows： group A （less than 32 weeks, 73 cases）, group B ,（between 32 and 34 weeks, 71 cases）, and group C （greater than 34 weeks, 269 cases）. The demographic characteristics of the subjects, complications, delivery modes and outcome of pregnancy were analyzed retrospectively. Results The systolic blood pressure at admission and the incidence of severe complications were significantly lower in group C than those in groups A and B, prolonged gestational weeks and days of hospitalization were significantly shorter in group C than those in groups A and B. Liver and kidney dysfunction, pleural and peritoneal effusion, placental abruption and postpartum hemorrhage were more likely to occur in group A compared with the other two groups. Twenty-four-hour urine protein levels at admission, intrauterine fetal death and days of hospitalization were risk factors that affected complications of severe preeclampsia. Gestational week at admission and delivery week were also risk factors that affected perinatal outcome. Conclusions Early onset severe preeclampsia should be defined as occurring before 34 weeks, and it is featured by more maternal complications and a worse perinatal prognosis compared with that defined as occurring after 34 weeks. Independent risk factors should be used to tailor the optimized individual treatment plan, to balance both maternal and neonatal safety.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.

Prevalence of hypertensive disorders of pregnancy,associated factors and pregnancy complications in a primigravida population

Background:Hypertensive disorders of pregnancy(HDP)are among obstetrics'most intriguing and yet unsolved problems.It is one of the major causes of maternal and perinatal morbidity and mortality.This study estimates the prevalence of hypertensive disorders of pregnancy,their associated risk factors and pregnancy complications in primiparous women.Methods:All primigravida who gave birth in our hospital from December 2020 to December 2021 were included in the study.The prevalence,risk factors,mode of delivery,and maternal and fetal outcomes of hypertensive disorders of pregnancy in primigravidae were collected from the patient's medical records.Statistical analysis was done using the SPSS 18.0 software package.The Chi-square test was used to analyse the association between the risk factors and hypertensive disorders of pregnancy in primigravida.Results:A total of 807 women were included in the study,and the mean age was 26.34±3.84 years.The prevalence of hypertensive disorders of pregnancy in primigravidae was found to be 18.6%.Among the prevalent population,79.3%of women had gestational hypertension.The findings indicate that hypertension in pregnancy has a significant relationship with risk factors such as increased maternal age(p<0.004),family history of hypertension in pregnancy(p<0.001),body mass index>30 kg/m^(2)(p<0.001),hyperglycaemia in pregnancy(p<0.001),IVF pregnancy(p<0.004)and polycystic ovary syndrome(p<0.001).The most reported adverse maternal and perinatal outcomes were placental abruption(p<0.001),postpartum haemorrhage(p<0.001),prematurity(p<0.001),and fetal growth restriction(p<0.001).Conclusion:The study emphasises the importance of knowledge and timely assessment of risk factors of HDP.It also highlights the need for pre-conceptional counselling,which includes early detection,careful monitoring and treatment of HDP for preventing morbidity and mortality related to this disorder and it should be followed up even in the postpartum period.

Obstetrical Disease Spectrum in China： An Epidemiological Study of 111,767 Cases in 2011

Background：No national research on maternal and fetal complications and outcomes has been carried out in the mainland of China in recent years.This study was to provide a scientific basis for better control of obstetrical and neonatal diseases and better allocation of medical resources by analyzing the epidemiological characteristics of obstetrical diseases in the mainland of China.Methods：Hospitalized obstetrical cases from 19 tertiary and 20 secondary hospitals in 14 provinces （nationally representative） during the period January 1,2011 to December 31,2011 were randomly selected.The general condition,pregnancy complications,and perinatal outcomes of the patients were studied.Results：The top five medical and surgical complications of pregnant women in the mainland of China were anemia （6.34％）,uterine fibroids （2.69％）,thyroid disease （1.11％）,thrombocytopenia （0.59％）,and heart disease （0.59％）.The incidences of premature rupture of membranes （PROM）,preterm birth,prolonged pregnancy,hypertensive disorders complicating pregnancy （HDCP）,multiple pregnancy,intrahepatic cholestasis of pregnancy （ICP）,placenta previa,placental abruption,postpartum hemorrhage,and amniotic fluid embolism were 15.27％,7.04％,6.71％,5.35％,1.57％,1.22％,1.14％,0.54％,3.26％ and 0.06％,respectively.The incidences of anemia and prolonged pregnancy were significantly lower in tertiary than secondary hospitals （P ＜ 0.001）,whereas the incidence of uterine fibroids,thyroid diseases,thrombocytopenia,heart disease,PROM,preterm birth,HDCP,multiple pregnancy,ICP,placenta previa,and placental abruption were significantly higher in tertiary than secondary hospitals （P ＜ 0.001）.The cesarean section （CS） rate was 54.77％.The newborn sex ratio was 119：100,and 1.03％ of the neonates were malformed.The percentages of low birth weight and fetal macrosomia in full-term babies were 2.10％ and 7.09％,respectively.Conclusions：The incidence of some obstetrical diseases is still high in the mainland of China.The CS rate is much higher than World Health Organization recommendations,in which CS delivery by maternal request （CDMR） accounted for a large proportion.The government should propose solutions to reduce CS rate,especially the rate of CDMR.Most obstetrical complications have higher incidence in tertiary hospitals compared with secondary hospitals.It is important to manage the health of pregnant women systematically,especially those with high-risk factors.

Infants at risk of significant hyperbilirubinemia in poorly-resourced countries:evidence from a scoping review

Background:Neonatal hyperbilirubinemia is frequently associated with disproportionately high rates of bilirubin-induced mortality and long-term morbidities in low-and middle-income countries(LMICs).This scoping review aimed to identify possible et iological/risk factors for clinically significant hyperbilirubinemia in LMICs so as to guide intervention and future research priorities.Data sources:We systematically searched PubMed,Scopus,Excerpt Medica Database,Cumulative Index to Nursing and Allied Health Literature,WHO Library Database,African Index Medicus,African Journals Online,Latin American and Caribbean Health Sciences Literature,and Indian Medical Journals for reports published between January 1990 and August 2014 in LMICs with per capita income of≤US$6000.We included studies on the etiology of neonatal hyperbilirubinemia or hyperbilirubinemia as signifi cant morbidity for relevant maternal,perinatal and neonatal disorders without restriction on study design.Results:A total of 131 studies were identified in 23 LMICs from different regions of the world.The factors most frequently associated with neonatal hyperbilirubinemia(in approximately 10%of all studies)were ABO and Rhesus incompatibilities,diabetes mellitus,glucose-6-phosphate dehydrogenase defi ciency,prematurity/low birth weight,infection,birth trauma,and drug-induced labor.The role of exclusive breast-feeding and genetic factors was sparsely explored.Conclusions:Several maternal,perinatal and neonatal factors are associated with neonatal hyperbilirubinemia in LMICs.Improved research efforts and strategies to address these factors are warranted to curtail the disease burden in these countries.