Obstetrical and neonatal outcomes in obese women / Resultados obstétricos y neonatales en las mujeres obesas

OBJECTIVE: To compare the incidence of antenatal and intrapartum complications and neonatal outcomes among pre-pregnant obese women. METHODS: At the Sud-Reunion Hospital's maternity, Reunion Islands, France, over a 54-month period, each obese pregnant woman (BMI > or = 30 kg/m2) delivering a singleton after 22-weeks gestation was compared to the next age and parity-matched woman of normal pre-pregnancy weight (BMI 18.5-25 kg/m2), who delivered after the index case. The Students t test, Mann and Whitney test, Chi-square test and logistic regression model were used for statistical analysis. RESULTS: The study enrolled 2081 obese women and 2081 controls. The incidences of pre-eclampsia, chronic and pregnancy-induced hypertension, chronic and gestational diabetes mellitus were increased in the obese women group. Prenatal care in obese women required a high rate of hospitalizations as well as a high rate of insulin treatment. Obese women were more likely to be delivered by Caesarean section. The rate of in utero fetal death, neonatal and perinatal death was significantly higher in the obese women group. The high BMI in relation with both pre-eclampsia and in utero fetal death remained unchanged after adjustment of other risk factors. CONCLUSION: Obese women were more likely to present several obstetric complications and to be delivered by Caesarean section. Obstetricians who decide on a first Caesarean section in an obese woman should be aware of the cumulated obesity and uterine scar risks that could threaten any subsequent Caesarean section.

OBJETIVO: Comparar la incidencia de las complicaciones antenatales e intraparto, y los resultados neonatales entre las mujeres obesas pre-embarazadas. MÉTODOS: Por un periodo de más de 54 meses, cada mujer obesas embarazadas (IMC $ 30 kg/m2) dando a luz singletons después de 22 semanas de gestación, en el Hospital de Maternidad de Sud-Reunion, Reunion Island, Francia, fue comparados con la mujer de peso normal pre-embarazada siguiente, pareada por edad y paridad (IMC 18.5-25 kg/m2) dando a luz después del caso del índice. Para el an álisis estadístico se usó la prueba T de Student, la prueba de Mann-Whitney, la prueba de chi-cuadrado, y el modelo de regresión logística. RESULTADOS: El estudio enroló a 2081 mujeres obesas y 2081 controles. Las incidencias de pre-eclampsia, hipertensión inducida por el embarazo y crónica, así como la diabetes mellitus gestacional y crónica, aumentaron en el grupo de mujeres obesas. El cuidado prenatal en las mujeres obesas requirió una alta tasa de hospitalizaciones así como una alta tasa de tratamiento de insulina. Las mujeres obesas eran m ás propensas a tener el parto por ces área. La tasa de muerte fetal in útero, muerte neonatal y perinatal fue significativamente m ás alta en el grupo de mujeres obesas. El alto IMC en relación tanto con la pre-eclampsia como con la muerte fetal en útero permaneció igual después del ajuste de otros factores de riesgo. El alto IMC tanto en relación con la pre-eclampsia como con respecto la muerte fetal in útero permaneció igual después del ajuste de otros factores de riesgo. CONCLUSIÓN: Las mujeres obesas tuvieron mayor propensión a presentar varias complicaciones obstétricas y tener el parto mediante cesárea. Los obstetras que deciden practicar una primera cesárea en una mujer obesa deben tener conciencia de la obesidad acumulada y los riesgos de cicatriz uterina que podrían amenazar cualquier cesárea posterior.

Evaluation of neonatal sepsis screening in a tropical area Part III: Neonatal sepsis in meconium stained deliveries

Of the 6,060 consecutive live births delivered at the University Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newborns (10.4) presented with meconium stained (MS) amniotic fluid, of which 595 (94) received bacteriological screening at birth (light MS, n = 543; thick MS, n = 52). Thirty (5) of MS newborns had a bacteraemia (n = 13, group B streptococcus, GBS), and 128 (21.5) a bacterial positive gastric aspirate (n = 54, GBS). Sixty-six newborns among MS babies needed tracheal suctioning (11) in the delivery room for meconium inhalation. Among these 595 screened MS newborns, 286 (48) presented clinical signs of postmaturity at birth, having therefore an explanation for their MS condition. For the other MS newborns without the postmaturity explanation, we experienced twofold increased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counterparts. We conclude that when meconium stained deliveries are associated with postmaturity signs, one may not need to initiate prophylactic antibiotic treatment at birth unless they present with other traditional risk factors for neonatal sepsis such as intrapartum fever and prolonged rupture of membranes.

Evaluation of neonatal sepsis screening in a tropical area. Part II: Evaluation of intrapartum chemoprophylaxis protocol

The authors report on an analysis of a chemoprophylaxis protocol at the University Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an intrapartum chemoprophylaxis protocol, evaluate its results, and try to identify possible necessary modifications to the existing protocol. Although more than 90 of women had at least one bacterial screening (vaginal or urinary) during the last trimester of pregnancy, approximately 75 of mothers who were heavily colonized group B streptococcus (GBS) at delivery were not detected by this systematic screening. As is also reported in other tropical areas where a great proportion of neonatal sepsis occurs in term babies, low birthweight was not a specific risk factor in this study when controlling for other major risk factors such as fever and premature rupture of membranes. Intrapartum chemoprophylaxis was associated with an approximate threefold decrease in the risk of GBS neonatal bacteraemia among at risk deliveries. The results suggest that, in our tropical context, prolonged rupture of membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemoprophylaxis as it accounted for the majority of cases of neonatal bacteraemia that escaped the existing protocol.

Evaluation of neonatal sepsis screening in a tropical area. Part I: Major risk factors for bacterial carriage at birth in Guadeloupe

This prospective study reports on screening for neonatal sepsis among 3,372 live births out of 6,060 consecutive deliveries at the University Hospital of Pointe-Ó-Pitre, Guadeloupe, during a 30-month period. Group B Streptococcus (GBS) was the most common pathogen, representing 46 (89/194) of positive blood cultures and 52 (335/637) of positive gastric aspirates. Although only 3,372 (55) of all live births were screened, 637 (10) had gastric bacterial carriage at birth; of those, 335 (5.5) involved GBS. Similarly, there were 194 (3.2) positive blood cultures, of which 89 (1.5) involved GBS. In this report, all newborns who presented with a positive GBS blood culture had at least one of the external tests positive for GBS (gastric, ear canal, rectum and placenta). Thirty-seven per cent (14/38) of positive neonatal blood cultures occurred in newborns with foetid liquor while in deliveries with intrapartum fever 16.5 (32/195) of blood cultures were positive. In our clinical practice, characteristics that were evident in the delivery room (without knowledge of prenatal follow-up) such as foetid liquor, intrapartum fever, prolonged rupture of membranes, foetal tachycardia and meconium staining were associated with the great majority of neonatal sepsis.