Obstetric Clinical Analysis in 8 Cases With Cushing’s Syndrome / 中山大学学报(医学科学版)

ObjectiveTo summarize and analyze the clinical characteristics， diagnosis process， treatment process， and obstetric outcomes of pregnant women with Cushing's syndrome， helping to optimize pregnancy management. MethodsA retrospective study was conducted on 8 pregnant women with Cushing’s syndrome who were hospitalized in the First Affiliated Hospital， Sun Yat-sen University between January 2006 and August 2022. The clinical characteristics， management and obstetric outcomes were recorded. ResultsPreeclampsia was detected in 4 cases，pre-gestational diabetes mellitus in 2 cases， gestational diabetes mellitus in 5 cases， and hypokalemia in all 8 cases. Elevated serum cortisol， disappearance of day-night rhythm of cortisol， increased 24-hour urine cortisol and decrease in serum ACTH were found in 8 cases by laboratory examination. Furthermore， adrenal adenoma was detected in all 8 cases by ultrasonography or Magnetic Resonance Imaging. Three cases underwent laparoscopic adrenalectomy in the second trimester and 4 cases received surgery after delivery. The diagnosis of adrenal cortical adenoma was confirmed by pathological report. Six cases had preterm birth， while one patient delivered after 37 weeks of gestation and one patient suffered from spontaneous abortion. Among 7 cases of live birth， 6 patients underwent cesarean section and 1 patient had vaginal delivery. Of all newborns， 3 had low birth weight. One case had a birth defect. Four infants were transferred to the neonatal intensive care unit， and two infants died. One child was diagnosed with nephrotic syndrome at 2 years of age. ConclusionsCushing's syndrome is rare and high risk during pregnancy. It requires multidisciplinary diagnosis， treatment， and long-term follow-up. Drug therapy carries a risk of progression and requires intensive care during pregnancy， postpartum follow-up， and specialist treatment.

Advanced maternal age and obstetric outcome

Background: The objective of this study was to compare the adverse obstetric and perinatal outcome of pregnancies in women with advanced maternal age > 35 years with that of younger women in age group 20-34 years.Methods: A retrospective comparative study was carried out in department of obstetrics and gynecology at Adesh Medical College over the period of one year from June 2017 to June 2018. The obstetric and perinatal outcome of 100 women with advanced maternal age (study group) was compared with those of 100 younger women aged 20-34 years (control group).Results: Among antenatal complications, women of advanced maternal age had increased incidence of hypertensive disorder of pregnancy (26.6% versus 4.4%; p = 0.00009) and breech presentation (8.8% versus 1.1%; p = 0.04).  The rate of caesarean delivery was significantly higher in advanced maternal age (28.8% versus 17.7%; p = 0.05). In perinatal outcome, older women had significantly higher incidence of perinatal death (7.7% versus 0%; p = 0.01).Conclusions: Thus, from this study, it can be concluded that advanced age women had higher incidence of hypertensive disorder of pregnancies and mal presentation, were more likely to deliver by caesarean section and had increased incidence of perinatal death.

Obstetrics outcome in pregnant women with cardiac disease in tertiary care center, Dehradun, India

Background: Incidence of heart disease in pregnancy is about 1%. Pregnant patient with cardiac disease can present with lot of challenges for the obstetrician, paediatrician and the cardiologist. With improvement in diagnostic, medical, surgical management, more patient with cardiac diseases especially congenital are able to reach reproductive age. Therefore, still a cardiac disease remains a significant cause of maternal death. Maternal and fetal prognosis both is affected by the care given and the skills used in the treatment of the individual patient. Hospital has resulted in majority of cardiac disease patient being managed in a tertiary care center and this provide an opportunity to report on clinical experiences of pregnancy with cardiac disease, their management and obstetrical outcomes.Methods: This was a retrospective study, with all the patients detailed demographic information, diagnosis, course in the hospital, management, maternal and fetal outcome was obtained from the medical records and files.Results: Incidence of cardiac disease was found to be 0.7%, 47% of pregnant women fell in age group of 26-30 years, 38.2% were primigravida, only 23.53% were booked, and half of them belonged to NYHA II class. 73.5% had Rheumatic heart disease and the most common obstetrics complications were preterm labor and anemia. LSCS was done in 29.4% cases and 38.2% of the newborns were premature.Conclusions: Prematurity anaemia, IUGR, are the common obstetrical complication in pregnant patient with cardiac disease which can be taken care with increased awareness and pre-conceptional counselling especially in patient with congenital heart disease. For optimization of maternal and neonatal outcomes in these patients, dedicated team of obstetrician, fetal medicine specialist, pediatricians, cardiologist and anesthesiologist is the prime requirement.

Evaluation of vitamin D levels in term pregnancy and its obstetric outcome in Indian women

Background: Vitamin D deficiency is currently a global pandemic affecting all age groups. Vitamin D is considered a fundamental hormone in calcium homeostasis and bone health. Risk of vitamin D deficiency increases during pregnancy due to increased maternal and fetal demands and altered vitamin D metabolism. Recently, maternal vitamin D deficiency has been linked to adverse pregnancy outcomes, including preeclampsia, gestational diabetes, fetal growth restriction and preterm birth. Adequate vitamin D status appears to be relevant to health at all ages, and even in prenatal life.Methods: This is a cross sectional, observational study conducted in the department of obstetrics and gynaecology at R. L. Jalappa Hospital. A total number of 160 subjects were included. 5 ml of venous blood was collected and was centrifuged at 3000 rpm and stored at - 80°C till analysis. Analysis of 25-hydroxy Vitamin D was done using ELISA.Results: Majority of the subjects were vitamin D deficient (81.87%) and 12.5% were vitamin D insufficient and only 5.63% were vitamin D sufficient. The prevalence of vitamin D deficiency was more among primigravidas (85.6%) and was associated with higher rates of caesarean section (92.4%). High prevalence of vitamin D deficiency was seen in lower middle socioeconomic class (62.5%). Maternal vitamin D deficiency was associated low birth weight of neonates (100%).Conclusions: In this study it was concluded that majority of subjects were vitamin D deficient and belonged to lower middle socioeconomic class. Majority of this subjects who underwent caesarean section were vitamin D deficient. Vitamin D deficiency was associated only with low birth weight of neonates and no other adverse obstetric outcome.

A Study on Obstetric Outcome of Postdated Pregnancy among Private Hospital Patients in Sylhet

Introduction: Any pregnancy which has passed beyondexpected date of delivery (EDD) is called postdated pregnancyor prolonged pregnancy.Objective: Main goal of this study is to evaluate obstetricoutcome in postdated pregnancy.Method: This was a prospective observational type study.Patients whose pregnancy extended beyond 40 weeks ofgestational age, patients who were sure of the date of lastmenstrual period (LMP) along with 1st trimester obstetrics scanwere included for this study. Patients not sure of LMP wereexcluded in this study. The study was conducted in theDepartment of Obstetrics and Gynecology, of different privatehospital Sylhet for study duration of 3 years. Total 223 caseswere selected purposively for this study.Results: The study result shows fetus condition among the223 pregnant women highest 96.41% were alive and only3.59% were dead. Male baby and female baby was almostsame male 49.33% and female baby 50.67%. After deliverybaby admitted in hospital 76.23%, NICU 6.28% not admitted17.49%. Most of the pregnant women’s (88.34%) managementwas oligo induction failure and rest was laparoscopy. Peroperative finding of the patients shows highest 74.89% pretermpre-mature rapture of membrane, 18.83% Ectopic pregnancyand 6.28% rapture uterus.Conclusion: Postdated pregnancy having 50% risk ofrecurrence in next pregnancy. It is a high risk pregnancy thefoetal complication in the form of foetal distress, meconiumaspiration syndrome, birth trauma etc. It also increases rate ofinstrumental delivery and operative delivery.

Evaluation of maternal and fetal outcomes in pregnancy with heart disease

Background: Heart diseases complicate >1% of all pregnancies and is the leading indirect cause of maternal deaths. Present study attempted determining the maternal and fetal outcome in pregnant women with heart disease using various relevant parameters.Methods: A total of 44 consecutive cases of heart disease with pregnancy that were admitted at the study centre from December 2013 to August 2015 were included and analyzed for outcome with respect to age, parity, associated comorbidities, nature of cardiac lesions, type of valvular involvement, NYHA functional class, type of anaesthesia used, mode of delivery, maternal outcome, fetal outcome, birth weight of babies and maternal and fetal mortality, if any.Results: Rheumatic heart disease 26 (59.1%) was the commonest lesion observed to be affecting pregnant patients, followed by congenital heart disease (10, 22.7%). Mitral valve (30, 68.2%) was found most commonly affected, followed by aortic valve (10, 22.7%). Regurgitant lesions (26, 59.09%) were commoner than stenotic ones (14, 31.81%). Four (9.1%) patients went into left ventricular failure and had to be admitted to ICU. Of these, one patient (2.3%) died.Conclusions: Maternal heart disease is one of the important causes of maternal mortality. The obstetrician needs to have strong suspicion of the entity right from the start, so as to improve upon the maternal as well as fetal outcomes.

A Clinical Study of Post-dated Pregnancy among Government and Private Hospital Patients in Patuakhali

Introduction: Any pregnancy that has passed past expecteddate of delivery (EDD) is called post-dated pregnancy orprolonged pregnancy.Objective: The main objective of this study is to appraiseobstetric outcome for post-dated pregnancy in Patuakhali.Method: This was a potential observational type study.Patients whose pregnancy protracted beyond 40 weeks ofgestational age, patients who were certain of the date of lastmenstrual period (LMP) along with 1st trimester obstetrics scanwere included for this study. Patients not sure of LMP wereexcluded in this study. The study was conducted in thedepartment of obstetrics and gynaecology, of different privatehospital Patuakhali for study duration of 2 years. Total 150cases were selected purposively for this study.Results: Age segmentation of patients where the age ofpregnant women ranged from 16 to 30 years. Among the 150pregnant women highest 64% were in the age of 26-30 years.Delivery method amongst the 150 pregnant women are highestat 86% were caesarean delivery followed by normal deliveryonly 14%. Parity distribution among the 150 pregnant womenhighest 57.33% were Primigravida followed by Multigravida41.34% and 2nd pregnant were only 1.33%. Babies’ conditionamongst the 150 pregnant women, highest 96.30% foetuswere alive upon delivery and only 3.70% of the foetus weredead. In the gender distribution of the foetus, 49.33% wereborn as male and 50.67% were female. After delivery, thebabies that were admitted in hospital were 76.40%, in NICU6.40%, and not admitted in the hospital after delivery were at17.20% and 88.40% of the pregnant women’s managementresulted in oligo induction failure and the rest 11.60% wereconducted upon laparoscopy. Per operative findings of theselected patients show that the highest 74.40% were pretermpre-mature rupture of membrane, 18.80% were ectopicpregnancy and 6.80% had ruptured uterus.Conclusion: Post-dated pregnancy having almost 50% risk ofrecurrence in next pregnancy. It is a high-risk pregnancy thefoetal complication in the form of foetal distress, meconiumaspiration syndrome, birth trauma etc. It also raises rate ofinstrumental delivery and operative delivery.

Obstetric outcomes after uterine myomectomy: Laparoscopic versus laparotomic approach

OBJECTIVE: To compare the pregnancy-related complications after laparoscopic and laparotomic uterine myomectomy. METHODS: A retrospective study of 415 women who received laparoscopic (n = 340) or laparotomic (n = 75) resection of uterine leiomyomas in one center. The mean follow-up period was 26.5 months in laparoscopic group and 23.9 months in laparotomic group. RESULTS: Fifty-four and 12 pregnancies occurred in laparoscopic and laparotomic myomectomy group, respectively. The major obstetric outcomes were similar between two groups. There was no ectopic pregnancy or preterm birth. There were two cases of obstetric complication in laparoscopic group only; one experienced neonatal death and postpartum hemorrhage due to placental abruption and the other underwent subtotal hysterectomy due to uterine dehiscence identified during Cesarean section. CONCLUSION: Uterine rupture or dehiscence after laparoscopic myomectomy occurred in 3.7% (2/54) which lead to unfavorable outcome. Appropriate selection of patients and secure suture techniques appears to be important for laparotomic myomectomy in reproductive-aged women.

Lupus eritematoso sistémico y embarazo / Systemic lupus erythematosus and pregnancy

El lupus eritematoso sistémico (LES) se asocia con diversos eventos adversos en el embarazo como parto prematuro, pre-eclampsia y pérdidas gestacionales. Gracias a los avances terapéuticos el pronóstico del embarazo en mujeres con LES ha mejorado. Además de las complicaciones relacionadas con el embarazo, las mujeres con LES tienen un alto riesgo de complicaciones médicas durante la gestación como hipertensión, enfermedad renal, síndrome antifosfolípido, diabetes pregestacional o actividad lúpica, las cuales afectan el curso de la enfermedad y empeoran los resultados del embarazo. El embarazo aumenta la probabilidad de recaídas del LES. Aunque no es posible predecir cuándo se presentará una recaída en una paciente, esta es más probable si la enfermedad ha permanecido activa en los seis meses previos a la concepción.

Systemic lupus erythematosus (SLE) is associated with multiple adverse pregnancy outcomes, including fetal loss, preterm birth, and pre-eclampsia. With treatment advances, the prognosis of pregnancy in women with SLE has improved. In addition to complications related to pregnancy, SLE women are at increased risk for medical complications during pregnancy such as hypertension, renal disease, antiphospholipid syndrome, pregestational diabetes or active SLE which affect the course of the disease and worse the outcome of pregnancy. Pregnancy increases the likelihood of a lupus flare. It is not possible to predict when an individual patient will flare, although flare is more likely if disease has been active within six months of conception.

Atividade lúpica durante a gestação / Systemic lupus erythematosus activity during pregnancy

O lúpus eritematoso sistêmico é uma doença inflamatória crônica, de natureza autoimune, caracterizada pela presença de diversos autoanticorpos, com manifestações clínicas polimórficas e com períodos de exacerbações e remissões. O desenvolvimento da doença está ligado à predisposição genética e a fatores ambientais, como a luz ultravioleta e a alguns medicamentos. As mulheres portadoras de lúpus cursam com gestações de alto risco, pois apresentam maiores taxas de abortamento, partos prematuros, restrição do crescimento fetal, mortalidade perinatal e, ainda, a Síndrome do Lúpus Neonatal. Estudos mostram que a taxa de abortamento, nesses casos, varia de 20 a 22 porcento. A pesquisa de anticorpos antifosfolípides nessas pacientes é positiva em 27 porcento das análises, implicando em maiores taxas de abortamentos, óbito fetal, prematuridade e restrição do crescimento fetal. É uma doença de várias faces e deve ser questionada como diagnóstico diferencial em situações clínicas na gestação. O início do quadro durante a gravidez é raro, sendo uma situação grave tanto para a mãe como para o feto. O momento para a concepção deve ser programado em período fora de atividade da doença, quando a paciente, possivelmente, estará utilizando pequenas doses de corticosteroide. A gestação deve ser desaconselhada quando a doença está em atividade, principalmente se associada a fatores de gravidade, como nefrite lúpica, hipertensão arterial crônica e síndrome dos anticorpos antifosfolípides. O pré-natal dessas gestantes deve ser realizado por uma equipe multidisciplinar em centro de referência.

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease, which is characterized by the presence of different autoantibodies and polymorphic clinical manifestations, with periods of exacerbation and remission. The development of the disease is related to a genetic predisposition and to environmental factors such as ultraviolet light and some drugs. Women with SLE are subject to high-risk pregnancies since they present higher rates of abortion, premature delivery, fetal growth retardation, perinatal mortality, and even neonatal lupus. Studies have shown that abortion may occur in 20 to 22 percent of the cases. In these patients, the investigation of antiphospholipid antibodies is positive in 27 percent of the tests, implying higher rates of abortion, fetal death, prematurity and fetal growth retardation. SLE is a disease of many facets and should be considered as a differential diagnosis in clinical situations during pregnancy. The onset of manifestations during pregnancy is rare but may occur, and represents a serious situation for both the mother and fetus. The time of conception should be programmed during a period without disease activity, when the patient is possibly using small doses of corticosteroids. The patient should be counseled not to become pregnant when the disease is active, especially when associated with severity fators such as lupus nephritis and involvement of the central nervous system. The prenatal follow-up of these women should be performed by a multidisciplinary team at a referral center.

Clinical course and obstetrical outcomes of 94 pregnancies in Korean patients with systemic lupus erythematosus (SLE) / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to assess the maternal and fetal outcomes in pregnant women with systemic lupus erythematosus (SLE) and to evaluate clinical and laboratory markers for preterm birth and lupus flares. METHODS: 94 pregnancies of 60 patients were retrospectively evaluated from Jan 1997 to Sep 2004. We used clinical and laboratory data from the medical records and statistics analysis by Chi-square test, using SPSS 15.0 V. RESULTS: Pregnancy resulted in 74 (78.7%) live births, 11 (11.7%) spontaneous abortions, 2 (2.1%) therapeutic abortion, and 4 (4.2%) stillbirths. Thirty-seven cases (47.4%) were delivered by cesarean section. Obstetric complications included 17.9% of preterm births, 26.9% of preeclampsia, and 20.5% of IUGR. There were 31 (39.7%) uncomplicated cases among the pregnancies over 20 gestational weeks. There were 12 of transient neonatal lupus, 2 of neonatal death due to prematurity, and 51 of normal births. Low C4, myocarditis, pleural effusion prior to pregnancy, activity at conception, antiphospholipid antibody syndrome were significantly associated with preterm birth. The maternal long-term effect of pregnancy was poor, because 44.7% were in deterioration of cardiovascular, hematologic or renal function after delivery. Lupus nephritis, proteinuria, hematuria, and activity at conception were significantly associated with lupus flare during pregnancy. CONCLUSION: Pregnant women with active SLE at conception should be intensively monitored with maternal and fetal surveillance. It is essential to control disease activity during pregnancy. However, adequate pregnancy follow-up and delivery care by multidisciplinary effort with experience in management of patients with SLE resulted in a better outcome of lupus pregnancy.

Impact of Maternal Age of 40 Years or Older on Pregnancy Outcomes / 대한주산의학회잡지

OBJECTIVE: The aim of this study was to examine the effects of maternal age on perinatal and obstetric outcomes with respect to maternal age older than 40 years. METHODS: A retrospective review of maternal and newborn medical records of women who delivered their babies in the hospitals of the Catholic University of Korea between January 1, 2000 and July 1, 2005 was conducted to compare pregnancy complications and perinatal outcomes in three age groups; women aged 25~29 years (group A; n=214), those aged 35~39 years (group B; n=276), and those aged 40 years and older (group C; n=347). RESULTS: The incidences of GDM (gestational diabetes mellitus), preterm birth and cesarean section in group C were by far the greatest among the three groups. The incidence of postterm delivery in group A was the highest among the three groups. Previous cesarean section and elderly gravida were the most frequent causes of cesarean section in group C. The incidences of low birth weight (<2,500 g) and the NMICU(neonatal medical intensive care unit) admission rate in group C were higher than those in group B, but not significantly different from those in group A. CONCLUSION: Maternal ages of 35~39 years do not appear to be associated with adverse perinatal and obstetrical outcomes. Maternal ages of over 40 years influence the incidences of PIH (pregnancy induced hypertension), GDM, preterm birth, cesarean section, placenta previa, low birth weight and NMICU admission.

Study of Obstetric Outcomes in Congenital Uterine Malformations / 대한산부인과학회지

OBJECTIVE: The purpose of this study was to establish the distribution and obstetric outcomes in women with congenital uterine malformations. METHODS: A review of the medical records from the department of obstetrics and gynecology from January 1995 to June 2004 were diagnosed 79 patients with congenital uterine malformations. All of the cases were divided into groups according to classification of ASRM (American Society for Reproductive Medicine), which is based on the degree of failure of normal development of the female genital tact. The obstetric outcomes were compared between the groups. Statistical processing of the material was carried with Pearson chi square test. RESULTS: 79 patientss with congenital uterine malformations were diagnosed by operation or imaging studies. Symmetric congenital uterine malformations, consisting of bicornuate uterus (45.6%), septate uterus (19.0%), and uterus didelphys (31.6%), were the most common, constituting 96.2% of the malformations. Two patients (2.5%) had unicornuate uterus and one patient (1.3%) had arcuate uterus. No cases of the agenesis type and T-shaped uteri were found. 196 pregnancies occurred in the 74 patients. Only 43.4% of the pregnancies reached term, while 8.2% resulted in preterm delivery, and 48.4% terminated as miscarriages. CONCLUSION: Obstetric complications occur more frequently among women with congenital uterine malformations than among women in general. Knowledge concerning of congenital uterine malformations is important in recognizing and managing the obstetric complications that may result.

Obstetric Outcome after Renal Transplantation / 대한산부인과학회잡지

OBJECTIVE: To evaluate the outcome of pregnancy in kidney transplanted women, and correlate this with the time of transplantation to conception. MATERIAL AND METHODS: We analyzed the outcome of 31 pregnancies from 21 allograft recipients at Kangnam St. Mary's Hospital, Catholic Medical Center from January 1990 through December 2000. For each reported pregnancy we reviewed obstetrical, medical and pediatric records. For children follow-up and for those whose obstetric procedures were taken in other hospitals, we did a questionarie and telephone interviews. RESULTS: Of the 31 pregnancies followed by us, there were 23 live-born offspring delivered by 21 mothers and 8 stillborn/abortuses, including five artificial abortuses. The mean gestational age at delivery was 36.18+/-0.6 weeks and the mean birth weight of the offspring was 2,525+/-137gm. Only 43.4% was delivered after 37weeks of gestation. Preterm delivery rate (delivered before 37weeks of gestation) was 56.5%. Common obstetric complications were intrauterine growth restriction (39.1%) preterm labor (35%), premature rupture of membrane (30%), preeclampsia (30%), and maternal complications were deterioration of renal function (5%) and rejection of allograft (18%) after delivery. Mean interval from transplantation to pregnancy was 4.7 years. Twelve pregnancies occurred within the first 2 years of transplantation, while 19 pregnancies occurred after that period. No difference was noted in neonatal body weight between 2 groups (p=0.824). There was no difference in mean interval from transplantation to pregnancy in the delivery group (5.21+/-0.9 years) vs. the abortion group (4.57+/-1.1 years) (p=0.207). All women continued with her medication during pregnancy, based on cyclosporine and/or azathioprine and steroids. No congenital anomaly was noted in the newborn. When follow up lately, one boy with neurofibromatosis and a girl with recurrent hematuria were noted. CONCLUSION: Although pregnancy in renal allograft patient is hazardous, good outcome can be expected if function of the allograft is good before conception.

Obstetric outcome in women with a history of recurrent miscarriage / 대한산부인과학회잡지

OBJECTIVE: To obtain etiology and obstetric outcome of women who had a history of recurrent miscarriage. METHODS: From 1 June 1998 to 30 June 2000, 82 patients who attended infertility & current miscarriage clinic at Samsungcheil hospital and progressed beyond 24 weeks gestation following pregnancy were included in this study. The control population was 154 pregnancies considering age and parity over the same period. Retrospectively, we analyse the etiology of recurrent miscarriage and compare obstetric outcomes of two groups. RESULTS: The etiology of recurrent miscarriage was immunologic factor (36.6%), unexplained (30.4%), anatomic cause (13.4%), endocrinologic abnormality (13.4%) and chromosomal abnormality (5.6%). The rate of preterm delivery (11%) and incidence of pregnancy induced hypertention (8.5%) were significantly higher than those of control group (3.2% and 2.5% respectively). There was no significant difference in the rate of small for gestational age, oligohydroamnios, cesarean section, perinatal loss and the incidence of gestational diabetes mellitus. CONCLUSION: The pregnancy with a history of recurrent miscarriage is associated with increased risk of pregnancy induced hypertension and preterm delivery and represent a population at high risk of obstetric problems. Therefore, close surveillance during antenatal period is required.