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Purpose: To study the effect of increasing grades of hypertensive retinopathy (HTR) on neonatal outcomes among preeclamptic women and assess the various maternal risk factors for HTR. Methods: A prospective cohort study was conducted on 258 preeclamptic women. The systolic and diastolic blood pressure (SBP and DBP), liver, and renal function parameters were collected besides basic demographic details. Dilated fundus examination with the Keith–Wagner–Barker classification was used to grade HTR. Following delivery, neonatal outcomes were evaluated. Results: Of the 258 preeclamptic women recruited, 53.1% had preeclampsia (PE), and 46.9% had severe preeclampsia. With increasing grades of HTR, a significant association with low birth weight (LBW) (p = 0.012) and preterm gestational age (p = 0.002) was noted but not with the Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score (p = 0.062). Also, it did not increase the risk of retinopathy of prematurity (ROP), with most babies, even those born to mothers with high grades of HTR, showing no evidence of ROP (p = 0.025). Among the maternal factors, increasing age (p = 0.016), SBP (p < 0.001), DBP (p < 0.001), serum creatinine (p = 0.035), alanine aminotransferase (p = 0.008), lower hemoglobin (Hb) (p = 0.009), lower platelet (p < 0.001), and severe PE (p < 0.001) have been found to significantly affect the grade of HTR. Conclusion: Higher grades of HTR in the preeclamptic mother are associated with preterm delivery and LBW of the neonates but neither affect the APGAR score nor pose the risk of developing ROP
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ABSTRACT Objective: Pregnant women with type 1 diabetes (T1D) have an increased risk of maternal-fetal complications. Regarding treatment, continuous subcutaneous insulin infusion (CSII) has advantages compared to multiple daily injections (MDI), but data about the best option during pregnancy are limited. This study's aim was to compare maternal-fetal outcomes among T1D patients treated with CSII or MDI during pregnancy. Subjects and methods: This study evaluated 174 pregnancies of T1D patients. Variables of interest were compared between the groups (CSII versus MDI), and logistic regression analysis was performed (p < 0.05). Results: Of the 174 included pregnancies, CSII was used in 21.3% (37) and MDI were used in 78.7% (137). HbA1c values improved throughout gestation in both groups, with no difference in the first and third trimesters. The frequency of cesarean section was significantly higher in the CSII group [94.1 vs. 75.4%, p = 0.017], but there was no significant difference in the frequency of other complications, such as miscarriage, premature delivery and preeclampsia. The mean birth weight and occurrence of neonatal complications were also similar, except for the proportion of congenital malformations, which was significantly lower in the CSII group [2.9 vs. 15.6%, p = 0.048]. In regression analysis, the association of CSII with cesarean section and malformations lost significance after adjusting for HbA1c and other covariates of interest. Conclusion: In this study, we observed a higher frequency of cesarean section and a lower occurrence of congenital malformations in the CSII group, but the adjusted results might indicate that these associations are influenced by glycemic control.
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ABSTRACT Objective To assess the effects of enfuvirtide on pregnancy in albino rats and their fetuses. Methods Forty pregnant EPM 1 Wistar rats were randomly allocated into four groups: control (E) (distilled water twice/day), G1 (4mg/kg/day enfuvirtide), G2 (12mg/kg/day enfuvirtide), and G3 (36mg/kg/day enfuvirtide) groups. On the 20th day of gestation, the rats were anesthetized and subjected to cesarean section. Their blood was collected for laboratory analysis, and they were sacrificed. The offspring's fragments of their kidneys, liver, and placentas and the maternal rats' fragments of their lungs, kidneys, and liver were separated in the immediate postpartum period for light microscopy analysis. Results No maternal deaths occurred. In the second week at the end of pregnancy, the mean weight of the G3 Group was significantly lower than that of the G2 Group (p=0.029 and p=0.028, respectively). Analyzing blood laboratory parameters, the G1 Group had the lowest mean amylase level, and the G2 Group had the lowest mean hemoglobin level and the highest mean platelet count. In the morphological analysis, there were no changes in organs, such as the kidneys and liver, in both the maternal rats and offspring. Three maternal rats in the G3 Group had pulmonary inflammation in the lungs. Conclusion Enfuvirtide has no significant adverse effects on pregnancy, conceptual products, or functional alterations in maternal rats.
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Background:Sub-Saharan African countries have some of the worst maternal mortality ratios in the world sub-regions. Uncoordinated antenatal care practices and delivery outside health institutions are some of the determinants of thesedeaths experienced in the region. The objective of the study is todetermine some of these erring behavioral antenatal practices that are inimical to good obstetric outcomes and how health care planners can use the results to close thesegaps of maternal mortality and save lives.Method:This study was a cross sectional retrospective study of the women who delivered at The Niger Delta University Teaching Hospital, Okolobiri, between 1 st June,2021 to 1st June, 2022. The study compared the maternal and fetal outcomes between the booked andunbooked patients who delivered during this period. Relevant data to the study were extracted from patients' medicalrecords using a proforma and data collected entered SPSS Version 25 foranalysis.Results:Three hundred and forty-six patients participated in the stud, 72.3 % were booked and 27.7%were unbooked. Place of delivery N = 253, 75.5 % delivered in health facilities and 24.5 in non-Health facilities. Unbooked patients have prolonged labor lasting more than 24 hours, suffered more blood loss during delivery, their babies have more unfavorable one minute Apgar, all compared to outcomes of the booked patientsConclusion:Booked patients have more favorable pregnancy outcomes compared to the unbooked patients. Health care planners and care providers should devote more time and resources to unbooked patients to have favorable pregnancy outcomes
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Prenatal Care , Delivery of Health Care , Pregnancy Outcome , Case-Control StudiesABSTRACT
Introduction@#Although it is likely that outcomes in pregnancy differ between regions due to differences in health‑care delivery, resources, and health protocols, the rampant increase in COVID‑19 cases has proven its effects on the maternal and fetal outcomes. But to what extent does COVID‑19 in pregnancy affect adverse maternal and neonatal outcomes compared to non‑COVID‑19 pregnant patients?@*Objectives@#This study aims to compare maternal outcomes (morbidity, mortality, intensive care unit [ICU] admissions, and cesarean section [CS] rate) and fetal outcomes (prematurity, APGAR score, neonatal ICU [NICU] admission, and mortality) between COVID‑19 and non‑COVID‑19 cases.@*Methodology@#A retrospective cohort study was done through chart review of 240 patients, 120 for the COVID‑19 group and 120 for the non‑COVID‑19 group. Demographic data, as well as maternal outcomes (i.e., morbidity, mortality, ICU admissions, and emergency CS), and adverse fetal outcomes (i.e., prematurity, low APGAR, NICU admission, and mortality) were gathered. These outcomes were also classified according to disease severity for the COVID‑19 group. The effect of using investigational drugs to outcomes was also determined.@*Results@#This study shows that adverse maternal outcomes were significantly increased with COVID‑19 infection. Mortality was increased by 10% while morbidities (acute respiratory distress syndrome, disseminated intravascular coagulation, hemorrhage, and sepsis) were increased by 35%. ICU admission for COVID‑19 patients was 10.8% higher, and the emergency CS rate was also increased by 10% in the COVID‑19 group. Results also showed increased adverse fetal outcomes for the COVID‑19 group, with a 10.8% increase in neonates being born prematurely, an 11.67% increase in low APGAR score, a 9.16% increase in mortality, and a 10% increase in NICU admission. The use of investigational drugs in cases of severe and critical COVID‑19 did not have any significant benefits to the outcomes.@*Conclusion@#COVID‑19 infection significantly increases both maternal and fetal outcomes, and these adverse effects correspond to the severity of the disease. The use of investigational drugs in severe and critical COVID‑19 cases has no significant benefit to maternal and fetal outcomes.
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SUMMARY OBJECTIVE: To assess the prevalence of maternal alloantibodies in pregnant women at a maternity hospital in northeastern Brazil and describe their perinatal outcomes. METHODS: A retrospective cohort study reviewed maternal and newborn medical records between January 2017 and October 2018 to assess for the presence of maternal alloantibodies. RESULTS: The following maternal alloantibodies were found in the 41 cases surveyed: anti-D, 28 cases (45%); anti-C, 7 cases (11%); anti-c, 1 case (1.6%); anti-E, 4 cases (6.4%); anti-Cw, 1 case (1.6%); anti-K, 2 cases (3.2%); anti-Jka, 1 case (1.6%); anti-M, 3 cases (4.8%); anti-Fya, 2 cases (3.2%); anti-Fyb, 1 case (1.6%); anti-Lea, 5 cases (8%); anti-Leb, 3 cases (4.8%); and anti-Dia, 4 cases (6.4%). Anti-D antibodies were the most frequent cause of erythrocyte alloimmunization (80%). Fetal anemia was observed in four pregnancies based on the peak systolic velocity of the middle cerebral artery. In one case, the mother showed anti-M, and anti-Lea alloimmunization, but the direct antiglobulin test results for the newborn were negative, and no unfavorable neonatal outcomes were observed. In one case of a mother with anti-C and anti-D alloimmunization, the neonate showed anti-D antibodies only in the serological panel and required phototherapy. Neonates with plasma antibodies and jaundice requiring phototherapy only had a serological panel with anti-D, anti-C, anti-c, and anti-E antibodies. Intervention was required for 2.5% of pregnant women with positive antibody screens and 81% of newborns with positive direct antiglobulin test results. CONCLUSION: Despite being a rare condition, maternal alloimmunization by irregular antibodies can result in high perinatal morbidity and mortality.
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Background: The upward trend of caesarean section and its associated morbidity/mortality especially in low- and middle-income areas make regular appraisal of the procedure necessary. Objective: To evaluate caesarean section; its rate, indications, and maternal and fetal outcomes in Asaba. Methods: A retrospective study of all caesarean sections carried out at the obstetrics unit of the Federal Medical Centre, Asaba, between July 1, 2018, and June 31, 2020. Data was analyzed using SPSS version 20. Results: There were 2778 deliveries during the period, out of which 705 had caesarean sections, giving an overall caesarean section rate of 25.4%. There were 456 (64.7%) emergency caesarean sections. The commonest indication for caesarean section was repeat caesarean section 196 (27.8%), while cephalo-pelvic disproportion 87 (12.3%) was the commonest indication for emergency caesarean section. Majority of the babies had low APGAR score at 1min and 5mins, 126 (27.6%) and 50 (11.0%) from emergency than elective caesarean section 16 (6.4%) and 5 (2.0%) at 1min and 5mins respectively (x2=17.963, P<0.001). There were 31 (4.2%) perinatal deaths out of which majority 28 (6.1%) were from emergency caesarean sections (x2=9.412 P=0.002). The commonest post-operative complication was postpartum anemia (140 (19.9%) while caesarean section case fatality was 0.6%. Conclusion: This study showed a caesarean section rate of 25.4% with repeat caesarean section and Cephalopelvic disproportion being the most common indication for elective and emergency caesarean section respectively. Emergency caesarean section accounted for most of the cases and is associated with a higher risk of maternal and perinatal morbidity and mortality
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Schools, Nursery , Cesarean Section , Birth Rate , Fatal Outcome , Fetal MortalityABSTRACT
Introducción: en la provincia de La Pampa no hay registro del número de pacientes con diabetes gestacional (DG) que vuelve a control metabólico posparto, cuando se conoce el riesgo que evolucione a diabetes mellitus tipo 2 (DM2). Objetivos: analizar en el Hospital Público Interzonal (Dr. Lucio Molas) el porcentaje de mujeres con DG que volvió a control metabólico posparto y desarrolló DM2 durante seis años de seguimiento. Materiales y métodos: estudio descriptivo ambispectivo en 44 pacientes con DG diagnosticada en 2013 con seguimiento hasta el 31/12/2019. Se analizaron antecedentes previos de DG y familiares de diabetes (AFD), edad, semana de gestación del diagnóstico con glucemia/prueba de tolerancia oral a la glucosa (PTOG), índice de masa corporal (IMC), presión arterial, vía del parto, peso del recién nacido, HbA1c. Resultados: en 2013 se efectuaron 1.238 partos, 44 pacientes (3,7%) tenían DG diagnosticada, 68% mediante PTOG. Presentaban 43% AFD, 38,6% sobrepeso, 20,45% obesidad, 68,2% cesáreas y 11,4% recién nacidos con alto peso. En seis años de seguimiento, 54,5% de estas pacientes realizó control metabólico; este grupo, a diferencia del grupo sin control, presentó mayor IMC al inicio del embarazo (t:2,103; p<0,02), glucemia basal (t:10,59; p<0,001), presión arterial sistólica (t:2,629; p<0,01), diastólica (t:1,965; p<0,05) y macrosomía fetal (4 vs 1). El 33,3 % manifestó DM2 predominantemente a partir de tres años del posparto. Conclusiones: el 54,5% de las pacientes con DG concurrió a control metabólico posparto tardíamente, y el 33,3% evolucionó a DM2; incluso estas pacientes presentaron mayor número de factores de riesgo obstétricos y cardiometabólicos que el grupo sin control al inicio del embarazo.
Introduction: there is no register of the number of women with gestational diabetes (GD) that have undergone metabolic post-partum control in the province of La Pampa, even though it is well-known the increased associated risk of becoming a diabetes type 2 patient (T2DM). Objectives: to analyze at the Interzonal Public Hospital (Dr. Lucio Molas) the percentage of women with GD who returned to postpartum metabolic control and developed T2DM during six years of follow-up. Materials and methods: descriptive ambispective study in 44 patients with GD diagnosed in 2013 with follow-up until 31 December 2019. Different characteristics were analyzed in all participants: previous history of GD and family members of diabetes (FHD), age, gestational week of the diagnosis with fasting glucose or oral glucose tolerance test (OGTT), body mass index (BMI), blood pressure, delivery route, newborn weight, glycated hemoglobin (HbA1C). Results: a number of 1,238 of deliveries were performed in 2013, 44 women (3.7%) developed GD diagnosed by OGTT (68%), 43% presented FHD, 38.6% overweight, 20.45% obesity. Among the totality of deliveries 68.2% were by caesarea and 11.4% high birth weight newborns. In six years of follow-up, 54.5% of these patients underwent metabolic control, presenting this group, unlike the group without control, higher BMI at the beginning of pregnancy (t:2.103; p<0.02), fasting blood glucose (t:10 .59; p<0.001), systolic blood pressure (t:2.629; p<0.01), diastolic blood pressure (t; 1.965; p<0.05) and fetal macrosomia (4 vs 1). 33.3% developed T2DM predominantly from at three years postpartum. Conclusions: the present study reported that 54.5% of women with GD performed a late metabolic postpartum control evolving 33.3% developed T2DM presenting higher obstetric and cardiometabolic risk factors than the group without control at the beginning of pregnancy.
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Humans , Diabetes, Gestational , Blood Glucose , Gestational Age , Diabetes Mellitus, Type 2ABSTRACT
Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers.
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Resumen Objetivo: describir los desenlaces materno-fetales en embarazadas con categoría de riesgo III-IV según la Organización Mundial de la Salud (OMS). Métodos: se revisaron las historias clínicas de 41 embarazadas con categoría de riesgo III-IV según la OMS, atendidas en un hospital de tercer nivel en Medellín, Colombia. Se recolectaron variables demográficas, clínicas y ecocardiográficas en un formulario diseñado para tal fin. Las variables primarias están orientadas a la evaluación de los desenlaces maternos y fetales. Los análisis estadísticos se realizaron con el software IBM-SPSS versión 23. Resultados: la tasa de eventos neonatales fue mayor que la tasa de eventos maternos (68.3 vs. 31.7%). Los desenlaces maternos primarios y secundarios ocurrieron en un 31.7 y 12.2% respectivamente. La distribución según la categoría de riesgo de la OMS fue del 7.3% en el grupo III y del 92.7% en el grupo IV. Solo hubo una muerte materna no relacionada con enfermedad cardiovascular. La presencia de insuficiencia tricuspídea moderada/severa se asoció con prematuridad (p 0.006) y las gestantes con presión sistólica pulmonar ≥ 50 mm Hg tuvieron mayor número de neonatos con distrés respiratorio (p 0.010). La falla cardiaca derecha se relacionó con muerte materna (p 0.014) y prematuridad (p 0.019), mientras que la de falla cardiaca izquierda se asoció con muerte neonatal (p 0.003). Conclusiones: la enfermedad cardiovascular materna es causa frecuente de alta morbilidad y mortalidad materno-fetal. Este estudio identificó los principales desenlaces maternos y fetales, sin embargo, se requieren estudios con mayor tamaño de muestra.
Abstract Objective: To describe the maternal-fetal outcomes in pregnant woman with risk classification of III-IV according to the World Health Organization (WHO). Methods: A review was carried out on the medical records of 41 pregnant women with WHO risk classification of III-IV, treated in a tertiary hospital in Medellin, Colombia. Demographic, clinical, and cardiac ultrasound variables were recorded on a form designed for this purpose. The primary variables were directed at evaluating the fetal and maternal outcomes. The statistical analysis was performed using IBM-SPSS software version 23. Results: The neonatal events rate was greater than the maternal events rate (68.3% vs. 31.7%). Primary and secondary outcomes occurred in 31.7% and 12.2%, respectively. The distribution according to WHO risk category was 7.3% in risk group III, and 92.7% in group IV. There was only one maternal death unrelated to cardiovascular disease. The presence of moderate-severe tricuspid insufficiency was associated with prematurity (P=.006), and the mothers with a pulmonary systolic pressure ≥ 50 mm Hg had a greater number of newborns with respiratory distress (P=.010). Right heart failure was associated with maternal death (P=.014) and prematurity (P=.019), whilst left heart failure was associated with neonatal death (P=.003). Conclusions: Maternal cardiovascular disease is a frequent cause of high maternal-fetal morbidity and mortality. Although this study identified the main maternal and fetal outcomes, studies with a greater sample size are required.
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Humans , Female , Adult , Pregnancy , Cardiovascular Diseases , Infant, Premature , Maternal Death , Perinatal DeathABSTRACT
Background: To study the effect of HIV and duration of ART on term of delivery, newborn birth weight and adverse fetal outcomes.Methods: Prospective comparative study of 40 HIV seropositive pregnant females with varying duration of ART (tenofovir 300 mg + lamivudine 300 mg + efavirenz 600 mg) and HIV seronegative pregnant females attending ANC and delivering in department of obstetrics and gynecology at S. M. S. Medical College, Jaipur, Rajasthan, India.Results: Most HIV seropositive patients were in age group 25 to 30 years and more number were booked in comparison to unbooked. Adverse fetal outcomes were seen more in HIV seropositive patients and they were found to be statistically significant (p=0.029). No relationship could be derived of duration of ART on either the birth weight or term of delivery or adverse fetal outcomes.Conclusions: Maternal HIV infection was significantly found associated with adverse fetal outcome and this was not affected by the use of ART.
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Background: Hypothyroidism and anemia in pregnancy causes significantly high maternal and fetal morbidity and mortality. Aim of this study was to determine the prevalence of anemia, grade and type of anemia in hypothyroid pregnant patients.Methods: This prospective study was conducted at department of obstetrics and gynecology, CSSH, Meerut, Uttar Pradesh over a period of 2 years from August 2017 to August 2019. Patients who attended the OPD during the study period were included in the study according the inclusion criteria and were studied for the clinical profile, obstetric history and detailed examination. Investigations were done including hemoglobin, blood grouping, urine routine, HbsAg, Anti-HCV, HIV, RBS and serum TSH. The women with raised serum TSH, indicating hypothyroidism, test for free T3, free T4 and anti-TPO was done, and the hypothyroid females with anemia were further investigated with GBP for the type of anemia, data evaluated with adequate statistical analysis.Results: A total 223 patients, enrolled in the study, prevalence of anemia in hypothyroid patients was 69.95%. Most patients with overt hypothyroidism had mild anemia 26 (68.4%), while in sub-clinical hypothyroid patients’ group most of the patients had moderate anemia. In the overt hypothyroid and subclinical hypothyroid group dimorphic anemia was the most prevalent form of anemia with 52.6% and 74.6% respectively.Conclusions: Prevalence of anemia in hypothyroid pregnant patients is 69.95%. Dimorphic anemia is most prevalent; hence it is important to study anemia in antenatal patients with hypothyroidism and appropriate strategies should be used to prevent and treat anemia.
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Background: Methotrexate (MTX) which is folic acid antagonist is used to treat many diseases, including rheumatic, inflammatory, autoimmune disorders or malignancies; it is also used for the medical treatment of ectopic pregnancy and termination of pregnancy. The objective of this study was to assess the impact of folic acid in preventing congenital anomalies (CAs) in the fetus of pregnant that take long-term low dose methotrexate.Methods: The study included 1569 with history of low dose methotrexate therapy <25 mg/week that stopped one month before pregnancy, they were divided into 3 groups; Group 1 comprised 272 pregnant women, Group 2 comprised 367 pregnant women both groups take folic acid 4-5 weeks preconception and for the first 12-13 weeks gestation, the dose in the 1st group was 0.4 mg/day while in 2nd Group 4 mg/day, Group 3 comprised of 930 pregnant disease-matched with no folic acid. Group 4 comprised of 1015 pregnant no underlying autoimmune and no folic acid intake.Results: The overall rate of CAs and cardiovascular CAs were higher in fetuses of Group 3 (OR: 1.7; 95% CI: 1.1-2.7) and (OR: 2.7; 95% CI: 1.4-5.2) respectively compared to the overall rate of CAs and cardiovascular CAs in other groups. Other adverse outcomes as abortion, preterm delivery, preeclampsia, placenta abruption, PROM, low birth weight, admission to NICU, IUGR and IUFD were higher in Group 3 and 4 than in Group 1 and 2. There were no significant differences in umbilical arterial PH. The Apgar scores <7 at 1, 5 min and gestational age at delivery were higher in Group 1 and 2 than Group 3 and 4.Conclusions: There was a certain reduction in methotrexate teratogenic effect on the fetuses with folic acid intake during pregnancy, these pregnancies might benefit from taking of folic acid in high doses before conception and during the first trimester of pregnancy and improvement in fetal and maternal outcomes but the explanation of this effect requires further study.
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Abstract Background: The improvement in surgical techniques has contributed to an increasing number of childbearing women with complex congenital heart disease (CCC). However, adequate counseling about pregnancy in this situation is uncertain, due to a wide variety of residual cardiac lesions. Objectives: To evaluate fetal and maternal outcomes in pregnant women with CCC and to analyze the predictive variables of prognosis. Methods: During 10 years we followed 435 consecutive pregnancies in patients (pts) with congenital heart disease. Among of them, we selected 42 pregnancies in 40 (mean age of 25.5 ± 4.5 years) pts with CCC, who had been advised against pregnancy. The distribution of underlying cardiac lesions were: D-Transposition of the great arteries, pulmonary atresia, tricuspid atresia, single ventricle, double-outlet ventricle and truncus arteriosus. The surgical procedures performed before gestation were: Fontan, Jatene, Rastelli, Senning, Mustard and other surgical techniques, including Blalock, Taussing, and Glenn. Eight (20,0%) pts did not have previous surgery. Nineteen 19 (47.5%) pts had hypoxemia. The clinical follow-up protocol included oxygen saturation recording, hemoglobin and hematocrit values; medication adjustment to pregnancy, anticoagulation use, when necessary, and hospitalization from 28 weeks, in severe cases. The statistical significance level considered was p < 0.05. Results: Only seventeen (40.5%) pregnancies had maternal and fetal uneventful courses. There were 13 (30.9%) maternal complications, two (4.7%) maternal deaths due to hemorrhage pos-partum and severe pre-eclampsia, both of them in women with hypoxemia. There were 7 (16.6%) stillbirths and 17 (40.5%) premature babies. Congenital heart disease was identified in two (4.1%) infants. Maternal and fetal complications were higher (p < 0.05) in women with hypoxemia. Conclusions: Pregnancy in women with CCC was associated to high maternal and offspring risks. Hypoxemia was a predictive variable of poor maternal and fetal outcomes. Women with CCC should be advised against pregnancy, even when treated in specialized care centers.
Resumo Fundamento: A contínua habilidade na conduta das cardiopatias congênitas complexas (CCC) tem permitido o alcance da idade fértil. Contudo, a heterogeneidade das lesões cardíacas na idade adulta limita a estimativa do prognóstico da gravidez. Objetivo: Estudar a evolução materno-fetal das gestantes portadoras de CCC e analisar as variáveis presumíveis de prognóstico. Método: No período de 10 anos, 435 gestantes portadoras de cardiopatias congênitas foram consecutivamente incluídas no Registro do Instituto do Coração (Registro-InCor). Dentre elas, foram selecionadas 42 gestações em 40 mulheres com CCC (24,5 ± 3,4 anos) que haviam sido desaconselhadas a engravidar. As cardiopatias de base distribuíram-se em: transposição das grandes artérias, atresia pulmonar, atresia tricúspide, ventrículo único, dupla via de saída de ventrículo direito, dupla via de entrada de ventrículo esquerdo e outras lesões estruturais. As cirurgias realizadas foram Rastelli, Fontan, Jatene, Senning, Mustard e outros procedimentos combinados, como tunelização, Blalock Taussing e Glenn. Oito pacientes (20%) não haviam sido operadas, e 19 (47,5%) apresentavam hipoxemia. O protocolo de atendimento incluiu: registro da saturação de oxigênio, hemoglobina sérica, hematócrito, ajuste das medicações, anticoagulação individualizada e hospitalização a partir de 28 semanas de gestação, em face da gravidade do quadro clínico e obstétrico. Na análise estatística, o nível de significância adotado foi de 0,05. Resultado: Somente 17 gestações (40,5%) não tiveram complicações maternas nem fetais. Houve 13 problemas maternos (30,9%) e 2 mortes (4,7%) causadas por hemorragia pós-parto e pré-eclâmpsia grave, ambas em pacientes que apresentavam hipoxemia. Houve 7 perdas fetais (16,6%), 17 bebês prematuros (40,5%) e 2 recém-nascidos (4,7%) com cardiopatia congênita. As complicações materno-fetais foram significativamente maiores em pacientes que apresentavam hipoxemia (p < 0,05). Conclusão: O alcance da idade reprodutiva em pacientes com CCC é crescente; contudo, a má evolução materno-fetal desaconselha a gravidez, particularmente nas pacientes que apresentam hipoxemia.
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Humans , Female , Pregnancy , Infant, Newborn , Adolescent , Adult , Young Adult , Pregnancy Complications, Cardiovascular/physiopathology , Heart Defects, Congenital/physiopathology , Pregnancy Complications, Cardiovascular/classification , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/mortality , Prognosis , Maternal Mortality , Gestational Age , Fetal Mortality , Heart Defects, Congenital/classification , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/mortalityABSTRACT
Background: Women with intrahepatic cholestasis of pregnancy (ICP) have an increased risk for postpartum haemorrhage, dyslipidaemia, preterm labour and operative interference. Fetus in ICP has been associated with an increased incidence of preterm labour, preterm prelabour rupture of membrane, fetal distress, abnormal CTG, meconium staining, spontaneous intrauterine death. The present study was done to evaluate the perinatal outcomes – maternal outcomes and fetal outcomes of ICP.Methods: This was a prospective observational study carried out in a tertiary care teaching hospital. Total 1100 pregnant women were screened during the study period. Patients with ICP were identified in maternity care units after eliciting history about itching. Pregnancies with pregnancy induced hypertension and other liver diseases in pregnancy were excluded.Results: 62 pregnant women with prevalence rate of 5.64% have been found to be suffering from ICP. The most frequently affected (22, 35.48%) age-group with ICP were belong to age > 35 years. A majority of pregnant women with intrahepatic cholestasis of pregnancy was of multipara. ICP was highly significantly associated with small for gestational age (SGA, p-value: 0.0003); abnormal cardiotocography (CTG, p-value: 0.0002); and meconium stained liquor (p-value: 0.0001). Caesarean section as mode of delivery found significantly associated (p-value: 0.0033) with ICP. Insomnia (p-value: 0.0045); dyslipidemia (p-value: 0.0011); and postpartum haemorrhage (p-value: 0.0122) were also found significantly with ICP.Conclusions: ICP can adversely affect fetal as well as maternal pregnancy outcomes. Maternal outcomes have good prognosis, but fetal outcomes can be improved by timely and effective intervention.
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Background: Hyperemesis gravidarum (HG) is associated with maternal weight loss, nutritional deficiencies, fluid and electrolyte abnormalities, which may lead to adverse fetal and maternal outcomes. The purpose of this study was to evaluate the relationship of hyperemesis gravidarum to maternal and foetal outcomes.Methods: A hospital-based prospective observational study was carried out. All patients with singleton pregnancy diagnosed as / history of hyperemesis gravidarum the current pregnancy was included in the study. The pregnant women with multiple pregnancy, molar pregnancy, presence of pre-gestational diabetes, pre-gestational hypertension, and other causes of nausea such as appendicitis and pyelonephritis were excluded from the study.Results: 36 pregnant women with prevalence rate of 3.28% have been found to be suffering from HG. Almost half (17, 47.22%) of the pregnant women with HG had age less than 25 years. The significant association (p-value: 0.0099) has been found between parity and smoking with HG. HG was significantly associated with low birth weight (p-value: 0.0133); small for gestational age (SGA) (p-value: 0.0316); APGAR score < 7 after 1 minute (p-value: 0.0060); and APGAR score <7 after 5 minutes (p-value: 0.0006). There is no association found between mode of delivery, gestational diabetes, and pregnancy-induced hypertension with HG.Conclusions: HG can adversely affect fetal as well as maternal, though not significant, pregnancy outcomes.
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Background: All-natural birth has a purpose and a plan; who would think of tearing open the chrysalis as the butterfly is emerging? Who would break the shell to pull the chick out?” ~ Marie Mongon. It is of particular interest, in light of increased incidence of abdominal delivery throughout the country and in the world, to judge the validity of this procedure when used for the first time in the multipara.Methods: All the cases of Primary caesarean delivery in multipara over a period of 18 months were studied with regards to the indication, associated risks factors, and perinatal morbidity and mortality. The primary objective of the study was to find out the status of primary Lower Segment Caesarean Section (LSCS) in multipara in tertiary care center.Results: The overall incidence of LSCS was 30.7%. The incidence of Primary LSCS in multipara was 23.4%. The most common indication of LSCS was Foetal Distress i.e. 40.8%. Almost all caesarean sections were done in Emergency (99.2%). 12.3% of patients underwent PPH intra-operatively with 0.7% patient requiring Obstetric hysterectomy. Majority of the neonates were admitted in NICU for Respiratory Distress (30%). Major cause of Post-operative morbidity was wound gape seen in 10.8% patients.Conclusions: The fact that a multipara has had one or more vaginal deliveries should be regarded as an optimistic historical fact, not as diagnostic criteria for spontaneous delivery of the pregnancy at hand. Hence a multiparous woman in labour requires the same attention as that of primigravida and may still require a caesarean section for safe delivery. Good antenatal and intrapartum care and early referral will help reduce the maternal and perinatal morbidity.
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Abstract Objective To review the existing recommendations on the prenatal care of women with systemic lupus erythematosus (SLE), based on currently available scientific evidence. Methods An integrative review was performed by two independent researchers, based on the literature available in the MEDLINE (via PubMed), EMBASE and The Cochrane Library databases, using the medical subject headings (MeSH) terms "systemic lupus erythematosus" AND "high-risk pregnancy" OR "prenatal care." Studies published in English between 2007 and 2017 were included; experimental studies and case reports were excluded. In cases of disagreement regarding the inclusion of studies, a third senior researcher was consulted. Forty titles were initially identified; four duplicates were excluded. After reading the abstracts, 7 were further excluded and 29 were selected for a full-text evaluation. Results Systemic lupus erythematosus flares, preeclampsia, gestation loss, preterm birth, fetal growth restriction and neonatal lupus syndromes (mainly congenital heartblock) were the major complications described. The multidisciplinary team should adopt a specific monitoring, with particular therapeutic protocols. There are safe and effective drug options that should be prescribed for a good control of SLE activity. Conclusion Pregnant women with SLE present an increased risk for maternal complications, pregnancy loss and other adverse outcomes. The disease activity may worsen and, thereby, increase the risk of other maternal-fetal complications. Thus, maintaining an adequate control of disease activity and treating flares quickly should be a central goal during prenatal care.
Resumo Objetivo Revisar as recomendações existentes sobre o cuidado pré-natal às mulheres comlúpus eritematoso sistêmico (LES), combase emevidências científicas atualmente disponíveis. Métodos Revisão integrativa realizada por dois pesquisadores independentes, com base na literatura disponível nos bancos de dados MEDLINE (via PubMed), EMBASE e The Cochrane Library, usando os cabeçalhos de assuntos médicos, ou termos MeSH, "systemic lupus erythematosus" E "high-risk pregnancy" OU "prenatal care." Estudos publicados em inglês entre 2007 e 2017 foram incluídos; estudos experimentais e relatos de caso foram excluídos. Em caso de desacordo, umterceiro pesquisador sênior foi consultado. Quarenta títulos foram inicialmente identificados; quatro duplicatas foram excluídas. Após leitura dos resumos, mais 7 artigos foramexcluídos e 29 foram selecionados para uma avaliação de texto completo. Resultados Surtos de LES, pré-eclâmpsia, perda de gestação, parto prematuro, restrição de crescimento fetal e síndromes de lúpus neonatal foram as principais complicações descritas. A equipe multidisciplinar deve adotar um monitoramento específico, com protocolos terapêuticos apropriados. Há drogas seguras e eficazes que devem ser prescritas para um bom controle do LES. Conclusão Gestantes com LES apresentam risco aumentado de complicações maternas, perda de gravidez e outros desfechos adversos. A atividade da doença pode piorar e, assim, aumentar o risco de outras complicações. Assim, manter um controle adequado da atividade da doença e tratar rapidamente os surtos deve ser um objetivo central durante o pré-natal.
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Humans , Female , Pregnancy , Pregnancy Complications/therapy , Prenatal Care , Lupus Erythematosus, Systemic/therapy , Follow-Up Studies , Practice Guidelines as TopicABSTRACT
Objective To explore the influence of late pregnancy complicating uterus myoma on the maternal and fetal out‐comes .Methods A total of 368 patients with late pregnancy complicating uterus myoma were taken as the observation subjects . The influence situation of size ,number and location of uterus myoma on the pregnancy ,delivery ,puerperium and maternal‐fatal out‐comes was analyzed .Results The incidence rate of threatened abortion ,threatened premature delivery ,abnormal fetal position ,pla‐centa praevia and placental abruption in complicating uterus myoma with diameter≥5 cm ,multiple ,intramural and cervial myoma was obviously higher than that in complicating uterus myoma with diameter<5 cm ,single and subserous myoma or submucous my‐oma (P<0 .05) .The cesarean section rate for the uterus myoma with diameter≥5 cm ,multiple and intramural myoma was signifi‐cantly increased (P<0 .05) .The incidence rate of fetal distress ,fetal anomaly ,premature infant ,low birth weight infant ,and neo‐natal asphyxia in uterus myoma with diameter≥5 cm ,multiple ,and intramural myoma was obviously increased(P<0 .05) .Conclu‐sion The late pregnancy complicating large ,multiple and intramural myoma has more obvious adverse reactions on maternal‐fetal prognosis .
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@#BACKGROUND: Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia. METHODS: A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95％CI and P value less than 0.05 were considered statistically significant. RESULTS: Of the 4525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2％ of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5％ of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95％CI 1.3–24.1) latency >24 hours (AOR=2.8, 95％CI 1.7–11.8), residing in rural areas (AOR=4.2, 95％CI 3.96–29.4) and birth weight less than 2500 g were associated with unfavorable outcomes. CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.