The association of gestational age at delivery with neonatal outcomes in prenatally diagnosed vasa previa.

OBJECTIVE: To report on the association of gestational age at delivery and neonatal outcomes in prenatally diagnosed vasa previa. METHODS: A retrospective cohort study at two academic/community hybrid hospitals, covered by the same maternal-fetal medicine group. Neonatal characteristics and outcomes were compared between cases of prenatally diagnosed vasa previa delivered at gestational age <36 weeks and ≥36 weeks. RESULTS: We identified 59 cases of vasa previa, of which 2 were excluded, one due to delivery at 28 weeks for preeclampsia, and one because it was not diagnosed prenatally, leaving 57 pregnancies in our study. There were 2 sets of twins. As such, there were 59 newborns. The mean gestational age at delivery was 35.08 (± 0.27) weeks for those delivered at <36 weeks, and 36.11 (±0.16) weeks for those delivered ≥36 weeks. All cases were delivered by cesarean. Delivery at ≥36 weeks was associated with greater mean birth weight (2774 g (±376.3 g)) compared with 2292.5 g (± 406.8 g) for those babies delivered at <36 weeks (p < 0.001). In addition, there were shorter hospital stays for the babies delivered at ≥36 weeks (median 3 days; interquartile range (IQR) 3,3) when compared with those delivered at <36 weeks (median 13 days; IQR 3,20). In addition, delivery at ≥36 weeks was associated with lower rates of intubation, jaundice and respiratory distress syndrome. Importantly, no cases of rupture of the membranes or vessel rupture occurred in either group. CONCLUSION: Our study suggests that delivery at ≥36 weeks is safe for asymptomatic patients with prenatally diagnosed vasa previa, and may be associated with improved neonatal outcomes. We suggest that stable asymptomatic patients with prenatal diagnosis of vasa previa be delivered at 36 weeks rather than at less than 36 weeks. This will reduce neonatal morbidity with no apparent increased risk to babies.

Urinary tract infection associated with ureteral stents in renal transplantation.

OBJECTIVES: In the mid 1980s, ureteral stents were used in renal transplantation when ureteral injury had occurred. Subsequently, it was shown that routine ureteral stent placement at the time of transplantation reduced urological complications. We carried out a chart review on renal transplant patients and noted which patients developed urinary tract infections (UTIs) with stents in place, and whether these infections ultimately affected transplant outcome. We sought to distinguish subgroups of patients who were more likely to develop infection and to identify the optimum time for stent removal. PATIENTS AND METHODS: We performed a retrospective chart review of 213 patients who underwent renal transplantation in 1994 and 1995. Adequate follow-up information was available on 167 patients with intraoperative stent placement. Of these 167 patients, 4 patients expired and 8 required transplant nephrectomy due to complications unrelated to the stent. RESULTS: In total, 35 patients (22.6%) developed a post-operative UTI. One infection occurred during the first week following transplant, 3 developed within 2 weeks, and importantly, the remaining 32 infections occurred more than 2 weeks after transplant. An increase in infections in diabetics (25.7%) as compared to other transplant recipients (20.2%) was noted. Patients with cadaveric renal transplants are also at higher risk of UTI (24%) compared to those with living related donors (15%). CONCLUSION: The use of ureteral stents is safe, but is associated with a UTI rate of 22.6%. To reduce infection rates, we recommend stent removal within 14 days and earlier if possible, particularly in diabetic patients who have received a cadaveric renal transplant.