Conservative management of a near-term cervico-isthmic pregnancy, followed by a successful subsequent pregnancy: a case report.

OBJECTIVE: To describe a rare case of a cervico-isthmic pregnancy with anterior placenta percreta that was treated at 34 weeks of gestation by removing the placenta and the attached uterine wall in one piece. DESIGN: Case report. SETTING: Tertiary university hospital. PATIENT(S): A 32-year-old woman was diagnosed with a cervico-isthmic pregnancy and an anterior placenta percreta at 34 weeks' gestation at delivery by a cesarean section. INTERVENTION(S): Delivery of the neonate was performed by a uterine incision beyond the limits of the placenta. Thereafter, the placenta and the attached uterine wall were removed step by step by ligature section. MAIN OUTCOME MEASURE(S): Intraprocedural or postprocedural complications and fertility preservation. RESULT(S): The delivery was successfully performed without intraprocedural or postprocedural complications and with preservation of the patient's fertility. A successful pregnancy was conducted 1 year later. CONCLUSION(S): In case of cervico-isthmic pregnancy with anterior placenta percreta, resection in one block of the placenta and the attached uterine wall may be an option for preserving fertility.

Development of a nomogram to predict occurrence of preeclampsia.

OBJECTIVE: The objective was to create a nomogram for the individual prediction of preeclampsia (PE). STUDY DESIGN: In a prospective population-based study that included 4777 patients, PE occurred in 2.4%. Age, body mass index, parity, previous preeclampsia (PPE), chronic hypertension, diastolic blood pressure (DBP), and proteinuria at first visit, and second trimester ultrasonography and umbilical artery Doppler resistance index (UARI) data were used to develop and calibrate a nomogram based on a multivariate logistic regression model. RESULTS: Based on multivariate analysis, nulliparity (P=0.002), PPE (P=0.004), DBP (P<0.0001), biparietal diameter (P=0.011), and UARI (P=0.08) were introduced into a nomogram. Based on these variables, the nomogram had good discrimination (area under the ROC curve=0.73, P<0.01) and calibration (unreliability index=-5.2 x 10(-4)). This nomogram was validated by bootstrapping. CONCLUSION: Our nomogram predicts the probability of preeclampsia. After validation in an independent population, this tool could be used to plan a preventive trial.

Are perinatal and maternal outcomes different during expectant management of severe preeclampsia in the presence of intrauterine growth restriction?

OBJECTIVE: The purpose of this study was to compare perinatal and maternal outcomes in women with singleton pregnancies and severe preeclampsia (SPE) expectantly managed at 24-33 weeks' gestation (wk) that resulted at birth in severe intrauterine growth restriction (SIUGR, < 5th percentile) to those without SIUGR. STUDY DESIGN: Two hundred thirty-nine women undelivered after antenatal steroids were expectantly managed. Perinatal and maternal outcomes were analyzed according to fetal growth status. Students t-test, chi-square test, logistic regression analysis, and odds ratio were calculated. RESULTS: Fifty-eight pregnancies resulted in an SIUGR neonate. Median latency periods (5 vs 5 d) and delivery gestational ages (30.6 vs 30.3 wk) were similar in the 2 groups. Controlling for gestational age at delivery, only fetal death remained associated with SIUGR (OR: 6.4; 95% CI 1.05-39.35, P = .04). Maternal outcomes were similar in the 2 groups. CONCLUSION: In severe preeclamptic women at 24-33 weeks, SIUGR is associated with increased risk of fetal death but does not affect maternal complications.

Maternal and perinatal outcomes during expectant management of 239 severe preeclamptic women between 24 and 33 weeks' gestation.

OBJECTIVE: This study was undertaken to determine maternal and perinatal outcomes after expectant management of severe preeclampsia between 24 and 33 weeks' gestation. STUDY DESIGN: A prospective observational study of 239 women with severe preeclamptic and undelivered after antenatal steroid prophylaxis was performed. Pregnancy prolongation and maternal and perinatal morbidities were analyzed according to the gestational age at time of expectant management: 24 to 28, 29 to 31, and 32 to 33 weeks. Statistical analysis was performed by Student t test and chi(2) test. RESULTS: The days of pregnancy prolongation were significantly higher among those managed at less than 29 weeks (6) compared with the other groups (4). There were 13 perinatal deaths: 12 in those managed at less than 29 weeks and 1 in those managed at 29 to 31 weeks. Neonatal morbidities were significantly higher among those managed at less than 29 weeks compared with the other groups. There were no instances of maternal death or eclampsia. Maternal morbidities were similar among the groups. CONCLUSION: Expectant management of severe preeclampsia at 24 to 33 weeks in a tertiary care center is associated with good perinatal outcome with a minimal risk for the mother.