Influence of ovarian torsion on reproductive outcomes and mode of delivery.

Purpose: To investigate differences in reproductive outcomes among patients before and following ovarian torsion. Study design: In this retrospective cohort study, we investigated the reproductive outcomes of patients who underwent surgery for ovarian torsion between 1988 and 2015 in a tertiary medical center. Data on deliveries before and after ovarian torsion were compared. Results: During the study period, 199 women underwent surgery due to ovarian torsion. The majority (91.4%; n = 182) underwent detorsion, and 8.6% (n = 17) underwent unilateral adnexectomy. At the time of the torsion, 27.6% (n = 55) of patients were pregnant. Among women who suffered from ovarian torsion, about half (52%) of the deliveries occurred before the torsion and 48% following the torsion. No significant difference in the live birth rate was noted (p = 0.19). The fertility treatment rate in our cohort was 7.5% before and 5% after the torsion (p = 0.01). In addition, live birth, cesarean delivery, and fertility treatment rates were similar in women who underwent detorsion vs. those who had adnexectomy. Conclusion: Surgically treated ovarian torsion does not appear to negatively influence fertility and live birth potential.

Maternal preeclampsia and long-term infectious morbidity in the offspring - A population based cohort analysis.

OBJECTIVE: We evaluated the association between maternal preeclampsia and long-term infectious morbidity of the offspring. STUDY DESIGN: A retrospective cohort analysis was performed, evaluating risk of long-term infectious morbidity in children born to women with and without preeclampsia between the years 1991-2014. Infectious morbidity included hospitalizations of offspring during childhood. Infants were followed until age 18 years or until hospitalization. Multiple gestations, newborns with congenital malformations and perinatal deaths were excluded. Cumulative incidence rates of infectious morbidity were compared. A Cox proportional hazards model was employed to control for various confounders including gestational age and cesarean delivery (CD). RESULTS: During the study period 239,725 newborns were included: 96% (n = 230,217) without preeclampsia, 3% (n = 7280) with mild preeclampsia and 0.9% (n = 2228) with severe preeclampsia, defined mostly by evidence of maternal organ dysfunction. Hospitalization rate due to infectious morbidity was significantly higher for offspring to mothers with severe preeclampsia in comparison to those with no preeclampsia (13.1% vs 11%, P = 0.008), specifically respiratory and bacterial infections. The Kaplan-Meier survival curve demonstrated that offspring born to mothers with severe preeclampsia had a significantly higher cumulative incidence of hospitalization (Log-rank test P value = 0.026). However, while controlling for confounders in the Cox regression model, severe preeclampsia was not found as an independent risk factor (adjusted hazard ratio 0.95, 95% confidence interval 0.8-1.1, P = 0.36). CONCLUSION: While severe preeclampsia is associated with higher risk for long-term infectious morbidity of the offspring, it seems that the association is due to prematurity and CD, but not the preeclampsia per-se.

Maternal chorioamnionitis & long term neurological morbidity in the offspring.

BACKGROUND: Chorioamnionitis is a common and potentially devastating complication of pregnancy associated with maternal and perinatal adverse outcomes. OBJECTIVE: To evaluate a possible association between maternal chorioamnionitis and long-term pediatric neurological morbidity. STUDY DESIGN: A population-based retrospective cohort analysis was performed comparing the risk of long-term neurological morbidity. Pediatric neurological morbidity evaluated included hospitalizations with neurological morbidity. Kaplan-Meier survival curves were constructed to compare the cumulative neurological morbidity and a Cox regression model was used to control for confounders. RESULTS: 238 622 newborns were included. Of them, 0.5% were born to mothers with chorioamnionitis. 3.1% offspring were hospitalized with a neurological condition. Total neurological morbidity was not significantly more common in the chorioamnionitis group (3.8% vs. 3.1% respectively, OR 1.23, 95% CI 0.9-1.6, p = 0.147). However, a significant and independent association was noted between maternal chorioamnionitis and cerebral palsy. (0.5% vs. 0.1%, OR 5.77, 95% CI 2.5-13.0, p = 0.001). In a Cox proportional hazards model, controlling for preterm delivery, birthweight, maternal factors and mode of delivery the association between chorioamnionitis and cerebral palsy remained significant (adjusted HR = 2.78, 95% CI 1.20-6.43, P = 0.016). CONCLUSION: Maternal chorioamnionitis is associated with cerebral palsy in the offspring, independently of other birth circumstances such as preterm delivery and birthweight.

Gender Affects Long-Term Neurological Outcome of Neonates.

OBJECTIVE: We evaluated the possible association between fetal gender and long-term pediatric neurological morbidity. METHODS: We performed a population-based retrospective cohort analysis comparing the risk of long-term neurological morbidity (up to age 18 years) of children born during the years 1991 to 2013 according to their gender. Neurological morbidity evaluated included hospitalizations in childhood involving pervasive developmental disorder, obstructive sleep apnea, cerebral palsy, epilepsy, and infantile spasms and disorders of eating as recorded in the hospital files. Multiple pregnancies and fetal congenital malformations were excluded. Kaplan-Meier survival curves were constructed to compare the cumulative neurological morbidity over the study period. A Cox proportional hazards model was used to control for obstetrical confounders, including gestational age at birth, birth weight, and maternal factors. RESULTS: During the study period, 240,953 newborns were included in the long-term analysis: 51.0% (n = 122,840) males and 49.0% (n = 118,113) females. Hospitalizations for neurological problems (up to age 18 years) were significantly more common in males compared with females (1.1% vs 0.8%, respectively, odds ratio 1.31, 95% confidence interval 1.2 to 1.4, P < 0.001). Specifically, pervasive developmental disorder and obstructive sleep apnea were found to be significantly more common in males, and cerebral palsy reached borderline significance (0.1% vs 0.04%, odds ratio 1.39, 95% confidence interval 0.9 to 1.9, P = 0.06). The Kaplan-Meier survival curves demonstrated males to have a significantly higher cumulative incidence of total neurological morbidity as well as of pervasive developmental disorder and obstructive sleep apnea (all log-rank test P values <0.001). In the Cox regression model, male gender exhibited an independent association with long-term neurological morbidity, while adjusting for birth weight, gestational age, and other confounding variables (adjusted hazard ratio 1.29, 95% confidence interval 1.2 to 1.4, P < 0.001). CONCLUSION: Males are at an increased risk for pediatric neurological morbidity independent of gestational age at birth and birth weight.

Maternal Inflammatory Bowel Disease During Pregnancy is Not a Risk Factor for Long-term Morbidity of the Offspring.

BACKGROUND AND AIMS: To investigate whether offspring of women suffering from inflammatory bowel disease [IBD] during their pregnancy are at an increased risk for long-term paediatric morbidity. METHODS: In this population-based cohort study, we investigated the incidence of long-term [up to the age of 18 years] hospitalizations due to cardiovascular, endocrine, neurological, haematological, respiratory, gastrointestinal, and urinary paediatric morbidities of offspring of mothers affected by IBD during their pregnancy. Deliveries occurred between the years 1991 and 2014 in a regional tertiary medical centre. Newborns with congenital malformations as well as multiple pregnancies were excluded from the study. RESULTS: During the study period, 255 352 deliveries met the inclusion criteria; 278 offspring were born to mothers with IBD. During the follow-up period, children born to mothers with IBD did not have an increased risk for long-term [up to the age of 18 years] morbidity compared with the control group. CONCLUSION: Maternal IBD during pregnancy is not a risk factor for long-term paediatric morbidity of the offspring.

Reproductive outcomes following uterine septum resection.

OBJECTIVE: To determine the reproductive outcome following hysteroscopic septum resection in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries. STUDY DESIGN: A retrospective, cohort study investigating reproductive outcomes following septum resection was conducted. Patients who had no other apparent cause for spontaneous miscarriage or preterm delivery were included in the study. Reproductive outcomes were compared between pregnancies prior to and after the septum resection. Multiple pregnancies were excluded. RESULTS: Twenty-eight patients met the inclusion criteria with a total of 85 pregnancies, 45 prior and 40 after septectomy. The mean gestational age increased from 33.73 ± 6.27 (weeks) prior to the resection to 38.47 ± 1.71 (weeks) after it (p < 0.05). The mean birth weight increased from 2520 ± 764.4 (g) to 3202.6 ± 630.2 (g) after the resection. Spontaneous miscarriage rate dropped from 63.6% to 12.5%. Multivariate analysis models showed uterine septectomy to be independently associated with increased gestational age at delivery (ß = 0.606, Adjusted R(2 )= 0.328, CI 10.647-20.612, p < 0.01), increased birth weight (ß = 0.424, Adjusted R(2 )= 0.129, CI 202.097-1210.287, p < 0.01) and with lower risk for preterm delivery (OR = 0.073, CI 0.16-0.327, p < 0.01). CONCLUSION: Hysetroscopic resection of a uterine septum improves reproductive outcomes in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries.