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1.
J Perinat Med ; 49(5): 546-552, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-33470959

RESUMO

OBJECTIVES: An international diagnostic criterion for amniotic fluid embolism (AFE) diagnosis has recently been published. Data regarding subsequent pregnancies is scarce. We sought to implement recent diagnostic criteria and detail subsequent pregnancies in survivors. METHODS: A case series of all suspected AFE cases at a tertiary medical center between 2003 and 2018 is presented. Cases meeting the diagnostic criteria for AFE were included. Clinical presentation, treatment, and outcomes described. Pregnancy outcomes in subsequent pregnancies in AFE survivors detailed. RESULTS: Between 2003 and 2018 14 women were clinically suspected with AFE and 12 of them (85.71%) met the diagnostic criteria for AFE. Three cases occurred during midtrimester dilation and evacuation procedures, and the remaining occurred in the antepartum period. Of the antepartum cases, mode of delivery was cesarean delivery or vacuum extraction for expedited delivery due to presentation of AFE in 8/9 cases (88.88%). Clinical presentation included cardiovascular collapse, respiratory distress and disseminated intravascular coagulopathy (DIC). Heart failure of varying severity was diagnosed in 75% (9/12) cases. Composite maternal morbidity was 5/12 (41.66%), without cases of maternal mortality. 11 subsequent pregnancies occurred in four AFE survivors. Pregnant women were followed by a high-risk pregnancy specialist and multidisciplinary team if pregnancy continued beyond the early second trimester. Six pregnancies resulted in a term delivery. No recurrences of AFE were documented. CONCLUSIONS: Use of a diagnostic criterion for diagnosis of AFE results in a more precise diagnosis of AFE. Nevertheless, the accuracy of clinical diagnosis is still high. Subsequent pregnancies were not associated with AFE recurrence.


Assuntos
Cesárea , Embolia Amniótica , Complicações do Trabalho de Parto , Vácuo-Extração , Adulto , Cesárea/métodos , Cesárea/estatística & dados numéricos , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/etiologia , Coagulação Intravascular Disseminada/prevenção & controle , Diagnóstico Precoce , Embolia Amniótica/diagnóstico , Embolia Amniótica/epidemiologia , Embolia Amniótica/fisiopatologia , Embolia Amniótica/terapia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Israel/epidemiologia , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/fisiopatologia , Complicações do Trabalho de Parto/cirurgia , Seleção de Pacientes , Gravidez , Resultado da Gravidez/epidemiologia , Trimestres da Gravidez , Gravidez de Alto Risco , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologia , Síndrome do Desconforto Respiratório/prevenção & controle , Estudos Retrospectivos , Vácuo-Extração/métodos , Vácuo-Extração/estatística & dados numéricos
2.
Eur J Obstet Gynecol Reprod Biol ; 253: 187-190, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32890818

RESUMO

OBJECTIVE: Prediction of success of trial of labor after cesarean delivery (TOLAC) is of major importance. We investigated the impact of polyhydramnios on the success rate of TOLAC. STUDY DESIGN: A retrospective cohort study of all women with singleton pregnancies ≥ 34th weeks of gestation who underwent TOLAC after one previous cesarean delivery, between 2011 and 2016 in a single tertiary care center. Polyhydramnios was defined as amniotic fluid index ≥ 240 mm. Primary outcome was defined as the rate of successful TOLAC. RESULTS: 31,245 women gave birth during the study period, of them 1637 (5.3 %) women underwent TOLAC and met inclusion criteria. 39 (2.4 %) women with polyhydramnios were compared to a control group of 1598 (97.6 %) women with amniotic fluid index < 240 mm. Polyhydramnios significantly reduced the rate of successful TOLAC: 69.2 % (27/39) in the study group compared to 85.8 % (1371/1598) in the control group (P = 0.009). In a subgroup analysis based on amniotic fluid index, women with AFI > 270 mm had substantially lower TOLAC success rate [9/19 (47.4 %) vs 18/20 (90 %); P = 0.006]. There was no difference in the rate of uterine rupture between the groups (0/39 (o%) vs 9/1598 (0.56 %); P = 0.64). Logistic regression analysis revealed that polyhydramnios remained significantly associated with higher rates of cesarean delivery [OR 3.09 (95 % CI, 1.37-6.98)] after adjustment for confounding factors. CONCLUSION: Polyhydramnios was associated with significantly reduced TOLAC success rate with no statistical difference in the rate of uterine rupture. This information should be considered in physician counseling.


Assuntos
Poli-Hidrâmnios , Nascimento Vaginal Após Cesárea , Estudos de Coortes , Feminino , Humanos , Poli-Hidrâmnios/epidemiologia , Gravidez , Estudos Retrospectivos , Prova de Trabalho de Parto
3.
Arch Gynecol Obstet ; 300(5): 1245-1252, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31576451

RESUMO

PURPOSE: Information regarding the use of barbed suture in gynecologic surgery is limited. Our aim was to compare maternal morbidity following caesarean deliveries performed with barbed compared with non-barbed suture for uterine closure. METHODS: A historical cohort study from a single tertiary institution. The study group composed of all women that underwent term, uncomplicated singleton caesarean deliveries, where uterine closure was performed with ETHICON's Stratafix®, a polydioxanone barbed suture, compared with caesarean deliveries where uterine closure was performed with ETHICON's VICRYL®, a Polyglactin 910 non-barbed suture. The primary outcomes were the rate of maternal morbidity including the rate of red packed cells transfusion and a composite of infectious morbidity. Operation duration was also evaluated. An analysis restricted to elective caesarean deliveries was performed comparing the suture types. RESULTS: Three thousand and sixty patients were included in the study; 1337 in the study group and 1723 in the control group. There was no significant difference in the rate of the primary outcomes (red packed cells transfusion: 2.5% in the barbed suture vs. 2.1% in the non-barbed suture groups; p = 0.47; composite maternal morbidity: 3.8% vs. 4.8%, respectively; p = 0.18). Barbed suture was associated with reduced risk of postoperative ileus compared with the non-barbed suture (0.3% vs. 1.0%, respectively; p = 0.02) and a longer operation time (31 vs. 29 min, respectively; p < 0.001). In the analysis restricted to elective caesarean deliveries only the duration of operation remained significantly different between the groups. CONCLUSIONS: The rate of short term maternal morbidities among patients undergoing uterine closure with barbed suture during caesarean delivery is similar to the non-barbed suture.


Assuntos
Cesárea/mortalidade , Complicações Pós-Operatórias/mortalidade , Técnicas de Sutura/efeitos adversos , Útero/cirurgia , Adulto , Estudos de Coortes , Feminino , Humanos , Gravidez , Estudos Retrospectivos
4.
Arch Gynecol Obstet ; 300(4): 881-887, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31346701

RESUMO

PURPOSE: To determine the rate of obstetric and neonatal complications associated with intrahepatic cholestasis of pregnancy in twin versus singleton gestations. METHODS: A retrospective cohort study including patients diagnosed with intrahepatic cholestasis of pregnancy at a single tertiary center between 2011 and 2016. Women were allocated into two groups: twin pregnancies (n = 56) and singleton pregnancies (n = 186). Obstetric and neonatal outcomes were compared between the two groups. RESULTS: Intrahepatic cholestasis of pregnancy was diagnosed earlier in gestation in twin compared to singleton pregnancies (33.1 ± 2.8 vs. 35.1 ± 3.0 weeks, respectively; adjusted P < 0.001). Maternal serum levels of fasting total bile acids were significantly higher in twin pregnancies compared to singletons [27 (IQR 16-44) vs. 16 (IQR 10-26) µmol/L, respectively; P = 0.01]. None of the pregnancies in our cohort was complicated by fetal death. Apgar score at 5 min and umbilical artery and vein PH at delivery were comparable between the two groups. CONCLUSIONS: Intrahepatic cholestasis of pregnancy in twin pregnancies appears to be more severe compared to singletons, as reflected by an earlier presentation and higher levels of maternal serum total bile acids. Large prospective studies are required to customize a management strategy specific for women with twin pregnancies and intrahepatic cholestasis of pregnancy.


Assuntos
Colestase Intra-Hepática/complicações , Adulto , Colestase Intra-Hepática/patologia , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez , Gravidez de Gêmeos , Estudos Retrospectivos , Fatores de Risco
5.
J Obstet Gynaecol ; 37(1): 44-47, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28219313

RESUMO

We compared the rates of instrumental delivery in a cohort of nulliparous women at term (n = 19,416), to primiparous women who attempted labour after prior caesarean (TOLAC) (n = 1747). The rate of instrumental deliveries was higher in the TOLAC group compared to nulliparous gravidas (17.3 vs. 15% respectively, p = 0.001). The difference was more prominent for women who eventually had successful vaginal delivery (TOLAC: 23.9% vs. CONTROLS: 17.1%, p < 0.0001 respectively). Based on our results, previous caesarean whether urgent or elective was associated with an increased risk of instrumental delivery in the subsequent pregnancy.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/cirurgia , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/etiologia , Paridade , Gravidez
6.
J Matern Fetal Neonatal Med ; 29(8): 1318-21, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26177055

RESUMO

OBJECTIVE: Evaluate physiologic factors associated with reduced maternal perception of fetal movements (RFM). METHODS: A historical cohort study of all women (years 2011-2013, n = 399) that visited the maternal emergency room (ER) (gestational age 24 + 0-42 + 0) due to RFM (group A), that was compared to a control group consisted from women with normal perception of fetal movements (group B). Groups were compared for maternal characteristics (age, gravity, parity, BMI), gestational age, placental location, gestational age at birth and fetal outcomes (birth-weight and Apgar scores). RESULTS: In a multivariate regression analysis, including maternal age, height, weight, BMI, gestational age on admission to ER, gravity, parity and placental location, only two variables remained significantly associated with RFM - nulliparity (OR = 2.28, p = 0.001) and anterior placenta (OR = 1.44, p = 0.034). Group A was not associated with lower Apgar scores (1 and 5-min, p = 0.40 and 0.57, respectively) or low birth-weight (p = 0.76), nor was it associated with prematurity (p = 0.41), low (<7) 5-min Apgar score, fetal death or neonatal death. CONCLUSIONS: Reduced fetal movements are associated with anterior placenta and nulliparity.


Assuntos
Movimento Fetal , Percepção , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Análise Multivariada , Paridade , Placenta/fisiologia , Gravidez
7.
Med Sci Monit ; 21: 1124-30, 2015 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-25892459

RESUMO

BACKGROUND: Fetal sex and maternal age are each known to affect outcomes of pregnancies. The objective of the present study was to investigate the influence of the combination of maternal age and fetal sex on pregnancy outcomes in term and post-term singleton pregnancies. MATERIAL AND METHODS: This was a retrospective study on term singleton pregnancies delivered between 2004 and 2008 at the Chaim Sheba Medical Center. Data collected included maternal age, fetal sex, and maternal and neonatal complications. The combined effect of fetal sex and maternal age on complications of pregnancy was assessed by multivariable logistic regression models. RESULTS: The study population comprised 37,327 pregnancies. The risk of operative deliveries increased with maternal age ≥ 40 and in pregnancies with male fetuses. The risk of maternal diabetes and of longer hospitalization increased as maternal age increased, and in women ≥ 40 carrying male fetuses. The risk of hypertensive disorders increased in pregnancies with males as maternal age advanced. The risk of shoulder dystocia and neonatal respiratory complications increased in male neonates born to women<40. The risk of neonatal hypoglycemia increased in males for all maternal ages. CONCLUSIONS: Risk assessment for fetal sex and advanced maternal age were given for different pregnancy complications. Knowledge of fetal sex adds value to the risk assessment of pregnancies as maternal age increases.


Assuntos
Idade Materna , Resultado da Gravidez , Caracteres Sexuais , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez
8.
J Perinat Med ; 43(5): 585-90, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25222591

RESUMO

OBJECTIVE: Magnesium sulfate (MgSO4) administered to women at risk for preterm delivery decreases the risk of cerebral palsy in their children. However, the neuroprotective effect of MgSO4 has not been shown in twin gestations. Thus, the aim of this study was to determine the maternal serum levels of magnesium in twin vs. singleton pregnancies following intravenous treatment of MgSO4. METHODS: Case control study including two groups of pregnant women who received intravenous MgSO4: (1) twin gestations (n=83) and (2) singleton pregnancies (n=83). Maternal serum magnesium levels 6 and 24 h after initiation of treatment were determined in both groups. RESULTS: Maternal serum levels of magnesium were significantly lower among patients with twin gestations compared to those with singleton ones 6 h after initiation of treatment (4.6 vs. 4.8 mg/dL, P=0.003). In addition, the rate of pregnant women who obtained therapeutic levels 6 h after initiation of treatment was significantly lower in twin gestations than in singleton ones (36% vs. 58%, P=0.008). Multiple regression analysis revealed that twin gestations were independently and significantly associated with low maternal serum magnesium levels. CONCLUSIONS: Maternal serum concentrations of magnesium are lower in twin pregnancies than in singleton ones following MgSO4 treatment, which might explain the decreased neuroprotective effect of MgSO4 reported in twin pregnancies.


Assuntos
Sulfato de Magnésio/administração & dosagem , Magnésio/sangue , Gravidez de Gêmeos/sangue , Nascimento Prematuro/sangue , Nascimento Prematuro/prevenção & controle , Adulto , Estudos de Casos e Controles , Paralisia Cerebral/sangue , Paralisia Cerebral/etiologia , Paralisia Cerebral/prevenção & controle , Feminino , Humanos , Recém-Nascido , Infusões Intravenosas , Deficiência de Magnésio/sangue , Deficiência de Magnésio/complicações , Fármacos Neuroprotetores/administração & dosagem , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Análise de Regressão
9.
J Perinat Med ; 43(4): 391-4, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24552966

RESUMO

OBJECTIVE: To determine the admission to delivery interval and the rate of immediate delivery in twin versus singleton gestation complicated by spontaneous preterm labor (SPTL). METHODS: A retrospective cohort study of pregnant women presenting with advanced cervical dilatation of 3-5 cm and frequent uterine contractions at 24-34 weeks of gestation was performed. The rate of progression to delivery within 12 h and 24 h, as well as rates of prolonged latency, were compared between twins and singletons gestations. RESULTS: Sixty-nine women were included, of which 25 carried twins and 44 singletons. The overall rate of spontaneous delivery within 12 h and 24 h was 47.8% and 59.4%, respectively, and similar between twins and singletons. Nevertheless, prolonged latency of 10 days or more after presentation was more frequent among twins compared with singletons [10/25 (40%) vs. 7/44 (15.9%), respectively; P=0.026]. Moreover, women carrying twins presenting with advanced cervical dilatation had a better chance of completing a full 2-dose antenatal betamethasone course compared with singletons [19/25 (76%) of twins compared with 21/44 (47.7%) of singletons, odds ratio 3.5, 95% confidence interval 1.16-10.34; P=0.022]. CONCLUSION: Up to 60% of women presenting with advanced cervical dilatation prior to 34 weeks' gestation give birth within 24 h. Nevertheless, women carrying twins have a better chance of completing a betamethasone course and having prolonged latency compared with singletons.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Primeira Fase do Trabalho de Parto , Trabalho de Parto Prematuro , Gravidez de Gêmeos/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos
10.
J Perinat Med ; 41(5): 543-8, 2013 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-23612627

RESUMO

OBJECTIVE: To evaluate obstetric outcome after stillbirth according to placental and prothrombotic risk factors. METHODS: Obstetric outcomes of women with prior stillbirth and subsequent pregnancies were reviewed. Data on the immediate subsequent pregnancy included fetal loss, stillbirth, obstetric/medical complications, gestational age and birth weight at delivery, mode of delivery, thrombophilia, and prescribed medication. Placental stillbirth was defined as stillbirth associated with placental abruption, intrauterine growth restriction (IUGR), or histological evidence of placental infarcts. Controls were unselected women who gave birth at our center during a single calendar year. Factors influencing recurrence risks were estimated. RESULTS: Seventy-three subsequent pregnancies were identified. Five out of 73 (6.8%) women had a repeat stillbirth, significantly higher than controls (relative risk 22.2, 95% confidence interval 8.9-55.4). Four out of five repeat stillbirth cases occurred <37 weeks gestation. Hypertensive complications, diabetes and abruption were higher, while gestational age and birth weight at delivery were significantly lower than controls. Prior placental stillbirth was associated with a 10.5 times higher risk of IUGR in the subsequent pregnancy compared with non-placental stillbirth. All five repeat stillbirth cases occurred in thrombophilic women. CONCLUSION: Women with prior stillbirth face an increased risk of pregnancy complications and stillbirth recurrence, especially with concurrent thrombophilia. Most repeat stillbirth cases occur preterm.


Assuntos
Complicações na Gravidez/etiologia , Natimorto , Descolamento Prematuro da Placenta/etiologia , Adulto , Estudos de Casos e Controles , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Placenta/patologia , Gravidez , Complicações na Gravidez/patologia , Resultado da Gravidez , Recidiva , Fatores de Risco , Trombofilia/complicações , Adulto Jovem
11.
Med Sci Monit ; 18(9): PH77-81, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22936200

RESUMO

BACKGROUND: To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. MATERIAL/METHODS: A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000-4250 g, 4250-4500 g and ≥4500 g). RESULTS: The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000-4250 g, 4250-4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000-4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. CONCLUSIONS: Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500 g group.


Assuntos
Distocia/epidemiologia , Macrossomia Fetal/epidemiologia , Hipoglicemia/epidemiologia , Mortalidade Materna/história , Hemorragia Pós-Parto/epidemiologia , Resultado da Gravidez/epidemiologia , Cesárea/estatística & dados numéricos , Distocia/etiologia , Feminino , Macrossomia Fetal/complicações , Peso Fetal/fisiologia , História do Século XXI , Humanos , Israel/epidemiologia , Modelos Logísticos , Razão de Chances , Hemorragia Pós-Parto/etiologia , Gravidez , Estudos Retrospectivos
12.
Acta Obstet Gynecol Scand ; 91(7): 844-9, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22471810

RESUMO

OBJECTIVE: To compare maternal and neonatal outcomes of term large for gestational age (LGA) pregnancies and adequate for gestational age (AGA) pregnancies. DESIGN: Retrospective analysis. SETTING: Large university research medical center. POPULATION: All term singleton LGA (birthweight ≥ 90th percentile) and AGA pregnancies (birthweight 10.1-89.9th percentile) delivering between 2004 and 2008. METHODS: Data collected included maternal age, gestational age at delivery, mode of delivery, birthweight, fetal sex, and maternal and neonatal complications. Birthweight percentiles were determined according to locally derived gender-specific birthweight tables. MAIN OUTCOME MEASURES: Comparisons between LGA and AGA pregnancies and between LGA 90-94.9th, 95-98.9th and ≥ 99th percentile. RESULTS: The study population comprised 34 685 pregnancies; 3900 neonates matched the definition of term LGA. Maternal age and gestational age at delivery were significantly higher for LGA neonates. Significantly more LGA neonates were born by cesarean section, and significantly more LGA pregnancies were complicated by postpartum hemorrhage (PPH), shoulder dystocia or neonatal hypoglycemia, and had a longer hospitalization period. Maternal and neonatal risks increased as birthweight increased from the 90-94.9th to 95-98.9th to ≥ 99th percentile. Specifically, the risks of shoulder dystocia (odds ratio 2.61, 3.35 and 5.11, respectively), PPH (odds ratio 1.81, 2.12 and 3.92, respectively) and neonatal hypoglycemia (odds ratio 2.53, 3.8 and 5.19, respectively) all increased linearly with birthweight percentile. CONCLUSIONS: Large for gestational age pregnancies are associated with an increased rate of cesarean section, PPH, shoulder dystocia and neonatal hypoglycemia, as well as longer hospitalization. These risks increase as the birth percentile rises. These risks need to be emphasized in pre-delivery counseling.


Assuntos
Macrossomia Fetal/epidemiologia , Idade Gestacional , Doenças do Recém-Nascido/epidemiologia , Resultado da Gravidez , Adolescente , Adulto , Cesárea/estatística & dados numéricos , Distribuição de Qui-Quadrado , Distocia/epidemiologia , Feminino , Humanos , Hipoglicemia/epidemiologia , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Idade Materna , Pessoa de Meia-Idade , Hemorragia Pós-Parto/epidemiologia , Gravidez , Estudos Retrospectivos
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