Intended delivery mode and neonatal outcomes in pregnancies with fetal growth restriction.

Objective: To compare neonatal outcomes in pregnancies with fetal growth restriction (FGR) by intended delivery mode.Methods: This is a retrospective cohort study of singleton pregnancies with FGR that were delivered ≥34.0 weeks gestation. Neonatal outcomes were compared according to the intended delivery mode, which the attending obstetrician determined. Of note, none of the subjects had a contraindication to labor. Crude and adjusted odds ratios (ORs) and corresponding confidence intervals (CIs) were calculated via logistic regression models to assess the potential association between intended delivery mode and neonatal morbidity defined as a composite outcome (i.e. umbilical artery pH ≤7.1, 5-min Apgar score ≤7, admission to the neonatal intensive care unit, hypoglycemia, intrapartum fetal distress requiring expedited delivery, and perinatal death). A sensitivity analysis excluded intrapartum fetal distress requiring emergency cesarean delivery from the composite outcome since only patients with spontaneous labor or labor induction could meet this criterion. Potential confounders in the adjusted effects models included maternal age, body mass index, hypertensive disorders, diabetes, FGR type (i.e. early or late), and oligohydramnios.Results: Seventy-two (34%) patients had an elective cesarean delivery, 73 (34%) had spontaneous labor and were expected to deliver vaginally, and 67 (32%) underwent labor induction. The composite outcome was observed in 65.3%, 89%, and 88.1% of the groups mentioned above, respectively (p < 0.001). Among patients with spontaneous labor and those scheduled for labor induction, 63% and 47.8% required an emergency cesarean delivery for intrapartum fetal distress. Compared to elective cesarean delivery, spontaneous labor (OR 4.32 [95% CI 1.79, 10.42], p = 0.001; aOR 4.85 [95% CI 1.85, 12.66], p = 0.001), and labor induction (OR 3.92 [95% CI 1.62, 9.49] p = 0.002; aOR 5.29 [95% CI 2.01, 13.87], p = 0.001) had higher odds of adverse neonatal outcomes.Conclusion: In this cohort of FGR, delivering at ≥34 weeks of gestation, pregnancies with spontaneous labor, and those that underwent labor induction had higher odds of neonatal morbidity than elective cesarean delivery.

Chikungunya infection in pregnancy - reassuring maternal and perinatal outcomes: a retrospective observational study.

OBJECTIVE: To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). DESIGN: Retrospective observational study. SETTING: Grenada. POPULATION: Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible. METHODS: This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA. MAIN OUTCOME MEASURES: Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity. RESULTS: Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (µ = 898 days, σ = 277 days) compared with infections outside of pregnancy (µ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%). CONCLUSION: CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV. TWEETABLE ABSTRACT: Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.

Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia.

Perinatal morbidity and mortality in late-term and post-term pregnancy. NEOSANO perinatal network's experience in Mexico.

OBJECTIVE: The objective of this study is to identify adverse perinatal outcomes associated with pregnancies at or beyond 40 weeks. STUDY DESIGN: Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO's Perinatal Network Database from April 2006 to April 2009. Multiple births, babies with inaccurate gestational age or babies with congenital malformations were excluded. Logistic regression models were used to analyze perinatal complications associated with pregnancies ≥ 40 weeks. RESULT: A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were of 40 to 40[frac67] weeks, 3024 (14.2%) 41 to 41[frac67] weeks and 388 (1.8%) 42 to 44 weeks of gestation. Adverse perinatal outcomes associated with 40 to 40[frac67] weeks deliveries were (odds ratio; 95% confidence interval): macrosomia (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse perinatal outcomes associated with 41 to 41[frac67] weeks were macrosomia (2.5; 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 to 13.8), stillbirth (4.3; 1.4 to 13.5), 5' Apgar <4 (4.2; 1.1 to 15.7), chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean delivery (1.8; 1.3 to 2.4). CONCLUSION: An increased risk for perinatal and maternal complications were detected as early as 40 weeks' gestation. The risks of stillbirth and neonatal death were significantly higher in the post-term group than the control group.

Oligoidrâmnio isolado em gestação a termo: qual a melhor conduta? / Isolated oligohydramnios in term pregnancy: which is the best management?

Em gestações de alto risco, a detecção de oligoidrâmnio está associada a várias complicações. Entretanto, o diagnóstico de oligoidrâmnio isolado, em gestações de baixo risco a termo, sem comprometimento da vitalidade fetal, tem suscitado controvérsia na literatura. Os autores realizaram uma revisão sistemática, com o objetivo de responder sobre a importância do oligoidrâmnio isolado e a melhor abordagem, seja conservadora, seja intervencionista.

The detection of oligohydramnios in high risk pregnancies is associated with several complications. However, the diagnosis of isolated oligohydramnios in low risk pregnancies to term, without fetal disease, created controversy in literature. The authors conducted a systematic review in order to answer about the importance of isolated oligohydramnios and the best approach, whether conservative or interventionist.

Acute fatty liver of pregnancy.

A 17-year-old-female at 39 weeks gestation, presented with pelvic pain, proteinuria and a decrease in fetal heart rate. Timely caesarean section was performed. The postoperative course was complicated by acute renal failure, acute pancreatitis, acute liver failure, anemia, thrombocytopenia, systemic inflammatory response syndrome (SIRS), prolonged coagulopathy, hyperbilirubinemia, ecclampsia, and psychosis. The clinical features and laboratory abnormalities, in conjunction with the timing of gestational age, led to the diagnosis of acute fatty liver of pregnancy. Prompt diagnosis and supportive care in an intensive care unit provided for a positive outcome.

Parto pretérmino y sufrimiento fetal secundarios a peritonitis por apendicitis aguda perforada / Premature labor and fetal distress in a women with perforating acute appendicitis

La apendicitis aguda es la urgencia quirúrgica no obstétrica más frecuente durante el embarazo. Se ha asociado a parto pretérmino y a morbimortalidad fetal y materna, especialmente cuando se complica con peritonitis. Los cambios anatómicos, fisiológicos y bioquímicos que se producen durante la gestación pueden alterar los síntomas y signos típicos asociados a la apendicitis. Esto puede retrasar el diagnóstico y dar lugar a un aumento de la morbimortalidad materna y fetal. Presentamos el caso de una paciente gestante de 35 semanas en que la dificultad en el diagnóstico de apendicitis aguda conllevó a un cuadro de peritonitis, secundario a perforación apendicular, que causó dinámica uterina prematura y sufrimiento fetal.

Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy. It has been associated with premature labour and fetal and maternal morbidity and mortality, especially when complicated with peritonitis. Anatomical, physiological and biochemical changes during pregnancy may alter typical symptoms and signs associated with appendicitis. This can result in delayed diagnosis and lead to an increase in mother's and fetus morbimortality. We present a case of a pregnant woman at 35 weeks of gestation in whom the difficulty in diagnosis of acute appendicitis resulted in the appearance of peritonitis because of appendix perforation, which was the cause of preterm labour and fetal distress.

Repercusión del embarazo prolongado en resultados perinatales / Repercution of the prolonged pregnancy in perinatal results

Se realiza un estudio de casos y controles con las gestantes con embarazo prolongado que parieron en el Hospital General Docente Dr. Agostinho Neto de Guantánamo. Se determina la repercusión del embarazo prolongado, que culmina en operación cesárea, en los resultados perinatales en nuestro medio. Se tomaron 140 gestantes con embarazo prolongado y que terminaron por vía cesárea y 150 con embarazos normales que terminaron también por esta vía. Se determinan algunas variables como: edad, paridad, forma de inicio del trabajo de parto, complicaciones maternas de las cesáreas e indicaciones de las cesáreas. Las gestantes con embarazo prolongado tienen 3 veces más posibilidades de terminar el embarazo mediante inducción del parto que el resto de las embarazadas a término. No existen diferencias estadísticamente significativas en las complicaciones relacionadas a la operación cesárea. El sufrimiento fetal agudo es 2 veces más frecuente entre los embarazos prolongados y la inducción fallida es 3 veces más frecuente (AU)

Evolução neurologica de recem-nascidos com asfixia neonatal / Neurological outcome of newborns with neonatal asphyxia

O objetivo deste estudo foi avaliar a evolução do exame neurológico e do desenvolvimento, pelo Denver developmental screening test (DDST), no primeiro ano de vida e a associação dessa evolução com variáveis maternas, obstétricas, perinatais, neonatais e pós-neonatais, numa população de 81 recém-nascidos de termo com asfixia neonatal, na Maternidade do Centro de Atenção Integral à Saúde da Mulher (CAISM) da Universidade Estadual de Campinas, de janeiro de 1991 a janeiro de 1999. Foi realizado um estudo descritivo observacional de coorte retrospectiva, do seguimento desses recém-nascidos, realizado em consultas com três, seis meses e um ano. Asfixia neonatal foi diagnosticada pela presença de pelo menos três dos seguintes critérios: Apgar de 5º minuto menor que seis, tempo de reanimação maior que um minuto, comprometimento neurológico e comprometimento sistêmico. Inicialmente foi feita análise descritiva do exame neurológico nas diversas consultas, análise comparativa das diversas consultas, com o teste de McNemar para amostras emparelhadas e a seguir análise bivariada e múltipla para as variáveis independentes e a evolução neurológica e de desenvolvimento de um ano. Com um ano, 54 ( 66,6 por cento) crianças eram normais e destas, 34 tiveram alterações transitórias em pelo menos uma das consultas e 27 (33,3 por cento) tinham exame neurológico anormal. O DDST mostrou 66 (81,5 por cento) normais e 15 (18,5 por cento) com atraso. Na análise bivariada, as variáveis estatisticamente significativas, para exame neurológico alterado com um ano, foram a hipertensão arterial sistêmica materna, edema cerebral no ultra-som, o exame neurológico de uma semana e tempo de internação > 12 dias. Na análise múltipla, somente mostraram associação...

The aim of this study was to evaluate the neurological examination and neurodevelopment by Denver Development Screening Test (DDST) evolution, at one year and its association with clinical variables, in 81 term neonates with birth asphyxia, born in the Maternity Unit of the Center for Integral Assistance to Women?s Health at the State University of Campinas, from january 1991 to january 1999. The study had a observational rectrospective cohort design, of the folow-up of these neonates at three, six months and one year. Neonatal asphyxia was diagnosed by the presence of at least three of the folowing criteria: an Apgar score of less than six at five minutes, a need for positive pressure ventilation via an endotracheal tube for more than one minute after delivery, hipoxic-ischemic encephalopathy, and sistemic abnormalities during neonatal period. The statistical analysis employed, was innitially descriptive of different consultations, then, comparative, with McNemar test for matched samples and then, bivariate and multiple, to evaluate the relationship between independent variables or interactions of variables and abnormal neurological examination and delayed DDST. At year, 54 (66,6 per cent) infants were normal, 34 of wich, had transient abnormalities, at least in one of consultations and 27 (33,3 per cent) had normal neurological examination. The DDST showed to be normal in 66 (81,5) and delayed in 15 (18,5 per cent). In bivariate analysis, maternal chronic hipertension, ultrassonografy with brain edema, neurological examination at seven days and discharge, a lenght of hospital stay more than 12 days, were factors associated...

Uterus inferior segment compression as a clinical test for diagnosing nuchal cord.

To investigate sensitivity, specificity, positive and negative predictive values and accuracy of uterus inferior segment compression (UISC) as clinical test for diagnosing nuchal cord. This test is used empirically. The clinical test was applied to 214 pregnant women in the first phase of delivery with single cephalic fetuses. The main observation was deceleration of the fetal heart rate by performing the clinical test in the presence of nuchal cord. Statistic analysis was done by chi2-test. The results were: sensitivity 35.7%, specificity 84.8%, positive predictive value 45.4%, negative predictive value 78.8% and accuracy 71.9% (chi2=10.66, p=0.0011). The UISC could be used as a tool in the initial exploration of the term pregnant woman in labor without complications to rule out the presence of nuchal cord. When the UISC test is positive, close vigilance is recommended along with the availability of an emergency team in case of fetal distress.

[Color Doppler flowmetry values in fetuses with nuchal cord encirclement]. / Valores de flujometría Doppler color en fetos con circular de cordón.

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.

Hiperamonemia neonatal secundaria a asfixia perinatal: informe de un caso / Hiperamonemia secondary neonatal to asphyxia perinatal: report from a case

Se describe el caso de un recién nacido postérmino de 43 semanas de gestación, obtenido por cesárea, que cursó con asfixia perinatal severa y aspiración masiva del meconio, por lo que se sometió a ventilación mecánica intermitente por siete días y se complicó con hipoglicemia sintomática e hiperamonemia transitoria. Mediante la restricción de proteínas y terapia de soporte, el paciente tuvo una evolución favorable. Se revisan las causas de hiperamonemia neonatal, sus consecuencias fisiopatológicas y su manejo actual en el recién nacido

Influencia do uso da ocitocina para conducao do trabalho de parto sobre vitalidade do recem-nato / Influence of the oxyticin use for conduction of the newborn

Foi realizado um estudo retrospectivo com o objetivo de determinar se o uso da ocitocina influencia de alguma forma o estado de vitalidade do recem-nato. Na Maternidade Darcy Vargas, em Joinville(SC), 300 mulheres foram selecionadas dos prontuarios desta instituicao quanto ao uso ou nao de ocitocina para conducao do trabalho de parto. A proposta de analise projeta-se entre dois grupos que sao o de uso de ocitocina e o de nao uso de ocitocina. As conclusoes sao favoraveis ao uso de ocitocina na conducao do trabalho de parto.