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Journal of Clinical Medicine Aug 2023Endometriosis is a major cause of infertility, and considering its pathophysiology, it is expected to affect pregnancy outcomes as well. This study aimed to evaluate...
Endometriosis is a major cause of infertility, and considering its pathophysiology, it is expected to affect pregnancy outcomes as well. This study aimed to evaluate whether endometriosis is associated with adverse pregnancy outcomes after successful conception. Data from singleton pregnancy deliveries between January 2014 and October 2019 were obtained from the Korean Health Insurance Review and Assessment Service database. We compared the clinical characteristics and adverse pregnancy outcomes of women with and without endometriosis. A total of 1,251,597 pregnant women were enrolled; of these, 32,951 (2.6%) were assigned to the endometriosis group. Women with endometriosis had significantly more adverse pregnancy outcomes than those without endometriosis. Adverse pregnancy outcomes associated with endometriosis included preterm labor, preterm birth, preeclampsia, fetal growth restriction, placenta previa, placental abruption, antepartum and postpartum hemorrhage, and stillbirth. This study also showed an increased risk of postpartum hemorrhage, blood transfusion, uterine artery embolization, and cesarean hysterectomy in the endometriosis group compared to the non- endometriosis group. The cesarean delivery rate was significantly higher in the endometriosis group than in the non-endometriosis group, even after excluding cases of antenatal obstetric complications that could increase the risk of cesarean delivery. Women with endometriosis not only have difficulty conceiving, but also have a significantly higher risk of adverse pregnancy outcomes.
PubMed: 37629431
DOI: 10.3390/jcm12165392 -
Obstetrics and Gynecology International 2022Globally, antepartum hemorrhage is the main cause of perinatal and maternal morbidity and mortality during pregnancy and childbearing.
BACKGROUND
Globally, antepartum hemorrhage is the main cause of perinatal and maternal morbidity and mortality during pregnancy and childbearing.
OBJECTIVE
To assess adverse perinatal and maternal outcomes and associated factors among women with antepartum hemorrhage in Jimma University Medical Center, Southwest Ethiopia, 2020.
METHODS
Prospective cross-section study was conducted, and data were collected through face to face interview among pregnant women admitted with antepartum hemorrhage. Patient condition was observed and followed up, and patient card was reviewed. Data were coded, checked, entered into EPI version 4.6, and exported to SPSS version 26.0 for analysis. Multivariate logistic regression analysis was made to determine independent factors associated with adverse outcomes.
RESULT
A total of 377 pregnant women were included, and nearly half (192 (50.9%)) of women experienced adverse maternal outcome and 113 (30%) women experienced adverse perinatal outcome. The status of vital sign, address, parity, antenatal care, duration of bleeding before arrival, gestational age, prematurity, and amount of vaginal bleeding were factors significantly associated with adverse maternal and perinatal outcome at value <0.05.
CONCLUSION
Vital sign derangement, vaginal bleeding for ≥12 hrs, gestation age before 37 weeks, rural address, prim parity, amount of vaginal bleeding, and prematurity baby has predicted high rate of adverse perinatal and maternal outcomes. Jimma Hospital should give patient-centered service and strengthen counseling on danger sign of pregnancy to alert women early health care seeking and immediate resuscitation, and appropriate management should be given for women admitted with APH to minimize of adverse perinatal and maternal outcomes.
PubMed: 36060708
DOI: 10.1155/2022/4594136 -
Critical Care (London, England) Sep 2023We examined the risk of severe life-threatening morbidity in pregnant patients with Covid-19 infection.
BACKGROUND
We examined the risk of severe life-threatening morbidity in pregnant patients with Covid-19 infection.
METHODS
We conducted a population-based study of 162,576 pregnancies between March 2020 and March 2022 in Quebec, Canada. The main exposure was Covid-19 infection, including the severity, period of infection (antepartum, peripartum), and circulating variant (wildtype, alpha, delta, omicron). The outcome was severe maternal morbidity during pregnancy up to 42 days postpartum. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between Covid-19 infection and severe maternal morbidity using adjusted log-binomial regression models.
RESULTS
Covid-19 infection was associated with twice the risk of severe maternal morbidity compared with no infection (RR 2.02, 95% CI 1.76-2.31). Risks were elevated for acute renal failure (RR 3.01, 95% CI 1.79-5.06), embolism, shock, sepsis, and disseminated intravascular coagulation (RR 1.35, 95% CI 0.95-1.93), and severe hemorrhage (RR 1.49, 95% CI 1.09-2.04). Severe antepartum (RR 13.60, 95% CI 10.72-17.26) and peripartum infections (RR 20.93, 95% CI 17.11-25.60) were strongly associated with severe maternal morbidity. Mild antepartum infections also increased the risk, but to a lesser magnitude (RR 3.43, 95% CI 2.42-4.86). Risk of severe maternal morbidity was around 3 times greater during circulation of wildtype and the alpha and delta variants, but only 1.2 times greater during omicron.
CONCLUSIONS
Covid-19 infection during pregnancy increases risk of life-threatening maternal morbidity, including renal, embolic, and hemorrhagic complications. Severe Covid-19 infection with any variant in the antepartum or peripartum periods all increase the risk of severe maternal morbidity.
Topics: Female; Pregnancy; Humans; COVID-19; SARS-CoV-2; Canada; Disseminated Intravascular Coagulation; Pregnancy Complications, Infectious
PubMed: 37670329
DOI: 10.1186/s13054-023-04584-6 -
Archives of Women's Mental Health Feb 2018Timing of cortisol collection during pregnancy is an important factor within studies reporting on the association between maternal cortisol and depression during... (Review)
Review
Timing of cortisol collection during pregnancy is an important factor within studies reporting on the association between maternal cortisol and depression during pregnancy. Our objective was to further examine the extent to which reported associations differed across studies according to time of maternal cortisol collection during pregnancy. On December 15, 2016, records were identified using PubMed/MEDLINE (National Library of Medicine), EMBASE (Elsevier; 1974-), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO), PsycINFO (EBSCO), and Web of Science Core Collection (Thomson Reuters). Unique abstracts were screened using the following inclusion criteria: (1) maternal cortisol assessed during pregnancy; (2) antepartum depression assessed during pregnancy using a screening instrument; (3) reports on the association between maternal cortisol and antepartum depression; (4) provides information on timing of cortisol assessment during pregnancy, including time of day and gestation; and (5) not a review article or a case study. One thousand three hundred seventy-five records were identified, resulting in 826 unique abstracts. Twenty-nine articles met all inclusion criteria. On balance, most studies reported no association between maternal cortisol and antepartum depression (N = 17), and saliva and blood were the most common reported matrices. Morning and second and third trimesters were the most common times of collection during pregnancy. Among studies reporting an association (N = 12), second-trimester and third-trimester cortisol assessments more consistently reported an association and elevated cortisol concentrations were observed in expected recovery periods. Our review adds to the existing literature on the topic, highlighting gaps and strategic next steps.
Topics: Adolescent; Adult; Depression; Female; Humans; Hydrocortisone; Middle Aged; Mothers; Pregnancy; Saliva; Young Adult
PubMed: 28942465
DOI: 10.1007/s00737-017-0777-y -
International Journal of Critical... 2023The fields of Obstetrics and Gynecology and Critical Care often share medically and surgically complex patients. Peripartum anatomic and physiologic changes can... (Review)
Review
The fields of Obstetrics and Gynecology and Critical Care often share medically and surgically complex patients. Peripartum anatomic and physiologic changes can predispose or exacerbate certain conditions and rapid action is often needed. This review discusses some of the most common conditions responsible for the admission of obstetrical and gynecological patients to the critical care unit. We will consider both obstetrical and gynecologic concepts including postpartum hemorrhage, antepartum hemorrhage, abnormal uterine bleeding, preeclampsia and eclampsia, venous thromboembolism, amniotic fluid embolism, sepsis and septic shock, obstetrical trauma, acute abdomen, malignancies, peripartum cardiomyopathy, and substance abuse. This article aims to be a primer for the Critical Care provider.
PubMed: 37180304
DOI: 10.4103/ijciis.ijciis_20_22 -
Therapeutics and Clinical Risk... 2021Antepartum hemorrhage (APH) in women with placenta previa (PP) has been associated with increased perinatal complications. The present study aims to evaluate the...
PURPOSE
Antepartum hemorrhage (APH) in women with placenta previa (PP) has been associated with increased perinatal complications. The present study aims to evaluate the maternal and neonatal outcomes, and risk factors related to this condition.
METHODS
This retrospective study was conducted in the Obstetrics and Gynecology Department of the Second Affiliated Hospital of Army Military Medical University from January 2016 to September 2019, which included all women with PP. The clinical and ultrasound features in patients with or without APH were compared.
RESULTS
There were 233 women with APH and 302 women without APH in the cohort. Most of the women with APH were prone to adverse maternal and neonatal outcomes. In the logistic regression analysis, cervical length was inversely correlated to APH (OR: 0.972, 95% CI: 0.952~0.993), while complete PP increased the risk for APH (OR: 2.121, 95% CI: 1.208~3.732). Furthermore, the anterior placenta increased the risk for APH (OR: 1.664, 95% CI: 1.139~2.430), the partial absence of the over lying myometrium increased the risk for APH (OR: 2.015, 95% CI: 1.293~3.141), and the previous history of uterine artery embolization (UAE) increased the highest risk for APH (OR: 11.706, 95% CI: 1.424~96.195).
CONCLUSION
Obstetricians should be aware of the increased risk of adverse pregnancy outcomes related to APH in women with complete PP, short cervical length, anterior placenta, and partially absent over lying myometrium. Prior UAE is a novel risk factor associated with increased prevalence of APH.
PubMed: 33469297
DOI: 10.2147/TCRM.S288461 -
Hematology. American Society of... Dec 2017When should a patient with a known thrombophilia or prior venous thromboembolism (VTE) receive low-molecular-weight heparin (LMWH) prophylaxis during pregnancy and/or... (Review)
Review
When should a patient with a known thrombophilia or prior venous thromboembolism (VTE) receive low-molecular-weight heparin (LMWH) prophylaxis during pregnancy and/or the postpartum period? Accurately predicting thrombotic and bleeding risks and knowing what to do with this information is at the heart of decision-making in these challenging scenarios. This article will explore the concept of a risk threshold from clinician and patient perspectives and provide guidance for the use of antepartum and postpartum LMWH prophylaxis in women with a known thrombophilia or prior VTE. Advice for the management of LMWH prophylaxis use around labor and delivery is also reviewed.
Topics: Female; Heparin, Low-Molecular-Weight; Humans; Postpartum Period; Pregnancy; Pregnancy Complications; Thromboembolism
PubMed: 29222251
DOI: 10.1182/asheducation-2017.1.160 -
The Journal of Maternal-fetal &... Sep 2021Women with liver transplants may be at increased risk for adverse outcomes.
BACKGROUND
Women with liver transplants may be at increased risk for adverse outcomes.
OBJECTIVE
The objectives of this study were to evaluate trends and provide recent data on outcomes for women with a liver transplant.
STUDY DESIGN
The National (Nationwide) Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project from 1998 to 2014 was used for this repeated cross-sectional analysis. Women aged between 15 and 54 years, with a history of liver transplant who underwent delivery, antepartum, or postpartum hospitalizations were identified. Temporal trends in deliveries of women with liver transplants were analyzed. The risk for severe maternal morbidity (SMM) excluding transfusion based on criteria from the Centers for Disease Control and Prevention (CDC), as well as for individual outcomes including hypertensive diseases of pregnancy, postpartum hemorrhage, placental abruption, liver rejection, cesarean delivery, preterm delivery, and coagulopathy during delivery hospitalizations were analyzed. Risks of SMM during antepartum and postpartum hospitalizations were also analyzed. An adjusted log-linear regression model for SMM during delivery hospitalizations including demographic factors, hospital characteristics, and underlying comorbidity was performed. The chi-squared or Fisher's exact test was used for comparisons. Temporal trends were analyzed with the Cochran-Armitage trend test. Population weights were applied to create national estimates.
RESULTS
From 1998 to 2014, an estimated 1165 births occurred by women with a liver transplant. The number of births occurring by women with liver transplants increased over the study period from 1.0 per 100,000 in 1998-2000 to 2.8 per 100,000 in 2012-2014 ( < .01). The risk for CDC SMM excluding transfusion was significantly higher during delivery hospitalizations among women with compared to without liver transplant (8.0 versus 0.5%, < .01, unadjusted risk ratio 15.4, 95% CI 12.7-18.6). Women with liver transplant were also at significantly higher risk for abruption (2.5 versus 1.0%, = .03), hypertensive diseases of pregnancy (27.8 versus 6.9%, < .01), postpartum hemorrhage (8.0 versus 2.8%, = .01), cesarean delivery (51.7 versus 29.5%, < .01), preterm delivery (27.5 versus 7.0%, < .01), and coagulopathy (3.1 versus 0.3%, < .01). A diagnosis of liver rejection was present during 4.1% of delivery hospitalizations for women with liver transplant. In the adjusted analysis for severe morbidity excluding transfusion risk was retained with liver transplant associated with increased likelihood of this adverse outcome (aRR 8.49, 95% CI 5.59-12.87). Women with liver transplants were at significantly higher likelihood of undergoing antepartum and postpartum admissions, and of experiencing SMM during these hospitalizations.
CONCLUSION
In this analysis of antepartum, delivery, and postpartum hospitalizations, women with liver transplant were at significantly higher risk for both SMM during all hospitalizations and for a range of adverse outcomes including placental abruption, hypertensive diseases of pregnancy, postpartum hemorrhage, cesarean delivery, and coagulopathy delivery during delivery hospitalizations. While deliveries to women with liver transplant were rare, these births became more frequent over the study period.
Topics: Adolescent; Adult; Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Female; Humans; Infant, Newborn; Liver Transplantation; Middle Aged; Placenta; Postpartum Hemorrhage; Pregnancy; Young Adult
PubMed: 31564182
DOI: 10.1080/14767058.2019.1674804 -
Frontiers in Reproductive Health 2021A diagnosis of endometriosis is associated with increased risks of adverse pregnancy outcomes including placenta praevia and preterm birth. Some studies have also... (Review)
Review
A diagnosis of endometriosis is associated with increased risks of adverse pregnancy outcomes including placenta praevia and preterm birth. Some studies have also suggested associations with gestational hypertension, foetal growth restriction, gestational diabetes, perinatal death, and obstetric haemorrhage. This review aims to assess the impact of pre-pregnancy surgical treatment of endometriosis on future obstetric outcomes. A search of the Medline, Embase and PubMed electronic databases was performed to identify studies reporting pre-pregnancy surgery for endometriosis and subsequent pregnancy outcome compared to controls with unresected endometriosis. Three studies met the inclusion criteria. The studies were heterogenous in design, definition of study groups and outcome measures. All three studies were judged at critical risk of bias. Pre-pregnancy excision of endometriosis was associated with an increased risk of caesarean section in one of two studies, OR 1.72 (95% CI 1.59-1.86) and OR 1.79 (95% CI 0.69-4.64). Placenta praevia rates were also increased in one of two studies OR 2.83 (95% CI 0.56-12.31) and OR 2.04 (95% CI 1.66-2.52). One study found increased risks of preterm birth, small for gestational age, gestational hypertension, and antepartum and postpartum haemorrhage (all < 0.05) with pre-pregnancy excision of endometriosis. There is insufficient evidence examining the role of pre-pregnancy endometriosis surgery in ameliorating adverse pregnancy outcomes, and thus reliable conclusions cannot be drawn. Prospectively designed studies are needed to assess the relationship between surgical treatments for endometriosis and obstetric outcome and examine potential confounders such as comorbid adenomyosis and infertility.
PubMed: 36303984
DOI: 10.3389/frph.2021.750750 -
International Journal of Medical... 2013To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
PURPOSE
To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
METHODS
We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated.
RESULTS
Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups.
CONCLUSION
Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.
Topics: Adult; Cardiotocography; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Placenta; Placenta Previa; Pregnancy; Pregnancy Complications; Premature Birth; Risk Factors; Ultrasonography, Prenatal; Uterine Hemorrhage
PubMed: 24151440
DOI: 10.7150/ijms.6416