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Ugeskrift For Laeger Sep 2019Underweight, defined as BMI ≤ 18.5 kg/m2, is found in 4.2% of pregnancies in Denmark. Pre-pregnancy underweight is more often seen in relation to psychiatric... (Review)
Review
Underweight, defined as BMI ≤ 18.5 kg/m2, is found in 4.2% of pregnancies in Denmark. Pre-pregnancy underweight is more often seen in relation to psychiatric disorders, e.g. anorexia nervosa, and diet restrictions and associates with adverse pregnancy outcomes, such as antepartum haemorrhage requiring blood transfusion, preterm birth, small for gestational age infants, and impaired ability to breastfeed. In this review, we recommend identification of possible underlying medical or psychiatric disorders, focus on sufficient gestational weight gain, and relevant vitamin and mineral substitution.
Topics: Body Mass Index; Denmark; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Retrospective Studies; Risk Factors; Thinness
PubMed: 31566180
DOI: No ID Found -
Cureus Jul 2022Anemia in pregnancy has a number of adverse effects. This study aims to estimate anemia prevalence in pregnant women and examine the associations between maternal anemia...
BACKGROUND
Anemia in pregnancy has a number of adverse effects. This study aims to estimate anemia prevalence in pregnant women and examine the associations between maternal anemia with maternal characteristics, maternal outcomes during pregnancy and delivery, and neonatal outcomes at a university hospital in Riyadh.
MATERIALS AND METHODS
A cross-sectional study was undertaken among 400 women who delivered at the hospital. Data were collected through a data extraction sheet. Multivariate analysis was adopted according to the results of univariate analysis.
RESULTS
Overall anemia prevalence was 39% (including 21% moderate anemia and 18% mild anemia); the rest, 61%, were normal. Non-intake of intravenous iron was more common among mothers with mild anemia (65.3%) compared to normal and moderately anemic (p=0.001). Significant differences between groups were found in relation to maternal outcomes such as pregnancy-induced hypertension (p=0.019), antepartum hemorrhage (p=0.001), postpartum hemorrhage (p=0.002), and non-intake of blood transfusion during pregnancy (p=0.012) and emergency cesarean section (p=0.017). Neonatal outcomes, including congenital malformations (p=0.003) and admission to the neonatal intensive care unit (NICU) (p<0.001), were higher in mildly anemic mothers. Statistically significant relationships were found between anemia in pregnancy and postpartum hemorrhage (odds ratio [OR] = 3.61; confidence interval [CI] 1.52-8.58; p=0.004), congenital malformations (OR = 5.09; CI 1.81-14.29; p=0.002), NICU admissions (OR=8.32; CI 2.77-24.96; p=0.001), and low birth weight (LBW; OR=1.833; CI 1.021-3.294; p=0.042).
CONCLUSIONS
The study highlights the association of maternal anemia with adverse events in mothers, such as postpartum hemorrhage. Among neonates, congenital malformations, low birth weight, and higher admissions to the NICU have been reported.
PubMed: 36039215
DOI: 10.7759/cureus.27238 -
Scientific Reports Jun 2024Pre-eclampsia (PE) is a hypertensive disorder characterised by systemic vascular resistance and endothelial dysfunction. It is known to influence choroidal thickness...
Pre-eclampsia (PE) is a hypertensive disorder characterised by systemic vascular resistance and endothelial dysfunction. It is known to influence choroidal thickness (CT). No previous studies have explored the antepartum and postpartum changes in CT with respect to the protein-creatinine ratio (PCR), a measure of proteinuria that is a clinical hallmark of PE. This study evaluated the correlations between antepartum and postpartum CT and the PCR in patients with PE. In this retrospective study, sixty-six eyes (66 patients) were analysed. The patients were divided into two groups according to the median PCR value (2.36 mg/mg): low PCR group (< 2.36 mg/mg) and high PCR group (≥ 2.36 mg/mg). Ophthalmologic clinical data were collected and assessed. We observed higher antepartum CT and higher mean arterial pressure in high PCR group than in low PCR group. Moreover, postpartum CT decreased significantly in high PCR group. In the multivariate analysis, CT changes were correlated with antepartum CT and antepartum PCR after logarithm transformation. In conclusion, a greater decrease in CT was observed in high PCR group than in low PCR group. Further, the antepartum PCR showed a correlation with the extent of CT reduction.
Topics: Humans; Female; Pre-Eclampsia; Pregnancy; Proteinuria; Adult; Choroid; Postpartum Period; Retrospective Studies; Creatinine
PubMed: 38830948
DOI: 10.1038/s41598-024-63359-3 -
The Cochrane Database of Systematic... Apr 2015Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This... (Review)
Review
BACKGROUND
Monoamniotic twin pregnancies are formed when a single egg is fertilised and the resulting inner cell mass splits to form twins sharing the same amniotic sac. This condition is rare and affects about one in 10,000 pregnancies overall. Monoamniotic twin pregnancies are susceptible to complications including cord entanglement, increased congenital anomalies, intrauterine growth restriction, twin-to-twin transfusion syndrome and increased perinatal mortality. All twin pregnancies also carry additional maternal risks including pre-eclampsia, anaemia, antepartum haemorrhage, postpartum haemorrhage and operative delivery.The optimal timing for the delivery of monoamniotic twins is not known. The options include 'planned early delivery' between 32 and 34 weeks, or alternatively awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation), unless there is a specific indication for earlier delivery.
OBJECTIVES
To assess whether routine early delivery in monoamniotic twin pregnancies improves fetal, neonatal or maternal outcomes compared with 'expectant management'. Expectant management means awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation in many centres), unless a specific indication for delivery occurs in the meantime, e.g. for non-reassuring antenatal testing.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015).
SELECTION CRITERIA
Published and unpublished randomised controlled trials (including cluster-randomised trials) comparing outcomes for women and infants who were randomised to planned early delivery of a monoamniotic twin pregnancy with outcomes for women and infants who were randomised to either planned term delivery or expectant management. However, we did not identify any trials for inclusion in this review.Quasi-randomised controlled trials, trials published in abstract form only, and trials using a cross-over design are not eligible for inclusion in this review.
DATA COLLECTION AND ANALYSIS
No trials were identified by the search strategy.
MAIN RESULTS
No trials were identified by the search strategy.
AUTHORS' CONCLUSIONS
Monoamniotic twins are rare, and there is insufficient randomised controlled evidence on which to draw strong conclusions about the best management. In their absence, we can refer to historical case series and expert consensus. Management plans should take into consideration the availability of high-quality neonatal care if early delivery is chosen. Women and their families should be involved in the decision making about these high-risk pregnancies.Ongoing, multicentre audits of maternal and perinatal outcomes for monoamniotic twins are needed in order to inform families and clinicians about up-to-date perinatal outcomes with contemporary obstetric practice. Research should consider the social and economic implications of planned interventions, as well as the perinatal outcomes.
Topics: Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy, Twin; Twins, Monozygotic; Watchful Waiting
PubMed: 25906204
DOI: 10.1002/14651858.CD008820.pub2 -
The Cochrane Database of Systematic... Jul 2009Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a severe form of pre-eclampsia. Pre-eclampsia is a multi-system disease of pregnancy associated... (Review)
Review
BACKGROUND
Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a severe form of pre-eclampsia. Pre-eclampsia is a multi-system disease of pregnancy associated with an increase in blood pressure and increased perinatal and maternal morbidity and mortality. Eighty per cent of women with HELLP syndrome present before term. There are suggestions from observational studies that steroid treatment in HELLP syndrome may improve disordered maternal hematological and biochemical features and perhaps perinatal mortality and morbidity.
OBJECTIVES
To summarise the evidence on the effects of corticosteroids on maternal and neonatal mortality and morbidity in women with HELLP syndrome.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2003). We scanned lists of references from review articles and primary studies.
SELECTION CRITERIA
Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with HELLP syndrome were sought.
DATA COLLECTION AND ANALYSIS
The two authors independently applied inclusion criteria, assessed trial quality and extracted relevant data.
MAIN RESULTS
Of the five studies reviewed (n = 170), three were conducted antepartum and two postpartum. Four of the studies randomised participants to standard therapy or dexamethasone. One study compared dexamethasone with betamethasone. Dexamethasone versus control There were no significant differences in the primary outcomes of maternal mortality and morbidity due to placental abruption, pulmonary oedema and liver hematoma or rupture. Of the secondary maternal outcomes, there was a tendency to a greater platelet count increase over 48 hours, statistically significantly less mean number of hospital stay days (weighted mean difference (WMD) -4.50, 95% confidence interval (CI) -7.13 to -1.87), mean interval (hours) to delivery (41 +/- 15) versus (15 +/- 4.5) (p = 0.0068) in favour of women allocated to dexamethasone.There were no significant differences in perinatal mortality or morbidity due to respiratory distress syndrome, need for ventilatory support, intracerebral hemorrhage, necrotizing enterocolitis and a five minute Apgar less than seven. The mean birthweight was significantly greater in the group allocated to dexamethasone (WMD 247.00, 95% CI 65.41 to 428.59).Dexamethasone versus betamethasone There were no significant differences in all the maternal and perinatal mortality and in primary morbidity outcomes.Women randomised to dexamethasone fared significantly better for: oliguria, mean arterial pressure, mean increase in platelet count, mean increase in urinary output and liver enzyme elevations.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and perinatal mortality, major maternal and perinatal morbidity.
Topics: Adrenal Cortex Hormones; Betamethasone; Dexamethasone; Female; HELLP Syndrome; Humans; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 19588331
DOI: 10.1002/14651858.CD002076.pub3 -
Cureus Jan 2023Preeclampsia is a type of hypertensive disorder of pregnancy that can cause significant maternal and perinatal morbidity and mortality. Hypertension and proteinuria are...
Preeclampsia is a type of hypertensive disorder of pregnancy that can cause significant maternal and perinatal morbidity and mortality. Hypertension and proteinuria are the keystones of the disease, though systemic end-organ dysfunction may follow. The pathogenesis is multifactorial, with known influences by placental, vascular, renal, and immunological dysfunction. This is a case of preeclampsia complicated by preterm delivery and antepartum intracerebral hemorrhage secondary to aneurysm rupture, presenting as dull headaches and blurry vision, commonly associated with severe features.
PubMed: 36843722
DOI: 10.7759/cureus.34086 -
Acta Obstetricia Et Gynecologica... Jan 2020The objective was to evaluate the association between fetal sex and adverse pregnancy outcome, while correcting for fetal growth and gestational age at delivery.
INTRODUCTION
The objective was to evaluate the association between fetal sex and adverse pregnancy outcome, while correcting for fetal growth and gestational age at delivery.
MATERIAL AND METHODS
Data from the Netherlands Perinatal Registry (1999-2010) were used. The study population comprised all white European women with a singleton delivery between 25 and 42 weeks of gestation. Fetuses with structural or chromosomal abnormalities were excluded. Outcomes were antepartum death, intrapartum/neonatal death (from onset of labor until 28 days after birth), perinatal death (antepartum death or intrapartum/neonatal death), a composite of neonatal morbidity (including infant respiratory distress syndrome, sepsis, necrotizing enterocolitis, meconium aspiration, persistent pulmonary hypertension of the newborn, periventricular leukomalacia, Apgar score <7 at 5 minutes, and intracranial hemorrhage) and a composite adverse neonatal outcome (perinatal death or neonatal morbidity). Outcomes were expressed stratified by birthweight percentile (
p90 [large for gestation]) and gestational age at delivery (25 -27 , 28 -31 , 32 -36 , 37 -42 weeks). The association between fetal sex and outcome was assessed using the fetus at risk approach. RESULTS
We studied 1 742 831 pregnant women. We found no increased risk of antepartum, intrapartum/neonatal and perinatal death in normal weight and large-for-gestation males born after 28 weeks compared with females. We found an increased risk of antepartum death among small-for-gestation males born after 28 weeks (relative risk [RR] 1.16-1.40). All males born after 32 weeks of gestation suffered more neonatal morbidity than females regardless of birthweight percentile (RR 1.07-1.34). Infant respiratory distress syndrome, sepsis, persistent pulmonary hypertension of the newborn, Apgar score <7 at 5 minutes, and intracranial hemorrhage all occurred more often in males than in females.
CONCLUSIONS
Small-for-gestation males have an increased risk of antepartum death and all males born after 32 weeks of gestation have an increased risk of neonatal morbidity compared with females. In contrast to findings in previous studies we found no increased risk of antepartum, intrapartum/neonatal or perinatal death in normal weight and large-for-gestation males born after 28+0 weeks.
Topics: Adult; Apgar Score; Birth Weight; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Male; Netherlands; Perinatal Death; Pregnancy; Pregnancy Outcome; Registries; Risk Factors; Sex Factors
PubMed: 31424085
DOI: 10.1111/aogs.13709 -
Journal of Family Medicine and Primary... Dec 2023Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired...
INTRODUCTION
Pregnancy-related acute kidney injury (PRAKI) is acute kidney injury (AKI) occurring during pregnancy, labor, and postpartum period. AKI is defined as suddenly impaired kidney function with the retention of nitrogenous and other waste products. In high population country like India, not all deliveries are done tertiary care. Even not all are registered one if delivery is conducted at a hospital setup. The majority of patients are being managed by available obstetrician at local places. Early diagnosis and timely management of complications related to pregnancy are very important to avoid PRAKI. We aim to study maternal risk factors and fetomaternal outcome in PRAKI.
MATERIALS AND METHODS
A prospective study is conducted between 2021 and 2022 in the Department of Obstetrics and Gynaecology, VMMC, and Safdarjung Hospital, New Delhi. For antenatal and delivered women up to 6 weeks, 50 patients were recruited according to KDIGO (Kidney Disease International Global Outcomes) criteria. Patients were followed with CBC, serum electrolytes, serial KFT, urine input/output monitoring, and USG-KUB. Dialysis was done if indicated. Complete renal recovery was considered if S.Cr ≤1.0 mg/dl within 6 weeks of diagnosis of AKI. For statistical significance, a value of less than 0.05 was considered.
RESULTS
The majority of patients were unbooked, 21-25 years of age, and belonged to lower socioeconomic status (54%). Risk factors were: preeclampsia (28%), puerperal sepsis (24%), PPH (20%), abruption (14%), pyelonephritis (4%), acute gastroenteritis (4%), gestational hypertension with superimposed preeclampsia (2%), antepartum eclampsia (2%), and thrombotic microangiopathy (2%). Hemodialysis is required in 23 (46%). Complete renal recovery was seen in 40 (80%) and partial renal recovery in 3 (6%). Maternal mortality was 14% and causes were: puerperal sepsis (57%), preeclampsia with severe features with MODS (29%), and antepartum eclampsia with hepatorenal failure (14%). Fetal outcome: 76% live birth, 24% intrauterine death, and 16% early neonatal death.
CONCLUSION
Most common risk factors for PRAKI are preeclampsia followed by puerperal sepsis and PPH where all are preventable causes.
PubMed: 38361835
DOI: 10.4103/jfmpc.jfmpc_924_23 -
BMJ Open Nov 2022Internet-based interventions are often hampered by high dropout rates. The number of individuals who decline to participate or dropout are reported, but reasons for... (Randomized Controlled Trial)
Randomized Controlled Trial
Antepartum and labour-related single predictors of non-participation, dropout and lost to follow up in a randomised controlled trial comparing internet-based cognitive-behaviour therapy with treatment as usual for women with negative birth experiences and/or post-traumatic stress following...
OBJECTIVES
Internet-based interventions are often hampered by high dropout rates. The number of individuals who decline to participate or dropout are reported, but reasons for dropout are not. Identification of barriers to participation and predictors of dropout may help improve the efficacy of internet-based clinical trials. The aim was to investigate a large number of possible predictors for non-participation and dropout in a randomised controlled trial for women with a negative birth experience and/or post-traumatic stress following childbirth.
SETTING
A childbirth clinic at a university hospital in Sweden.
PARTICIPANTS
The sample included 1523 women who gave birth between September 2013 and February 2018. All women who rated an overall negative birth experience on a Likert scale, and/or had an immediate caesarean section (CS), and/or severe postpartum haemorrhage (≥ 2000 mL) were eligible.
METHODS
Demographic, antepartum, and labour-related/postpartum predictors were investigated for non-participation (eligible but denied participation), pre-treatment dropout (prior to intervention start), treatment dropout, and loss to follow-up. Descriptive statistics and logistic regression were used in the data analysis.
RESULTS
A majority (80.3 %) were non-participants. Non-participation was predicted by lower level of education, being foreign-born, no experience of counselling for fear of childbirth, multiparity, vaginal delivery (vs CS and vacuum-assisted delivery) and absence of: preeclampsia, anal sphincter injury and intrapartum fetal distress. Pretreatment dropout was predicted by the absence of severe haemorrhage. Treatment dropout was predicted by vaginal delivery (), vertex presentation and good overall birth experience. Loss to follow-up was predicted by vaginal delivery (vs immediate CS or vacuum-assisted delivery) and absence of intrapartum fetal distress.
CONCLUSIONS
Mothers with no obstetric complications were more likely to not participate and dropout at different time points. Both demographic, antepartum and obstetrical variables are important to attend to while designing procedures to maximise participation in internet-delivered cognitive-behavioral therapy.
TRIAL REGISTRATION NUMBER
ISRCTN39318241.
Topics: Female; Pregnancy; Humans; Cesarean Section; Fetal Distress; Lost to Follow-Up; Stress Disorders, Post-Traumatic; Parturition; Delivery, Obstetric; Cognitive Behavioral Therapy; Internet; Cognition
PubMed: 36442895
DOI: 10.1136/bmjopen-2022-063214 -
Canadian Family Physician Medecin de... Jul 2020To provide family physicians with an understanding of blood bank tests performed during pregnancy. The value of routine blood type and antibody tests, as well as the... (Review)
Review
OBJECTIVE
To provide family physicians with an understanding of blood bank tests performed during pregnancy. The value of routine blood type and antibody tests, as well as the follow-up required when a patient develops a red blood cell antibody or experiences a fetal-maternal hemorrhage (FMH) will be reviewed.
SOURCES OF INFORMATION
The approach described is based on the authors' clinical expertise and peer-reviewed literature from 1967 to 2020.
MAIN MESSAGE
An ABO and RhD group and antibody screen test is performed on every pregnant patient during the first trimester. Although antibodies to red blood cell antigens occur infrequently, some can lead to substantial adverse fetal or neonatal consequences including hemolytic disease of the fetus and newborn. Early identification and quantification of important antibodies ensures that at-risk mothers are referred to and followed by obstetricians experienced with high-risk care. Another valuable and related test is the FMH test. For RhD-negative women, these tests are performed at every delivery and following antepartum events that could contribute to FMH. This test determines the number of fetal red blood cells in the maternal circulation and is used to determine the dose of Rh immune globulin an RhD-negative mother requires to prevent alloimmunization to fetal RhD.
CONCLUSION
An understanding of blood bank tests performed during pregnancy and their role and limitations is vital to optimal practice and aids clinicians in their decision making. When there is doubt or confusion regarding antenatal testing or immunoprophylaxis, consult the regional laboratory or transfusion medicine specialists for additional guidance.
Topics: Erythrocytes; Female; Fetomaternal Transfusion; Humans; Infant, Newborn; Isoantibodies; Pregnancy; Rh Isoimmunization; Rho(D) Immune Globulin
PubMed: 32675093
DOI: No ID Found