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Liu Y, Hu T, Qian Y, Wang J, Hu R, Xiao L, Liao N, Liu Z, Wang H, Liu S, Zhang Z. Prenatal diagnosis of chromosomal aberrations by chromosomal microarray analysis and pregnancy outcomes of fetuses with polyhydramnios. J Matern Fetal Neonatal Med 2024; 37:2344089. [PMID: 38710614 DOI: 10.1080/14767058.2024.2344089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/12/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES To explore the prenatal clinical utility of chromosome microarray analysis (CMA) for polyhydramnios and evaluate the short and long-term prognosis of fetuses with polyhydramnios. METHODS A total of 600 singleton pregnancies with persistent polyhydramnios from 2014 to 2020 were retrospectively enrolled in this study. All cases received amniocentesis and were subjected to CMA results. All cases were categorized into two groups: isolated polyhydramnios and non-isolated polyhydramnios [with soft marker(s) or with sonographic structural anomalies]. All fetuses were followed up from 6 months to five years after amniocentesis to acquire short and long-term prognosis. RESULTS The detection rates of either aneuploidy or pathogenic copy number variants in fetuses with non-isolated polyhydramnios were significantly higher than those with isolated polyhydramnios (5.0 vs. 1.5%, p = 0.0243; 3.6 vs. 0.8%, p = 0.0288). The detection rate of total chromosomal abnormalities in the structural abnormality group was significantly higher than that in the isolated group (10.0 vs. 2.3%, p = 0.0003). In the CMA-negative cases, the incidence of termination of pregnancy, neonatal and childhood death, and non-neurodevelopmental disorders in fetuses combined with structural anomalies was significantly higher than that in fetuses with isolated polyhydramnios (p < 0.05). We did not observe any difference in the prognosis between the isolated group and the combined group of ultrasound soft markers. In addition, the risk of postnatal neurodevelopmental disorders was also consistent among the three groups (1.6 vs. 1.3 vs. 1.8%). CONCLUSION For low-risk pregnancies, invasive prenatal diagnosis of isolated polyhydramnios might be unnecessary. CMA should be considered for fetuses with structural anomalies. In CMA-negative cases, the prognosis of fetuses with isolated polyhydramnios was good, and polyhydramnios itself did not increase the risk of postnatal neurological development disorders. The worse prognosis mainly depends on the combination of polyhydramnios with structural abnormalities.
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Affiliation(s)
- Yanyan Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ting Hu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yanping Qian
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Jiamin Wang
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Rui Hu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Like Xiao
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Na Liao
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhushu Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - He Wang
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Shanling Liu
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhu Zhang
- Department of Medical Genetics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Critchlow E, Wodoslawsky S, Makhamreh MM, Rice SM, Turan OM, Firman B, McLaren R, Araji S, Al-Kouatly HB. Maternal outcomes of a cohort of pregnancies affected by non-immune hydrops fetalis. Int J Gynaecol Obstet 2024; 165:318-327. [PMID: 37897049 DOI: 10.1002/ijgo.15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/09/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To describe the maternal outcomes of a prospective cohort of non-immune hydrops fetalis (NIHF) pregnancies with negative standard-of-care evaluations. METHODS This study was a secondary analysis of a prospective cohort study of NIHF pregnancies with negative work-ups (infection, alloimmune anemia, fetomaternal hemorrhage, and chromosomal disorders). Outcomes were obstetric complications, including pre-eclampsia, mirror syndrome, preterm birth, polyhydramnios, postpartum hemorrhage, and maternal mental health. RESULTS Forty pregnancies were included. Four patients developed pre-eclampsia (4/40, 10.0%); three occurred postpartum. None was diagnosed with mirror syndrome. Of the 31 continued pregnancies, 16 (51.6%) resulted in early fetal death or stillbirth and 15 (48.4%) resulted in live births. Of the 15 live births, 8 (53.3%) were delivered by primary cesarean delivery; 5 (62.5%) were for hydrops fetalis. Eleven live births (73.3%) were delivered preterm; 9 (81.8%) were indicated, most commonly for fetal indications (7/9, 77.8%). Polyhydramnios occurred in 14/40 (35.0%) cases. Where EBL was recorded (n=37), there were 5 (13.5%) cases of postpartum hemorrhage and an additional 3 (8.1%) had uterine atony without hemorrhage. Eighteen patients (18/40, 45.0%) had new-onset or exacerbated depression or anxiety symptoms. CONCLUSION Our study identified several important adverse outcomes of pregnancies complicated by NIHF with negative standard-of-care evaluations, including a high rate of postpartum pre-eclampsia and worsened mental health. We identified a higher rate of cesarean delivery and preterm birth, both primarily for fetal indications. We also observed the known relationship between polyhydramnios, hemorrhage, and atony, but noted that this risk included pregnancies concluding in dilation and evacuation. Counseling after a diagnosis of NIHF should include these adverse outcomes.
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Affiliation(s)
- Elizabeth Critchlow
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sascha Wodoslawsky
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mona M Makhamreh
- Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York, USA
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Stephanie M Rice
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ozhan M Turan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Maryland, Baltimore, Maryland, USA
| | - Brandy Firman
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Rodney McLaren
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara Araji
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Mississippi, Jackson, Mississippi, USA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kechagias KS, Triantafyllidis KK, Zouridaki G, Savvidou M. Obstetric and neonatal outcomes in pregnant women with idiopathic polyhydramnios: a systematic review and meta-analysis. Sci Rep 2024; 14:5296. [PMID: 38438422 PMCID: PMC10912321 DOI: 10.1038/s41598-024-54840-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
Although the assessment of the amniotic fluid volume in pregnancy is part of the fetal wellbeing surveillance, the impact of idiopathic polyhydramnios (IP) on maternal and perinatal outcomes in unknown. The aim of this meta-analysis was to investigate the association of IP with different maternal and perinatal outcomes. We screened five electronic databases until December 2023 and performed data extraction and quality assessment using ROBINS-E in duplicates. Pooled risk ratios and 95% confidence intervals (95% CI) were calculated with a random effects model. 38 studies were included. Patients with IP were at increased risk of perinatal complications including preterm delivery (RR 1.96, 95% CI 1.35-2.86; I2 = 92%), placental abruption (RR 3.20, 95% CI 2.20-4.65; I2 = 2%), delivery via caesarean section (RR 1.60, 95% CI 1.39-1.84; I2 = 95%) and postpartum haemorrhage (RR 1.98, 95% CI 1.22-3.22; I2 = 84%). Similarly, IP was associated with increased risk of adverse perinatal outcomes including low APGAR score (RR 3.0, 95% CI 1.23-7.35; I2 = 95%), stillbirth (RR 4.75, 95% CI 2.54-8.86; I2 = 9%) and perinatal mortality (RR 4.75, 95% CI 2.67-8.48; I2 = 37%). This meta-analysis suggests that pregnant women with IP may be at increased risk of perinatal complications and adverse neonatal outcomes. However, data remains inconclusive considering the low quality and high heterogeneity of included studies.PROSPERO registration number: CRD42022359944.
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Affiliation(s)
- Konstantinos S Kechagias
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK.
| | | | - Georgia Zouridaki
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK
| | - Makrina Savvidou
- Department of Metabolism, Digestion and Reproduction & Department of Surgery and Cancer, Faculty of Medicine, IRDB, Imperial College London, Hammersmith Campus, Du Cane Road, 3rd Floor, London, W12 0NN, UK
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
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Chen YS, He JF, Li DZ. Amnioreduction in cases of polyhydramnios: a low-risk procedure. Am J Obstet Gynecol MFM 2024; 6:101234. [PMID: 38000503 DOI: 10.1016/j.ajogmf.2023.101234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Yong-Shan Chen
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Jie-Fu He
- Prenatal Diagnosis Unit, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Jinsui Road 9, Zhujiang New Town, Guangzhou 510623, China.
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Soni S, Gebb JS, Moldenhauer JS. Reply to the letter to the editor regarding amnioreduction versus expectant management in pregnancies with moderate to severe polyhydramnios. Am J Obstet Gynecol MFM 2024; 6:101235. [PMID: 37996043 DOI: 10.1016/j.ajogmf.2023.101235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Shelly Soni
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19103.
| | - Juliana S Gebb
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19103
| | - Julie S Moldenhauer
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19103
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Schoen CN, Backley S, Orr L, Roy A, Corlin T, Knee AB. Induction of labor versus expectant management in patients with idiopathic polyhydramnios. Eur J Obstet Gynecol Reprod Biol 2024; 292:182-186. [PMID: 38039900 DOI: 10.1016/j.ejogrb.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To evaluate whether induction of labor is associated with lower risk of cesarean section compared to expectant management in patients with isolated polyhydramnios. STUDY DESIGN This is a single-center, retrospective cohort study of patients with pregnancies complicated by idiopathic polyhydramnios, documented between 34 and 38 weeks gestation, who were delivered between July 2012 and February 2020. The primary outcome was cesarean delivery. Secondary outcomes included chorioamnionitis, endometritis, postpartum hemorrhage, preeclampsia/gestational hypertension, and composite neonatal morbidity. RESULTS There were 194 patients included with idiopathic polyhydramnios - 115 underwent induction and 79 patients were expectantly managed. Planned induction was associated with a lower rate of CD compared with expectant management but did not meet statistical significance (19.1 % vs 30.4 %, aOR 0.51, 95 % CI 0.24, 1.05). A similar effect was seen when stratifying for parity: both nulliparous (9.1 % vs 16.3 %, aOR 0.59, 95 % CI 0.17, 1.98) and multiparous (32.7 % vs 47.2 %, aOR 0.45, 95 % CI 0.18, 1.15) patients had a lower CD rate when there was a planned induction, though neither group met statistical significance. No differences in maternal or fetal secondary outcomes were identified (chorioamnionitis, endometritis, postpartum hemorrhage, preeclampsia/gestational hypertension, composite neonatal morbidity). CONCLUSION Lower rates of cesarean section were associated with labor induction for patients with isolated polyhydramnios, but confidence intervals did not reach statistical significance.
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Affiliation(s)
- Corina N Schoen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, UMASS Chan Medical School -Baystate, Springfield, MA 01199, USA.
| | - Sami Backley
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX 077030, USA
| | - Lauren Orr
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, WellSpan Health System, York, PA 17403, USA
| | - Amrita Roy
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY 14620, USA
| | - Tiffany Corlin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Alexander B Knee
- Department of Medicine, UMASS Chan Medical School -Baystate, Springfield, MA, USA; Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA 01199, USA
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Soni S, Paidas Teefey C, Gebb JS, Khalek N, Neary K, Miller K, Moldenhauer JS. Amnioreduction vs expectant management in pregnancies with moderate to severe polyhydramnios. Am J Obstet Gynecol MFM 2023; 5:101192. [PMID: 37858792 DOI: 10.1016/j.ajogmf.2023.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/20/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The rate of polyhydramnios is higher in pregnancies complicated by congenital anomalies. These pregnancies have higher rates of peripartum complications. Amnioreduction is offered to relieve maternal symptoms such as dyspnea, abdominal and respiratory discomfort, and other issues like satiety. OBJECTIVE This study aimed to report the rates of amnioreduction and its associated complications in pregnancies with moderate to severe polyhydramnios secondary to fetal anomalies. We also sought to determine if amnioreduction provided additional benefits, including prolongation of pregnancy and a decrease in the rates of peripartum morbidities associated with moderate to severe polyhydramnios. STUDY DESIGN This was a retrospective review of anomalous singleton pregnancies with moderate to severe polyhydramnios that were evaluated and delivered at a single center between 2013 and 2021. Peripartum outcomes were compared between pregnancies that underwent amnioreduction and those that were expectantly managed. Mann-Whitney U tests were used to compare continuous variables and Fisher's exact tests were used for categorical variables. A multiple regression model was created to understand the effects of amnioreduction on gestational age at delivery. RESULTS A total of 218 singleton pregnancies met the inclusion criteria of moderate to severe polyhydramnios in the study period. Of those, 110 patients (50.5%) underwent amnioreduction and 108 patients (49.5%) opted for expectant management. A total of 147 procedures were performed at a median gestational age of 32.5 weeks and a median of 1900 mL of amniotic fluid was removed per procedure. Complications occurred in 10.9% (n=16) of procedures, including preterm delivery within 48 hours in 5.4% cases (n=8). The median amniotic fluid index was higher in the amnioreduction group than in the expectant group (38.9 cm vs 35.5 cm; P<.0001). Patients who underwent amnioreduction had an earlier median gestational age at delivery (36.3 weeks vs 37.0 weeks; P=.048), however, the rates of spontaneous preterm delivery were similar. A higher percentage of women in the amnioreduction group had vaginal delivery (49.4% vs 30.5%; P=.01) and lower rates of uterine atony (2.4% vs 13.7%; P=.006). In the multiple linear regression analysis, the gestational age at delivery positively correlated with gestational age at amnioreduction after controlling for amniotic fluid volume (P<.0001; 95% confidence interval, 0.34-0.71). In addition, the patients in the amnioreduction group were twice as likely to have a vaginal delivery (P=.02). CONCLUSION Amnioreduction in the setting of moderate-severe polyhydramnios has a reasonably low rate of complications but does not provide any benefits in terms of prolonging the pregnancy. The procedure may increase the likelihood of vaginal delivery and lower the rates of uterine atony.
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Affiliation(s)
- Shelly Soni
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer).
| | - Christina Paidas Teefey
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Juliana S Gebb
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Nahla Khalek
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
| | - Kayla Neary
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Kendra Miller
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer)
| | - Julie S Moldenhauer
- Richard D. Wood Jr Center for Fetal Diagnosis & Treatment, Department of General, Thoracic & Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, Neary, Miller, and Moldenhauer); Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (Drs Soni, Paidas Teefey, Gebb, Khalek, and Moldenhauer)
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Abstract
OBJECTIVE Idiopathic polyhydramnios is among the most common etiologies of polyhydramnios. However, conflicting evidence exists regarding the relationship between polyhydramnios and neonatal morbidity. We investigated the association between pregnancies with and without idiopathic polyhydramnios and neonatal morbidity at term. STUDY DESIGN This is a retrospective cohort study of singleton, term (i.e., ≥370/7 weeks) pregnancies from 2014 to 2018. Pregnancies complicated by fetal anomalies, pregestational diabetes, and multifetal gestation were excluded. Pregnancies complicated by idiopathic polyhydramnios were defined by the deepest vertical pocket (DVP) ≥8 cm or amniotic fluid index (AFI) ≥24 cm after 20 weeks' gestation and were compared with women without polyhydramnios at time of delivery. These groups were matched 1:2 by gestational age within 7 days at delivery and maternal race. The primary outcome was a composite neonatal morbidity (neonatal death, respiratory morbidity, hypoxic-ischemic encephalopathy, therapeutic hypothermia, seizures, and umbilical artery pH < 7.10). Outcomes were compared between pregnancies with and without idiopathic polyhydramnios. Unadjusted and adjusted risk ratios were estimated using multivariable logistic regression. RESULTS Idiopathic polyhydramnios was diagnosed in 192 pregnancies and were matched to 384 pregnancies without polyhydramnios. After adjustment for obesity, women with pregnancies complicated by idiopathic polyhydramnios had an increased risk of composite neonatal morbidity 21.4 versus 5.5% (adjusted risk ratio [aRR] = 4.0, 95% confidence interval [CI]: 2.3-6.7). Term neonatal respiratory morbidity was the primary driver 20.3 versus 4.2%, (aRR = 4.8, 95% CI: 2.7-8.7) and included higher use of continuous positive airway pressure 19.8 versus 3.4%, p <0.01 and the need for supplemental oxygen at >12 hours of newborn life 6.8 versus 1.8%, p <0.01. CONCLUSION Idiopathic polyhydramnios is associated with term neonatal respiratory morbidity at delivery and during the subsequent hours of newborn life, compared with pregnancies without idiopathic polyhydramnios. Further studies are needed to minimize neonatal morbidity at term. KEY POINTS · Idiopathic polyhydramnios is associated with increased risk of neonatal morbidity at term.. · Increasing idiopathic polyhydramnios severity was associated with a trend toward worsening morbidity at term.. · Idiopathic polyhydramnios at term requires respiratory support at delivery and during neonatal care..
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Affiliation(s)
- Brock Polnaszek
- Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brooke Liang
- Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Fan Zhang
- Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alison G Cahill
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of Texas at Austin Dell Medical School, Austin, Texas
| | - Nandini Raghuraman
- Division of Maternal Fetal Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Omar M Young
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Vanda R, Bazrafkan M, Rouhani M, Bazarganipour F. Comparing pregnancy, childbirth, and neonatal outcomes in women with idiopathic polyhydramnios: a prospective cohort study. BMC Pregnancy Childbirth 2022; 22:399. [PMID: 35546395 PMCID: PMC9097041 DOI: 10.1186/s12884-022-04625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In this prospective cohort study, the perinatal outcome in idiopathic polyhydramnios compared with normal pregnancies was examined. METHODS This was a prospective cohort study of 180 singleton pregnancies who received care at the referral gynecology clinic of Yasuj, Iran between 2018-2020. The inclusion criteria comprised singleton pregnancies, gestational age > 34 weeks; fetuses without structural and chromosomal abnormalities in pregnancy screening test, no maternal diabetes, negative TORCH negative screening test, no Rh factor isoimmunization. Polyhydramnios was defined as: (i) amniotic fluid index ≥ 24 cm; (ii) maximal vertical pocket of ≥ 8 cm. Perinatal outcomes were recorded in both groups. RESULTS Postpartum hemorrhage (7.8% vs. 2.2; OR: 1.60; 95% CI 1.09-2.34) and cesarean delivery (51.11% vs. 21.11; OR: 1.88; 95% CI 1.42-2.50) and respiratory distress (4.4 v vs. 0; OR: 2.04; 95 C CI 1.75-2.80) was significantly higher in the idiopathic polyhydramnios (P ≤ 0.05) compared to normal pregnancy, which increased with severity of idiopathic polyhydramnios. CONCLUSION In conclusion, the results of the current study, suggest that idiopathic polyhydramnios may be associated with a higher rate of postpartum hemorrhage, cesarean delivery, and respiratory distress than a normal pregnancy.
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Affiliation(s)
- Raziyeh Vanda
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mahnaz Bazrafkan
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Maryam Rouhani
- Department of Gynecology and Obstetrics, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Fatemeh Bazarganipour
- Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Bicocca MJ, Qureshey EJ, Chauhan SP, Hernandez-Andrade E, Sibai BM, Nowlen C, Stafford I. Semiquantitative Assessment of Amniotic Fluid Among Individuals With and Without Diabetes Mellitus. J Ultrasound Med 2022; 41:447-455. [PMID: 33885190 DOI: 10.1002/jum.15725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the rate and severity of abnormal amniotic fluid volumes (oligohydramnios or polyhydramnios), as well as the distribution of amniotic fluid levels, in pregnancies with and without diabetes. METHODS We performed a retrospective cohort study of singleton nonanomalous pregnancies receiving an ultrasound examination (USE) in the third trimester. Pregnancies were categorized into those with and without diabetes and subcategorized by diabetes type. The primary outcomes were oligohydramnios or polyhydramnios. Polyhydramnios was also examined by severity. The association between maternal diabetes status and oligohydramnios or polyhydramnios was assessed using logistic regression. In addition, we computed gestational age-specific amniotic fluid index (AFI) and deepest vertical pocket (DVP) centiles for pregnancies with and without diabetes. RESULTS There were 60,226 USEs from 26,651 pregnancies that met inclusion criteria. There were 3992 (15.0%) pregnancies with diabetes and 22,659 (85.0%) without diabetes. Using AFI, the rate of polyhydramnios was 10.5 versus 3.8% (odds ratio [OR] 2.95; 95% confidence interval [CI] 2.62-3.32) for pregnancies with versus without diabetes, respectively; using DVP, the rate of polyhydramnios was 13.9 versus 5.4% (OR 2.84; 95% CI 2.56-3.15). Rates of oligohydramnios were also increased in pregnancies with diabetes (3.3 versus 2.6%; OR 1.26; 95% CI 1.04-1.52). The AFI and DVP were significantly higher in the cohort with diabetes between 28 and 36 weeks. CONCLUSION Within our study population, pregnancies with diabetes had increased rates of oligohydramnios and polyhydramnios as well as increased gestational age-specific amniotic fluid volumes between 28 and 36 weeks. A higher prevalence of polyhydramnios was observed using DVP as compared to AFI; nevertheless, associations were similar using either method.
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Affiliation(s)
- Matthew J Bicocca
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Emma J Qureshey
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Edgar Hernandez-Andrade
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Carol Nowlen
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Irene Stafford
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Li X, Liu X, Zuo Y, Gao J, Liu Y, Zheng W. The risk factors of gestational diabetes mellitus in patients with polycystic ovary syndrome: What should we care. Medicine (Baltimore) 2021; 100:e26521. [PMID: 34397795 PMCID: PMC8341335 DOI: 10.1097/md.0000000000026521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/15/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT The influencing factors of gestational diabetes mellitus (GDM) in the polycystic ovary syndrome (PCOS) patients remain unclear, we aimed to investigate the risk factors of GDM in patients with PCOS, to provide reliable evidence for the prevention and treatment of GDM in PCOS patients.PCOS patients treated in our hospital from January 1, 2019 to October 31, 2020 were included. The personal and clinical treatment details of GDM and no GDM patients were analyzed. Logistic regressions were performed to analyze the factors influencing the occurrence of GDM.A total of 196 PCOS patients were included, the incidence of GDM in patients with PCOS was 23.98%. There were significant differences in the age, body mass index, insulin resistance index, fasting insulin, testosterone, androstenedione, and sex hormone-binding protein between GDM and no GDM patients with PCOS (all P < .05), and no significant differences in the family history of GDM, the history of adverse pregnancy, and multiple pregnancies were found (all P > .05). Age ≥30 years (odds ratio (OR) 2.418, 95% confidence interval (CI) 1.181-3.784), body mass index ≥24 kg/m2 (OR 1.973, 95%CI 1.266-3.121), insulin resistance index ≥22.69 (OR 2.491, 95%CI 1.193-4.043), fasting insulin ≥22.71 mIU/L (OR 2.508, 95%CI 1.166-5.057), testosterone ≥2.85 nmol/L (OR 1.821, 95%CI 1.104-2.762), androstenedione ≥6.63 nmol/L (OR 1.954, 95%CI 1.262-2.844), sex hormone-binding protein <64.22 nmol/L (OR 1.497, 95%CI 1.028-2.016) were the independent risk factors of GDM in patients with PCOS (all P < .05). The incidence of preeclampsia, premature delivery, premature rupture of membranes, polyhydramnios, and postpartum hemorrhage in the GDM group was significantly higher than that of the no-GDM group (all P < .05). There was no significant difference in the incidence of oligohydramnios between the 2 groups (P = .057).The incidence of GDM in PCOS patients is high, and the measures targeted at the risk factors are needed to reduce the occurrence of GDM in patients with PCOS.
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Affiliation(s)
- Xiaocui Li
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
| | - Xinru Liu
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
| | - Yan Zuo
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
| | - Jiejun Gao
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
| | - Yan Liu
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
| | - Wei Zheng
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, China
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12
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Karaçam Z, Kizilca Çakaloz D, Demir R. The impact of adolescent pregnancy on maternal and infant health in Turkey: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2021; 50:102093. [PMID: 33592347 DOI: 10.1016/j.jogoh.2021.102093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/02/2021] [Accepted: 02/08/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To examine the impact of adolescent pregnancy on maternal and infant health on the basis of studies conducted in Turkey. MATERIAL AND METHODS Systematic reviews and meta-analyses of cross-sectional and case-control. A systematic scan was performed in January 2020 based on the keywords "adolescent pregnancy or teenage pregnancy and Turkey" in the electronic databases PubMed, Clinical Key, Science Direct, Web of Science, Google Scholar, National Thesis Center, DergiPark, Ulakbim, Turkish Medline and Turkish Clinics. Two of the authors carried out a scan independently of each other, making a selection of articles, performing data extraction and quality assessment procedures under the supervision of the senior researcher. RESULTS The results of a total of 38 studies, of which twenty-three were cross-sectional and 15 were case-control, were compiled for the meta-analysis (adolescents: 20,768; control: 59,481). The results of the meta-analysis showed that the more common effects of adolescent pregnancies were preterm birth (OR: 2.12, p < 0.001), early membrane rupture (OR: 1.49, p < 0.001), anemia (OR: 2.60, p < 0.001), low birthweight/intrauterine growth retardation (OR: 2.06, p < 0.001), and fetal distress (OR: 1.78, p = 0.003). On the other hand, it was observed in the meta-analysis that childbirth by cesarean section (OR: 0.70, p < 0.001), gestational diabetes (OR: 0.35, p < 0.001), placenta previa (OR: 0.52, p = 0.01), polyhydramnios (OR: 0.52, p = 0.04) and macrosomia (OR: 0.54, p < 0.001) were less common among adolescents compared to adults. CONCLUSION Our review revealed that adolescent pregnancy had an adverse impact on maternal and infant health in terms of preterm childbirth, early membrane rupture, anemia, low birthweight/intrauterine growth retardation, low Apgar scores and fetal distress.
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Affiliation(s)
- Zekiye Karaçam
- Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
| | - Damla Kizilca Çakaloz
- Aydın Adnan Menderes University, Faculty of Health Sciences, Division of Midwifery, Aydın, Turkey.
| | - Rukiye Demir
- Aydın Adnan Menderes University, Health Sciences Institute, Division of Midwifery, Aydın, Turkey.
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Pariente G, Walfisch A, Wainstock T, Landau D, Sergienko R, Sheiner E. Prenatal exposure to isolated amniotic fluid disorders and the risk for long-term endocrine morbidity of the offspring. Arch Gynecol Obstet 2020; 302:873-878. [PMID: 32602001 DOI: 10.1007/s00404-020-05674-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Amniotic fluid abnormalities may be associated with adverse perinatal outcomes, some of which are endocrine related. OBJECTIVE To evaluate whether in utero exposure to amniotic fluid abnormalities is associated with long-term endocrine morbidity in the offspring. STUDY DESIGN In this cohort study, the incidence of long-term endocrine disorders was compared between singletons exposed and non-exposed to oligohydramnios or polyhydramnios. RESULTS During the study period, 195 943 newborns were included in the study, of them 2.0% (n = 4072) and 2.9% (n = 5684) were exposed to oligohydramnios and polyhydramnios, respectively. Long-term endocrine morbidity was higher among children exposed to isolated amniotic fluid disorders, as was also noted in the Kaplan-Meier survival curve (log-rank test p < 0.001). Abnormal amniotic fluid volume was found to be independently associated with long-term endocrine morbidity of the offspring according to a Cox regression model controlled for clinically related confounders. CONCLUSION In utero exposure to isolated amniotic fluid abnormalities is independently associated with long-term endocrine morbidity in the offspring.
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Affiliation(s)
- Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
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Rotem R, Salem-Yaniv S, Sandler-Rahat H, Yohay D, Sade S, Yahav L, Weintraub AY. Adherence to postpartum diabetes mellitus screening, do associated pregnancy complications make a difference? Diabetes Res Clin Pract 2020; 159:107972. [PMID: 31805350 DOI: 10.1016/j.diabres.2019.107972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/16/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
AIMS We aimed to investigate the impact of Gestational Diabetes Mellitus (GDM) complications on compliance with postpartum Diabetes screening. METHODS A retrospective cohort study was conducted comparing screening rates of women with and without GDM associated complications who delivered at the Soroka University Medical Center, between 2016 and 2017. The screening test of choice was a 2-hour 75 g oral glucose tolerance test, taken 6-12 weeks after delivery. GDM associated complications included one or more of the following: polyhydramnios, macrosomia, shoulder dystocia or cesarean section. Univariate analysis was used in order to examine if GDM associated complications were associated with postpartum diabetes screening. RESULTS During the study period a 164 women were included, of which, 82 women had suffered from GDM associated complications and comprised the study group and 82 women with GDM but without complications comprised the comparison group. Women in the study group were significantly older with a higher parity order. Induction rates were significantly higher among the comparison group, whereas, cesarean section rates were higher among the study group. No difference was noted with regard to neonatal outcomes. Women in the study group were not found to be more likely to be given screening recommendations at discharge (P = 0.50), at their postpartum visit (P = 0.36) or to perform DM screening postpartum (P = 0.17). CONCLUSION Women with GDM associated complications had a higher rate of compliance to postpartum DM screening recommendations. However, in the current study this difference did not reach statistical significance.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.
| | - Simrit Salem-Yaniv
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Sandler-Rahat
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Yahav
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Matěcha J, Nováčková M. Idiopathic polyhydramnios. Ceska Gynekol 2020; 85:417-421. [PMID: 33711902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A comprehensive overview on idiopathic polyhydramnios and associated complications. DESIGN Review article. SETTING Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and Hospital Na Bulovce, Prague, Czech Republic; Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic. METHODS Literature search using the databases Web of Science, Ovid, Cochrane, Medline databases and an analysis of articles published in peer-reviewed journals with impact factor in the years 1958-2020. RESULTS Polyhydramnios occurs in 0.2-2% of pregnancies. Pregnancies with polyhydramnios are more often complicated by abnormal foetal lie or presentation and, moreover, should be associated with adverse pregnancy outcomes, particularly with the higher incidence of intrauterine foetal death, placental abruption, labour induction, caesarean sections, prolonged first stage of labor and shoulder dystocia. CONCLUSION The moderate and severe forms of idiopathic polyhydramnios are associated with the higher risk of adverse pregnancy outcomes that implies the need for intensive monitoring of a pregnant woman and the foetus both in pregnancy and during the delivery itself.
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Abstract
OBJECTIVES To assess adverse outcome of polyhydramnios without morphological abnormalities and to determine the factors associated with an adverse outcome. METHODS This is a retrospective observational cohort study conducted in a French tertiary care unit between 2008 and 2018 including all women with singleton pregnancy complicated by polyhydramnios. Presence of morphological abnormality was an exclusion criteria. The primary outcome was the rate of adverse outcome, defined by a composite criterion including death or postnatal discovery of malformation or chronic pathology. Maternal, obstetrical, paediatric and polyhydramnios characteristics were collected. RESULTS Ninety-one women with polyhydramnios were included. The rate of adverse outcome was 24.2% (22/91). This rate was 20,3% in case of idiopathic polyhydramnios and 33,3% in case of maternal diabetes associated. The postnatal mortality rate was 5.5%. The rate of malformations not diagnosed in antenatal was 11%. Obesity (50% vs. 18,8%; P=0,004), early diagnosis (72,7% before 32 WG vs. 44,9%; P=0,02), and severity of polyhydramnios (22,7% vs. 4,3% in severe polyhydramnios; P=0,01) were associated significantly with an adverse outcome. In these cases, the incidence of preterm delivery was higher. CONCLUSION Polyhydramnios must have second-line ultrasound, including isolated maternal diabetes. A systematic genetic assessment can be discussed.
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Affiliation(s)
- C Bertholdt
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
| | - A-L Fijean
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France
| | - O Morel
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France; IADI, Inserm U1254, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - C Zuily-Lamy
- Service d'obstétrique et de médecine fœtale, maternité régionale du CHRU de Nancy, 10, rue du Dr Heydenreich, 54000 Nancy, France
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Maghsoudlou S, Beyene J, Yu ZM, McDonald SD. Phenotypic Classification of preterm Birth Among Multiparous Women: A Population-Based Cohort Study. J Obstet Gynaecol Can 2019; 41:1433-1443.e12. [PMID: 31281043 DOI: 10.1016/j.jogc.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/12/2019] [Accepted: 03/18/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Global Alliance to Prevent Prematurity and Stillbirth developed a phenotypic classification for preterm birth using clinical presentation (rather than risk factors) to improve surveillance. The objective of this study was to determine distributions of preterm birth phenotypes and associations with Caesarean section, low Apgar score, and neonatal death in multiparous women, stratifying by first versus recurrent preterm births. METHODS This population-based cohort study used the Better Outcomes Registry and Network (BORN) of multiparous women giving birth in hospital with a singleton after 20 weeks in Ontario from 2012 to 2014 (Canadian Task Force Classification II-2). RESULTS In multiparous women with preterm birth, 29.6% had a history of recurrence, of whom 66.2% had at least one clinical condition associated with the phenotypic model, compared with 63.5% of first preterm births. In recurrent preterm births, criteria for maternal, fetal, and placental conditions were met in 44.5%, 37.9%, and 8.2%, respectively, compared with 36.8%, 39.0%, and 10.4%, respectively, of first preterm births. Associations of preterm birth with Caesarean section, low Apgar score, and neonatal death varied across clinical conditions but were similar between first and recurrent preterm births; for example, for recurrent preterm birth, Caesarean section for maternal, fetal, and placental conditions had odds ratios of 1.66 (95% confidence interval [CI] 1.32-2.07), 1.09 (95% CI 0.80-1.49), and 3.92 (95% CI 1.98-7.78), compared with first preterm birth odds ratios of 1.21 (95% CI 1.03-1.41), 0.92 (95% CI 0.77-1.10), and 6.24 (95% CI 4.07-9.56). CONCLUSION This study provides novel evidence of the utility of the preterm birth phenotypic classification model by using stratification for previous preterm birth, a robust predictor-with variation in phenotypes in initial and recurrent preterm births.
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Affiliation(s)
- Siavash Maghsoudlou
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Zhijie Michael Yu
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON
| | - Sarah D McDonald
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON; Department of Radiology, McMaster University, Hamilton, ON.
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Abstract
BACKGROUND Stillbirth is a death before the complete expulsion or extraction from the mother. The burden is severe and high in developing countries. Risk factors for stillbirth are not yet studied in Ethiopia. OBJECTIVE To identify risk factors of stillbirth among mothers delivered in public hospitals of Central Zone Tigray, Ethiopia. METHODS A case-control study design was used. Data collection period was from January to April 2018. Study subjects 63 cases and 252 controls were selected using systematic random sampling technique from respective hospitals. The interviewer-administered questionnaire, observational, and chart analysis were used to collect the data. A binary logistic regression model was employed. Results were presented at significance level P-value <0.05. RESULTS Maternal hypertension [AOR=12.83; 95% CI 3.38, 48.83], low birth weight [AOR=5.6; 95% CI 2.39, 13.38], pre-term [AOR=2.6;95%CI 1.12,6.16], alcohol intake [AOR=7.56; 95% CI 1.68, 34.04], polyhydramnios [AOR=13.43; 95% CI 3.63, 49.67], and meconium stained amniotic fluid [AOR=7.88; 95% CI 1.73, 8.18] were risk factors of stillbirth. CONCLUSION The risk of stillbirth is increased with increasing maternal complication like maternal hypertension, alcohol consumption, polyhydramnios, and meconium-stained amniotic fluid. The occurrence of preterm and low birth weight of the fetus had an effect on the risk of stillbirth.
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Affiliation(s)
- Hagos Tasew
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Micheal Zemicheal
- School of Medicine, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Girmay Teklay
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
| | - Teklewoini Mariye
- School of Nursing, College of Health Science and Comprehensive Specialized Hospital, Aksum University, Tigray, Ethiopia
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Drago F, Ciccarese G, Herzum A, Rebora A, Parodi A. Pityriasis Rosea during Pregnancy: Major and Minor Alarming Signs. Dermatology 2018; 234:31-36. [PMID: 29936509 DOI: 10.1159/000489879] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/07/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with human herpesvirus (HHV)-6 and/or HHV-7 reactivation. In pregnant women, PR may be associated with pregnancy complications. OBJECTIVE To determine relevant risk factors in the development of negative pregnancy outcome in PR. METHODS Between 2005 and 2017 at the Department of Dermatology, University of Genoa, we recruited 76 women who developed PR during pregnancy. In 60 patients without known risk factors for intrauterine fetal death (30 with pregnancy complications and 30 without) we analyzed the pregnancy week of PR onset, presence of enanthem and of constitutional symptoms, PR body surface area involvement, age, and in 50 patients (20 with pregnancy complications and 30 without), the viral load of HHV-6 and HHV-7 (copies/mL). RESULTS In logistic regression analysis, early onset of PR (p = 0.0017) and enanthem (p = 0.0392) proved to be significantly associated with pregnancy complications. HHV-6 viral load (copies/mL) (p < 0.0001), constitutional symptoms (p < 0.001), and PR body surface area involvement (p < 0.004) were also significantly associated with pregnancy complications. CONCLUSION The onset of PR before week 15 and enanthem may be considered major risk factors that should alarm the dermatologist. Constitutional symptoms and involvement of > 50% of the body area may be considered minor risk factors.
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Berger VK, Sparks TN, Jelin AC, Derderian C, Jeanty C, Gosnell K, Mackenzie T, Gonzalez JM. Non-Immune Hydrops Fetalis: Do Placentomegaly and Polyhydramnios Matter? J Ultrasound Med 2018; 37:1185-1191. [PMID: 29076544 PMCID: PMC6029704 DOI: 10.1002/jum.14462] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/27/2017] [Accepted: 08/05/2017] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Polyhydramnios and placentomegaly are commonly observed in nonimmune hydrops fetalis (NIHF); however, whether their ultrasonographic identification is relevant for prognosis is controversial. We evaluated outcomes of fetal or neonatal death and preterm birth (PTB) in cases of NIHF alone and in those with polyhydramnios and/or placentomegaly (P/PM). METHODS We conducted a retrospective cohort of singletons with NIHF evaluated between 1994 and 2013. Nonimmune hydrops fetalis was defined as 2 or more abnormal fluid collections, including ascites, pericardial effusion, pleural effusion, and skin edema. Primary outcomes were intrauterine fetal demise (IUFD) and neonatal death. Secondary outcomes were PTB (<37, < 34, and <28 weeks) and spontaneous PTB. Outcomes were compared between cases of NIHF alone and NIHF with P/PM. RESULTS A total of 153 cases were included; 21% (32 of 153) had NIHF alone, and 79% (121 of 153) had NIHF with P/PM. There was no significant difference in neonatal death (38.1% versus 43.0%; P = .809) between the groups. Intrauterine fetal demise was seen more frequently in NIHF alone (34.4% versus 17.4%; P = .049). Nonimmune hydrops fetalis-with-P/PM cases were more likely to deliver before 37 weeks (80.0% versus 57.1%; P = .045) and before 34 weeks (60.0% versus 28.6%; P = .015) and to have spontaneous PTB (64.4% versus 33.3%; P = .042). Adjusted odds ratios accounting for the etiology of NIHF supported these findings, with the exception of IUFD. CONCLUSIONS Compared to NIHF alone, pregnancies with NIHF and P/PM had a lower risk of IUFD and were at increased risk of PTB (<37 and <34 weeks) and spontaneous PTB. This information may help providers in counseling patients with NIHF and supports the need for close antenatal surveillance.
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Affiliation(s)
- Victoria K Berger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
| | - Teresa N Sparks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California, USA
- Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California, USA
| | - Angie C Jelin
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of General Surgery, St Mary's Medical Center, San Francisco, California, USA
| | - Chris Derderian
- Department of General Surgery, Emory University, Atlanta, Georgia, USA
| | - Cerine Jeanty
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California, USA
| | - Kristen Gosnell
- Fetal Treatment Center , University of California, San Francisco, California, USA
| | - Tippi Mackenzie
- Department of Surgery, University of California, San Francisco, California, USA
- Fetal Treatment Center , University of California, San Francisco, California, USA
| | - Juan M Gonzalez
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California, San Francisco, California, USA
- Fetal Treatment Center , University of California, San Francisco, California, USA
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Abstract
We evaluated implications of testing for gestational diabetes mellitus (GDM) in pregnancies complicated by third trimester isolated polyhydramnios with previous negative diabetes screening test. In this retrospective cohort study of 104 pregnant women with polyhydramnios between 2005 and 2013, all had normal first trimester fasting glucose and normal glucose challenge test (GCT < 140 mg/dL). Late onset GDM was diagnosed in five women (4.8%) with isolated polyhydramnios, one abnormal value in the oral glucose tolerance test (OGTT) was identified in four additional women (3.8%). No significant differences were found in risk factors for GDM, mean second trimester GCT (117.5 vs. 107.2 mg/dL, p = 0.38) or fasting glucose values (82 vs. 86 mg/dL, p = 0.29) between women in the polyhydramnios group with and without late GDM diagnosis. Moreover, no significant difference was found in relation to the mode of delivery or birth weight between the studied groups (3437 ± 611 vs. 3331 ± 515 g, p = 0.63). Diagnosis of third trimester polyhydramnios was not associated with increased risk for GDM or neonatal complications.
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Affiliation(s)
- Maya Frank Wolf
- a Department of Obstetrics & Gynecology , Galilee Medical Center, Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - David Peleg
- b Department of Obstetrics and Gynecology , Ziv Medical Center, Faculty of Medicine in Galilee, Bar-Ilan University , Zefat , Israel
| | - Talia Stahl-Rosenzweig
- c Department of Obstetrics and Gynecology , Baruch Padeh Medical Center , Poriya , Israel
| | - Yaffa Kurzweil
- d Department of Obstetrics and Gynecology , Assaf Harofeh Medical Center , Zerifin , Israel
| | - Yariv Yogev
- e Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel , and
- f Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
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22
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Bogdanet D, Egan AM, Reddin C, Kgosidialwa O, Kirwan B, Carmody L, Dunne FP. ATLANTIC DIP: Insulin Therapy for Women With IADPSG-Diagnosed Gestational Diabetes Mellitus. Does It Work? J Clin Endocrinol Metab 2017; 102:849-857. [PMID: 27901638 DOI: 10.1210/jc.2016-2911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 11/29/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Approximately 40% of women with gestational diabetes mellitus (GDM) diagnosed using International Association of the Diabetes and Pregnancy Study Group (IADPSG) criteria require insulin therapy. OBJECTIVE We assessed whether the outcomes for women with GDM treated with insulin are comparable to women with normal glucose tolerance (NGT). MATERIALS AND METHODS This retrospective cohort study included 752 women with insulin-treated GDM and 2496 women with NGT during pregnancy. Maternal and fetal outcomes were examined. RESULTS Infants of women with insulin-treated GDM had rates of macrosomia [adjusted odds ratio (aOR), 1.19; 95% confidence interval (CI), 0.87 to 1.63; P = 0.26], large for gestational age (LGA) (aOR, 1.07; 95% CI, 0.77 to 1.47; P = 0.67), and small for gestational age (SGA) (aOR, 0.70; 95% CI, 0.38 to 1.38; P = 0.26) similar to women with NGT. They were more likely to be hypoglycemic at birth (aOR, 6.85; 95% CI, 2.31 to 20.28; P < 0.01) and to require neonatal intensive care unit care (NICU) (aOR, 12.09; 95% CI, 8.72 to 16.76; P < 0.01), predominantly for nonmedical reasons. Maternal rates of hypertensive disorders (preeclampsia: aOR, 0.64; 95% CI, 0.34 to 1.12; P = 0.17; pregnancy-induced hypertension: aOR, 1.11; 95% CI, 0.74 to 1.66; P = 0.60) and hemorrhage (ante partum hemorrhage: aOR, 0.56; 95% CI, 0.19 to 1.58; P = 0.27; postpartum hemorrhage: aOR, 1.17; 95% CI, 0.68 to 2.03; P = 0.55) were similar between groups, but the risk of polyhydramnios was increased in the GDM cohort (aOR, 7.75; 95% CI, 3.96 to 15.16; P < 0.01). CONCLUSIONS Insulin treatment of IADPSG-diagnosed GDM results in rates of macrosomia, LGA, SGA, and maternal hypertensive disorders similar to those of women with NGT. Although NICU admissions are greater in the GDM cohort, they are primarily for nonmedical reasons. Neonatal hypoglycemia and polyhydramnios remain greater among women with insulin-treated GDM.
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Affiliation(s)
| | - Aoife M Egan
- Diabetes Research Centre, Galway SW4 671, Ireland; and
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway SW4 794, Ireland
| | | | | | - Breda Kirwan
- Diabetes Research Centre, Galway SW4 671, Ireland; and
| | | | - Fidelma P Dunne
- Diabetes Research Centre, Galway SW4 671, Ireland; and
- College of Medicine Nursing and Health Sciences, National University of Ireland, Galway SW4 794, Ireland
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23
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Czyzyk A, Podfigurna-Stopa A, Katulski K, Breborowicz GH, Genazzani AR, Meczekalski B. Pregnancy after oocyte donation in 45, X Turner syndrome women, complicated by gestational diabetes and polyhydramnios. Case report and mini-review of literature. Gynecol Endocrinol 2016; 32:609-611. [PMID: 26942946 DOI: 10.3109/09513590.2016.1153057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from Turner syndrome (TS) demonstrate characteristic clinical features, with a short stature and gonadal dysgenesis causing infertility in most patients. Spontaneous pregnancies in women with TS are quite rare and pregnancy outcomes involving an increased risk of miscarriage and stillbirths are observed. In this case report, we present a 28 years old pregnant woman with the diagnosis of TS. Due to hypergonadotrophic hypogonadism, she was proposed an in vitro fertilization (IVF) program with an oocyte donor from unrelated anonymous women. After the second transfer, implantation occurred. In the 24th week of gestation, gestational diabetes class 1 was diagnosed. In the 31st week of gestation, polyhydramnios was diagnosed, although other parameters were reassuring. Considering the polyhydramnios, along with the diagnosis of Turner syndrome in the mother, we decided to perform an elective cesarean section. Subsequently, a healthy term male was born. For most women with the diagnosis of TS, the only way to become pregnant is through oocyte donation. The aim of this work was to characterize the course of pregnancy in TS patient and review literature addressing this issue.
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Affiliation(s)
- Adam Czyzyk
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | | | - Krzysztof Katulski
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
| | - Grzegorz H Breborowicz
- b Department of Perinatology and Gynaecology , Poznan University of Medical Sciences , Poznan , Poland , and
| | - Andrea R Genazzani
- c Department of Reproductive Medicine and Child Development , Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
| | - Blazej Meczekalski
- a Department of Gynecological Endocrinology , Poznan University of Medical Sciences , Poznan , Poland
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Abstract
CONTEXT To our knowledge, no study has examined the effects of soy intake on metabolic status of women with gestational diabetes mellitus (GDM). OBJECTIVE This study was designed to assess the effects of soy intake on metabolic status of GDM women. METHODS A randomized clinical trial was performed among 68 women with GDM. Women were randomly assigned to receive either a control diet containing 0.8-g/kg protein (70% animal and 30% plant proteins) (n = 34) or a soy diet containing the same amount of protein with 35% animal protein, 35% soy protein, and 30% other plant proteins (n = 34) for 6 weeks. RESULTS Compared with soy protein consumption, the control group significantly increased fasting plasma glucose (+1.4 ± 11.6 vs -12.7 ± 13.2 mg/dL, P < .001), serum insulin levels (+5.0 ± 11.6 vs -0.9 ± 10.0 μIU/mL, P = .02), homeostasis model of assessment-insulin resistance (+1.2 ± 2.7 vs -0.8 ± 2.2, P = .002), and decreased quantitative insulin sensitivity check index (-0.007 ± 0.02 vs +0.01 ± 0.03, P = .004). Administration of the control diet resulted in a significant difference in serum triglycerides changes (+31.3 ± 38.0 vs +8.9 ± 46.1 mg/dL, P = .03) compared with soy protein. There were a significant decrease in total antioxidant capacity (-35.0 ± 136.2 vs +81.8 ± 188.8 mmol/L, P = .005) and glutathione (-41.3 ± 145.7 vs +53.3 ± 117.3 μmol/L, P = .004) by the control diet intake compared with soy protein. The control diet group had a higher incidence of newborn hyperbilirubinemia (32.4% vs 8.8%, P = .01) and newborn hospitalization (20.6% vs 2.9%, P = .02) compared with soy protein. CONCLUSION Soy protein consumption in women with GDM significantly improved the glucose homeostasis parameters, triglycerides, and biomarkers of oxidative stress, as well as reductions in the incidence of newborn hyperbilirubinemia and hospitalizations.
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Affiliation(s)
- Mehri Jamilian
- Department of Gynecology and Obstetrics (M.J.), School of Medicine, Arak University of Medical Sciences, Arak, Iran 38196; and Research Center for Biochemistry and Nutrition in Metabolic Diseases (Z.A.), Kashan University of Medical Sciences, Kashan, Iran 87159
| | - Zatollah Asemi
- Department of Gynecology and Obstetrics (M.J.), School of Medicine, Arak University of Medical Sciences, Arak, Iran 38196; and Research Center for Biochemistry and Nutrition in Metabolic Diseases (Z.A.), Kashan University of Medical Sciences, Kashan, Iran 87159
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25
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Stanescu AD, Banica R, Olaru G, Ghinda E, Birdir C. Idiopathic polyhydramnios and fetal gender. Arch Gynecol Obstet 2014; 291:987-91. [PMID: 25288271 DOI: 10.1007/s00404-014-3504-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/29/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the relationship between idiopathic polyhydramnios and fetal gender in the absence of fetal or maternal abnormalities. METHODS This was a retrospective population-based register study. 295 women with singleton pregnancies complicated by idiopathic polyhydramnios (amniotic fluid index (AFI) higher than 24 cm) who were delivered at our institution from January 2002 till December 2012 were included. Only pregnancies with an uncomplicated outcome were accepted in this study. The incidence of the male to female fetuses was compared with the one in the general population. RESULTS Among pregnancies complicated by idiopathic polyhydramnios, the following gender distribution was found: 72.9% male and 37.1% female. The distribution in the general population was 51.5% female and 48.5% male. The mean AFI was significantly increased in male fetuses (p < 0.001). The increased AFI did not correlate with gestation age, fetal head circumference or estimated fetal weight. CONCLUSIONS Idiopathic polyhydramnios is more frequent in male normal fetuses than in female ones.
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Affiliation(s)
- A D Stanescu
- "Saint John" Clinical Emergency Hospital, Bucur Maternity, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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26
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Abstract
PURPOSE To determine causes of polyhydramnios and the respective perinatal outcome. MATERIALS AND METHODS We retrospectively analyzed cases with polyhydramnios at the Medical University Graz, Austria from 2003 - 2011. Inclusion criteria were single deepest pocket ≥ 8 cm, amniotic fluid index ≥ 25 cm, each of the latter parameters > 95th percentile or subjective impression. Etiologies, including TORCH infection, diabetes and congenital malformations, as well as perinatal outcome were evaluated. RESULTS Out of 860 singleton pregnancies with polyhydramnios, 2.9 % had positive TORCH serology, 8.5 % had congenital anomalies, 19.8 % had maternal diabetes, and 68.8 % were idiopathic. The most common fetal anomalies were cardiac defects (32.9 %). Elective caesarean sections were more common in the groups with malformations and maternal diabetes. Low birth weight combined with severe polyhydramnios or maternal diabetes was associated with malformations. CONCLUSION Diagnosis of polyhydramnios should prompt glucose-tolerance testing, detailed sonography including fetal echocardiography, and TORCH serology. Especially pregnancies with polyhydramnios and small fetuses as well as those with maternal diabetes should be carefully evaluated for malformations.
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Affiliation(s)
- M Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - J Voetsch
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - C Koidl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz
| | - E Schest
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - M Haeusler
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - U Lang
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz
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27
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Sfeir R, Bonnard A, Khen-Dunlop N, Auber F, Gelas T, Michaud L, Podevin G, Breton A, Fouquet V, Piolat C, Lemelle JL, Petit T, Lavrand F, Becmeur F, Polimerol ML, Michel JL, Elbaz F, Habonimana E, Allal H, Lopez E, Lardy H, Morineau M, Pelatan C, Merrot T, Delagausie P, de Vries P, Levard G, Buisson P, Sapin E, Jaby O, Borderon C, Weil D, Gueiss S, Aubert D, Echaieb A, Fourcade L, Breaud J, Laplace C, Pouzac M, Duhamel A, Gottrand F. Esophageal atresia: data from a national cohort. J Pediatr Surg 2013; 48:1664-9. [PMID: 23932604 DOI: 10.1016/j.jpedsurg.2013.03.075] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 12/30/2022]
Abstract
PURPOSE A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. METHODS All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. RESULTS Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. CONCLUSIONS Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable.
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Affiliation(s)
- Rony Sfeir
- Reference Center for Congenital Oesophageal Anomalies, University Hospital Lille, France.
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28
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Knight KM, Thornburg LL, Pressman EK. Pregnancy outcomes in type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls. J Reprod Med 2012; 57:397-404. [PMID: 23091986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To characterize the neonatal and maternal outcomes of type 2 diabetic patients as compared with type 1 diabetic patients and nondiabetic controls. STUDY DESIGN We performed a retrospective cohort study reviewing perinatal outcomes of type 1 and type 2 diabetic patients and nondiabetic controls from July 2000 to August 2006. Analysis of variance, t testing and chi2 analysis were used to compare groups. Post hoc power analysis indicated 80% power was necessary to detect a 15% difference in composite poor neonatal outcomes. RESULTS A total of 64 type 2 and 64 type 1 diabetic patients were compared with 256 controls. Type 1 diabetic patients had higher incidences of composite poor neonatal outcome and congenital anomalies than did type 2 diabetic and control patients. Both diabetic groups had similarly higher incidences of cesarean delivery, preeclampsia, preterm delivery, polyhydramnios and macrosomia than did controls. CONCLUSION Type 2 diabetic patients have a decreased incidence of adverse neonatal outcomes when compared with that of type 1 diabetic patients. No difference was observed between the diabetic groups in the incidence of a majority of the adverse maternal outcomes examined, however both diabetic groups had overall worse outcomes that did nondiabetic controls.
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Affiliation(s)
- Kristin M Knight
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Rochester Strong Memorial Hospital, Rochester, New York, USA.
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29
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Bracho-Blanchet E, González-Chávez A, Dávila-Pérez R, Zalles Vidal C, Fernández-Portilla E, Nieto-Zermeño J. [Prognostic factors related to mortality in newborns with jejunoileal atresia]. CIR CIR 2012; 80:345-351. [PMID: 23374382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Jejuno-ileal atresia is one of the main causes of intestinal obstruction in neonates. The origin is vascular accidents in the fetal intestine. It is an entity that requires early and specialist management. OBJECTIVE to know the factors related to mortality in neonates with jejunoileal atresia. METHODS Case-control nested in a cohort design, comparative study during ten years, between deceased and survivors analyzing factors related to mortality before surgery and during surgery and in the postoperative course. RESULTS We analyzed 70 patients in 10 years, there were 10 deaths (14.2%). No one had a prenatal diagnosis. Factors related to mortality were: intestinal perforation with a relative risk (RR) of 4.4, peritonitis (RR: 5.6), the need of stomas (RR: 4.9), the presence of sepsis (RR: 4.6) and when the residual small bowel length was below 1 meter (RR: 7.4). CONCLUSION The delay in diagnosis causes late intervention and increased mortality delayed diagnosis promotes late transport of the neonate and enhances mortality, factors associated with mortality related to intestinal perforation. It is necessary to spread this disease in the medical community to improve prenatal and postnatal diagnosis.
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Affiliation(s)
- Eduardo Bracho-Blanchet
- Departamento de Cirugía General, Hospital Infantil de México Federico Gómez, Secretaría de Salud, México, D.F., Mexico.
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30
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Usui N, Kitano Y, Okuyama H, Saito M, Masumoto K, Morikawa N, Takayasu H, Nakamura T, Hayashi S, Kawataki M, Ishikawa H, Nose K, Inamura N, Sago H. Prenatal risk stratification for isolated congenital diaphragmatic hernia: results of a Japanese multicenter study. J Pediatr Surg 2011; 46:1873-80. [PMID: 22008320 DOI: 10.1016/j.jpedsurg.2011.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 05/09/2011] [Accepted: 06/06/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND/PURPOSE The aim of this study was to establish a prenatal prognostic classification system for risk-stratified management in fetuses with isolated congenital diaphragmatic hernia (CDH). METHODS A multi-institutional retrospective cohort study of isolated CDH, diagnosed prenatally in fetuses delivered during the 2002 to 2007 period at 5 participating institutions in Japan, was conducted. The risk stratification system was formulated based on the odds ratios of prenatal parameters for mortality at 90 days. The clinical severity in CDH infants were compared among the stratified risk groups. RESULTS Patients were classified into the 3 risk groups: group A (n = 48) consisted of infants showing liver-down with contralateral lung-to-thorax transverse area ratio (L/T) ratio ≥0.08; group B of infants showing liver-down with L/T ratio <0.08 or liver-up with L/T ratio ≥0.08 (n = 35), and group C of infants showing liver-up with L/T ratio <0.08 (n = 20). The mortality at 90 days in groups A, B, and C were 0.0%, 20.0%, and 65.0%, respectively. The intact discharge rates were 95.8%, 60.0%, and 5.0%, respectively. This system also accurately reflected the clinical severity in CDH infants. CONCLUSIONS Our prenatal risk stratification system, which demonstrated a significant difference in postnatal status and final outcome, would allow for accurate estimation of the severity of disease in fetuses with isolated CDH, although it needs prospective validation in a different population.
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Affiliation(s)
- Noriaki Usui
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Idris N, Wong SF, Thomae M, Gardener G, McIntyre DH. Influence of polyhydramnios on perinatal outcome in pregestational diabetic pregnancies. Ultrasound Obstet Gynecol 2010; 36:338-343. [PMID: 20503236 DOI: 10.1002/uog.7676] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study was carried out to evaluate the perinatal outcomes of pregnancy with pregestational diabetes mellitus complicated by polyhydramnios. METHODS This was a retrospective study of singleton pregnancies, with an antepartum diagnosis of polyhydramnios, seen at the maternal fetal medicine department of Mater Mothers' Hospital, a tertiary-level facility. All pregnancies in women with pregestational diabetes with a singleton pregnancy beyond 24 weeks of gestation, from 1996 to 2006, were reviewed (n = 314), and pregnancies complicated by polyhydramnios were identified (n = 59). Pregnancy outcomes of women whose pregnancy was complicated with polyhydramnios were compared to those without this complication. RESULTS The incidence of polyhydramnios in the study population was 18.8%. Women with polyhydramnios had increased hemoglobin A1c (HbA1c) levels throughout the pregnancy, and the difference was significant during the prepregnancy period and in the third trimester (P = 0.003 and P = 0.025, respectively). Significantly more mothers in the polyhydramnios group delivered preterm (54.2% vs. 33.3%, P = 0.004), the majority of which were iatrogenic preterm deliveries (44.1%). More pregnancies with polyhydramnios were delivered by Cesarean section (83.0% vs. 62%; P = 0.006), with the majority being performed electively in both groups (79.6% and 70.3%, respectively). Regardless, there were no significant differences in perinatal mortality rates, congenital abnormality rates, the incidences of low Apgar score, acidemia, hypoglycemia requiring intravenous therapy, phototherapy and ventilatory needs between the babies of the two groups. CONCLUSION Pregestational diabetic pregnancy with polyhydramnios is associated with poor diabetic control. Despite this, there is no significant increase in adverse perinatal outcome in these pregnancies, apart from a higher iatrogenic preterm birth rate.
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Affiliation(s)
- N Idris
- Department of Maternal Fetal Medicine, University of Queensland, Mater Mothers' Hospital, South Brisbane, QLD, Australia
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Bánhidy F, Acs N, Puhó EH, Czeizel AE. Pregnancy complications and birth outcomes of pregnant women with urinary tract infections and related drug treatments. ACTA ACUST UNITED AC 2009; 39:390-7. [PMID: 17464860 DOI: 10.1080/00365540601087566] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Maternal urinary tract infections in pregnancy showed an association with a higher rate of preterm birth in previous studies. The aim of this study was to check this relationship, and in addition to evaluate the efficacy of recent medical treatments. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was evaluated. Of 38,151 newborn infants, 2188 (5.7%) had mothers with urinary tract infections during pregnancy, and 90% of these maternal diseases were prospectively and medically recorded. The prevalence of pre-eclampsia and polyhydramnios showed an association with urinary tract infections during pregnancy. Pregnant women with urinary tract infections in pregnancy had a somewhat shorter gestational age (0.1 week) and a higher proportion of preterm births (10.4% vs 9.1%). These differences were correlated with the severity of urinary tract infections. However, the preterm-inducing effect of maternal urinary tract infections is preventable by some antimicrobial drugs such as ampicillin, cefalexin and cotrimoxazole. In conclusion, maternal urinary tract infections during pregnancy increase pre-eclampsia and polyhydramnios, and in addition the rate of preterm birth; however, the latter is preventable by appropriate drug treatments.
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Affiliation(s)
- Ferenc Bánhidy
- Second Department of Obstetrics and Gynaecology, Semmelweis University, School of Medicine, Budapest, Hungary
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Cheng WW, Lin SQ. [Analysis of risk factors for uteroplacental apoplexy complicating placental abruption]. Zhonghua Fu Chan Ke Za Zhi 2008; 43:593-596. [PMID: 19087494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To study the clinical characteristics, the outcome of pregnancy and the risk factors of uteroplacental apoplexy complicating severe placental abruption. METHODS A retrospectively study of the 52 cases of placental abruption who had delivered in our hospital from Jan. 2002 to Dec. 2006 was conducted. These cases were divided into 2 groups: 17 cases of uteroplacental apoplexy complicating placental abruption as observation group, the others with no uteroplacental apoplexy as control group. The risk factors of disease, clinical characteristics and the outcome of pregnancy between the two groups were compared. RESULTS (1) The incidence of placental abruption was 0.15% (52/35 049) among the total deliveries patients with uteroplacental apoplexy complicating placental abruption took up 0.05% (17/35 049) of all deliveries and 33% (17/52) of all abruption cases. (2) General information and delivery: There were no significant differences (P > 0.05) regarding their mean age and BMI in two groups. All women in observation group had C-section delivery, which were 21 in control group. 14 women had vaginal delivery. The incidence of premature labour was 88% (15/17) in observation group, and 49% (17/35) women in control group delivered after 37 weeks. Significant differences were observed regarding delivery methods and gestational weeks (P < 0.01). (3) RISK FACTORS: the incidence of preeclampsia, 71% (12/17), and the duration of disease, 6.4 hours, in observation group were more than those in control group, 20% (7/35) and 4.2 hours (P < 0.01). There were no significant differences between two groups in premature rupture, polyhydroamnions (P > 0.05). (4) Clinical characteristics in two groups: bloody amniotic fluid, fetal distress, hematometra and postpartum hemorrhage occurred in 82% (14/17) vs 26% (9/35), 65% (11/17) vs 29% (10/35), 35% (6/17) vs 6% (2/35), and 59% (10/17) vs 11% (4/35), with a significant difference (P < 0.01), but no statistical difference existed between indices such as abdominal pain, vaginal bleeding and abdominal tension (P > 0.05). (5) Placenta sites and abruption areas: placenta sites were distributed from anterior or posterior of uterine body 5/17 vs 24/35, the fundus or cornu of uterus 12/17 vs 11/35 (P < 0.01). All cases in observation group presented abruption areas > 1/3, and 9 cases >or= 2/3, 27 cases abruption areas < 1/3 and 8 cases abruption areas 1/3 - 2/3 in control group (P < 0.01). (6) Other complications and outcome: Hemorrhagic shock 3 vs 0, DIC 3 vs 0, hysterectomy 1 vs 0, intrauterine fetal death 3 vs 2, neonatal asphyxia 8 vs 5 and neonatal death 1 vs 0. There were significant differences (P < 0.01) between the two groups. CONCLUSIONS Preeclampsia, long duration of disease and fundal or cornual placenta a risk factors for uteroplacental apoplexy complicating placental abruption, which may lead to a poor maternal-fetal prognosis.
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Affiliation(s)
- Wei-Wei Cheng
- Department of Obstetrics, Affiliated International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University Medical College, Shanghai 200030, China.
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Kong LJ, Huang XH. [Analysis of the perinatal outcomes and management of twin-twin transfusion syndrome]. Zhonghua Fu Chan Ke Za Zhi 2008; 43:175-179. [PMID: 18788564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the perinatal outcomes of twin-twin transfusion syndrome (TTTS) and the management. METHODS During Nov 1, 2002 to Sep 30, 2005, 24 cases of TTTS in Beijing Obstetrics and Gynecology Hospital were analyzed. The outcomes of them were compared with the pregnancy without TTTS in all twins and in monozygotic twins. The outcomes of the blood-supplying fetus and the blood-recepter were compared. RESULTS 6.8% cases had TTTS in all twins. The group of TTTS had more maternal, fetal and neonatal complications than twins pregnancy without TTTS: polyhydramnios [37.5% (9/24) vs 2.1% (7/328), P < 0.01], gestational hypertension [20.8% (5/24) vs 7.0% (23/328), P = 0.043], premature labor [66.7% (16/24) vs 36.3% (119/328), P = 0.003], perinatal dead fetus in uterus [18.8% (6/32) vs 1.1% (7/640), P < 0.01], neonatal asphyxia [73.1% (19/26) vs 3.0% (19/632), P < 0.01], the proportion of NICU [88.5% (23/26) vs 23.4% (148/632), P < 0.01], neonatal death [15.4% (4/26) vs 1.7% (11/632), P = 0.002] and the rate of perinatal mortality [31.2% (0/32) vs 2.8% (18/632)]. Compared with the monozygotic twins without TTTS, in TTTS group there were more complications of the mother, the fetus and the neonates: gestational hypertension [20.8% (5/24) vs 9.9% (14/142), P = 0.224], premature labor [66.7% (16/24) vs 49.3% (70/142), P = 0.115], perinatal dead fetus in uterus [18.8% (6/32) vs 0.7% (2/282), P < 0.01], neonatal asphyxia [73.1% (19/26) vs 3.9% (11/280), P < 0.01], the proportion of NICU [88.5% (23/26) vs 29.3% (82/280), P < 0.01], neonatal death [15.4% (4/26) vs 2.1% (6/280), P = 0.006] and the rate of perinatal mortality [31.3% (10/32) vs 3.2% (8/282)]. The perinatal outcomes were better in those cases that the grades of TTTS were below 3 in the first diagnosis. CONCLUSIONS We should try to diagnose and treat TTTS as early as possible because the outcome is poor.
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Affiliation(s)
- Li-Jun Kong
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China
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Zaki M, Boyd PA, Impey L, Roberts A, Chamberlain P. Congenital myotonic dystrophy: prenatal ultrasound findings and pregnancy outcome. Ultrasound Obstet Gynecol 2007; 29:284-8. [PMID: 17238150 DOI: 10.1002/uog.3859] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The objective of this study was to assess the maternal and prenatal ultrasound findings and outcome in pregnancies complicated by congenital myotonic dystrophy Type 1 (DM1). METHODS A retrospective chart review of all patients with a diagnosis of DM1 and pregnancy presenting to the Oxford Radcliffe Hospital between 1990 and 2004 was undertaken. Obstetric case notes were reviewed and details of all pregnancies obtained. This included data on prenatal diagnostic tests and obstetric ultrasound scans performed as well as pregnancy complications and pregnancy outcome. Maternal and fetal CTG expansion size was also recorded where available. Maternal genetic case notes were reviewed for details of maternal grip myotonia. RESULTS Sixty pregnancies among 26 couples in which one of the parents was a carrier of DM1 were identified during the study period. These resulted in 36 (60%) pregnancies affected by congenital DM1 and 19 (31.7%) unaffected pregnancies. There were four miscarriages and one termination of pregnancy for non-medical reasons. Nineteen of the 36 affected pregnancies ended in termination following the antenatal diagnosis of congenital DM1 by either chorionic villus sampling (CVS) or amniocentesis. In the remaining 17 affected pregnancies (16 singleton and one twin) there was one miscarriage of an affected fetus with co-existing Down syndrome and eight perinatal deaths. The principal cause of perinatal death was respiratory failure in the early neonatal period. Antenatally noted clinical/sonographic abnormalities in these pregnancies included polyhydramnios (100%), talipes (26.6%) and borderline ventriculomegaly (13.3%). Uni- or bilateral talipes was noted at delivery in 10 of 16 (62.5%) neonates. Maternal grip myotonia was present in all but one of these cases. CONCLUSION The antenatal findings of polyhydramnios and talipes should prompt a search for maternal grip myotonia. If present, definitive testing for congenital DM1 should be considered.
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Affiliation(s)
- M Zaki
- Prenatal Diagnosis Unit, Women's Centre, Oxford Radcliffe Hospital, Headington, Oxford, UK
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Abstract
BACKGROUND The purpose of this study was to determine the incidence of polyhydramnios, the related maternal and perinatal morbidity, and to estimate the association between perinatal outcome and the degree of polyhydramnios in a Danish population. METHODS The study population consisted of 168 women with singleton pregnancies and polyhydramnios diagnosed by ultrasound as a largest two-diameter pocket of > 50 cm2. Mild polyhydramnios defined as > 50 and < 100 cm2, and severe polyhydramnios defined as > or = 100 cm2. The background population consisted of 8,347 pregnant women from the same hospital. Outcome measures were compared using chi2 test or Fisher's exact test. RESULTS The incidence of polyhydramnios was 2%, with 66.7% of cases mild, and 33.3% were severe polyhydramnios. The study population had an increased risk of emergency (19 versus 10.5%, p<0.001) and elective (11.3 versus 5.0%, p<0.001) caesarean section, as well as perinatal death (1.2 versus 0.3%, p<0.05) compared to the background population. In cases of severe polyhydramnios, there was an increased risk of caesarean section (44.6 versus 23.1%, p<0.005), birth weight > 4,000 g (28.6 versus 14.3%, p<0.05), and need for neonatal care (8.9 versus 0.9%, p<0.01) compared to mild cases. Apgar score < 7, perinatal death and structural malformations only occurred in women with severe polyhydramnios. CONCLUSION It is reasonable to distinguish between mild and severe polyhydramnios regarding special attention and follow-up, as caesarean section and perinatal morbidity and mortality are related to the degree of polyhydramnios. A two-diameter pocket > or = 100 cm2 could be used to separate mild from severe cases.
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Affiliation(s)
- Anne Bundgaard
- Department of Obstetrics and Gynaecology, Hvidovre Hospital, University of Copenhagen, capital region of Denmark.
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Xu ZM, Wu LF. [Correlation between amniotic fluid glucose concentration and amniotic fluid volume and neonatal birth weight in pregnancy complicated by gestational diabetes mellitus]. Zhonghua Fu Chan Ke Za Zhi 2006; 41:724-8. [PMID: 17327026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To investigate the relationship between amniotic fluid glucose concentration, amniotic fluid volume and neonatal birth weight in gestational diabetes mellitus (GDM). METHODS Two hundred and fifty-five singleton, normal term pregnant women were divided into three groups: GDM, gestational impaired glucose tolerance (GIGT) and normal pregnancy according to the results of a 50 g, 1 hour glucose challenge test (GCT) or of a 75 g oral glucose tolerance test (OGTT). There were 85 study subjects in each group. All women had GCT at 24 - 28 gestational weeks. When they had a positive GCT, in which glucose level was > or = 7.8 mmol/L, and < 10.6 mmol/L at 1 hour after oral 50 g glucose, they were required to have a 75 g OGTT. Amniotic fluid glucose concentration (AFG), amniotic fluid index (AFI), neonatal birth weight (NBW), maternal fasting glucose level (MFG) and umbilical venous glucose level (UvG) were compared in three groups. Statistical analysis of linear regression was done on these indices. RESULTS (1) The mean AFG in group GDM was (1.30 +/- 0.71) mmol/L, which was significantly greater than that in group GIGT, (1.02 +/- 0.57) mmol/L and that in normal group, (0.90 +/- 0.58) mmol/L. There were significant differences among three groups (P < 0.01). (2) In group GDM, the mean AFI was (16.1 +/- 4.6) cm, which was slightly greater than that in group GIGT, (14.8 +/- 4.3) cm (P > 0.05), but was significantly higher than that in normal group, (12.7 +/- 3.2) cm (P < 0.01). (3) The NBW of group GDM was (3612 +/- 510) g, which was lower than that of group GIGT, (3694 +/- 490) g, and higher than that of normal group, (3487 +/- 458) g, but there were no significant differences among three groups (P > 0.05). (4) Among women with GDM, AFG was significantly correlated with AFI (r = 0.330, P = 0.002), NBW (r = 0.347, P = 0.001), MFG (r = 0.589, P < 0.01), and with UvG (r = 0.218, P = 0.045). But in group GIGT and normal group, AFG was only correlated with AFI. (5) In GDM group, the AFG, (1.02 +/- 0.50) mmol/L; AFI, (13.9 +/- 4.2) cm; and NBW, (3497 +/- 475) g in women who had ideal blood glucose level were significantly lower than that in women whose blood glucose levels were not well-controlled [AFG, (1.92 +/- 0.76) mmol/L, AFI, (16.4 +/- 4.4) cm, NBW, (3869 +/- 481) g (P < 0.01, P < 0.05, P < 0.01)], and the mean values of these three indices were close to those of the control group. CONCLUSION In the cohort with GDM, there were correlations between AFG, AFI, and NBW. The results show that an active management could significantly improve the prognoses of the diabetes mothers and their fetuses.
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Affiliation(s)
- Ze-Mei Xu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital University of Medical Science, Beijing 100026, China
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Vink JY, Poggi SH, Ghidini A, Spong CY. Amniotic fluid index and birth weight: is there a relationship in diabetics with poor glycemic control? Am J Obstet Gynecol 2006; 195:848-50. [PMID: 16949424 DOI: 10.1016/j.ajog.2006.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 07/04/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate if the previously demonstrated relationship between macrosomia (> 4000 g) and polyhydramnios (> 25 cm) is linear across birth weights (BW) in diabetic patients with poor glycemic control. STUDY DESIGN Using a prospectively collected database of patients undergoing amniocentesis for fetal lung maturity for various indications with amniotic fluid index (AFI) obtained < or = 7 days before delivery and BWs available (n = 69), we computed gestational age (GA) specific AFI and BW centiles using standard tables. BW and AFI centiles were analyzed in diabetic patients with poor glycemic control using linear regression and ANOVA, with P < .05 significant. RESULTS In the poorly controlled diabetic population, a linear relationship existed between AFI and BW centiles, with the largest BW centiles having the highest AFI centiles (P < .0001). CONCLUSION The previously noted relationship between elevated AFI and BW centiles in the general patient population is linear in diabetic patients with poor glycemic control.
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Affiliation(s)
- Joy Y Vink
- Department of Obstetrics and Gynecology, Georgetown University Hospital, Washington, DC 20007, USA.
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Abstract
Many infants with a repaired esophageal atresia (EA) undergo fundoplication, aortopexy, or glossopexy because the mechanisms most responsible for airway obstruction and/or apparent life-threatening event (AO/ALTE) syndrome are considered to be gastroesophageal reflux (GER), tracheal compression (TC), or obstructive apnea, respectively. In the present study, we investigated whether these mechanisms are independent or interrelated. We developed a database of 120 consecutive patients with EA treated by the senior author between 1967-2002. We studied the clinical manifestations of patients with a cervical esophagostomy and/or blind lower esophageal stump, which ruled out TC and/or proximal esophageal GER as a mechanism for AO/ALTE. Of 25 neonates who underwent section/ligation of lower tracheo-esophageal fistula and/or feeding gastrostomy, 10 critically ill neonates died. Of 15 survivors, 9 infants had a feeding gastrostomy without an esophagostomy. Of these, 6 infants presented one or more episodes of AO, and 8 presented ALTE with or without AO. Subsequently, 5 of the 9 infants underwent an esophagostomy. Eventually, 11 infants had a feeding gastrostomy with an esophagostomy. Of the latter, 5 infants presented one or more episodes of AO, and 6 presented ALTE without AO. In conclusion, oral feeding, proximal esophageal GER, and TC are not essential for AO/ALTE syndrome to occur. They are probably factors which offer evidence of an underlying problem with control of upper airway patency.
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Affiliation(s)
- D A Cozzi
- Pediatric Surgery Unit, University of Rome La Sapienza, Rome, Italy
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Abstract
BACKGROUND Male fetal gender is associated with an overall increased risk of pre-eclampsia. However, it was recently shown that the male: female birth ratio was decreased in pre-eclampsia associated with preterm delivery. The reason for this discrepancy is not known. OBJECTIVE To investigate whether the fetal and newborn gender is associated with the incidence of antenatal maternal pregnancy complications, and to investigate if gender-associated risk changes with gestational age at delivery. METHODS Population-based study including 1,158,276 infants born in Sweden 1990-2001. Five maternal diagnosis groups (pre-eclampsia, infection, preterm premature rupture of membranes, abruptio placentae, and polyhydramnios) were explored in relation to newborn infant gender and gestational age at delivery. RESULTS When all gestational ages were evaluated, male newborn gender was associated with increased odds ratios for all five diagnosis groups, and for preterm birth before 37 weeks gestation, M/F ratio 1.17. In very preterm births (gestational age below 32 weeks), male newborn gender was associated with a significantly lower risk for pre-eclampsia (OR 0.88, 95%CI 0.80-0.97), and a marginally lower risk for polyhydramnios (OR 0.74, 95%CI 0.54-1.01). CONCLUSION The fetal gender seems to affect the occurrence of pre-eclampsia, and possibly also polyhydramnios. The finding could be due to an increased risk for spontaneous abortions in pregnancies with male fetuses, but could also be associated with the etiology of these conditions. Evaluation of antenatal pregnancy complications from a fetal/newborn gender perspective may contribute to new insights regarding their pathophysiological mechanisms.
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Affiliation(s)
- Emma Elsmén
- Department of Pediatrics, Lund University Hospital, Lund, Sweden.
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Abstract
OBJECTIVE Ultrasound estimation of amniotic fluid volume (AFI) is a critical component of antenatal surveillance. Alterations in AFI have classically been considered an indication of fetal compromise, but recent studies have called this into question. The present study was undertaken to reevaluate the relationship between AFI and perinatal outcome. STUDY DESIGN The perinatal data base of the authors' institution was queried for all patients in a 6-year period who had AFI evaluated. Two groups, 1 high-risk and 1 low-risk, were evaluated to determine the relationship between AFI and gestational age. An additional high-risk group that had AFI determined within 48 hours of delivery was also used to correlate AFI with intrapartum and perinatal outcomes. Statistical analysis was performed using linear regression analysis to evaluate the correlation between AFI and gestational age or birth weight. Additional correlations were done using analysis of variance, chi-square, Fisher exact test, or Student t test. Interaction between variables was analyses using logistic regression analysis. RESULTS Fourteen thousand seven hundred forty-seven AFI determinations in 4337 high-risk patients, and 1153 AFI determinations in 1153 low-risk patients were evaluated. There were no clinically significant correlations between AFI and gestational age. In the second high-risk group of 454 patients there was a significant correlation between polyhydramnios and large-for-gestational age infants, congenital anomalies, and an increase in cesarean section for delivery. There was an increased risk of nonreassuring fetal heart rate patterns during labor for the oligohydramnios patient, but only in preterm patients. There was no strong relationship between AFI and neonatal complications or length of stay in the neonatal intensive care unit. Logistic regression confirmed that AFI was not significantly correlated with perinatal outcome. CONCLUSION The present study suggests that AFI is a weaker predictor of perinatal outcome than has been classically suggested. Although the AFI identification of polyhydramnios was helpful in identifying LGA fetuses and fetuses at risk for congenital abnormalities, oligohydramnios was a rather weak predictor of poor perinatal outcome.
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Affiliation(s)
- William J Ott
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, St John's Mercy Medical Center, St Louis, MO, USA.
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Abstract
Amniotic fluid (AF) is a complex substance essential to fetal well-being. This article reviews recent discoveries and the current understanding of the origin and circulation of AF and its nutritive, protective, and diagnostic functions. Future directions for AF research are also discussed.
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Affiliation(s)
- Mark A Underwood
- Department of Pediatrics, University of California, Davis School of Medicine, Davis, CA 95616, USA
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Dafallah SE, Babikir HE. Risk factors predisposing to abruptio placentae. Maternal and fetal outcome. Saudi Med J 2004; 25:1237-40. [PMID: 15448774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE Abruptio placentae is one of the leading causes of perinatal deaths. Abruptio placentae increase the neonatal morbidity and mortality. It is one of the recognized causes of low birth weight. The purpose of this study was to examine the risk factors for abruptio placentae together with the maternal and fetal outcome in a large population based data set. METHODS All cases of abruptio placentae presented to the Department of Obstetrics, Wad Medani Teaching Hospital, Sudan during the period January 1997 through to December 2002 were collected. All infants born to those cases were also collected and analyzed as live birth or stillbirth. The live born infants were followed for one month to detect the neonatal deaths. The study also aimed to determine the predisposing factors for abruptio placentae. The study was designed as a case control study from live, singleton births and singleton fetal death. RESULTS The total number of abruptio placentae collected during this period was 1028, while the total number of births during the same period was 15620 giving and incidence of 1028/15620 (6.5%) for abruptio placentae. The combined stillbirths and first month deaths were 20.2%. Abruptio placentae was associated with pre-eclampsia, diabetes, polyhydramnios and hypertension. Parity and maternal age were not associated with an increased incidence of abruption placentae. CONCLUSION This study had the advantage of complete ascertainment of all reported cases of abruptio placentae during a period of 6-years. We found an increased risk for abruptio placentae associated with maternal diabetes, hypertension, pre-eclampsia and polyhydramnios. We found that infants born after abruptio placentae were small for gestational age and had lower Apgar scores than the control infants. The possibility of abruptio placentae should be considered by the clinician when managing pregnant women with any of those characteristics. Abruptio placentae should be managed in centers were there is advanced maternal and neonatal facilities.
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Erez O, Shoham-Vardi I, Sheiner E, Dukler D, Bashiri A, Mazor M. Hydramnios and small for gestational age are independent risk factors for neonatal mortality and maternal morbidity. Arch Gynecol Obstet 2004; 271:296-301. [PMID: 15243757 DOI: 10.1007/s00404-004-0656-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2003] [Accepted: 05/15/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective was to evaluate the contribution of hydramnios and small for gestational age (SGA) as a combined pathology to maternal and neonatal morbidity and mortality. METHODS The study population consisted of 192 SGA neonates with hydramnios, 5,515 SGA neonates with a normal amount of amniotic fluids, 3,714 appropriate for gestational age (AGA) neonates with polyhydramnios and 83,763 AGA neonates with a normal amount of amniotic fluid. A cross-sectional population based study was designed between the four study groups. Multiple logistic regression analysis was used to assess the contribution of these abnormalities and different risk factors to maternal and perinatal complications. RESULTS The combination of hydramnios/SGA was found to be an independent risk factor for perinatal mortality (OR 20.55; CI 12.6-33.4). Congenital anomalies, prolapse of cord, hydramnios, SGA and grand multiparity were also independent risk factors for perinatal mortality. Independent risk factors for neonatal complications were prolapse of umbilical cord (OR 4.13; 95% CI 1.48-11.5), hydramnios/SGA (OR 2.72; 95% CI 1.81-4.07), chronic hypertension (OR 2.45; 95% CI 1.02-5.9), congenital malformations (OR 1.93; 95% CI 1.14-3.24) and SGA (OR 1.47; 95% CI 1.07-2). Significant independent risk factors for medical interventions during labor were fetal distress (OR 198.46; 95% CI 47.27-825.27), GDM Class B-R (OR 21.22; 95% CI 2.34-192.25), GDM class A (OR 4.64; 95% CI 2.62-8.21), severe pregnancy-induced hypertension (PIH; OR 7.74; 95% CI 2.35-25.42), hydramnios (OR 1.95; 95% CI 1.3-2.91), hydramnios/SGA (OR 1.84; 95% CI 1.12-3.02) and malpresentation (OR 1.56; 95% CI 1.32-1.84). CONCLUSION The combination of hydramnios and SGA is an independent risk factor for perinatal mortality and maternal complications. We suggest that the growth restriction of these fetuses is responsible for the neonatal complications, while the hydramnios contributes mainly to maternal complications.
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Affiliation(s)
- Offer Erez
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Deurloo JA, Smit BJ, Ekkelkamp S, Aronson DC. Oesophageal atresia in premature infants: an analysis of morbidity and mortality over a period of 20 years. Acta Paediatr 2004; 93:394-9. [PMID: 15124846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM To determine the morbidity and mortality of premature infants born with oesophageal atresia (OA) and to evaluate historical changes in morbidity and mortality over time. METHODS Retrospective analysis of morbidity and mortality of all patients admitted for OA, with or without tracheo-oesophageal fistula, between 1982 and 2002. RESULTS The study group consisted of 197 consecutive patients, of whom 55 (28%) were premature and 21 (11%) very premature. Type A atresia was found more often in very premature and premature infants than in those born at term (p = 0.02). Type E atresia was not found in the premature group (p = 0.004). At least one associated congenital anomaly was also present in 121 patients (61%). Postoperative complications developed more often in very premature and premature infants than in those born at term (p < 0.001). Gastro-oesophageal reflux was diagnosed in 32/76 premature infants and in 41/121 term infants (p = 0.001). Mortality among very premature and premature infants was higher than among those born at term (p = 0.003). Withdrawal of treatment was the most frequent cause of death. CONCLUSION Premature infants with OA have a higher morbidity and mortality than term infants with OA. The complications of prematurity contribute significantly to morbidity and mortality in premature infants with OA. There is no reason to refrain from the standard treatment of OA in premature infants with no severe associated congenital anomalies.
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Affiliation(s)
- J A Deurloo
- Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC/Vrije University Medical Centre, Amsterdam, The Netherlands
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Nobile de Santis MS, Radaelli T, Taricco E, Bertini S, Cetin I. Excess of amniotic fluid: pathophysiology, correlated diseases and clinical management. Acta Biomed 2004; 75 Suppl 1:53-5. [PMID: 15301291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The evaluation of amniotic fluid volume represents, together with the evaluation of fetal growth, one of the most important indicators of fetal wellbeing. Amniotic fluid is produced by fetal urines with small aliquots from fetal membranes and lung fluids. The main determinant of its turnover is fetal swallowing together with a small absorption through fetal skin and membranes. The pathologic conditions that lead to an excess of amniotic fluid are represented by excessive production or by a reduction of the physiologic turnover. The most frequent cause is gestational diabetes. This complication can be diagnosed in 2-3% of pregnancies, as a result of increased insulin resistance, most frequently found in association with risk factors such as high maternal BMI. Placental hormones, such as HPL, act indeed to increase insulin resistance and can therefore lead to post-prandial hyperglycemia in predisposed mothers. Maternal hyperglicemia leads in turn to fetal hyperglycemia and fetal hyperinsulinemia. Increased amniotic fluid volume is not a constant feature, being associated with the most severe cases, but its evaluation is very useful in the clinical management. The resulting increase in uterine volume, also related to accelerated fetal growth, is a potential cause of premature delivery, a severe complication also considering the delay in fetal lung maturation observed with fetal hyperinsulinemia. The evaluation of the degree of polyhydramnios has to be pursued by ultrasound. Precise diagnostic steps must be followed in order to rule out other potentially associated causes. Amongst these, malformations of the intestinal tract, such as hesophageal atresia, that are associated with decreased or absent fetal swallowing, must be considered. The clinical workout must therefore include an ultrasound evaluation of fetal morphology together with an oral glucose tolerance test. The therapeutic approach will be defined according to the definition of the underlying cause. Many cases will benefit from bedrest, tocolysis and induction of lung maturation.
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Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Early diagnosis of gestational diabetes mellitus and prevention of diabetes-related complications. Eur J Obstet Gynecol Reprod Biol 2003; 109:41-4. [PMID: 12818441 DOI: 10.1016/s0301-2115(02)00480-3] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE [corrected] To test the hypothesis that an early diagnosis of gestational diabetes mellitus (GDM) could avoid some diabetes-related complications. STUDY DESIGN We compared the rates of pregnancy complications commonly related to diabetes between 189 (later screening group) and 235 (earlier screening group) women with GDM diagnosed before and after adding an universal glucose tolerance screening performed in the first antenatal visit to the traditional screening performed at 24-28 weeks of gestation. RESULTS Women in the later screening group were likely to have hydramnios (12.7 versus 2.1%, P<0.0001) and preterm deliveries (11.8 versus 5.5%; P=0.03). All cases of preterm premature rupture of membranes and fetal anomalies took place in the later screening group (P=0.03, P=0.007, respectively). Statistical analysis was performed using the Student's t-test, Mann-Whitney's U-test, Fisher's exact test and chi2-test. Statistical significance was set at 95% level (P<0.05). CONCLUSIONS Early glucose tolerance screening could avoid some diabetes-related complications in women with gestational diabetes. However, further studies are needed to know if it should be done in all pregnant women or only in those with a high risk of developing diabetes.
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Affiliation(s)
- Jose L Bartha
- Department of Obstetrics and Gynaecology, University Hospital of Puerto Real, Carretera Nacional IV, KM 665, 11150 Puerto Real, Cádiz, Spain.
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Abstract
OBJECTIVE To characterize the prevalence and ultrasound detection of fetal anomalies in pregnancies with hydramnios, and to estimate anomaly and aneuploidy risks when no sonographic abnormality is noted. METHODS This was a retrospective cohort study of singleton pregnancies with hydramnios. Hydramnios was categorized as mild, moderate, or severe based on greatest amniotic fluid index of 25.0-29.9 cm, 30.0-34.9 cm, or 35.0 cm or more, respectively. Antenatal anomaly detection was compared with assessment in the immediate neonatal period. Aneuploidy and fetal deaths were analyzed separately. RESULTS Hydramnios was diagnosed in 672 pregnancies, and 77 (11%) of neonates had one or more anomalies. Though more severe hydramnios was associated with higher likelihood of anomaly (P <.001), sonographic anomaly detection (79%) did not differ according to degree of hydramnios (P =.4). Of anomalies which eluded sonographic diagnosis, cardiac septal defects, cleft palate, imperforate anus, and tracheoesophageal fistula were the most frequent. If sonographic evaluation was normal, the risk of a major anomaly was 1% with mild hydramnios, 2% with moderate hydramnios, and 11% with severe hydramnios (P <.001). Aneuploidy was present in 10% of fetuses with sonographic anomalies and 1% without apparent sonographic anomalies. The fetal death rate was 4% in the setting of hydramnios; 60% of these cases had anomalies. CONCLUSION The anomaly detection rate in pregnancies with hydramnios was nearly 80%, irrespective of the degree of amniotic fluid increase. Residual anomaly risk after normal sonographic evaluation was 2% or less if hydramnios was mild or moderate and 11% if severe.
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Affiliation(s)
- Jodi S Dashe
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, USA.
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Stoll C, Alembik Y, Dott B, Roth MP. Risk factors in congenital abdominal wall defects (omphalocele and gastroschisi): a study in a series of 265,858 consecutive births. Ann Genet 2001; 44:201-8. [PMID: 11755106 DOI: 10.1016/s0003-3995(01)01094-2] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to describe the prevalence at birth of two abdominal wall defects (AWD), omphalocela and gastroschisis and to identify possible etiologic factors. The AWD came from 265,858 consecutive births of known ouome registered in the registry of congenital malformations of Strasbourg for the period 1979 to 1998. Request information on the child, the pregnancy, the parents and the family was obtained for cases and for controls. Hundred five cases with AWD were analysed, 55.2 % were omphalocele and 44.8 % were gastroschisis. The mean prevalence rate for omphalocele was 2.18 per 10,000 and for gastroschisis 1.76 per 10,000. Associated malformations were found in 74.1 % of omphalocele compared with 53.2 % of gastroschisis; 29.3 % of fetuses with omphalocele had an abnormal karyotype, 44,8 % had a recognizable syndrome, association or an unspecified malformation pattern; 51.0 % of fetuses with gastroschisis had additional malformations that were not of chromosomal origin, but 1 case. Antenatal ultrasound examination was able to detect 39 (67.2 %) cases of omphaloceles and 27 (57.4 %) cases of gastroschisis. In 30 (51.7 %) cases of omphalocele and in 7 (14.9 %) cases of gastroschisis parents opted for termination of pregnancy. The overall survival rate was 14 (24.1 %) for omphalocele and 30 (63.8 %) for gastroschisis. Weight, length and head circumference at birth of infants with AWD were less than those of controls. The weight of placenta of infants with AWD was not different from the weight of placenta of controls. Gastroschisis was associated with significantly younger maternal age than omphalocele. Pregnancies with AWD were more often complicated by threatened abortion, oligohydramnios and polyhydramnios. Mothers of children with AWD took more often medication during pregnancy than mothers of controls.
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Affiliation(s)
- C Stoll
- Service de génétique médicale, centre hospitalo-universitaire, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France.
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Magann EF, Sanderson M, Martin JN, Chauhan S. The amniotic fluid index, single deepest pocket, and two-diameter pocket in normal human pregnancy. Am J Obstet Gynecol 2000; 182:1581-8. [PMID: 10871481 DOI: 10.1067/mob.2000.107325] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to determine normative values for amniotic fluid index, single deepest pocket, and 2-diameter pocket across gestation. STUDY DESIGN Fifty patients with normal pregnancies at each gestational age between 14 and 41 weeks' gestation were recruited prospectively and scanned once. Data were transformed into logarithmic (base 10) values for analysis. Polynomial regression equations were used to predict the normal values for amniotic fluid index, single deepest pocket, and 2-diameter pocket across gestational age and to predict the weekly percentage changes. RESULTS The mean amniotic fluid index, single deepest pocket, and 2-diameter pocket values were significantly lower among patients at <37 weeks' gestation (n = 1150) than among those at > or =37 weeks' gestation (n = 250; P <.001 for all comparisons). The calculated prevalences of oligohydramnios (amniotic fluid index < or =5 cm, single deepest pocket <2 cm, or 2-diameter pocket <15 cm(2)) were significantly different (P <.0001) for the three techniques (8%, 1%, and 30%, respectively). Hydramnios (amniotic fluid index >24 cm, single deepest pocket >8 cm, or 2-diameter pocket >50 cm(2)) was also diagnosed with significantly different (P <.0001) frequencies (0%, 0.7%, and 3%, respectively). CONCLUSIONS This is the largest prospective study to date to provide normative data for each of three ultrasonographic techniques used to assess amniotic fluid volume. The single deepest pocket appears to be the preferable method, because its use is least likely to lead to the false-positive diagnosis of either oligohydramnios or hydramnios.
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Affiliation(s)
- E F Magann
- Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, USA
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