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Dai QH, Zhang L, Chen AE. Prognostic and reproductive outcomes in women who had uterine myomas removed during cesarean section and sutured using different techniques. BMC Womens Health 2024; 24:7. [PMID: 38166995 PMCID: PMC10763254 DOI: 10.1186/s12905-023-02852-9] [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: 08/30/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND In this study, the prognostic and reproductive outcomes of women who underwent excision of uterine myomas and were sutured using different techniques while undergoing a cesarean section were investigated. METHODS A total of 299 females who underwent cesarean section between January 2015 and June 2022 due to a scarred uterus were enrolled in this study. These participants were segregated into two categories: the experimental group (comprising 155 cases) in which uterine myoma (single lesion) was excised during the cesarean procedure, and the control group (consisting of 144 cases) in which only the cesarean section was conducted. A comparison between the two groups was carried out based on the following parameters: volume of intraoperative bleeding (mL), additional measures taken for intraoperative hemostasis (n, %), percentage (%) of patients experiencing postoperative fever, duration required for the passage of gas (hours [h]), length of hospital stay (days [d]), weight of newborns (kg) and their Apgar scores, and the reproductive outcomes of the experimental group assessed two years after the surgical procedure. RESULTS In the experimental group, the amount of bleeding during surgery, occurrence of postoperative fever among women, time taken for patients to resume passing gas, and length of hospital stay were 540.65 ± 269.12 mL, 9.03%, 15.99 ± 4.68 h, and 5.08 ± 1.18 days, respectively. In contrast, the control group had values of 409.03 ± 93.24 mL, 2.77%, 16.24 ± 4.92, and 4.47 ± 0.70 days, respectively (P < 0.05). No notable increase was observed in the need for additional intraoperative hemostasis measures, and there was no significant difference in the time it took for patients to pass gas after the surgery. All newborns had positive health status. In the experimental group, 25 patients underwent subsequent pregnancies, and 15 of them successfully reached full-term deliveries, all of which had positive outcomes. CONCLUSION Combining myomectomy with various suture methods during cesarean delivery did not cause excessive bleeding and resulted in healthy newborns. This approach offers the advantage of avoiding additional surgeries under anesthesia and can be considered a viable option. Subsequent pregnancies after myomectomy were considered high-risk.
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Affiliation(s)
- Qiao-Hong Dai
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China
| | - Lu Zhang
- Department of Internal Medicine, Ningbo Urology & Nephrology Hospital, Ningbo, 315000, China
| | - An-Er Chen
- Department of Gynecology and Obstetrics, Ningbo Women and Children's Hospital, 339 Liuting Street, Haishu District, Ningbo, Zhejiang, 315000, China.
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Tolcha FD, Dale TB, Anbessie TT. Chronic uterine inversion presenting with severe anemia 7 years after a home delivery and the subsequent successful pregnancy: a case report. J Med Case Rep 2023; 17:278. [PMID: 37400885 DOI: 10.1186/s13256-023-04012-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/26/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Uterine inversion is a clinical condition characterized by the folding of the uterine fundus into the uterine cavity or beyond the cervix. Chronic uterine inversions that manifest seven years after delivery are extremely rare, despite the fact that both acute and chronic uterine inversions are infrequent. Unlike uterine inversion during parturition, which can be promptly managed, chronic uterine inversion poses a diagnostic and management challenge. We, herein, report a patient who was managed and followed at our institution for chronic uterine inversion. CASE PRESENTATION A 28-year-old African female who was referred to our institution with complaints of secondary infertility for seven years, abnormal vaginal bleeding, and lower abdominal pain for 12 months with a mass-like sensation in the vagina. At presentation, she had pale conjunctiva and a protruded, rubbery mass in the cervix with indistinguishable cervical OS on vaginal examination. The patient was resuscitated with intravenous fluids and three units of blood, after which Haultain's procedure was performed. After 16 months on a contraceptive, she was able to conceive and deliver a healthy neonate. CONCLUSION Severe anemia can rarely be a presenting symptom of chronic uterine inversion. Following a surgical procedure for chronic uterus inversion, a successful delivery is possible if thorough follow-up is carried out.
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Affiliation(s)
- Fekata Defere Tolcha
- Madda Walabu University, Goba Referral Hospital, School of Medicine, Goba, Oromia, Ethiopia.
| | - Tufa Bube Dale
- Department of Obstetrics and Gynecology, Madda Walabu University, Goba Referral Hospital, Goba, Oromia, Ethiopia
| | - Tilahun Tufa Anbessie
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, Goba, Oromia, Ethiopia
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Niela-Vilen H, Ekholm E, Sarhaddi F, Azimi I, Rahmani AM, Liljeberg P, Pasanen M, Axelin A. Comparing prenatal and postpartum stress among women with previous adverse pregnancy outcomes and normal obstetric histories: A longitudinal cohort study. Sex Reprod Healthc 2023; 35:100820. [PMID: 36774741 DOI: 10.1016/j.srhc.2023.100820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/24/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The aim of this study was to compare subjectively and objectively measured stress during pregnancy and the three months postpartum in women with previous adverse pregnancy outcomes and women with normal obstetric histories. METHODS We recruited two cohorts in southwestern Finland for this longitudinal study: (1) pregnant women (n = 32) with histories of preterm births or late miscarriages January-December 2019 and (2) pregnant women (n = 30) with histories of full-term births October 2019-March 2020. We continuously measured heart rate variability (HRV) using a smartwatch from 12 to 15 weeks of pregnancy until three months postpartum, and subjective stress was assessed with a smartphone application. RESULTS We recruited the women in both cohorts at a median of 14.2 weeks of pregnancy. The women with previous adverse pregnancy outcomes delivered earlier and more often through Caesarean section compared with the women with normal obstetric histories. We found differences in subjective stress between the cohorts in pregnancy weeks 29 and 34. The cohort of women with previous adverse pregnancy outcomes had a higher root mean square of successive differences between normal heartbeats (RMSSD), a well-known HRV parameter, compared with the other cohort in pregnancy weeks 26 (64.9 vs 55.0, p = 0.04) and 32 (63.0 vs 52.3, p = 0.04). Subjective stress did not correlate with HRV parameters. CONCLUSIONS Women with previous adverse pregnancy outcomes do not suffer from stress in subsequent pregnancies more than women with normal obstetric histories. Healthcare professionals need to be aware that interindividual variation in stress during pregnancy is considerable.
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Mainali A, Infanti JJ, Thapa SB, Jacobsen GW, Larose TL. Anxiety and depression in pregnant women who have experienced a previous perinatal loss: a case-cohort study from Scandinavia. BMC Pregnancy Childbirth 2023; 23:111. [PMID: 36782148 PMCID: PMC9923894 DOI: 10.1186/s12884-022-05318-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/20/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Perinatal loss can have long-lasting adverse effects on a woman's psychosocial health, including during subsequent pregnancies. However, maternal mental health status after perinatal loss during subsequent pregnancy is understudied with very little data available for Scandinavian populations. AIMS The primary aim of the study was to explore the association between previous perinatal loss and anxiety/depression symptoms of expectant mothers during the subsequent pregnancy. The secondary aim of this study was to explore possible determinants of maternal mental health during the subsequent pregnancy, independent of previous perinatal loss. METHOD This case-cohort study is based on primary data from Scandinavian Successive Small-for-Gestational Age Births Study (SGA Study) in Norway and Sweden. The total case-cohort sample in the current study includes 1458 women. Cases include 401 women who had reported a previous perinatal loss (spontaneous abortion, stillbirth, or neonatal death) and who responded to two mental health assessment instruments, the State-Trait Anxiety Inventory (STAI), and the Centre for Epidemiological Studies Depression (CES-D) scale. Multiple linear regression models were used to assess the association between previous perinatal loss and maternal mental health in subsequent pregnancy. RESULTS Scandinavian pregnant women with previous perinatal loss reported higher symptoms for both anxiety and depression during their subsequent pregnancy compared to mothers in the same cohort reported no previous perinatal loss. Multiple linear regression analyses showed a positive association between previous perinatal loss and per unit increase in both total anxiety score (β: 1.22, 95% CI: 0.49-1.95) and total depression score (β: 0.90, 95% CI: 0.06-1.74). We identified several factors associated with maternal mental health during pregnancy independent of perinatal loss, including unintended pregnancy despite 97% of our population being married/cohabitating. CONCLUSION Women who have experienced previous perinatal loss face a significantly higher risk of anxiety and depression symptoms in their subsequent pregnancy.
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Affiliation(s)
- Anustha Mainali
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Jennifer J. Infanti
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Suraj Bahadur Thapa
- grid.5510.10000 0004 1936 8921Division of Mental Health and Addiction, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir W. Jacobsen
- grid.5947.f0000 0001 1516 2393Present Address: Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tricia L. Larose
- grid.5510.10000 0004 1936 8921Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Zepf J, Vonzun L, Krähenmann F, Strübing N, Moehrlen U, Meuli M, Mazzone L, Moehrlen T, Ochsenbein-Kölble N. Subsequent Pregnancy Outcomes after Open in utero Spina Bifida Repair. Fetal Diagn Ther 2022; 49:442-450. [PMID: 36455544 DOI: 10.1159/000527813] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Fetal spina bifida (SB) repair is a distinct therapeutic option in selected cases. Since this procedure may not only be associated with short-term obstetrical complications, the aim of this study was to assess the outcomes of subsequent pregnancies after open fetal SB repair. METHODS 138 patients having had open fetal SB repair at our center received a questionnaire regarding the occurrence, course, and outcome of subsequent pregnancies. Additionally, medical records were reviewed. All subsequent pregnancies with complete outcome data that progressed beyond 20 gestational weeks (GW) were included for further analysis. RESULTS 70% of all women answered the questionnaire. Out of this cohort, 35 subsequent pregnancies were reported in 29% of women. The rate of early pregnancy loss including elective terminations was 14%. All 29 pregnancies processing >20 GW ended in live births without preterm births <34th GW. Mean gestational age at delivery was 37.3 ± 1.4 GW. Uterine rupture occurred in two cases (7%) and uterine thinning/dehiscence was present in six cases (21%). No maternal transfusions were required. CONCLUSION When counseling women undergoing open fetal SB repair, one should consider possible risks for subsequent pregnancies, especially the one of uterine dehiscence and rupture that is similar compared to numbers reported after classical cesarean deliveries.
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Affiliation(s)
- Julia Zepf
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Franziska Krähenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Nele Strübing
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Ueli Moehrlen
- University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
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Xu Z, Sheng C, Yang Q, Wang J. Analysis of pregnancy outcomes following surgical treatment of cesarean scar pregnancy. BMC Pregnancy Childbirth 2022; 22:644. [PMID: 35974321 DOI: 10.1186/s12884-022-04965-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the surgical treatment approaches for patients with Cesarean scar pregnancy (CSP) and the effects on subsequent pregnancy. Methods CSP patients admitted to Shengjing Hospital of China Medical University from January 2013 to December 2018 were retrospectively analyzed to collect their clinical characteristics, and follow-up of postoperative pregnancies. Results A total of 1126 CSP patients were enrolled in this study, including 595 (52.84%) CSP type I, 415 (36.86%) CSP type II, and 116 (10.30%) CSP type III cases. There were significant differences between the three types of patients in terms of β-HCG levels, gestational sac diameter, clinical symptoms and presence of fetal heartbeat at diagnosis (P < 0.01). Among these, 89.90% of CSP type I, 88.90% of CSP type II and 50% of CSP type III patients were treated with hysteroscopic lesion excision, 7.9% of CSP type I and 2.2% of CSP type II patients underwent ultrasound-monitored curettage, and the remaining patients underwent lesion excision and and simultaneous repair of excised lesions by different routes (trans-laparoscopic, transabdominal or transvaginal methods). And 5.55% of CSP type I, 22.65% of CSP type II and 43.10% of CSP type III patients were treated with adjunctive uterine artery embolization (UAE). The patients were followed up for more than 2 years after surgery. Among the 166 re-pregnancies, 58 (34.94%) were normal pregnancies, 17 patients reoccurred with CSP, the recurrent rate of CSP was 10.24%. All 58 normal pregnancies were terminated by cesarean section, with a mean gestational week of delivery of (38.36 ± 2.25) weeks, a mean birth weight of (3228.45 ± 301.96)g, and the postnatal Apgar score was (9.86 ± 0.23) points at 1 min and all 5 min were 10 points. Logistic regression analysis suggested that the number of previous cesarean deliveries was a risk factor for recurrent CSP (RCSP) (OR = 10.82, 95% CI: 2.52–46.50, P = 0.001). Conclusions The type of CSP is related to β-HCG values, presence of fetal heartbeat, gestational sac diameter and clinical symptoms. Hysteroscopic therapy is a commonly used surgical procedure and UAE is often used as an adjuvant treatment. For subsequent pregnancies, the number of previous cesarean deliveries is a risk factor for recurrent CSP.
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Jha N, Madhuri MS, Jha AK, Kubera NS. Subsequent Pregnancy Outcome in Women with Prior Complete Uterine Rupture: A Single Tertiary Care Centre Experience. Reprod Sci 2022; 29:1506-1512. [PMID: 35246823 DOI: 10.1007/s43032-022-00906-1] [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: 07/26/2021] [Accepted: 02/25/2022] [Indexed: 11/28/2022]
Abstract
Limited data is available to assess the burden of maternal morbidity, mortality, and perinatal outcome after subsequent pregnancy in women with prior uterine rupture. Therefore, this retrospective descriptive study was conducted to determine subsequent pregnancy outcomes in a larger series of women with prior complete uterine rupture. All pregnant women who had complete uterine rupture were managed according to the standard Institute protocol. The women who conceived following a uterine repair from July 2011 to June 2020 were recruited into the study. Outcome measures included severe maternal morbidities and perinatal outcomes. Fifty-three women with prior complete uterine rupture were conceived subsequently. Two women had an abortion in the first and second trimester, respectively. None of the women developed recurrence of uterine rupture. However, three women developed uterine dehiscence in a total of 16 women who went into spontaneous labour before elective cesarean delivery at 32, 36, and 37 weeks, respectively. None of the women had placenta previa, placenta accreta, bowel injury, bladder injury and none required a hysterectomy. However, 16.7% of women needed a blood transfusion. None of the women required mechanical ventilation, inotropic support, and intensive care unit stay. Seventeen babies required neonatal intensive care admission, and prematurity (90%) was the most common reason, followed by low APGAR scores. In conclusion, subsequent pregnancy outcomes in women with prior uterine rupture appear acceptable in institutionalized care. Timing of cesarean delivery may have to be weighed against the risk of prematurity-associated neonatal morbidity and mortality.
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Affiliation(s)
- Nivedita Jha
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - M S Madhuri
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Ajay Kumar Jha
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - N S Kubera
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Berengere BM, Jessica S, Diane DW, Marie-Emmanuelle M, Marie-José S, Lisa O, Grosmaitre C, Laurent J S, Bernard G, Ville Y, Sylvain M. Prenatal attachment, anxiety and grief during subsequent pregnancy after medical termination of pregnancy. Attachment to which child? J Gynecol Obstet Hum Reprod 2022; 51:102353. [PMID: 35247609 DOI: 10.1016/j.jogoh.2022.102353] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/17/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate emotional distress and prenatal attachment throughout a subsequent pregnancy after Termination of Pregnancy (TOP) for fetal abnormality. METHODS Observational study, in a French Tertiary Maternity. POPULATION 25 women in a subsequent pregnancy after a medical termination of pregnancy for foetal abnormality, 18-year-old and older. Prenatal Interviews at 20 Gestationnal weeks (GW), 27 GW and 35 GW and Postnatal at 3 months and at each time self-administered questionnaires of anxiety, post-traumatic stress syndrome (PCLS) depressive symptoms (EPDS), prenatal attachment (PAI) and Perinatal Grief Scale (PGS). RESULTS Pregnancy onset, i.e. before 20 GW, showed increased prevalence of anxiety (16/23, 66.7%), depression (7/23, 30.4%) and post-traumatic stress symptoms (4/16, 25%). Total score on PGS is higher in onset of pregnancy than in the third trimester (p=0.005). Prenatal attachment was lower during early pregnancy (p = 0.003) and correlated inversely with grief intensity (p = 0.022). During late pregnancy, emotional symptoms decrease, and prenatal attachment stopped increase positively, specifically among women whose foetal abnormality in previous pregnancies were diagnosed late, at an average of 25 GW. CONCLUSION This research shows the specific dynamics of pregnancies following TOP and highlights the necessity for early prenatal psychological support. One should also pay special attention to prenatal attachment during late pregnancy even after knowing that the fetus is healthy.
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Affiliation(s)
- Beauquier-Maccotta Berengere
- Child Psychiatry Department, Perinatal unit, Necker Enfant Malades Hospital, Paris France; Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University.
| | - Shulz Jessica
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; EPS Ville-Evrard, Infant psychiatry 93i05, 202, avenue Jean Jaurès, 93330 Neuilly-sur-Marne
| | - De Wailly Diane
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University; Maternity and foetal medicine department Necker Enfant Malades Hospital France
| | | | | | - Ouss Lisa
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Catherine Grosmaitre
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Salomon Laurent J
- Child Psychiatry Department, Necker Enfant Malades Hospital, APHP Paris France. Université de Paris
| | - Golse Bernard
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
| | - Yves Ville
- Maternity and foetal medicine department, Necker Enfant Malades Hospital, Paris France. EA 7328, Université de Paris
| | - Missonnier Sylvain
- Laboratoire de Psychologie Clinique, Psychopathologie, Psychanalyse (PCPP, EA 4056), Paris Descartes University
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Nijkamp JW, Ravelli ACJ, Groen H, Erwich JJHM, Mol BWJ. Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study. BMC Pregnancy Childbirth 2022; 22:11. [PMID: 34983439 PMCID: PMC8725424 DOI: 10.1186/s12884-021-04355-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A history of stillbirth is a risk factor for recurrent fetal death in a subsequent pregnancy. Reported risks of recurrent fetal death are often not stratified by gestational age. In subsequent pregnancies increased rates of medical interventions are reported without evidence of perinatal benefit. The aim of this study was to estimate gestational-age specific risks of recurrent stillbirth and to evaluate the effect of obstetrical management on perinatal outcome after previous stillbirth. METHODS A retrospective cohort study in the Netherlands was designed that included 252.827 women with two consecutive singleton pregnancies (1st and 2nd delivery) between 1999 and 2007. Data was obtained from the national Perinatal Registry and analyzed for pregnancy outcomes. Fetal deaths associated with a congenital anomaly were excluded. The primary outcome was the occurrence of stillbirth in the second pregnancy stratified by gestational age. Secondary outcome was the influence of obstetrical management on perinatal outcome in a subsequent pregnancy. RESULTS Of 252.827 first pregnancies, 2.058 pregnancies ended in a stillbirth (8.1 per 1000). After adjusting for confounding factors, women with a prior stillbirth have a two-fold higher risk of recurrence (aOR 1.96, 95% CI 1.07-3.60) compared to women with a live birth in their first pregnancy. The highest risk of recurrence occurred in the group of women with a stillbirth in early gestation between 22 and 28 weeks of gestation (a OR 2.25, 95% CI 0.62-8.15), while after 32 weeks the risk decreased. The risk of neonatal death after 34 weeks of gestation is higher in women with a history of stillbirth (aOR 6.48, 95% CI 2.61-16.1) and the risk of neonatal death increases with expectant obstetric management (aOR 10.0, 95% CI 2.43-41.1). CONCLUSIONS A history of stillbirth remains an important risk for recurrent stillbirth especially in early gestation (22-28 weeks). Women with a previous stillbirth should be counselled for elective induction in the subsequent pregnancy at 37-38 weeks of gestation to decrease the risk of perinatal death.
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Affiliation(s)
- Janna W Nijkamp
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Anita C J Ravelli
- Department of Medical Informatics, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jan Jaap H M Erwich
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Ben Willem J Mol
- Department of Obstetrics and Gynecology, Monash University, Monash Medical Center, Clayton, Australia
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10
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Kennedy R, Roberts L, Davis G, Mangos G, Pettit F, Brown MA, O'Sullivan AJ, Henry A. The P4 study: Subsequent pregnancy maternal physiology after hypertensive and normotensive pregnancies. Pregnancy Hypertens 2021; 27:29-34. [PMID: 34864294 DOI: 10.1016/j.preghy.2021.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy are associated with subsequent increased risk of cardiometabolic disease. Adverse cardiometabolic measures are noted soon after hypertensive versus normotensive pregnancy (NP); to what degree these persist into a subsequent pregnancy (SP) is unknown. This study aimed to assess women's physiology early in SP after hypertensive pregnancy (HP: preeclampsia or gestational hypertension) or NP and compare SP to 6 months postpartum findings from the index pregnancy. STUDY DESIGN Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatric) observational cohort. Measurements six months after NP versus HP, and the SP at 11-13 weeks gestation. MAIN OUTCOME MEASURES Blood pressure (BP), blood and urine tests (urine ACR, HOMA-IR, LDL cholesterol), body composition, and contribution of maternal characteristics and inter-pregnancy factors to BP and body fat (FM%) in SP. RESULTS 49 women (34 NP, 15 HP). In the SP, post-HP women had higher BP (112/70 mmHg HP vs 102/64 mmHg NP; p < .001), with no significant drop from six months postpartum to early SP. On regression analysis, systolic and diastolic BP at 6-months were the major predictors for SP systolic (p < 0.001) and diastolic (p = 0.009) BP respectively in the SP. Longer interpregnancy interval and increased FM% 6-months postpartum were associated with higher SP FM% (p < 0.001). CONCLUSIONS BP and body fat six months postpartum were similar early in the SP for HP group, and postpartum BP and FM% were major predictors of their corresponding SP measurements. Postpartum/inter-pregnancy intervention programs to improve these cardiometabolic risk markers might help improve women's long-term health and require investigation.
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Affiliation(s)
- R Kennedy
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia.
| | - L Roberts
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Davis
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Mangos
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - F Pettit
- Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - M A Brown
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - A J O'Sullivan
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Endocrinology, St George Hospital, Sydney, Australia
| | - A Henry
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
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11
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Roitman MS, Wainstock T, Sheiner E, Leibson T, Pariente G. Ectopic pregnancy: perinatal outcomes of future gestations and long-term neurological morbidity of the offspring. Arch Gynecol Obstet 2021; 304:633-640. [PMID: 33566161 DOI: 10.1007/s00404-021-05991-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/29/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate perinatal outcomes and long-term neurological morbidity of offspring to mothers with a history of ectopic pregnancy. METHODS In this retrospective study, perinatal outcomes and long-term neurological morbidity of offspring were assessed among mothers with a history of ectopic pregnancy, either medically or surgically treated. The study groups were followed until 18 years of age for neurological-related morbidity. For perinatal outcomes, generalized estimated equation (GEE) models were used to control for confounders. A Kaplan-Meier survival curve was used to compare cumulative neurological morbidity incidence and Cox proportional hazards model was conducted to control for confounders. RESULTS A total of 243,682 mothers were included; 1424 mothers (0.58%) had a previous ectopic pregnancy, of which 25.6% (n = 365) were treated medically, and 74.3% (n = 1059) were treated surgically. Using GEE models, controlling for confounders, both surgically and medically treated ectopic pregnancies were noted as independent risk factors for preterm delivery in the subsequent pregnancies. Maternal history of surgically treated ectopic pregnancy was also independently associated with cesarean delivery. Offspring to mothers with previous ectopic pregnancy had comparable rates of long-term neurological morbidity. In the Cox proportional hazards model, controlling for confounders, being born to a mother with a history of previous ectopic pregnancy was not found to be independently associated with long-term neurological morbidity of offspring. CONCLUSIONS Maternal history of ectopic pregnancy is independently associated with preterm delivery. However, offspring of mothers with a history of ectopic pregnancy are not at an increased risk for long-term neurological morbidity.
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Affiliation(s)
- Melanie Shanie Roitman
- Faculty of Health Sciences, Joyce and Irving Goldman Medical School at Ben Gurion University of the Negev, Beer-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel.
| | - Tom Leibson
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Science, Ben-Gurion University of the Negev, POB 151, 84101, Beer-Sheva, Israel
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12
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Port Z, Ammari Z, Babapoor-Farrokhran S, Bozorgnia B. Assessing the future risks of subsequent pregnancies in peripartum cardiomyopathy. Heart Fail Rev 2021; 27:779-784. [PMID: 33433773 DOI: 10.1007/s10741-021-10075-z] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Peripartum cardiomyopathy is a myocardial disease process which occurs in young women either in late pregnancy or the early postpartum period. Due to the young age of women effected by this disease, many of these patients elect to pursue a subsequent pregnancy after their initial diagnosis. Currently, echocardiography is used to better elucidate the cardiovascular risks these young patients face when undergoing a subsequent pregnancy; however, the most accurate modality to determine these risks is debatable. In this review, we explore the current literature regarding the use and accuracy of resting transthoracic echocardiography, exercise stress echocardiography, and dobutamine stress echocardiography in risk stratification of a subsequent pregnancy in a patient with peripartum cardiomyopathy.
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Affiliation(s)
- Zachary Port
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA.
| | - Zaid Ammari
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
| | | | - Behnam Bozorgnia
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia, PA, USA
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13
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Gottardi E, Lecarpentier E, Villette C, Berman A, Redel D, Tsatsaris V, Goffinet F, Haddad B. Preeclampsia before 26 weeks of gestation: Obstetrical prognosis for the subsequent pregnancy. J Gynecol Obstet Hum Reprod 2021; 50:102000. [PMID: 33221560 DOI: 10.1016/j.jogoh.2020.102000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Gestational age at delivery seems to be a risk factor of recurrence of preeclampsia. The objective of this study was to analyze adverse pregnancy outcomes and recurrence of preeclampsia during the subsequent pregnancy in women with a history of pre-eclampsia delivered before 26 weeks of gestation. MATERIAL AND METHOD We performed a retrospective study in two French tertiary care hospitals between 2000 and 2018. Patients with a history of pre-eclampsia delivered before 26 weeks of gestation were analyzed. Information on the immediate subsequent pregnancy was collected. Adverse composite outcome was defined as recurrent preeclampsia, HELLP syndrome, placental abruption, fetal growth restriction <3rd percentile or <10e percentile with Doppler abnormalities, maternal death and fetal death. RESULTS Among the 107 patients who met the criteria, 48 were analyzed for a subsequent pregnancy. Seventeen women (35.4 %) developed an adverse composite outcome, occurring for 15 women (31.2 %) before 34 weeks. Ten women (20.8 %) developed a recurrent preeclampsia occurring for 5 women (10.4 %) before 34 weeks. We related 3 HELLP syndromes, 1 placental abruption, 9 fetal growth restrictions, 3 fetal deaths and no maternal death. Compared to baseline normotensive women, chronic hypertension was significantly associated with an increased risk of adverse composite outcome (19.3 vs 58.8 %, p-value 0.014). CONCLUSION In our population, preeclampsia with delivery before 26 weeks is associated with 35.4 % of adverse composite outcomes and 20.8 % of recurrent preeclampsia during the immediate subsequent pregnancy. These results justify the importance of an ongoing monitoring of these patients during subsequent pregnancy.
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14
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Zhang L, Bi S, Du L, Gong J, Chen J, Sun W, Shen X, Tang J, Ren L, Chai G, Wang Z, Chen D. Effect of previous placenta previa on outcome of next pregnancy: a 10-year retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:212. [PMID: 32293318 PMCID: PMC7161269 DOI: 10.1186/s12884-020-02890-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/20/2020] [Indexed: 11/14/2022] Open
Abstract
Background To determine the effects of previous placenta previa on the maternal and neonatal outcomes of the next pregnancy. Methods This 10-year retrospective cohort study was conducted in the Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, between January 2009 and 2018. We retrospectively analyzed the effects of a previous singleton pregnancy in women with and without placenta previa on the outcomes of the subsequent pregnancy. To control for confounders, we used multiple logistic regression models. Results A total of 57,251 women with singleton pregnancies gave birth during the 10-year study period. Among them, 6070 women had two consecutive births. For the first pregnancy, 1603 women delivered by cesarean delivery and 4467 by vaginal delivery. Among women with a history of cesarean delivery, placenta previa was an independent risk factor for hemorrhage (adjusted odds ratio [aOR]: 2.25, 95% confidence interval [CI]: 1.1–4.62), placenta accreta spectrum (PAS) disorders (aOR: 4.11, 95% CI: 1.68–10.06), and placenta previa (aOR: 6.24, 95% CI: 2.85–13.67) during the subsequent pregnancy. Puerperal infection, blood transfusion, and perinatal outcomes did not significantly differ between women with a history of placenta previa and women without this history. Among women with a history of vaginal delivery, placenta previa increased the risk of PAS disorders (aOR: 5.71, 95% CI: 1.81–18.03) and placenta previa (aOR: 4.14, 95% CI: 1.07–16.04) during the subsequent pregnancy. There was no significant difference between the two groups in terms of hemorrhage, blood transfusion, puerperal infection, and perinatal outcomes. Conclusions Women with a history of placenta previa are at risk for adverse outcomes such as postpartum hemorrhage, PAS disorders, and placenta previa in the subsequent pregnancy.
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Affiliation(s)
- Lizi Zhang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou, 510515, China
| | - Shilei Bi
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Lili Du
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jingjin Gong
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Jingsi Chen
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Wen Sun
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Xinyang Shen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou, 510515, China
| | - Jingman Tang
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Luwen Ren
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Guolu Chai
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China
| | - Zhijian Wang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Ave North, Guangzhou, 510515, China.
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Guangzhou Medical Centre for Critical Pregnant Women, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510150, China.
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Shim JI, Han AKW, Jeon HJ, Kim ML, Jung YW, Yun BS, Seong SJ, Shin E, Cho YJ, Rha SH. Clinical experience of uterine smooth muscle tumor of uncertain malignant potential in two gynecological centers: Oncological and obstetrical aspects. Eur J Obstet Gynecol Reprod Biol 2020; 246:7-13. [PMID: 31927240 DOI: 10.1016/j.ejogrb.2020.01.002] [Citation(s) in RCA: 8] [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: 09/25/2019] [Revised: 12/26/2019] [Accepted: 01/01/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the clinical characteristics and obstetrical and oncological outcomes of patients with uterine smooth muscle tumors of uncertain malignant potential (STUMP) and analyze the risk factors for recurrence. STUDY DESIGN A retrospective cohort study was performed at two gynecological centers using data collected between January 2008 and August 2018. All the patients enrolled were diagnosed with STUMP and had been followed up for at least 6 months. The patients' characteristics, treatment methods, recurrence rate, and subsequent pregnancy outcomes were evaluated. RESULTS The mean age of the 62 patients was 36.1 ± 9.1 years (median 35, range 20-55 years) and mean follow-up duration was 36.3 ± 26.8 months (29.5, 6-130). All the patients were of premenopausal status. Fourteen patients (22.6 %) were initially treated by hysterectomy and 48 (77.4 %) by myomectomy. During the study period, three patients (4.8 %) experienced recurrence. However, there was no statistical difference between myomectomy and hysterectomy in terms of the rate of recurrence of STUMP or sarcoma, and all patients survived even after recurrence. Multivariate analysis revealed that a history of previous myomectomy was the sole independent risk factor for recurrence (odds ratio = 51.071; 95 % confidence interval = 2.743-950.726; p = 0.008). Subsequent pregnancies were successful in 10 of 19 women (52.6 %) who tried to conceive. Two of them had ongoing pregnancies at the time of last follow-up; the remaining eight women experienced a total of 14 subsequent pregnancies. CONCLUSIONS The recurrence rate of STUMP was similar between hysterectomy and myomectomy. Therefore, fertility sparing myomectomy can be considered in women diagnosed with STUMP with close monitoring.
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Affiliation(s)
- Jung In Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Anthorny Kyung Woo Han
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Haeng Jun Jeon
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea.
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Eunah Shin
- Department of Pathology, CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Republic of Korea
| | - Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Dong-AUniversity College of Medicine, Busan, Republic of Korea
| | - Seo-Hee Rha
- Department of Pathology, Dong-A University Medical Center, Dong-A University College of Medicine, Busan, Republic of Korea
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16
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Hu HT, Xu JJ, Lin J, Li C, Wu YT, Sheng JZ, Liu XM, Huang HF. Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:273. [PMID: 29954355 PMCID: PMC6027796 DOI: 10.1186/s12884-018-1895-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/12/2018] [Indexed: 01/07/2023] Open
Abstract
Background Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non-indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.05–1.55), placenta previa (3.18, 2.15–4.71), placenta accreta (2.75, 1.75–4.31), and polyhydramnios (2.60, 1.57–4.31) in the mother and preterm delivery (1.37, 1.06–1.78), low birth weight (3.78, 2.07–6.90), macrosomia (5.04, 3.95–6.44), and neonatal jaundice (1.72, 1.39–2.14) in the baby. Conclusions CS in the first delivery markedly increases the risk of repeated CS and maternal-fetal complications in the subsequent pregnancy, especially in women with a non-indicated CS.
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Affiliation(s)
- Hong-Tao Hu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing-Jing Xu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Lin
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Cheng Li
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan-Ting Wu
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Zhong Sheng
- Department of Pathology and Pathophysiology, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xin-Mei Liu
- Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
| | - He-Feng Huang
- Department of Reproductive Medicine, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,Institute of Embryo-Fetal Original Adult Disease, Shanghai Key Laboratory for Reproductive Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. .,International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, 910 Hengshan Road, Shanghai, 200030, China.
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Yaméogo NV, Samadoulougou AK, Kagambèga LJ, Kologo KJ, Millogo GRC, Thiam A, Guenancia C, Zansonré P. Maternal and fetal prognosis of subsequent pregnancy in black African women with peripartum cardiomyopathy. BMC Cardiovasc Disord 2018; 18:119. [PMID: 29914408 PMCID: PMC6006934 DOI: 10.1186/s12872-018-0856-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/07/2018] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to describe maternal and fetal outcomes after pregnancy complicated by peripartum cardiomyopathy (PPCM). Methods We included women that had subsequent pregnancy (SSP) after PPCM and assessed maternal prognosis and pregnancy outcomes, in-hospital up to one week after discharge. Clinical and echocardiographic data were collected comparing alive and deceased women. Factors associated with pregnancy outcomes were assessed. Results Twenty-nine patients were included, with a mean age of 26.7 ± 4.6 years and a mean gravidity number of 2.3 ± 0.5 of. At the last medical control before subsequent pregnancy, there was no congestive heart failure, the mean left ventricular diastolic diameter (LVDD) was 53 ± 4 mm and the left ventricular ejection fraction (LVEF) was ≥50% in 13 cases (44.8%). Maternal outcomes were marked by 14 deaths (48.3%). Among the factors tested in univariate analysis, LVEF at admission had an excellent receiver-operating characteristic (ROC) curve to predict maternal mortality (AUC = 0.95; 95% CI 0.87–1, p < 0.001), with a cut off value of < 40% (sensitivity = 93% and specificity = 87%). Concerning fetal outcomes, baseline LVEF had the best area under the curve (AUC) to predict abortion or prematurity among all variables (AUC = 0.75; 95% CI 0.58–092, p = 0.003), with a cut-off value of < 50% (sensitivity = 79%, specificity = 67%). Conclusions SSP outcomes are still severe in our practice. Maternal mortality remains high and is linked to ventricular systolic function at admission (due to pregnancy), while fetal outcomes are linked to baseline LVEF before pregnancy.
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Affiliation(s)
| | | | | | - Koudougou Jonas Kologo
- Department of Cardiology, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso
| | | | - Anna Thiam
- Department of Cardiology, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso
| | - Charles Guenancia
- Department of Cardiology, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon CEDEX, France. .,PEC2, UFR Sciences de Santé, University Bourgogne Franche-Comté, Dijon, France.
| | - Patrice Zansonré
- Department of Cardiology, Yalgado Ouedraogo University Hospital, Ouagadougou, Burkina Faso
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18
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Jordan PA, Naidu M, Thakar R, Sultan AH. Effect of subsequent vaginal delivery on bowel symptoms and anorectal function in women who sustained a previous obstetric anal sphincter injury. Int Urogynecol J 2018; 29:1579-88. [PMID: 29600403 DOI: 10.1007/s00192-018-3601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/14/2018] [Indexed: 01/06/2023]
Abstract
Introduction and hypothesis Our primary objective was to prospectively evaluate anorectal symptoms, anal manometry and endoanal ultrasound (EAUS) in women who followed the recommended mode of subsequent delivery following index obstetric anal sphincter injuries (OASIs) using our unit’s standardised protocol. Our secondary objectives were to evaluate the role of internal anal sphincter defects and also to compare outcomes in a subgroup of symptomatic women with normal anorectal physiology. Methods This is a prospective follow-up study of pregnant women with previous OASIs who were counselled regarding subsequent mode of delivery between January 2003 and December 2014. Assessment involved the St Mark’s Incontinence Score (SMIS), anal manometry and EAUS at both antepartum and 3-month postpartum visits. Data were analysed using Wilcoxon and Mann–Whitney U tests. Results Three hundred and fifty women attended the perineal clinic over the study period, of whom 122 met the inclusion criteria (99 vaginal delivery [VD], 23 caesarean section). No significant worsening of anorectal symptoms was observed following subsequent delivery in the VD group (p = 0.896), although a reduced squeeze pressure was observed at 3 months postpartum (p < 0.001). There were no new defects on EAUS in either group. Conclusions This study showed no significant worsening of bowel symptoms and sphincter integrity apart from lower squeeze pressures at 3 months postpartum in the VD group when our standardised protocol was used to recommend subsequent mode of delivery. In the absence of a randomised study, use of this protocol can aid clinicians in their decision-making.
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Sliwa K, Petrie MC, Hilfiker-Kleiner D, Mebazaa A, Jackson A, Johnson MR, van der Meer P, Mbakwem A, Bauersachs J. Long-term prognosis, subsequent pregnancy, contraception and overall management of peripartum cardiomyopathy: practical guidance paper from the Heart Failure Association of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy. Eur J Heart Fail 2018; 20:951-962. [PMID: 29578284 DOI: 10.1002/ejhf.1178] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 02/11/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022] Open
Abstract
Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented.
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Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine & Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa.,Mary McKillop Institute, ACU, Melbourne, Australia
| | | | | | - Alexandre Mebazaa
- Hôpital Lariboisière, Université Paris Diderot, Inserm U942, Paris, France
| | | | - Mark R Johnson
- Department of Obstetrics, Imperial College School of Medicine, Chelsea and Westminster Hospital, London, UK
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Amam Mbakwem
- Department of Cardiology, Lagos University Hospital, Lagos
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Hannover, Germany
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Fortier E, Foster AM. Exploring young mothers' experiences with postpartum contraception in Ottawa: results from a multimethods qualitative study. Contraception 2018; 97:434-8. [PMID: 29326036 DOI: 10.1016/j.contraception.2017.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Postpartum contraception plays a significant role in reducing subsequent pregnancy. However, young mothers in Ottawa, the capital of Canada, face various barriers when trying to access contraception after delivery. Through this project, we aimed to explore these barriers and understand the decision-making processes of young mothers surrounding postpartum contraception. STUDY DESIGN We conducted 10 semistructured in-depth interviews with young mothers living in Ottawa who had experienced a subsequent pregnancy within 24months of their first childbirth. In addition, we interviewed 10 key informants who work with teenage mothers. We audio-recorded and transcribed all interviews and analyzed them using inductive and deductive techniques. We used ATLAS.ti software to manage our data. RESULTS Both young mothers and key informants report that teen mothers in Ottawa often do not use postpartum contraception or inconsistently use their chosen contraceptive method. Many factors, including cost, personal beliefs, personal priorities and knowledge, influence young mothers' decision making surrounding contraception. CONCLUSIONS Our study suggests that when young mothers do not use postpartum contraception, the reasons are complex; for some, this is a choice, and for others, this is the result of systems-level, service delivery and information barriers. Supporting policies to ensure that a full range of contraceptive methods are available and affordable and developing educational programs in Ottawa that are sex-positive and nonjudgmental appear warranted. IMPLICATIONS Ensuring that a full method mix, including contraceptive implants, is available to and affordable for young mothers in Ottawa could meet significant needs. Addressing existing systems-level, service delivery and information barriers through supporting evidence-based policies and sex-positive and nonjudgmental educational programs appears warranted.
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Hunter A, Tussis L, MacBeth A. The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis. J Affect Disord 2017; 223:153-164. [PMID: 28755623 DOI: 10.1016/j.jad.2017.07.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/15/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss. METHODS Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted. RESULTS We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = - 0.002, 95% CI = - 0.0639 to 0.0605). LIMITATIONS This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners. CONCLUSIONS Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.
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Affiliation(s)
- Amanda Hunter
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Lorena Tussis
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Angus MacBeth
- Department of Clinical and Health Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, Scotland, UK.
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22
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Matsuzaki S, Endo M, Ueda Y, Mimura K, Kakigano A, Egawa-Takata T, Kumasawa K, Yoshino K, Kimura T. A case of acute Sheehan's syndrome and literature review: a rare but life-threatening complication of postpartum hemorrhage. BMC Pregnancy Childbirth 2017; 17:188. [PMID: 28615049 PMCID: PMC5471854 DOI: 10.1186/s12884-017-1380-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 06/09/2017] [Indexed: 12/02/2022] Open
Abstract
Background Sheehan’s syndrome occurs because of severe postpartum hemorrhage causing ischemic pituitary necrosis. Sheehan’s syndrome is a well-known condition that is generally diagnosed several years postpartum. However, acute Sheehan’s syndrome is rare, and clinicians have little exposure to it. It can be life-threatening. There have been no reviews of acute Sheehan’s syndrome and no reports of successful pregnancies after acute Sheehan’s syndrome. We present such a case, and to understand this rare condition, we have reviewed and discussed the literature pertaining to it. An electronic search for acute Sheehan’s syndrome in the literature from January 1990 and May 2014 was performed. Case presentation A 27-year-old woman had massive postpartum hemorrhage (approximately 5000 mL) at her first delivery due to atonic bleeding. She was transfused and treated with uterine embolization, which successfully stopped the bleeding. The postpartum period was uncomplicated through day 7 following the hemorrhage. However, on day 8, the patient had sudden onset of seizures and subsequently became comatose. Laboratory results revealed hypothyroidism, hypoglycemia, hypoprolactinemia, and adrenal insufficiency. Thus, the patient was diagnosed with acute Sheehan’s syndrome. Following treatment with thyroxine and hydrocortisone, her condition improved, and she was discharged on day 24. Her next pregnancy was established 2 years after her first delivery. She required induction of ovulation for the next conception. The pregnancy, delivery, and postpartum period were uneventful. An electronic search of the literature yielded 21 cases of acute Sheehan’s syndrome. Presenting signs varied, including adrenal insufficiency (12 cases), diabetes insipidus (4 cases), hypothyroidism (2 cases), and panhypopituitarism (3 cases), with a median time of presentation after delivery for each of those conditions being 7.9, 4, 18, and 9 days, respectively. Serial changes in magnetic resonance imaging were reported in some cases of acute Sheehan’s syndrome. Conclusion Clinicians should be aware of the risk of acute Sheehan’s syndrome after a massive postpartum hemorrhage in order to diagnose it accurately and treat it promptly.
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Affiliation(s)
- Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomomi Egawa-Takata
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Donners JJAE, Kluivers KB, de Leeuw JW, van Dillen J, van Kuijk SMJ, Weemhoff M. Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists. Int Urogynecol J 2017; 28:1537-1542. [PMID: 28331968 PMCID: PMC5606937 DOI: 10.1007/s00192-017-3304-9] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/20/2017] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis National and international guidelines do not provide clear recommendations on the mode of delivery in a subsequent pregnancy after obstetric anal sphincter injury (OASI). The aim of this study was to investigate the opinion of gynecologists in The Netherlands on this choice and the extent to which this choice is affected by the gynecologist’s characteristics. Methods Of 973 gynecologists sent a questionnaire seeking their opinion on the mode of delivery in 16 different case descriptions, 234 (24%) responded. Factors influencing the opinion of the respondents on the mode of delivery, the presence of anal symptoms, the degree of OASI and the characteristics of the respondents were analyzed by univariate and multivariate logistic regression analysis. Results Recommendations on the mode of delivery in a subsequent pregnancy after OASI showed considerable variation. The recommendations depended on (previous) symptoms and the degree of OASI. For gynecologists who based their recommendations on endoanal ultrasonography outcomes (7–20% depending on the case), the degree of OASI and severity of (previous) symptoms were less important. Gynecologists basing their recommendations on endoanal ultrasonography recommended a primary cesarean section less often. Gynecologist’s characteristics (including years of experience, type of hospital and subspecialty) had a small effect on their recommendations on the mode of delivery. Conclusions Due to lack of evidence, recommendations of gynecologists in The Netherlands on the mode of delivery in a subsequent pregnancy after OASI vary widely and depend on (previous) symptoms and the degree of OASI. Gynecologists who based their recommendations on endoanal ultrasonography outcomes recommended cesarean section less often.
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Affiliation(s)
- Judith J A E Donners
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Kirsten B Kluivers
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jan W de Leeuw
- Obstetrics and Gynaecology, Ikazia, Rotterdam, Netherlands
| | - Jeroen van Dillen
- Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sander M J van Kuijk
- Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Mirjam Weemhoff
- Department of Obstetrics & Gynaecology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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van Gruting IMA, Müller MA, van Groningen K, Exalto N. Macroscopic and microscopic morphology of first trimester miscarriage and subsequent pregnancy outcome - An exploratory study. Placenta 2017; 53:16-22. [PMID: 28487015 DOI: 10.1016/j.placenta.2017.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/16/2017] [Accepted: 02/24/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Reduced chorionic villous vascularization is associated with first trimester miscarriage and second trimester fetal loss. Differences in villous vascularization have been observed in combination with complications in the third trimester of pregnancy. The aim of this study was to investigate whether abnormal morphology and reduced chorionic villous vascularization in first trimester miscarriages are associated with an increased risk on adverse outcome and/or pregnancy complications in subsequent pregnancy. Secondly, to assess the influence of these parameters on the length of the interpregnancy interval and infertility. METHODS In a retrospective cohort study 134 consecutive women who underwent dilatation and curettage for a miscarriage were included. The degree of chorionic villous vascularization in miscarriage tissue was determined by a pathologist. Ultrasound details of these miscarriages and clinical data on the subsequent pregnancy of these women were obtained. RESULTS Neither reduced vascularization nor early embryonic arrest in first trimester miscarriages are associated with an increased risk of a subsequent miscarriage or adverse obstetric and perinatal outcome of subsequent pregnancy. Abnormal morphology of the first trimester miscarriage did not influence the time to subsequent pregnancy. A shorter mean interpregnancy interval between miscarriages was observed after miscarriages with reduced chorionic villous vascularization (5.5 vs. 10.7 months; p = 0.051), showing a trend towards an association. DISCUSSION Chorionic villous vascularization and morphology have no influence on subsequent pregnancy outcome. Therefore it remains unknown what aspects of miscarriage are causing the increased risk on subsequent miscarriage and complications in the third trimester of the subsequent pregnancy.
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Affiliation(s)
- Isabelle M A van Gruting
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Moira A Müller
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Krijn van Groningen
- Department of Clinical Pathology, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Niek Exalto
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC: University Medical Centre Rotterdam, 's-Gravendijkwal 230, 3015 CE, The Netherlands.
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Meredith P, Wilson T, Branjerdporn G, Strong J, Desha L. "Not just a normal mum": a qualitative investigation of a support service for women who are pregnant subsequent to perinatal loss. BMC Pregnancy Childbirth 2017; 17:6. [PMID: 28056861 PMCID: PMC5217635 DOI: 10.1186/s12884-016-1200-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 12/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Following previous perinatal loss, women in a subsequent pregnancy may experience heightened emotions, such as anxiety and fear, with a range of longer-term implications. To support these women, the Mater Mothers' Bereavement Support Service in Brisbane, Australia, developed a Pregnancy After Loss Clinic (PALC) as a specialised hospital-based service. The present study investigated the experiences of mothers with previous perinatal loss in relation to: (a) their subsequent pregnancy-to-birth journey, and (b) the PALC service. Such research seeks to inform the ongoing development of effective perinatal services. METHOD A qualitative interview-based research design was employed with a purposive sample of 10 mothers who had previously experienced perinatal loss and who attended the Mater Mothers' PALC during their subsequent pregnancy in 2015. All mothers had subsequently delivered a live baby and were in a relationship with the father of the new baby. Women were aged between 22 and 39 years, primiparous or multiparous, and from a range of cultural backgrounds. Semi-structured interviews, conducted either at the hospital or by telephone by an experienced, independent researcher, lasted between 20 min and one hour. All interviews were audio-recorded and transcribed verbatim, with participant names changed. Interviews were analysed using content analysis by two researchers who were not involved in the service delivery or data gathering process. RESULTS Seven themes were identified from the interview material: The overall experience, The unique experience of first pregnancy after loss, Support from PALC, Experiences of other services, Recommendations for PALC services, Need for alternative services, and Advice: Mother to mother. CONCLUSIONS Participants spoke positively of the PALC services for themselves and their families. Anxieties over their subsequent pregnancy, and the desire for other health professionals to be more understanding were frequently raised. Recommendations were made to extend the PALC service and to develop similar services to support access for other families experiencing perinatal loss.
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Affiliation(s)
- Pamela Meredith
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Trish Wilson
- Bereavement Support Service, Mater Mothers Hospital, South Brisbane, QLD, Australia
| | - Grace Branjerdporn
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Jenny Strong
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Laura Desha
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
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Mills TA, Ricklesford C, Heazell AEP, Cooke A, Lavender T. Marvellous to mediocre: findings of national survey of UK practice and provision of care in pregnancies after stillbirth or neonatal death. BMC Pregnancy Childbirth 2016; 16:101. [PMID: 27154170 PMCID: PMC4859965 DOI: 10.1186/s12884-016-0891-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 04/30/2016] [Indexed: 05/07/2023] Open
Abstract
Background Pregnancy after stillbirth or neonatal death is an emotionally challenging life-event for women and adequate emotional support during pregnancy should be considered an essential component of quality maternity care. There is a lack of evidence surrounding the role of UK maternity services in meeting womens’ emotional and psychological needs in subsequent pregnancies. This study aimed to gain an overview of current UK practice and womens’ experiences of care in pregnancy after the death of a baby. Methods Online cross-sectional surveys, including open and closed questions, were completed on behalf of 138 United Kingdom (UK) Maternity Units and by 547 women who had experience of UK maternity care in pregnancy after the death of a baby. Quantitative data were analysed descriptively using SPSS software. Open textual responses were managed manually and analysed using the framework method. Results Variable provision of care and support in subsequent pregnancies was identified from maternity unit responses. A minority had specific written guidance to support care delivery, with a focus on antenatal surveillance and monitoring for complications through increased consultant involvement and technological surveillance (ultrasound/cardiotocography). Availability of specialist services and professionals with specific skills to provide emotional and psychological support was patchy. There was a lack of evaluation/dissemination of developments and innovative practice. Responses across all UK regions demonstrated that women engaged early with maternity care and placed high value on professionals as a source of emotional support. Many women were positive about their care, but a significant minority reported negative experiences. Four common themes summarised womens’ perceptions of the most important influences on quality and areas for development: sensitive communication and conduct of staff, appropriate organisation and delivery of services, increased monitoring and surveillance and perception of standard vs. special care. Conclusions These findings expose likely inequity in provision of care for UK parents in pregnancy after stillbirth or neonatal death. Many parents do not receive adequate emotional and psychological support increasing the risk of poor health outcomes. There is an urgent need to improve the evidence base and develop specific interventions to enhance appropriate and sensitive care pathways for parents.
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Affiliation(s)
- T A Mills
- School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK. .,Manchester Academic Health Sciences Centre, Manchester, UK.
| | - C Ricklesford
- Central Manchester Foundation NHS Trust, Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - A E P Heazell
- Institute of Human Development, The University of Manchester, Manchester, UK.,Central Manchester Foundation NHS Trust, Manchester, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - A Cooke
- School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
| | - T Lavender
- School of Nursing, Midwifery and Social Work, The University of Manchester, Room 4.334, Jean McFarlane Building, Oxford Rd, Manchester, M13 9PL, UK.,Manchester Academic Health Sciences Centre, Manchester, UK
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