Pub Date : 2022-03-03DOI: 10.1080/14767058.2022.2044471
Sarolta Szalai, N. Farkas, B. Veszprémi, J. Bódis, K. Kovács, B. Farkas
Abstract Objective: Radiation exposure is known to be mutagenic and teratogenic. The aim of this study was to analyze the effects of the increased ionizing radiation emitted by the Chernobyl nuclear disaster on maternal and fetal outcomes in Hungary. Methods: A retrospective analysis of abortion, stillbirth, and congenital anomaly data for pregnancies in Hungary between 1 January 1981 and 31 December 1991 was conducted. Results: Trend analysis revealed increasing trends in spontaneous and voluntary abortion rates in Hungary during the study time period, while late pregnancy losses showed a decreasing trend. Overall, there were generally decreasing incidence rates for birth defects throughout the 1980s. Increased voluntary abortions over the study period might reflect, at least in part, maternal anxiety in the post-Chernobyl years. Decreased late pregnancy loss over the same period may be attributable to improvements in prenatal diagnostics. A notable weakness of this study is that missing data could not be complemented due to the decades that have passed since the incident. Conclusions: In conclusion, the present data suggest that the nuclear catastrophe in 1986 did not cause a significant increase in pregnancy loss or congenital malformations in Hungary. BRIEF SUMMARY Radiation exposure in Hungary caused by the Chernobyl nuclear power plant disaster did not results in increases in fetal death or congenital anomaly rates.
{"title":"Assessment of the potential impacts of the Chernobyl nuclear disaster on maternal and fetal health in Hungary","authors":"Sarolta Szalai, N. Farkas, B. Veszprémi, J. Bódis, K. Kovács, B. Farkas","doi":"10.1080/14767058.2022.2044471","DOIUrl":"https://doi.org/10.1080/14767058.2022.2044471","url":null,"abstract":"Abstract Objective: Radiation exposure is known to be mutagenic and teratogenic. The aim of this study was to analyze the effects of the increased ionizing radiation emitted by the Chernobyl nuclear disaster on maternal and fetal outcomes in Hungary. Methods: A retrospective analysis of abortion, stillbirth, and congenital anomaly data for pregnancies in Hungary between 1 January 1981 and 31 December 1991 was conducted. Results: Trend analysis revealed increasing trends in spontaneous and voluntary abortion rates in Hungary during the study time period, while late pregnancy losses showed a decreasing trend. Overall, there were generally decreasing incidence rates for birth defects throughout the 1980s. Increased voluntary abortions over the study period might reflect, at least in part, maternal anxiety in the post-Chernobyl years. Decreased late pregnancy loss over the same period may be attributable to improvements in prenatal diagnostics. A notable weakness of this study is that missing data could not be complemented due to the decades that have passed since the incident. Conclusions: In conclusion, the present data suggest that the nuclear catastrophe in 1986 did not cause a significant increase in pregnancy loss or congenital malformations in Hungary. BRIEF SUMMARY Radiation exposure in Hungary caused by the Chernobyl nuclear power plant disaster did not results in increases in fetal death or congenital anomaly rates.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"49 2 1","pages":"9481 - 9488"},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78033535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-02DOI: 10.1080/14767058.2022.2044776
Ronald E. Iverson, Rachel L. Bocchino, Melissa Schapero, K. White
Abstract Purpose of the article Cesarean rates and maternal morbidity increase with the duration of the second stage of labor. We studied the effect of hourly evaluation and documentation during the second stage of labor on maternal and fetal outcomes. Materials and methods We performed a retrospective cohort study of all women who delivered at our urban, tertiary care hospital and underwent a second stage of greater than 60 min between 1 June 2016 and 31 May 2019. There were 1498 patients with complete data. Four hundred forty patients had hourly evaluation and documentation throughout the second stage and 1058 did not. We performed t-tests, Chi-squared, and regression analyses to compare cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage and blood transfusion rates, and fetal outcomes. We performed regression analyses to evaluate for independent effect of this intervention on each outcome. Results Patients with hourly evaluation and documentation had a decreased likelihood of cesarean delivery (8.2% vs. 20.3%, p < .001), shorter second-stage of labor (98.1 min vs. 177.5 min, p < .001), decreased quantitative blood loss (514.4 mL vs. 667.7 mL, p < .001), and hemorrhage rate (12.5% vs. 19.9%, p < .001). Hourly evaluation was associated with decreased transfusion rates (3.2% vs. 5.6%, p = .05) but was not related to the number of units transfused. Regression analyses confirmed the impact of hourly documentation when potential confounders were included. These differences in outcomes were also noted when evaluation was performed and documented within every 75 min. Hourly second-stage evaluation and documentation did not affect other maternal or infant morbidities. Conclusion Hourly evaluation and documentation in the second stage was associated with decreased cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage, and transfusion.
摘要本文目的剖宫产率和产妇发病率随第二产程的延长而增加。我们研究了产程第二阶段每小时评估和记录对产妇和胎儿结局的影响。材料和方法我们对2016年6月1日至2019年5月31日期间在我们的城市三级保健医院分娩并经历第二阶段超过60分钟的所有妇女进行了回顾性队列研究。1498例患者资料完整。440名患者在第二阶段每小时进行一次评估和记录，1058名患者没有。我们采用t检验、卡方检验和回归分析来比较剖宫产率、第二阶段持续时间、定量失血量、出血和输血率以及胎儿结局。我们进行了回归分析，以评估该干预措施对每个结果的独立影响。结果每小时评估和记录的患者剖宫产的可能性降低(8.2% vs. 20.3%， p < 0.001)，第二产程缩短(98.1 min vs. 177.5 min, p < 0.001)，定量失血量减少(514.4 mL vs. 667.7 mL, p < 0.001)，出血率降低(12.5% vs. 19.9%， p < 0.001)。每小时评估与输血率降低相关(3.2% vs. 5.6%， p = 0.05)，但与输血单位数无关。回归分析证实了包括潜在混杂因素时每小时记录的影响。当每75分钟进行评估并记录时，也会注意到这些结果的差异。每小时第二阶段评估和记录不影响其他产妇或婴儿发病率。结论第二阶段每小时评估和记录与剖宫产率、第二阶段持续时间、定量失血量、出血和输血减少有关。
{"title":"The association of hourly second-stage documentation with cesarean delivery and maternal blood loss","authors":"Ronald E. Iverson, Rachel L. Bocchino, Melissa Schapero, K. White","doi":"10.1080/14767058.2022.2044776","DOIUrl":"https://doi.org/10.1080/14767058.2022.2044776","url":null,"abstract":"Abstract Purpose of the article Cesarean rates and maternal morbidity increase with the duration of the second stage of labor. We studied the effect of hourly evaluation and documentation during the second stage of labor on maternal and fetal outcomes. Materials and methods We performed a retrospective cohort study of all women who delivered at our urban, tertiary care hospital and underwent a second stage of greater than 60 min between 1 June 2016 and 31 May 2019. There were 1498 patients with complete data. Four hundred forty patients had hourly evaluation and documentation throughout the second stage and 1058 did not. We performed t-tests, Chi-squared, and regression analyses to compare cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage and blood transfusion rates, and fetal outcomes. We performed regression analyses to evaluate for independent effect of this intervention on each outcome. Results Patients with hourly evaluation and documentation had a decreased likelihood of cesarean delivery (8.2% vs. 20.3%, p < .001), shorter second-stage of labor (98.1 min vs. 177.5 min, p < .001), decreased quantitative blood loss (514.4 mL vs. 667.7 mL, p < .001), and hemorrhage rate (12.5% vs. 19.9%, p < .001). Hourly evaluation was associated with decreased transfusion rates (3.2% vs. 5.6%, p = .05) but was not related to the number of units transfused. Regression analyses confirmed the impact of hourly documentation when potential confounders were included. These differences in outcomes were also noted when evaluation was performed and documented within every 75 min. Hourly second-stage evaluation and documentation did not affect other maternal or infant morbidities. Conclusion Hourly evaluation and documentation in the second stage was associated with decreased cesarean delivery rate, second-stage duration, quantitative blood loss, hemorrhage, and transfusion.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"1 1","pages":"9511 - 9516"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88751095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-02DOI: 10.1080/14767058.2022.2041596
Zehong Zhou, Jinjuan Wu, Guanglan Zhang, Jinying Yang
Abstract Aims To address the rate of spontaneous version in breech presentation until term and explore the risk factors for persistent breech presentation diagnosed by the second-trimester ultrasound examination. Methods This is a retrospective cohort study of pregnant women with a singleton pregnancy who had their ultrasound examination conducted at the time of 22–26 weeks of gestation in the Guangzhou Women and Children’s Medical Center. Cox regressions were applied to determine the strength of association between selected risk factors and persistent breech presentation. Results Among 25,313 pregnant women eligible for analysis, the prevalence of breech presentation was 36.8% (9,306/25,313) at 22–26 weeks of gestation, 4.2% (376/8,876) of which would remain in the breech presentation at the onset of labor (adjusted odds ratio [aOR], 0.39, 95% confidence interval [CI], 0.17–0.88). Multiparity (aOR, 0.39, 95% CI, 0.30–0.52) and longer gestational weeks at delivery (aOR, 0.50, 95% CI, 0.44–0.56) were associated with a lower risk of persistent breech presentation (PBP). Female fetus, lateral or fundal placenta, and known uterine malformation was each associated with an increased odd of 1.4 (aOR, 95% CI, 1.11–1.70), 2.4 (aOR, 95% CI,1.50–3.73), 3.1 (aOR, 95% CI, 1.71–5.53) and 8.7 (aOR, 95% CI, 3.84–19.84) times in the persistent breech presentation, respectively. Conclusion The prevalence of the breech presentation was 36.8% between 22 and 26 weeks of gestation, and approximately 4% would have been in the persistent breech presentation until the onset of labor. Higher educational attainment, multiparity and longer gestational weeks at delivery were significantly decreasing the risk of persistent breech presentation. While the pregnant women with age >40 years, female fetus, lateral or fundal placenta and known uterine malformation were associated increased risk of persistent breech presentation.
{"title":"Spontaneous cephalic version and risk factors for persistent breech presentation: a longitudinal retrospective cohort study","authors":"Zehong Zhou, Jinjuan Wu, Guanglan Zhang, Jinying Yang","doi":"10.1080/14767058.2022.2041596","DOIUrl":"https://doi.org/10.1080/14767058.2022.2041596","url":null,"abstract":"Abstract Aims To address the rate of spontaneous version in breech presentation until term and explore the risk factors for persistent breech presentation diagnosed by the second-trimester ultrasound examination. Methods This is a retrospective cohort study of pregnant women with a singleton pregnancy who had their ultrasound examination conducted at the time of 22–26 weeks of gestation in the Guangzhou Women and Children’s Medical Center. Cox regressions were applied to determine the strength of association between selected risk factors and persistent breech presentation. Results Among 25,313 pregnant women eligible for analysis, the prevalence of breech presentation was 36.8% (9,306/25,313) at 22–26 weeks of gestation, 4.2% (376/8,876) of which would remain in the breech presentation at the onset of labor (adjusted odds ratio [aOR], 0.39, 95% confidence interval [CI], 0.17–0.88). Multiparity (aOR, 0.39, 95% CI, 0.30–0.52) and longer gestational weeks at delivery (aOR, 0.50, 95% CI, 0.44–0.56) were associated with a lower risk of persistent breech presentation (PBP). Female fetus, lateral or fundal placenta, and known uterine malformation was each associated with an increased odd of 1.4 (aOR, 95% CI, 1.11–1.70), 2.4 (aOR, 95% CI,1.50–3.73), 3.1 (aOR, 95% CI, 1.71–5.53) and 8.7 (aOR, 95% CI, 3.84–19.84) times in the persistent breech presentation, respectively. Conclusion The prevalence of the breech presentation was 36.8% between 22 and 26 weeks of gestation, and approximately 4% would have been in the persistent breech presentation until the onset of labor. Higher educational attainment, multiparity and longer gestational weeks at delivery were significantly decreasing the risk of persistent breech presentation. While the pregnant women with age >40 years, female fetus, lateral or fundal placenta and known uterine malformation were associated increased risk of persistent breech presentation.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"22 1","pages":"9452 - 9459"},"PeriodicalIF":0.0,"publicationDate":"2022-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79734435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-28DOI: 10.1080/14767058.2022.2044773
Jessica E Kloppenburg, A. Nunes, W. Jesdale, H. Leftwich
Abstract Objectives Hypertension during pregnancy is a leading cause of birthing parent mortality and adverse pregnancy outcomes. Since non-metropolitan communities face higher rates of several risk factors for hypertension in pregnancy and shortages in obstetrical services, persons residing in non-metropolitan areas may be at increased risk for adverse events compared to those living in metropolitan areas. Our study objectives were to examine by non-metropolitan vs. metropolitan birthing parent residence (1) the prevalence of chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP), and (2) the prevalence of cesarean delivery, preterm birth, low birth weight, APGAR <7 at 5 min, NICU admission, and stillbirth/neonatal death among the group of birthing parents with cHTN and among the group of birthing parents with HDP. Methods Using U.S. Natality data from 2016 to 2018, we described the prevalence of cHTN and HDP and the association of each with several birthing parent and neonatal outcomes, stratified by non-metropolitan versus metropolitan county of birthing parent residence. Multivariable Poisson regression models were used to calculate adjusted prevalence ratios for these adverse outcomes. Results The prevalence of cHTN among pregnant individuals was 2.2% in non-metropolitan areas and 1.8% in metropolitan areas. For HDP, the prevalence was 7.4% in non-metropolitan areas and 6.6% in metropolitan areas. After adjusting for several sociodemographic characteristics among those with HDP, the prevalence ratio for an APGAR score < 7 at 5 min (aPR 1.34, 95% CI 1.29–1.38) and stillbirth/neonatal death (aPR 1.36, 95% CI 1.15–1.62) was increased among offspring born to birthing parents who resided in non-metropolitan counties. Similar results were seen among those with cHTN. Conclusions The prevalence of cHTN and HDP is elevated among birthing parents residing in non-metropolitan areas. Also, the prevalence of APGAR <7 and stillbirth//neonatal death following pregnancies complicated by hypertension were higher among neonates born to birthing parents residing in non-metropolitan areas. Further research should investigate the robustness of these findings using alternate definitions of rural and urban areas and the possible link between low APGAR score, low NICU admission, and stillbirth/neonatal death among birthing parents residing in non-metropolitan counties.
目的妊娠期高血压是导致分娩父母死亡和不良妊娠结局的主要原因。由于非大都市社区面临着怀孕期间高血压的几种风险因素的较高比率和产科服务的短缺，与居住在大都市地区的人相比，居住在非大都市地区的人发生不良事件的风险可能更高。我们的研究目的是通过非大都市和大都市出生父母的居住地来检验(1)慢性高血压(cHTN)和妊娠高血压疾病(HDP)的患病率，以及(2)cHTN和HDP出生父母组中剖宫产、早产、低出生体重、5分钟APGAR <7、NICU入院和死产/新生儿死亡的患病率。方法利用2016年至2018年的美国出生数据，我们描述了cHTN和HDP的患病率，以及它们与几种出生父母和新生儿结局的关系，并按出生父母居住地的非大都市县与大都市县进行了分层。使用多变量泊松回归模型计算这些不良结果的校正患病率。结果妊娠个体cHTN患病率非都市地区为2.2%，都市地区为1.8%。非大都市地区HDP患病率为7.4%，大都市地区为6.6%。在调整了HDP患者的几个社会人口学特征后，居住在非大都市县的出生父母所生的后代中，5分钟时APGAR评分< 7的患病率(aPR 1.34, 95% CI 1.29-1.38)和死产/新生儿死亡(aPR 1.36, 95% CI 1.15-1.62)增加。在cHTN患者中也看到了类似的结果。结论居住在非大都市地区的新生儿父母cHTN和HDP患病率较高。此外，居住在非大都市地区的出生父母所生的新生儿APGAR <7和妊娠合并高血压后死产//新生儿死亡的患病率更高。进一步的研究应该使用农村和城市地区的替代定义来调查这些发现的稳健性，以及居住在非大都市县的分娩父母中低APGAR评分、低NICU入院率和死产/新生儿死亡之间的可能联系。
{"title":"Prevalence and outcomes of hypertension in pregnancy in non-metropolitan and metropolitan communities","authors":"Jessica E Kloppenburg, A. Nunes, W. Jesdale, H. Leftwich","doi":"10.1080/14767058.2022.2044773","DOIUrl":"https://doi.org/10.1080/14767058.2022.2044773","url":null,"abstract":"Abstract Objectives Hypertension during pregnancy is a leading cause of birthing parent mortality and adverse pregnancy outcomes. Since non-metropolitan communities face higher rates of several risk factors for hypertension in pregnancy and shortages in obstetrical services, persons residing in non-metropolitan areas may be at increased risk for adverse events compared to those living in metropolitan areas. Our study objectives were to examine by non-metropolitan vs. metropolitan birthing parent residence (1) the prevalence of chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP), and (2) the prevalence of cesarean delivery, preterm birth, low birth weight, APGAR <7 at 5 min, NICU admission, and stillbirth/neonatal death among the group of birthing parents with cHTN and among the group of birthing parents with HDP. Methods Using U.S. Natality data from 2016 to 2018, we described the prevalence of cHTN and HDP and the association of each with several birthing parent and neonatal outcomes, stratified by non-metropolitan versus metropolitan county of birthing parent residence. Multivariable Poisson regression models were used to calculate adjusted prevalence ratios for these adverse outcomes. Results The prevalence of cHTN among pregnant individuals was 2.2% in non-metropolitan areas and 1.8% in metropolitan areas. For HDP, the prevalence was 7.4% in non-metropolitan areas and 6.6% in metropolitan areas. After adjusting for several sociodemographic characteristics among those with HDP, the prevalence ratio for an APGAR score < 7 at 5 min (aPR 1.34, 95% CI 1.29–1.38) and stillbirth/neonatal death (aPR 1.36, 95% CI 1.15–1.62) was increased among offspring born to birthing parents who resided in non-metropolitan counties. Similar results were seen among those with cHTN. Conclusions The prevalence of cHTN and HDP is elevated among birthing parents residing in non-metropolitan areas. Also, the prevalence of APGAR <7 and stillbirth//neonatal death following pregnancies complicated by hypertension were higher among neonates born to birthing parents residing in non-metropolitan areas. Further research should investigate the robustness of these findings using alternate definitions of rural and urban areas and the possible link between low APGAR score, low NICU admission, and stillbirth/neonatal death among birthing parents residing in non-metropolitan counties.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"43 1","pages":"9489 - 9495"},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89662431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-27DOI: 10.1080/14767058.2022.2044777
Peilin Zhang, Tsu Haymar, Farah Al-Sayyed, Sylvia Dygulski, B. Dygulska, Arooj Devi, S. Lederman, C. Salafia, R. Baergen
Abstract Objective Maternal age, maternal obesity and neonatal sex dimorphism are known to affect pregnancy and neonatal outcome. However, the effects of these factors on specific placental pathology are less well-documented. Study design Clinical information, placental pathology and neonatal data from singleton delivery were collected at our hospital in March 2020 to October 2021 and correlation studies were performed. Results A total 3,119 singleton placentas were examined between March 2020 and October 2021 in conjunction with clinical information and neonatal birth data. Advanced maternal age (>35) was significantly associated with a variety of pregnancy complications and placental pathology including preeclampsia/pregnancy induced hypertension (Pre/PIH), gestational diabetes mellitus (GDM2), intrauterine growth restriction (IUGR), and increased maternal body mass index (BMI) at delivery. Maternal obesity (BMI >30 at the time of delivery) was significantly associated with a variety of clinical features and placental pathology including PRE/PIH, GDM2 and decidual vasculopathy (mural arterial hypertrophy). No specific placental pathology was associated with neonatal sex except for more maternal inflammatory response (MIR, chronic deciduitis) in neonates of male sex. Conclusion Maternal age and maternal obesity were associated with not only clinical complications of pregnancy and neonatal birth weight but also specific placental pathology. Understanding the effects of maternal and environmental factors will help improve pregnancy outcome.
{"title":"Placental pathology associated with maternal age and maternal obesity in singleton pregnancy","authors":"Peilin Zhang, Tsu Haymar, Farah Al-Sayyed, Sylvia Dygulski, B. Dygulska, Arooj Devi, S. Lederman, C. Salafia, R. Baergen","doi":"10.1080/14767058.2022.2044777","DOIUrl":"https://doi.org/10.1080/14767058.2022.2044777","url":null,"abstract":"Abstract Objective Maternal age, maternal obesity and neonatal sex dimorphism are known to affect pregnancy and neonatal outcome. However, the effects of these factors on specific placental pathology are less well-documented. Study design Clinical information, placental pathology and neonatal data from singleton delivery were collected at our hospital in March 2020 to October 2021 and correlation studies were performed. Results A total 3,119 singleton placentas were examined between March 2020 and October 2021 in conjunction with clinical information and neonatal birth data. Advanced maternal age (>35) was significantly associated with a variety of pregnancy complications and placental pathology including preeclampsia/pregnancy induced hypertension (Pre/PIH), gestational diabetes mellitus (GDM2), intrauterine growth restriction (IUGR), and increased maternal body mass index (BMI) at delivery. Maternal obesity (BMI >30 at the time of delivery) was significantly associated with a variety of clinical features and placental pathology including PRE/PIH, GDM2 and decidual vasculopathy (mural arterial hypertrophy). No specific placental pathology was associated with neonatal sex except for more maternal inflammatory response (MIR, chronic deciduitis) in neonates of male sex. Conclusion Maternal age and maternal obesity were associated with not only clinical complications of pregnancy and neonatal birth weight but also specific placental pathology. Understanding the effects of maternal and environmental factors will help improve pregnancy outcome.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"23 1","pages":"9517 - 9526"},"PeriodicalIF":0.0,"publicationDate":"2022-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81048314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-01DOI: 10.1080/14767058.2019.1659773
W. Sepulveda
Abstract Objective To determine the antenatal course and perinatal outcome of pregnancies in which a triple nuchal cord was detected prenatally by ultrasound. Methods Singleton pregnancies presenting for ultrasound evaluation after 24 weeks of gestation were routinely screened for the presence of nuchal cord loops using two-dimensional and color-Doppler ultrasound. Fetuses with more than two nuchal cord loops were identified from our fetal medicine database and their ultrasound reports and medical records were reviewed. Results During the study period from July 2014 to February 2019, 10 singleton fetuses with triple nuchal cord were identified, for a prevalence of 1 in 506 or 0.2%. No cases of more than three nuchal cord loops were detected. No predisposing factors were identified. Cases detected after 36 weeks (n = 4) delivered by cesarean section after 37 weeks and the diagnosis of triple nuchal cord was confirmed in all of them. Cases detected before 36 weeks (n = 6) underwent fetal surveillance. Among these cases, the umbilical cord unraveled itself from around the fetal neck in at least one loop in 83% of these cases. Overall, eight (80%) of the neonates were delivered by cesarean section for different reasons; in only two, the sole indication for cesarean delivery was the presence of the triple nuchal cord. All the infants had a good perinatal outcome, although one newborn infant was small for gestational age. Conclusions Ultrasound detection of triple nuchal cord during late pregnancy was associated with good perinatal outcomes. However, this prenatal finding was also associated with a high rate of cesarean section. In preterm pregnancies, multiple loops will reduce spontaneously in the majority of cases, so expectant management is indicated. In term pregnancies, the decision regarding the optimal timing and mode of delivery should be discussed with the parents taking into account the individual clinical scenarios.
{"title":"Antenatal course and perinatal outcome after ultrasound detection of triple nuchal cord: a case series","authors":"W. Sepulveda","doi":"10.1080/14767058.2019.1659773","DOIUrl":"https://doi.org/10.1080/14767058.2019.1659773","url":null,"abstract":"Abstract Objective To determine the antenatal course and perinatal outcome of pregnancies in which a triple nuchal cord was detected prenatally by ultrasound. Methods Singleton pregnancies presenting for ultrasound evaluation after 24 weeks of gestation were routinely screened for the presence of nuchal cord loops using two-dimensional and color-Doppler ultrasound. Fetuses with more than two nuchal cord loops were identified from our fetal medicine database and their ultrasound reports and medical records were reviewed. Results During the study period from July 2014 to February 2019, 10 singleton fetuses with triple nuchal cord were identified, for a prevalence of 1 in 506 or 0.2%. No cases of more than three nuchal cord loops were detected. No predisposing factors were identified. Cases detected after 36 weeks (n = 4) delivered by cesarean section after 37 weeks and the diagnosis of triple nuchal cord was confirmed in all of them. Cases detected before 36 weeks (n = 6) underwent fetal surveillance. Among these cases, the umbilical cord unraveled itself from around the fetal neck in at least one loop in 83% of these cases. Overall, eight (80%) of the neonates were delivered by cesarean section for different reasons; in only two, the sole indication for cesarean delivery was the presence of the triple nuchal cord. All the infants had a good perinatal outcome, although one newborn infant was small for gestational age. Conclusions Ultrasound detection of triple nuchal cord during late pregnancy was associated with good perinatal outcomes. However, this prenatal finding was also associated with a high rate of cesarean section. In preterm pregnancies, multiple loops will reduce spontaneously in the majority of cases, so expectant management is indicated. In term pregnancies, the decision regarding the optimal timing and mode of delivery should be discussed with the parents taking into account the individual clinical scenarios.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"108 1","pages":"3246 - 3251"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84857171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-24DOI: 10.1080/14767058.2021.1962370
Giulia Di Renzo
The coronavirus SARS-CoV-2 was identified as the causative agent for a series of atypical respiratory diseases in China in December 2019. This infection was officially declared a pandemic by the WHO on March 2020, and it has affected over 170 million people in the world. In Emilia-Romagna, there is a Surveillance System of stillbirth (SB) since 2014. It records and audits, in a multidisciplinary way, each single case reported by every birth centre of the Region. In this study, we compared SB information collected in the Surveillance System database in pandemic period (March to December 2020) with the ones in the same period, recorded in the previous 6 years. SB was defined according to WHO recommendation. The numbers of birth per years was obtained by Birth certificates (CedAP). During pandemic, there were 89 SB out of 25,225 births allowing a rate of 3.52/1000. For the same period, in the previous 6 years, SB rate ranged from 3.00 (83/27,625) in 2018 to 3.55 (91/26,493) in 2019. Overall, SB rate did not change. No cases of SB were detected in pregnant women affected by SARS-CoV-2 infection. Risk factors as maternal age, years of education, country of origin, gestational weight gain and smoking did not change, while an increased number of SB was recorded in multiparous women (OR 1.62, 95%IC 1.02-2.55) and in overweight ones (OR 1.64, 95%IC 1.03-2.62). Overall, the proportion of preterm births was not substantially different between pandemic period compared to the previous period (OR 1.34, IC95% 0.81-2.23). However, there was a significant increase of SB cases occurring at 22+0-24+6 weeks (OR 3.55, 95%IC 1.49-8.45). Moreover, we found almost double increase of small for gestational age (SGA) infants (OR 1.88, 95%IC 1.16-3.05) and SB related to multiple pregnancy (OR 2.15, 95%IC 1.01-4.56) in pandemic period. The multivariate analysis confirms a higher risk of SB in overweight mothers with SGA infants at 22+0-24+6 weeks during pandemic (respectively OR 1.65, 95%IC 1.01-2.69, OR 1.73, 95%IC 1.03-2.92, and OR 2.18, 95%IC 1.13-4.19) (Table 1). According to ReCoDe classification, there were not significant changes in the frequency of SB causes, compared to the previous period. However, there was a trend toward an increase of the placental abruption cases (17/89 vs 67/555: OR 1.72, 95%IC 0.96-3.09). The quality of pregnancy care was evaluated by using CESDI grade, where grades 2 and 3 refer to substandard care (2: different management might have made a difference to outcome;3: different management would have been reasonably expected to have made a difference to outcome). At audit, cases with grade 2 or 3 during pandemic was 6%, similar to the reference period (10%). No significantly changes occurred in the number of obstetric evaluations as well as in the number of ultrasounds exams. Globally, SARS-CoV-2 pandemic did not substantially influence SB incidence and pregnancy cares. The pandemic restrictions might have affected the access of women at risk to
{"title":"22° CONGRESSO NAZIONALE AGORA’ SIMP – LA BUONA MEDICINA PERINATALE DOPO IL COVID (POST-COVID GOOD PERINATAL MEDICINE)","authors":"Giulia Di Renzo","doi":"10.1080/14767058.2021.1962370","DOIUrl":"https://doi.org/10.1080/14767058.2021.1962370","url":null,"abstract":"The coronavirus SARS-CoV-2 was identified as the causative agent for a series of atypical respiratory diseases in China in December 2019. This infection was officially declared a pandemic by the WHO on March 2020, and it has affected over 170 million people in the world. In Emilia-Romagna, there is a Surveillance System of stillbirth (SB) since 2014. It records and audits, in a multidisciplinary way, each single case reported by every birth centre of the Region. In this study, we compared SB information collected in the Surveillance System database in pandemic period (March to December 2020) with the ones in the same period, recorded in the previous 6 years. SB was defined according to WHO recommendation. The numbers of birth per years was obtained by Birth certificates (CedAP). During pandemic, there were 89 SB out of 25,225 births allowing a rate of 3.52/1000. For the same period, in the previous 6 years, SB rate ranged from 3.00 (83/27,625) in 2018 to 3.55 (91/26,493) in 2019. Overall, SB rate did not change. No cases of SB were detected in pregnant women affected by SARS-CoV-2 infection. Risk factors as maternal age, years of education, country of origin, gestational weight gain and smoking did not change, while an increased number of SB was recorded in multiparous women (OR 1.62, 95%IC 1.02-2.55) and in overweight ones (OR 1.64, 95%IC 1.03-2.62). Overall, the proportion of preterm births was not substantially different between pandemic period compared to the previous period (OR 1.34, IC95% 0.81-2.23). However, there was a significant increase of SB cases occurring at 22+0-24+6 weeks (OR 3.55, 95%IC 1.49-8.45). Moreover, we found almost double increase of small for gestational age (SGA) infants (OR 1.88, 95%IC 1.16-3.05) and SB related to multiple pregnancy (OR 2.15, 95%IC 1.01-4.56) in pandemic period. The multivariate analysis confirms a higher risk of SB in overweight mothers with SGA infants at 22+0-24+6 weeks during pandemic (respectively OR 1.65, 95%IC 1.01-2.69, OR 1.73, 95%IC 1.03-2.92, and OR 2.18, 95%IC 1.13-4.19) (Table 1). According to ReCoDe classification, there were not significant changes in the frequency of SB causes, compared to the previous period. However, there was a trend toward an increase of the placental abruption cases (17/89 vs 67/555: OR 1.72, 95%IC 0.96-3.09). The quality of pregnancy care was evaluated by using CESDI grade, where grades 2 and 3 refer to substandard care (2: different management might have made a difference to outcome;3: different management would have been reasonably expected to have made a difference to outcome). At audit, cases with grade 2 or 3 during pandemic was 6%, similar to the reference period (10%). No significantly changes occurred in the number of obstetric evaluations as well as in the number of ultrasounds exams. Globally, SARS-CoV-2 pandemic did not substantially influence SB incidence and pregnancy cares. The pandemic restrictions might have affected the access of women at risk to","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"22 1","pages":"1 - 128"},"PeriodicalIF":0.0,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76739604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/14767058.2019.1663820
A. Wood, Michelle Tang, T. Truong, C. Feldman, C. Pieper, A. Murtha
Abstract Objective To determine the prevalence of Mycoplasmataceae species in pregnant women and evaluate their association with immune system mediators. Methods Women were prospectively enrolled between 16–22 weeks’ gestation. Vaginal swabs were self-collected and analyzed with PCR for Mycoplasma hominis (MH) and Mycoplasma genitalium (MG) as well as Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) (collectively, Myc). Immune mediators were measured via Luminex multiplex assay. Women with vaginal Mycoplasmataceae were compared to women without Myc, and women with Mycoplasma species (MH or MG) were compared to women without MH or MG. Linear regression models were used to investigate the relationship of the presence of Mycoplasmataceae on log-transformed immune mediators while controlling for confounders using propensity scores. Results One-hundred-twenty women were enrolled and had complete lab data available. Colonization was 20.8, 2.5, 10.0, and 48.3% for MH, MG, UU, and UP, respectively. Women with any Mycoplasmataceae were more likely to be younger, of the Black race, and have public insurance. There were no significant differences in immune mediators between women with vaginal Mycoplasmataceae versus those without. After controlling for confounders, women with MH and/or MG had significantly elevated levels of IL-1β compared to women without MH or MG (estimate = 1.12; 95% CI = 0.33, 1.93). There were no other significant differences in immune mediators in women with MH and/or MG compared to those without. Conclusions Colonization rates were highest for UP and lowest for MG. Higher IL-1β levels were seen in the presence of MH and/or MG, indicating that these less frequently encountered organisms may incite a stronger host response. There were no other significant differences in immune mediator levels.
摘要目的了解孕妇支原体科菌的流行情况，并探讨其与免疫系统介质的关系。方法前瞻性纳入妊娠16-22周的妇女。自行采集阴道拭子，用PCR检测人支原体(MH)、生殖支原体(MG)、解脲支原体(UU)和细小脲原体(UP) (Myc)。免疫介质通过Luminex多重试验测定。阴道支原体科的妇女与没有Myc的妇女进行比较，支原体种类(MH或MG)的妇女与没有MH或MG的妇女进行比较。使用线性回归模型来研究支原体科在对数转化免疫介质上存在的关系，同时使用倾向评分控制混杂因素。结果120名妇女入选，有完整的实验室资料。MH、MG、UU和UP的定殖率分别为20.8%、2.5%、10.0%和48.3%。患有支原体科的女性更有可能是年轻的黑人，并且有公共保险。阴道支原体科感染的女性与未感染支原体科的女性在免疫介质方面没有显著差异。在控制混杂因素后，与没有MH和/或MG的女性相比，患有MH和/或MG的女性IL-1β水平显著升高(估计= 1.12;95% ci = 0.33, 1.93)。与未患MH和/或MG的妇女相比，患有MH和/或MG的妇女的免疫介质没有其他显著差异。结论UP菌定植率最高，MG菌定植率最低。在MH和/或MG存在的情况下，IL-1β水平升高，表明这些不太常见的生物可能会引发更强的宿主反应。在免疫介质水平上没有其他显著差异。
{"title":"Vaginal Mycoplasmataceae colonization and association with immune mediators in pregnancy","authors":"A. Wood, Michelle Tang, T. Truong, C. Feldman, C. Pieper, A. Murtha","doi":"10.1080/14767058.2019.1663820","DOIUrl":"https://doi.org/10.1080/14767058.2019.1663820","url":null,"abstract":"Abstract Objective To determine the prevalence of Mycoplasmataceae species in pregnant women and evaluate their association with immune system mediators. Methods Women were prospectively enrolled between 16–22 weeks’ gestation. Vaginal swabs were self-collected and analyzed with PCR for Mycoplasma hominis (MH) and Mycoplasma genitalium (MG) as well as Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP) (collectively, Myc). Immune mediators were measured via Luminex multiplex assay. Women with vaginal Mycoplasmataceae were compared to women without Myc, and women with Mycoplasma species (MH or MG) were compared to women without MH or MG. Linear regression models were used to investigate the relationship of the presence of Mycoplasmataceae on log-transformed immune mediators while controlling for confounders using propensity scores. Results One-hundred-twenty women were enrolled and had complete lab data available. Colonization was 20.8, 2.5, 10.0, and 48.3% for MH, MG, UU, and UP, respectively. Women with any Mycoplasmataceae were more likely to be younger, of the Black race, and have public insurance. There were no significant differences in immune mediators between women with vaginal Mycoplasmataceae versus those without. After controlling for confounders, women with MH and/or MG had significantly elevated levels of IL-1β compared to women without MH or MG (estimate = 1.12; 95% CI = 0.33, 1.93). There were no other significant differences in immune mediators in women with MH and/or MG compared to those without. Conclusions Colonization rates were highest for UP and lowest for MG. Higher IL-1β levels were seen in the presence of MH and/or MG, indicating that these less frequently encountered organisms may incite a stronger host response. There were no other significant differences in immune mediator levels.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"8 1","pages":"2295 - 2302"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90422672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-01DOI: 10.1080/14767058.2019.1661989
L. AL-HAFEZ, S. Chauhan
Abstract Objectives Uterine tachysystole (TS) has been defined by the American College of Obstetrics and Gynecologists (ACOG) as “more than five contractions in 10 minutes, averaged over a 30-minute window”. The objective of this study was to survey all active members of the Central Association of Obstetricians and Gynecologists (CAOG) in order to assess the obscurity behind the definition of TS as well as the management. Study design The survey listed 16 questions consisting of demographics, definitions of TS, management of five hypothetical clinical cases (HCC), their personal experience, and adverse outcomes. This survey was delivered to all active members of CAOG. A priori, we considered the terminology and management to be consistent if at least 75% of the respondents were concordant in their answers. Results There was no consistency in the answers that pertained to the definition of tachysystole nor to the questions regarding the next step in management in the hypothetical clinical cases. When the MFM and generalists answers were analyzed, there were no statistically significant differences in their individual answers. Conclusion This is the first survey publication on uterine tachysystole and is notable for inconsistency in the definition, frequency with which it is encountered and hypothetical management of TS. The divergent response suggests that ambiguity regarding tachysystole persists, despite ACOG attempts to rectify it.
{"title":"Uterine tachysystole: a survey of CAOG members suggests persistent ambiguity","authors":"L. AL-HAFEZ, S. Chauhan","doi":"10.1080/14767058.2019.1661989","DOIUrl":"https://doi.org/10.1080/14767058.2019.1661989","url":null,"abstract":"Abstract Objectives Uterine tachysystole (TS) has been defined by the American College of Obstetrics and Gynecologists (ACOG) as “more than five contractions in 10 minutes, averaged over a 30-minute window”. The objective of this study was to survey all active members of the Central Association of Obstetricians and Gynecologists (CAOG) in order to assess the obscurity behind the definition of TS as well as the management. Study design The survey listed 16 questions consisting of demographics, definitions of TS, management of five hypothetical clinical cases (HCC), their personal experience, and adverse outcomes. This survey was delivered to all active members of CAOG. A priori, we considered the terminology and management to be consistent if at least 75% of the respondents were concordant in their answers. Results There was no consistency in the answers that pertained to the definition of tachysystole nor to the questions regarding the next step in management in the hypothetical clinical cases. When the MFM and generalists answers were analyzed, there were no statistically significant differences in their individual answers. Conclusion This is the first survey publication on uterine tachysystole and is notable for inconsistency in the definition, frequency with which it is encountered and hypothetical management of TS. The divergent response suggests that ambiguity regarding tachysystole persists, despite ACOG attempts to rectify it.","PeriodicalId":22921,"journal":{"name":"The Journal of Maternal-Fetal & Neonatal Medicine","volume":"59 1","pages":"2369 - 2374"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86999600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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