VP13.04: Detection of fetal abnormalities on routine third trimester scan: does it impact perinatal outcomes?

Background.Oligohydramnion in the first half of pregnancy, combined with congenital abnormalities in the fetus has objective difficulties in diagnosis. The morphology features and type of defects associated with oligohydramnion, which manifests in the first half of pregnancy, are not sufficiently studied at the present stage. Aims to evaluate the clinical significance of diagnosing oligohydramnion in the first half of pregnancy in women with congenital fetal malformations. Materials and methods.The analysis of the course of pregnancy and perinatal outcomes in 77 women with low water content in combination with congenital malformations of the fetus and 72 patients with a normal amount of amniotic fluid and no congenital malformations of the fetus was performed. The patients of the main group were divided into two subgroups depending on the severity of oligohydramnion: the 1st subgroup (n = 54) patients with severe oligohydramnion and the 2nd subgroup (n = 23) patients with moderate oligohydramnion. The amount of amniotic fluid was determined by 3D/4D ultrasound (1321 weeks of gestation) and the structure of fetal abnormalities associated with oligohydramnion was analyzed. We evaluated perinatal outcomes in women with congenital malformations of the fetus in combination with oligohydramnion and the effect of its severity on the outcome of pregnancy. Results.In the main group (n = 77), fetal abnormalities were detected in patients: urinary system 39 (50.6%), respiratory system 4 (5.2%), heart 1 (1.3%), chromosomal and genetic abnormalities 14 (18.2%), central nervous system 3 (3.9%), osseous system 3 (3.9%), multiple 13 (16.9%). In the main group (n = 77), pregnancy was terminated for medical indications in 47 (61%) cases, in 6 (7.8%) spontaneous miscarriage occurred, in 5 (6.5%) antenatal fetal death. 19 (24.7%) children were born alive, and surgical treatment in the neonatal period was required in 8 (10.4%) cases. In the 1st subgroup (n = 54) in 53 (98.1%) cases, there was a loss of the fetus, in 1 (1.9%) the newborn died on the 9th day. In the 2nd subgroup (n = 23), fetal death occurred in 5 (21.7%) cases, 18 (78.3%) children were born alive, and 8 (44.4%) newborns were operated on in the neonatal period. In the control group, all pregnancies ended with the birth of healthy children. A decrease in ultrasound imaging of internal organs in the fetus was observed when a pregnant woman was obese (BMI more than 35). Conclusions.Oligohydramnion in the first half of pregnancy in combination with fetal malformation should be considered an extremely unfavorable clinical sign for the prognosis of pregnancy and the health of the fetus and newborn. 3D/4D ultrasound scanning allows you to reliably determine oligohydramnion in the first half of pregnancy, and the degree of its severity to assume the nature of complications.

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High-Grade Fetal Vascular Malperfusion Is Associated With Diffuse Chorionic Hemosiderosis

Pediatric and Developmental Pathology ◽

10.1177/10935266211064694 ◽

2021 ◽

pp. 109352662110646

Author(s):

Eoghan E. Mooney ◽

Emma Crotty

Keyword(s):

Perinatal Outcomes ◽

Low Grade ◽

High Grade ◽

Third Trimester ◽

The Third ◽

Term Delivery ◽

Venous Bleeding ◽

Placental Membranes ◽

Adverse Perinatal Outcomes ◽

Cord Length

Introduction Diffuse chorionic hemosiderosis (DCH) is an abnormality of the placental membranes characterized by the deposition of iron pigment. It is usually secondary to recurrent venous bleeding in early pregnancy. In many papers, it is associated with pre-term delivery. Fetal vascular malperfusion (FVM) is an abnormality of the feto-placental circulation that may be seen at any stage of gestation, but most often in the third trimester. It may be graded as low grade (LGFVM) or high grade (HGFVM). No link has been identified in the placental literature between DCH and FVM, but we have noted the 2 co-existing in placentas submitted for analysis. This study explored a possible association of these 2 entities. Methods Laboratory records were searched for singleton cases coded as DCH based on diagnosis on H&E stain over a 6-year period. Of 4478 placentas reported, 66 cases were coded as DCH (1.5%). These were classified as showing HGFVM, LGFVM, or no FVM. Controls (n = 132) were gestational age-matched cases without DCH. Cord length, coiling, insertion, or other abnormalities were noted. Membranes were classified as normal or circumvallate. Results were analyzed using Graphpad. Results Gestation ranged between 16 and 41 weeks gestation. 14/66 (21%) cases of DCH showed HGFVM and 2/66 (3%) showed LGFVM. 16/132 (12%) controls showed HGFVM and 21/132 (15.9%) had LGFVM. Where FVM is present, high-grade FVM is significantly associated with DCH versus controls ( P < .0031 Fischer’s Test). Discussion HGFVM occurs significantly more often in placentas with DCH than in controls. Both FVM and DCH are associated with adverse perinatal outcomes, and a possible relationship between the 2 remains to be clarified.

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Perinatal outcomes in women with severe acute respiratory syndrome coronavirus 2 infection: comparison with contemporary and matched pre-COVID-19 controls

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0313 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Miha Lucovnik ◽

Mirjam Druskovic ◽

Marijana Vidmar Simic ◽

Ivan Verdenik ◽

Vita Mesaric ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Critically Ill ◽

Maternal Death ◽

Reference Group ◽

Close Contact ◽

Perinatal Outcomes ◽

Linear Regression Models ◽

Third Trimester ◽

Adverse Perinatal Outcomes ◽

Log Linear

Abstract Objectives To compare perinatal outcomes in women with vs. without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods Perinatal outcomes in SARS-CoV-2 positive pregnant women who delivered at our institution between October 27th 2020 and January 31st 2021 were compared to SARS-CoV-2 negative pregnancies (contemporary controls) and historical 2019 controls matched by maternal age, pre-pregnancy body mass index and parity. Testing was performed based on symptoms or close contact at any time during pregnancy and as part of universal screening at hospital admission. Multivariable log-linear regression models were used adjusting for potential confounders (p < 0.05 statistically significant). Results One thousand three hundred seventeen women delivered at our institution during the study period. 1,124 (85%) tested negative and 193 (15%) positive for SARS-CoV-2. 189 (98%) were infected during third trimester. 19 (10%) were asymptomatic, 171 (89%) had mild to moderate coronavirus disease 2019 (COVID-19), and 3 (2%) were critically ill with one case of maternal death. There were no significant differences in preterm birth, small-for-gestational-age birth weight, congenital anomalies, operative delivery, intrapartum hypoxia, and perinatal mortality in SARS-CoV-2 positive pregnancies compared to contemporary reference group or historical controls from pre-COVID-19 period. Labor was more commonly induced in SARS-CoV-2 positive women compared to reference SARS-CoV-2 negative group (68 [35%] vs. 278 [25%], adjusted odds ratio 1.62; 95% confidence interval 1.14–2.28). Conclusions SARS-CoV-2 infection in pregnancy was not strongly associated with adverse perinatal outcomes. While the majority of SARS-CoV-2 positive women had no or mild/moderate symptoms, 2% were critically ill, with one case of maternal death.

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Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia, Gujarat

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20173455 ◽

2017 ◽

Vol 6 (8) ◽

pp. 3418

Author(s):

Rohit Jain ◽

Chintan Upadhyay ◽

Latika Mehta ◽

Bipin Nayak ◽

Gaurav Desai

Keyword(s):

Adverse Pregnancy Outcome ◽

Perinatal Outcomes ◽

Lactic Dehydrogenase ◽

Fetal Outcome ◽

Third Trimester ◽

Medical College ◽

Severity Of Disease ◽

Still Births ◽

Adverse Pregnancy ◽

A Prospective Study

Background: Serum LDH levels can be used to assess the extent of cellular death and thereby the severity of disease in this group of women. This will help in making decision, about the management guidelines to the better the maternal and fetal outcome. Objective of present study was compare serum LDH levels in the normal pregnant women and in women with preeclampsia and eclampsia in ante-partum period and to study the association of maternal and perinatal outcomes with serum LDH levels.Methods: It is a prospective study done at Obstetrics and Gynecology department, GMERS medical college and civil hospital, Gandhinagar during August-September 2016. Participants were divided into four groups according to severity of disease and into three groups according to serum LDH level.Results: Mean level of LDH (IU/l) in Control, Mild pre-eclampsia, Severe pre-eclampsia & Eclampsia was 302.33, 398.56, 675.26 & 1589.85 respectively. Out of total 34 cases with LDH level >800 IU/L, 47.1% cases had ≥160 mm hg SBP & 52.9% had ≥110 mm hg DBP, mean gestational age and mean baby weight was 36.88 week and 1950 gm, mean apgar score at 10 min was 6.96, 47.1% had uneventful outcome, whereas 58.8% had neonatal complications and 5.9% had neonatal death. Almost 26.5% still births, 47.1% perinatal deaths.Conclusions: Higher serum LDH levels during pregnancy have significant association with severity of disease and maternal and fetal outcomes in patients of preeclampsia and eclampsia and can be considered as a supportive prognostic tool from early third trimester.

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Prescriptive Reference Standards of Third-Trimester Cerebroplacental Ratio and Its Physiological Determinants

Fetal Diagnosis and Therapy ◽

10.1159/000508366 ◽

2020 ◽

Vol 47 (10) ◽

pp. 757-764

Author(s):

Marta Rial-Crestelo ◽

Laura Garcia-Otero ◽

Annalisa Cancemi ◽

Mariella Giannone ◽

Elena Escazzocchio ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Perinatal Outcomes ◽

Reference Standards ◽

Low Risk ◽

Maternal Body Mass Index ◽

Third Trimester ◽

Maternal Body ◽

Cerebroplacental Ratio ◽

Singleton Pregnancies

Objective: To construct valid reference standards reflecting optimal cerebroplacental ratio and to explore its physiological determinants. Methods: A cohort of 391 low-risk pregnancies of singleton pregnancies of nonmalformed fetuses without maternal medical conditions and with normal perinatal outcomes was created. Doppler measurements of the middle cerebral artery and umbilical artery were performed at 24–42 weeks. Reference standards were produced, and the influence of physiological determinants was explored by nonparametric quantile regression. The derived standards were validated in a cohort of 200 low-risk pregnancies. Results: Maternal body mass index was significantly associated with the 5th centile of the cerebroplacental ratio. For each additional unit of body mass index, the 5th centile was on average 0.014 lower. The derived 5th, 10th, and 50th centiles selected in the validation cohort were 5, 9.5, and 51% of the measurements. Conclusions: This study provides methodologically sound prescriptive standards and suggests that maternal body mass index is a determinant of a cutoff commonly used for decision-making.

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How often do we identify fetal abnormalities during routine third‐trimester ultrasound? A systematic review and meta‐analysis

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.16468 ◽

2020 ◽

Vol 128 (2) ◽

pp. 259-269 ◽

Cited By ~ 2

Author(s):

L Drukker ◽

E Bradburn ◽

GB Rodriguez ◽

NW Roberts ◽

L Impey ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Third Trimester ◽

Fetal Abnormalities

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Perinatal Outcomes of Monochorionic-Diamniotic Twin Pregnancies Uncomplicated at 28 Weeks of Gestation

Japanese Clinical Medicine ◽

10.4137/jcm.s38895 ◽

2016 ◽

Vol 7 ◽

pp. JCM.S38895 ◽

Cited By ~ 3

Author(s):

Shunji Suzuki

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Perinatal Outcomes ◽

Second Trimester ◽

Perinatal Complications ◽

Third Trimester ◽

The Third ◽

Perinatal Center ◽

Twin Pregnancies

We examined the prevalence of specific perinatal complications of monochorionic-diamniotic twin pregnancies in cases without any abnormal findings until the second trimester of pregnancy. This was a retrospective cohort study performed at a tertiary perinatal center in Tokyo, Japan. There were 88 cases of uncomplicated monochorionic-diamniotic twin pregnancies at 28 weeks of gestation. In five of them (5.7%), there were serious complications associated with placental circulatory imbalance between the twins during the third trimester of pregnancy. Two cases were complicated by twin–twin transfusion syndrome, two cases were complicated by twin anemia–polycythemia sequence, and one case was complicated by acute twin–twin transfusion syndrome. In the five cases, no abnormal ultrasonographic findings or symptoms were recognized one or two weeks prior to the diagnosis. Fifty-eight cases (65.9%) were delivered at term uneventfully. Serious complications due to placental circulatory imbalance between twins occurred in about 6% of cases during the third trimester of pregnancy.

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