Grand multiparity and obstetric outcomes in a contemporary cohort: the role of parity

Background: Thrombophilia is a disorder of haemostatic system that results in increased tendency of thrombus formation in both venous and arterial vascular system. The thrombotic events are not only restricted to venous thromboembolism but also can cause fetal loss (abortions or recurrent abortions and fetal demise), placental abruption, intrauterine growth restriction and severe pre-eclampsia. This study evaluates the role of administering thromboprophylaxis with heparin and ecosprin to patients with thrombophilia in pregnancy with previous history of adverse obstetric outcomes.Methods: This prospective study was conducted in 60 patients diagnosed with thrombophilia during pregnancy. The objective of the study was to determine the role of administering low dose ecosprin and heparin as thromboprophylaxis in achieving live births in these patients with thrombophilia. All patients included in this study were prophylactically administered low dose ecosprin with either unfractionated heparin (5000 IU s.c, BD) or low molecular weight heparin (40 mg s.c, OD) during pregnancy. Patients were followed up in the antenatal period and the obstetric outcome noted. Comparisons were made between the obstetric outcomes of these patients receiving the aforesaid thromboprophylaxis with those of previous untreated pregnancies during which no ecosprin or heparin had been administered. The data obtained were subjected to statistical analysis using Students ‘t’ test and Chi square analysis. P value <0.05 was considered statistically significant.Results: Fifty nine of the sixty patients with thrombophilia and previous adverse pregnancy outcome who received prophylaxis with ecosprin and heparin during the present pregnancy had live births (98.33%; p <0.0001). Fifty-eight (96.66%) of these patients progressed to term delivery and one (1.67%) pregnancy resulted in a pre-term birth.Conclusions: Present study reveals that prophylaxis with low dose ecosprin and heparin administered to patients with thrombophilia (acquired or inherited) with history of previous adverse obstetric outcome resulted in a positive outcome in terms of a significantly higher number of live births. However, larger studies are needed to further elaborate on the role of thromboprophylaxis in pregnancies with inherited thrombophilia.

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Effects of Maternal Obesity On Placental Phenotype

Current Vascular Pharmacology ◽

10.2174/1570161118666200513115316 ◽

2020 ◽

Vol 19 (2) ◽

pp. 113-131 ◽

Cited By ~ 2

Author(s):

A.L. Fowden ◽

E.J. Camm ◽

A.N. Sferruzzi-Perri

Keyword(s):

Potential Role ◽

Maternal Obesity ◽

Endocrine Function ◽

Obstetric Outcomes ◽

Contributory Factor ◽

Intrauterine Development ◽

Maternal Undernutrition ◽

Clinical Complications ◽

Adverse Impacts

: The incidence of obesity is rising rapidly worldwide with the consequence that more women are entering pregnancy overweight or obese. This leads to an increased incidence of clinical complications during pregnancy and of poor obstetric outcomes. The offspring of obese pregnancies are often macrosomic at birth although there is also a subset of the progeny that are growth-restricted at term. Maternal obesity during pregnancy is also associated with cardiovascular, metabolic and endocrine dysfunction in the offspring later in life. As the interface between the mother and fetus, the placenta has a central role in programming intrauterine development and is known to adapt its phenotype in response to environmental conditions such as maternal undernutrition and hypoxia. However, less is known about placental function in the abnormal metabolic and endocrine environment associated with maternal obesity during pregnancy. This review discusses the placental consequences of maternal obesity induced either naturally or experimentally by increasing maternal nutritional intake and/or changing the dietary composition. It takes a comparative, multi-species approach and focusses on placental size, morphology, nutrient transport, metabolism and endocrine function during the later stages of obese pregnancy. It also examines the interventions that have been made during pregnancy in an attempt to alleviate the more adverse impacts of maternal obesity on placental phenotype. The review highlights the potential role of adaptations in placental phenotype as a contributory factor to the pregnancy complications and changes in fetal growth and development that are associated with maternal obesity.

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Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report

Journal of Institute of Medicine ◽

10.3126/jiom.v41i2.26561 ◽

2019 ◽

Vol 41 (2) ◽

pp. 67-69

Author(s):

Uma Shrestha

Keyword(s):

Perinatal Mortality ◽

Elderly Women ◽

Gestational Hypertension ◽

Adverse Outcomes ◽

Obstetric Outcomes ◽

Labor Dystocia ◽

Grand Multiparity ◽

Emergency Cesarean ◽

Increased Risk ◽

Multiparous Women

Parity more than five is grand multiparty and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and prenatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among youngprimigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grandmultiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome.

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Role of first trimester HbA1c as a predictor of adverse obstetric outcomes in a multi-ethnic cohort.

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2016-2581 ◽

2016 ◽

pp. jc.2016-2581 ◽

Cited By ~ 4

Author(s):

Laura Mañé ◽

Juana Antonia Flores-Le Roux ◽

David Benaiges ◽

Marta Rodríguez ◽

Irene Marcelo ◽

...

Keyword(s):

First Trimester ◽

Obstetric Outcomes

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The Brabant study: design of a large prospective perinatal cohort study among pregnant women investigating obstetric outcome from a biopsychosocial perspective

BMJ Open ◽

10.1136/bmjopen-2020-038891 ◽

2020 ◽

Vol 10 (10) ◽

pp. e038891

Author(s):

Margreet Meems ◽

Lianne Hulsbosch ◽

Madelon Riem ◽

Christina Meyers ◽

Tila Pronk ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Thyroid Function ◽

Maternal Distress ◽

Obstetric Outcomes ◽

Social Changes ◽

Obstetric Outcome ◽

Partner Relationship ◽

Pregnancy Distress

BackgroundPregnancy is characterised by many biological and psychosocial changes. Adequate maternal thyroid function is important for the developing fetus throughout gestation. Latent class analyses recently showed three different patterns of change in thyroid function throughout pregnancy with different associations with obstetric outcome. Maternal distress during the pregnancy (anxiety and depression) negatively affects obstetric outcome. Pregnancy distress in turn may be affected by personality traits and attachment styles. Moreover, during the pregnancy, substantial social changes occur in the partner relationship and work experience. The aim of the Brabant study is to investigate the association between thyroid function trajectories and obstetric outcomes. Moreover, within the Brabant study, we will investigate how different trajectories of pregnancy distress are related to obstetric outcome, and the role of personality in this association. We will evaluate the possible role of maternal distress and attachment style on maternal–fetal bonding. Finally, we will study social changes in the perinatal period regarding partner relationship and well-being and performance at work.Methods and analysisThe Brabant study is a longitudinal, prospective cohort study of an anticipated 4000 pregnant women. Women will be recruited at 8–10 weeks gestation among community midwife practices in South-East Brabant in the Netherlands. Thyroid function parameters (TSH and fT4), thyroid peroxidase antibody and human chorionic gonadotrophin will be assessed at 12, 20 and 28 weeks gestation. Moreover, at these three time points women will fill out questionnaires assessing demographic and obstetric features, life style habits and psychological and social variables, such as depressive symptoms, personality, partner relationship quality and burnout. Data from the obstetric records will also be collected.Ethics and disseminationThe study has been approved by the Medical Ethical Committee of the Máxima Medical Center Veldhoven. Results will be submitted to peer-reviewed journals in the relevant fields and presented on national and international conferences.

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Exploring the Role of Fusobacterium nucleatum in Preterm Birth: A Narrative Review

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5409 ◽

2020 ◽

Vol 8 (F) ◽

pp. 253-259

Author(s):

Biagio Rapone ◽

Elisabetta Ferrara ◽

Ilaria Converti ◽

Matteo Loverro ◽

Maria Teresa Loverro ◽

...

Keyword(s):

Preterm Birth ◽

Intrauterine Infection ◽

Fusobacterium Nucleatum ◽

Current Data ◽

Oral Microbiome ◽

Obstetric Outcomes ◽

Adverse Pregnancy ◽

Negative Impacts ◽

Poor Outcomes

In recent years, substantive attention has been drawn to the relationship between oral microbiome homeostatic equilibrium disruption and systemic health, demonstrating the negative impacts of this reciprocal biological interplay. Increasingly, there is a concern over the potential noxious effect of oral microbiome dysbiosis on obstetric poor outcomes, focusing on preterm birth. This epidemiological observation remains unexplained, although biologically plausible mechanism has been proposed. Intrauterine infection has long been associated with adverse pregnancy, when the elicitation of an immune response is determinant. There is evidence that Fusobacterium nucleatum (FN), a Gram-negative anaerobe ubiquitous in the oral cavity, infects the mouse placenta originating in the decidua basalis. Based on the current data in literature, we performed a review to provide resources for the explanation of the potential impact of microbiome dysbiosis on poor obstetric outcomes, focusing on the role of FN.

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