Waiting for induction: maternal outcomes in elective inductions of labor at increasing gestational age

Objective Breast cancer is one of the most frequently diagnosed cancers in pregnancy and is commonly treated with chemotherapy. To date, studies examining effects of chemotherapy during pregnancy on fetal growth have yielded conflicting results, and most are limited by small sample sizes or are nonspecific with respect to cytotoxic regimen or type of cancer treated. We sought to evaluate the effect of chemotherapy for breast cancer in pregnancy on birthweight and small for gestational age infants. Study Design This is a retrospective cohort study of 74 women diagnosed with pathologically confirmed breast cancer during pregnancy between 1997 and 2018 at one of three academic medical centers, who had a singleton birth with known birthweight. Forty-nine received chemotherapy and 25 did not receive chemotherapy. Linear regression modeling was used to compare birthweight (by gestational age and sex-specific z-score) by chemotherapy exposure. Subanalyses of specific chemotherapy regimen and duration of chemotherapy exposure were also performed. Placental, neonatal, and maternal outcomes were also analyzed by chemotherapy exposure. Results In the adjusted model, chemotherapy exposure was associated with lower birthweight (∆ z-score = − 0.49, p = 0.03), but similar rates of small for gestational age (defined as birthweight <10th percentile for gestational age) infants (8.2 vs. 8.0%, p = 1.0; Fisher’s exact test). Each additional week of chemotherapy (∆ z-score = − 0.05, p = 0.03) was associated with decreased birthweight, although no association was found with specific chemotherapy regimen. Chemotherapy exposure was associated with lower median placental weight percentile by gestational age (9th vs. 75th, p < 0.05). Secondary maternal outcomes were similar between the group that did and did not receive chemotherapy. Conclusion Chemotherapy for breast cancer in pregnancy in this cohort is associated with lower birthweight but no difference in the rate of small for gestational age infants. Key Points

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Perinatal and maternal outcome after vitrification of blastocysts: a Nordic study in singletons from the CoNARTaS group

Human Reproduction ◽

10.1093/humrep/dez212 ◽

2019 ◽

Cited By ~ 2

Author(s):

Erica Ginström Ernstad ◽

Anne Lærke Spangmose ◽

Signe Opdahl ◽

Anna-Karina Aaris Henningsen ◽

Liv Bente Romundstad ◽

...

Keyword(s):

Gestational Age ◽

Lower Risk ◽

Placenta Previa ◽

Collaborative Study ◽

Blastocyst Transfer ◽

Fertility Treatment ◽

Maternal Outcomes ◽

Cleavage Stage ◽

Significant Difference ◽

Per Se

Abstract STUDY QUESTION Is transfer of vitrified blastocysts associated with higher perinatal and maternal risks compared with slow-frozen cleavage stage embryos and fresh blastocysts? SUMMARY ANSWER Transfer of vitrified blastocysts is associated with a higher risk of preterm birth (PTB) when compared with slow-frozen cleavage stage embryos and with a higher risk of a large baby, hypertensive disorders in pregnancy (HDPs) and postpartum hemorrhage (PPH) but a lower risk of placenta previa when compared with fresh blastocysts. WHAT IS KNOWN ALREADY Transfer of frozen-thawed embryos (FETs) plays a central role in modern fertility treatment, limiting the risk of ovarian hyperstimulation syndrome and multiple pregnancies. Following FET, several studies report a lower risk of PTB, low birth weight (LBW) and small for gestational age (SGA) yet a higher risk of fetal macrosomia and large for gestational age (LGA) compared with fresh embryos. In recent years, the introduction of new freezing techniques has increased treatment success. The slow-freeze technique combined with cleavage stage transfer has been replaced by vitrification and blastocyst transfer. Only few studies have compared perinatal and maternal outcomes after vitrification and slow-freeze and mainly in cleavage stage embryos, with most studies indicating similar outcomes in the two groups. Studies on perinatal and maternal outcomes following vitrified blastocysts are limited. STUDY DESIGN, SIZE, DURATION This registry-based cohort study includes singletons born after frozen-thawed and fresh transfers following the introduction of vitrification in Sweden and Denmark, in 2002 and 2009, respectively. The study includes 3650 children born after transfer of vitrified blastocysts, 8123 children born after transfer of slow-frozen cleavage stage embryos and 4469 children born after transfer of fresh blastocysts during 2002–2015. Perinatal and maternal outcomes in singletons born after vitrified blastocyst transfer were compared with singletons born after slow-frozen cleavage stage transfer and singletons born after fresh blastocyst transfer. Main outcomes included PTB, LBW, macrosomia, HDP and placenta previa. PARTICIPANTS/MATERIALS, SETTING, METHODS Data were obtained from the CoNARTaS (Committee of Nordic ART and Safety) group. Based on national registries in Sweden, Finland, Denmark and Norway, the CoNARTaS cohort includes all children born after ART treatment in public and private clinics 1984–2015. Outcomes were assessed with logistic multivariable regression analysis, adjusting for the country and year of birth, maternal age, body mass index, parity, smoking, parental educational level, fertilisation method (IVF/ICSI), single embryo transfer, number of gestational sacs and the child’s sex. MAIN RESULTS AND THE ROLE OF CHANCE A higher risk of PTB (<37 weeks) was noted in the vitrified blastocyst group compared with the slow-frozen cleavage stage group (adjusted odds ratio, aOR [95% CI], 1.33 [1.09–1.62]). No significant differences were observed for LBW (<2500 g), SGA, macrosomia (≥4500 g) and LGA when comparing the vitrified blastocyst with the slow-frozen cleavage stage group. For maternal outcomes, no significant difference was seen in the risk of HDP, placenta previa, placental abruption and PPH in the vitrified blastocyst versus the slow frozen cleavage stage group, although the precision was limited. When comparing vitrified and fresh blastocysts, we found higher risks of macrosomia (≥4500 g) aOR 1.77 [1.35–2.31] and LGA aOR 1.48 [1.18–1.84]. Further, the risks of HDP aOR 1.47 [1.19–1.81] and PPH aOR 1.68 [1.39–2.03] were higher in singletons born after vitrified compared with fresh blastocyst transfer while the risks of SGA aOR 0.58 [0.44–0.78] and placenta previa aOR 0.35 [0.25–0.48] were lower. LIMITATIONS, REASONS FOR CAUTION Since vitrification was introduced simultaneously with blastocyst transfer in Sweden and Denmark, it was not possible to explore the effect of vitrification per se in this study. WIDER IMPLICATIONS OF THE FINDINGS The results from the change of strategy to vitrification of blastocysts are reassuring, indicating that the freezing technique per se has no major influence on the perinatal and maternal outcomes. The higher risk of PTB may be related to the extended embryo culture rather than vitrification. STUDY FUNDING/COMPETING INTEREST(S) The study is part of the ReproUnion Collaborative study, co-financed by the European Union, Interreg V ÖKS. The study was also financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (LUA/ALF 70940), Hjalmar Svensson Research Foundation and NordForsk (project 71 450). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER ISRCTN11780826.

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the PREGNANCY OUTCOMES DO INFLUENCE BY EXTREMES OF BODY MASS INDEX

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71i2.4841 ◽

2021 ◽

Vol 71 (2) ◽

pp. 690-93

Author(s):

Lubna Razzak ◽

Ramna Devi ◽

Sana Tariq ◽

Anchal Seetlani ◽

Sara Jamshed

Keyword(s):

Body Mass Index ◽

Cohort Study ◽

Gestational Diabetes ◽

Cesarean Section ◽

Body Mass ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Maternal Outcomes

Objective: To investigate whether extreme of body mass index (BMI) is associated with pregnancy outcomes. Study Design: Retrospective cohort study. Place and Duration of Study: Hamdard University Hospital, Karachi, Pakistan, from Feb 2019 to Jan 2020. Methodology: We conducted a retrospective cohort study of 1000 women delivered in between February 2019 to January 2020. BMI is categorized into four groups according to the Asian-Pacific cutoff points as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (>25 kg/m2). Maternal outcomes measured were pre-eclampsia, gestational diabetes, delivery by cesarean section, instrumental delivery, anemia, postpartum hemorrhage and fetal outcome included small for gestational age and large for gestational age. Logistic regression model was used to adjust the confounder. Maternal outcomes were evaluated with relative risks and 95% confidence intervals. Results: In results, 13%, 54%, 22%, 9% and 2% were underweight, normal body mass index, overweight, obese and morbidly obese categories respectively. The gestational diabetes, pre-eclampsia, labour induction, frequency of cesarean section, postpartum hemorrhage increased linearly with increasing body mass index and expressed as adjusted odds ratio (95% confidence interval) respectively: 10.0 (95% CI 3.5, 28.7), 5.3 (95% CI 2.0, 14.1), 2.7 (95% CI 1.1, 6.8), 4.9 (95% CI 2.8–8.8), 2.5 (95% CI 0.31– 20.6). The anemia and small for gestational age were found in underweight group with adjusted odd ratio2.47 (95% CI 1.6– 3.6), 4.6 (95% CI 2.6, 8.1) respectively........

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P2246Maternal and foetal outcomes of anticoagulation in pregnant women with preconception venous thromboembolism

European Heart Journal ◽

10.1093/eurheartj/ehz748.0724 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Soegaard ◽

F Skjoth ◽

P B Nielsen ◽

J Beyer-Westendorf ◽

T B Larsen

Keyword(s):

Preterm Birth ◽

Venous Thromboembolism ◽

Pregnant Women ◽

Gestational Age ◽

First Trimester ◽

Adverse Outcomes ◽

Congenital Defects ◽

Maternal Outcomes ◽

Foetal Loss ◽

Recurrent Vte

Abstract Background Anticoagulation is essential to prevent recurrent venous thromboembolism (VTE) during pregnancy in women with a history of preconception VTE. However, information on the safety of anticoagulant drugs in this setting is limited. Purpose To investigate the risk of maternal and foetal adverse outcomes associated with anticoagulant exposure during pregnancy. Methods Nationwide cohort of all pregnant women in Denmark with preconception VTE, 2000–2017. We linked individual-level data from nationwide registries on anticoagulant exposure, maternal and foetal outcomes. Results Among 5,099 pregnancies in 3,246 women with preconception VTE (mean age 31 years, 41% nulliparous), 36.4% were exposed to anticoagulants during first trimester (66.4% low-molecular-weight heparin (LMWH), 31.9% VKA, and 1.8% NOAC (Table). No maternal deaths occurred. Maternal outcomes were comparable among LMWH and unexposed women, whereas recurrent VTE and foetal loss was more prevalent in VKA and NOAC exposed women. Foetal risk was lowest in unexposed and LMWH exposed, whereas preterm birth was prevalent in VKA and NOAC exposed. Table 1. Maternal and foetal outcomes in pregnant women with preconception VTE according to first trimester anticoagulant exposure Maternal outcomes No anticoagulants LMWH VKA NOAC Total pregnancies/singleton foetuses, N 3,244/2,722 1231/1,124 591/442 33 /26 Recurrent VTE, % (N) 2.7 (89) 3.3 (41) 6.4 (38) – (<5) Antenatal bleeding, % (N) 2.3 (73) 2.7 (33) 1.5 (9) 0 Preeclampsia, % (N) 3.0 (98) 2.1 (26) 4.4 (26) – (<5) Foetal loss, % (N) 13.4 (436) 6.6 (81) 22.2 (131) 21.2 (7) Foetal outcomes in live singleton births, except stillbirth Stillbirth, % (N) 0.6 (17) 0.6 (7) – (<5) 0 Mean gestational age, days/birthweight, gram 246/3,458 246/3,471 238/3,212 243/3,138 Preterm birth (<37 weeks), % (N) 41.1 (1,111) 38.3 (428) 63.2 (277) 57.7 (15) Very preterm birth (<28 weeks), % (N) 0.9 (24) 1.3 (14) 2.7 (12) 0 Small for gestational age, % (N) 4.2 (109) 4.5 (49) 4.8 (20) – (<5) Mean 5-minute Apgar score, (sd) 9.8 (0.8) 9.8 (0.7) 9.8 (1.0) 9.7 (1.0) Congenital defects 8.4 (226) 9.0 (100) 10.0 (44) – (<5) Counts are supressed in cells with <5 observations to prevent disclosure of potentially identifiable information. Conclusion Our findings are reassuring and in support of the recommendation of LMWH for pregnant women with prior VTE. Few women were exposed to NOAC during pregnancy, and the safety of NOACs cannot be substantiated with the current level of evidence. Acknowledgement/Funding The Obel Family Foundation partly funded this research by an unrestricted grant.

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Maternal Hemoglobin Concentrations Across Pregnancy and Maternal and Child Health: A Systematic Review and Meta-analysis (P11-033-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-033-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Melissa Fox Young ◽

Brietta Oaks ◽

Sonia Tandon ◽

Reynaldo Martorell ◽

Kathryn Dewey ◽

...

Keyword(s):

Systematic Review ◽

Child Health ◽

Health Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Post Partum ◽

Meta Analysis ◽

Cochrane Review ◽

World Health ◽

Maternal Outcomes

Abstract Objectives Maternal anemia is a well-recognized global health problem; however, there remain questions on specific hemoglobin thresholds that predict health risk or protection for mother and child. Our objective was to conduct a systematic review and meta-analysis to examine the associations of maternal hemoglobin concentrations with a range of maternal and infant health outcomes, accounting for timing of measurement (preconception, first, second and third trimesters), etiology of anemia and cut-off category. Methods Our search strategy identified 7,677 articles. Screening and article selection was conducted using Covidence systematic review software to organize search results from PubMed and Cochrane Review. The systematic review included 272 studies and the meta-analysis included 102 studies. Results Low maternal hemoglobin (< 110 g/L) was associated with poor birth outcomes (low birth weight, OR (95%CI): 1.43 (1.31-1.55); preterm birth, 1.35 (1.25-1.46); small-for-gestational age, 1.08 (1.00-1.18); stillbirth, 1.43 (1.05-1.95); perinatal mortality, 1.73 (1.32-2.26); and neonatal mortality, 1.49 (1.19-1.87); and adverse maternal outcomes (post-partum hemorrhage, 2.17 (1.51-3.10); preeclampsia, 1.84 (1.31-2.59); and blood-transfusion, 6.57 (3.59-12.00). High maternal hemoglobin (> 130 g/L) was associated with increased odds of small-for-gestational age, 1.22 (1.08-1.37); stillbirth, 1.88 (1.21-2.91); preeclampsia, 1.48 (1.10-2.01); and gestational diabetes, 2.02 (1.63-2.50). Relationships varied by timing of measurement and cut-off category; limited data were available on anemia etiology. There were insufficient data for other maternal outcomes and long-term child health outcomes. Conclusions Current data are insufficient for determining if revisions to current hemoglobin cut-offs are required. Pooled high-quality individual-level data analyses as well as prospective cohort studies that measure hemoglobin throughout pregnancy would be valuable to inform the re-evaluation of hemoglobin cut-offs. Funding Sources This work was commissioned and financially supported by the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development of the World Health Organization (WHO), Geneva, Switzerland.

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Vegetarian diets during pregnancy, and maternal and neonatal outcomes

International Journal of Epidemiology ◽

10.1093/ije/dyaa200 ◽

2020 ◽

Author(s):

Samrawit F Yisahak ◽

Stefanie N Hinkle ◽

Sunni L Mumford ◽

Mengying Li ◽

Victoria C Andriessen ◽

...

Keyword(s):

Weight Gain ◽

Gestational Weight Gain ◽

Gestational Age ◽

Small For Gestational Age ◽

Neonatal Outcomes ◽

Maternal Outcomes ◽

Gestational Weight ◽

The Usa ◽

Maternal And Neonatal Outcomes ◽

Vegetarian Diets

Abstract Background Vegetarian diets are becoming increasingly popular in the USA. Limited research has examined the health consequences of vegetarian diets during pregnancy. We comprehensively examined associations of vegetarianism during pregnancy with maternal and neonatal outcomes. Methods We used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Fetal Growth Studies–Singletons, a prospective multi-site cohort of 1948 low-risk pregnant women of four races/ethnicities (White, Black, Hispanic, Asian/Pacific Islander) in the USA (2009–2013). Vegetarianism was self-reported and also defined based on dietary patterns measured using a self-administered first-trimester food-frequency questionnaire (full [lacto-ovo and vegan], pesco-, semi- and non-vegetarians). Neonatal outcomes included birthweight and neonatal anthropometric measures, small for gestational age, small for gestational age with neonatal morbidity and preterm delivery. Maternal outcomes included gestational weight gain, gestational diabetes, hypertensive disorders of pregnancy and gestational anaemia. Results Ninety-nine (6.2%) women self-reported being vegetarian. The diet-based definition identified 32 (2.0%) full vegetarians, 7 (0.6%) pesco-vegetarians and 301 (17.6%) semi-vegetarians. Neonates of diet-based full vegetarians had higher odds of being small for gestational age [adjusted odds ratio (ORadj) = 2.51, 95% confidence interval: 1.01, 6.21], but not of being small for gestational age with a postnatal morbidity. Full vegetarians had marginally increased the odds of inadequate second-trimester gestational weight gain (ORadj = 2.24, 95% confidence interval: 0.95, 5.27). Conclusion Vegetarian diets during pregnancy were associated with constitutionally smaller neonatal size, potentially via the mothers’ reduced gestational weight gain. Notably, vegetarianism was not associated with small-for-gestational-age-related morbidities or other adverse maternal outcomes.

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Antibiotic Timing in Previable Prelabor Rupture of Membranes Less Than 24 Weeks of Gestation

American Journal of Perinatology ◽

10.1055/s-0040-1718876 ◽

2020 ◽

Author(s):

Rubymel J. Knupp ◽

Sarah Pederson ◽

Christina Blanchard ◽

Jeff Szychowski ◽

Deepa Etikala ◽

...

Keyword(s):

Birth Weight ◽

Gestational Age ◽

Tertiary Care ◽

Prophylactic Antibiotic ◽

Neonatal Outcomes ◽

Maternal Outcomes ◽

Antibiotic Administration ◽

Neonatal Birth Weight ◽

Significant Difference ◽

Adverse Neonatal Outcomes

Objective This study aimed to compare neonatal and maternal outcomes between immediate and delayed prophylactic antibiotic administration after previable prelabor premature rupture of membranes (PROM) less than 24 weeks of gestation. Study Design Retrospective cohort study of singleton pregnancies with PROM between 160/7 and 236/7 weeks of gestational age conducted at a single tertiary care referral center between June 2011 and December 2015. Patients with multiple gestations, fetal anomalies, those who elected augmentation, or with a contradiction to expectant management, such as suspected intra-amniotic infection or stillbirth, were excluded from the study. We compared pregnancy characteristics, maternal complications, and neonatal outcomes between women who received a course of antibiotics within 24 hours of PROM and women who received antibiotics after 24 hours of PROM. The primary outcome was neonatal survival to hospital discharge. Secondary outcomes included gestational age at delivery, time from PROM to delivery, neonatal birth weight, days in the neonatal intensive care unit (NICU), composite adverse neonatal outcomes, and maternal morbidity. Results Ninety-four women met inclusion criteria, 57 (61%) received antibiotics within 24 hours of PROM and 37 (39%) received antibiotics 24 hours after PROM. Baseline maternal characteristics were similar in both groups. The mean gestational age at PROM was similar between groups at 20.8 ± 2.3 weeks in the immediate antibiotics group and 20.6 ± 2.1 weeks in the delayed antibiotics group (p = 0.48). Compared with delayed antibiotic administration, immediate antibiotic administration was not associated with a significant difference in latency time from PROM to delivery, rate of stillbirth, days in an ICU, or adverse neonatal outcomes. Maternal outcomes also did not differ significantly between groups. Neonatal birth weight was lower in the immediate antibiotics group (p = 0.012). Conclusion Our data suggest that there is no maternal or neonatal benefit to immediate administration of latency antibiotics compared with delayed administration. Key Points

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Maternal hypothyroidism and neonatal outcome

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20201647 ◽

2020 ◽

Vol 7 (5) ◽

pp. 1101

Author(s):

Hrishikesh S. Pai ◽

Rojo Joy ◽

Varghese Cherian ◽

Preethy Peter

Keyword(s):

Gestational Age ◽

Neonatal Outcome ◽

Growth Parameters ◽

Descriptive Study ◽

Maternal Outcomes ◽

Prompt Treatment ◽

Hypertensive Disorders ◽

Type Of Delivery ◽

Thyroid Abnormalities ◽

Age Category

Background: Hypothyroidism is widely prevalent in pregnant women but rate of detection is very low in developing countries. Hypothyroidism is easily treated, timely detection and treatment of the disorder could reduce the burden of adverse fetal and maternal outcomes. Objective of the study was to determine the immediate outcome in neonates born to mother with hypothyroidism.Methods: Prospective descriptive study.110 babies were observed for neonatal outcome.55 babies were born to hypothyroid mothers and 55 babies were born to mothers without thyroid abnormalities. These babies were observed for type of delivery, Gestational age, need for intensive care unit, growth parameters, Interventions required during the stay, sepsis was compared with those born to mothers without hypothyroidism.Results: Both the groups were similar in terms of type of delivery. No association between maternal hypothyroidism and Hypertensive disorders, gestational diabetes. Cases with prematurity are almost same in both groups. Most of babies were term gestation. The birth weight of babies was similar. Majority from both the group did not require any oxygen support. Majority of babies were in appropriate for age category. Both the groups were similar in incidence of small for gestational age and large of gestational age babies.Conclusions: Babies born to well treated hypothyroid mothers were similar in all aspects to babies born to non-hypothyroid mothers. These signify the importance of screening all antenatal mothers for hypothyroidism and prompt treatment to prevent adverse consequences on neonatal outcome.

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Lymphoma Occurring during Pregnancy: Obstetric Outcome and Overall Survival in a Series of 19 Patients

Blood ◽

10.1182/blood-2019-127391 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5289-5289

Author(s):

Anna Vanazzi ◽

Fedro Peccatori ◽

Barbara Buonomo ◽

Di Loreto Eugenia ◽

Giovanna Scarfone ◽

...

Keyword(s):

B Cell ◽

Hodgkin Lymphoma ◽

Gestational Age ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Obstetric Complications ◽

Age At Diagnosis ◽

Additional Patient ◽

Maternal Outcomes

INTRODUCTION AND BACKGROUND: Lymphoma during pregnancy is a rare and highly challenging condition. Recent evidences show that chemotherapy can be safely administered during pregnancy, however the effects on obstetric and neonatal outcomes are still largely unknown. Aim of this study is to illustrate the oncologic management and to investigate the obstetric, neonatal and maternal outcomes in a series of cases diagnosed with lymphomas during pregnancy. PATIENTS AND METHODS: A retrospective analysis has been conducted in a cohort of pregnant patients diagnosed with Hodgkin lymphoma (HL) and non-Hodgkin Lymphoma (NHL) between 2006 and 2019. Data were collected from the clinical databases and medical records at Istituto Europeo di Oncologia and IRCCS Policlinico di Milano (Milano, Italy). Data on maternal disease, treatments, obstetric complications, fetal and maternal outcomes were analyzed. RESULTS: We identified 19 pregnant patients diagnosed with HL and NHL. Their median age at diagnosis was 29 years (range 23-39). Nodular sclerosis HL was the most common histological subtype (9 patients); primary Mediastinal B-cell lymphoma (PMBCL) was diagnosed in 4 patients, Diffuse Large B Cell NHL in 2 patients, whereas Burkitt lymphoma, Anaplastic Large Cell Lymphoma (ALCL), Follicular NHL and primary cutaneous ALCL were diagnosed in one patient for each of these subtypes. Seven women were diagnosed with advanced disease, with bulky presentation in 5 of them and B symptoms in 3 patients. The median gestational age at diagnosis was 22 weeks (range 7-30). Three patients were diagnosed in the first trimester of pregnancy. Two of them opted for a termination of pregnancy in order to initiate immediate treatment. The remaining 17 pregnancies ended in a live birth. Overall, 8 pregnant women received antenatal chemotherapy, started at a median gestational age of 23 weeks (range 23-33). Treatment included ABVD in 4 patients, CEOP in 3 patients, CHOP in 1 patient (rituximab delayed after delivery in 4 patients). One additional patient received radiotherapy on cutaneous lesion delivered at 33 weeks (primary cutaneous ALCL). Seven out of 9 patients treated during pregnancy obtained a complete response (CR). In eight patients treatment was postponed (due to indolent histology or asymptomatic and non-bulky disease). Obstetric complications occurred during chemotherapy at week 33 in 1 patient with intrauterine growth restriction (IUGR) and oligohydramnios. After a median follow up of 32 months, 13/19 patients are alive and free of disease, 1 patient relapsed 6 y after diagnosis of HL and she is presently undergoing salvage treatment, 1 patient non yet evaluable, 4 patients lost at follow-up. CONCLUSIONS: Treating lymphomas during pregnancy is feasible, however the management of a pregnant patient with lymphoma requires multidisciplinary approach. In case of low risk disease and/or disease occurring in late gestational phase, therapy can be deferred to post-partum. If required, standard chemotherapeutic regimens can be administered during the 2nd and 3rd trimester, with minimal maternal or fetal complications. Starting treatment during pregnancy does not imply an adverse long-term outcome. Disclosures No relevant conflicts of interest to declare.

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Maternal Outcome in Women with Preeclampsia

10.53350/pjmhs211571769 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1769-1771

Author(s):

Uzma Siddique ◽

Syeda Khalida Naeem ◽

Bushra Begum Ramejo ◽

Aesha Sadaf Rizwan ◽

Moniza Imran ◽

...

Keyword(s):

Body Mass Index ◽

Renal Failure ◽

Acute Renal Failure ◽

Gestational Age ◽

Hellp Syndrome ◽

Placental Abruption ◽

Maternal Outcomes ◽

Blood Picture ◽

Maternal Complications ◽

Medical College

Aim: To determine the maternal outcomes in women presented with severe pre-eclampsia. Study Design: Prospective/Observational Place and Duration: Obs & Gynae department of Akhtar Saeed Medical and Dental College and Hospital, Lahore and Kausar hospital/Khairpur Medical College, Khairpur Mir’s Methods: Total 100 patients with ages 18 to 45 years presented with pre-eclampsia were included in this study. Patients detailed demographic including age, parity, gestational age, and body mass index were recorded after taking written consent. Patients complete blood picture was examined. Complications associated with preeclampsia were examined. Data was analyzed by SPSS 23.0. Results: Out of 100 patients 23 (23%) were ages <20 years, 42 (42%) were ages 20 to 30 years, 30 (30%) were ages 31 to 40 years and 5 (5%) were ages above 40 years. 41 (41%) were primigravida while 59 (59%) were multigravida. Mean gestational age was 34.11±3.88 weeks. HELLP syndrome found in 21 (21%) patients, 11 (11%) patients had eclampsia, and 16 (16%) patients had placental abruption, coagulopathy found in 4 (4%) patients, 3 (3%) patients developed acute renal failure and 2 (2%) patients were died. Conclusion: It is concluded that pre-eclampsia is highly associated with major maternal complications such as HELLP syndrome, eclampsia, placental abruption and maternal mortality. Keywords: Pre-eclampsia, HELLP Syndrome, Placental Abruption, Eclampsia, Mortality

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