Macrosomic Newborns Delivered at Term after Labor among Nondiabetic Women: Maternal and Neonatal Morbidities

Author(s):  
Han-Yang Chen ◽  
Suneet P. Chauhan

Abstract Objective This study aimed to compare morbidities among nonmacrosomic versus macrosomic singleton live births of nondiabetic women who labored. Study Design This retrospective study utilized the 2003 revision of U.S. birth certificate data of singleton live births (2011–2013) at 37 to 41 weeks who labored. The primary outcomes were composite maternal and neonatal morbidities (CMM and CNM, respectively). We compared these outcomes by birth weight, 2,500 to 3,999 g (group 1; reference), 4,000 to 4,449 g (group 2), and 4,500 to 5,999 g (group 3). We used multivariable Poisson regression analyses to examine the association between birth weight groups and the outcomes. Results Among 6,691,338 live births, 92.0% were in group 1, 7.1% in group 2, and 0.9% in group 3. The overall CMM and CNM rates were 4.4 and 6.8 per 1,000 live births, respectively. Compared with group 1, the risk of CMM was significantly higher in group 2 (adjusted risk ratio [aRR] = 1.50; 95% confidence interval [CI]: 1.44–1.56) and group 3 (aRR = 2.00; 95% CI: 1.82–2.19). Likewise, the risk of CNM was significantly higher in group 2 (aRR = 1.38; 95% CI: 1.33–1.43) and group 3 (aRR = 2.57; 95% CI: 2.40–2.75) than in group 1. Conclusion Nondiabetic women who labor with a macrosomic newborns have a significantly higher rate of adverse outcomes than nonmacrosomic.

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu Liu ◽  
Jing Li ◽  
Wanyu Zhang ◽  
Yihong Guo

AbstractOestradiol, an important hormone in follicular development and endometrial receptivity, is closely related to clinical outcomes of fresh in vitro fertilization-embryo transfer (IVF-ET) cycles. A supraphysiologic E2 level is inevitable during controlled ovarian hyper-stimulation (COH), and its effect on the outcome of IVF-ET is controversial. The aim of this retrospective study is to evaluate the association between elevated serum oestradiol (E2) levels on the day of human chorionic gonadotrophin (hCG) administration and neonatal birthweight after IVF-ET cycles. The data of 3659 infertile patients with fresh IVF-ET cycles were analysed retrospectively between August 2009 and February 2017 in First Hospital of Zhengzhou University. Patients were categorized by serum E2 levels on the day of hCG administration into six groups: group 1 (serum E2 levels ≤ 1000 pg/mL, n = 230), group 2 (serum E2 levels between 1001 and 2000 pg/mL, n = 524), group 3 (serum E2 levels between 2001 and 3000 pg/mL, n = 783), group 4 (serum E2 levels between 3001 and 4000 pg/mL, n = 721), group 5 (serum E2 levels between 4001 and 5000 pg/mL, n = 548 ), and group 6 (serum E2 levels > 5000 pg/mL, n = 852). Univariate linear regression was used to evaluate the independent correlation between each factor and outcome index. Multiple logistic regression was used to adjust for confounding factors. The LBW rates were as follows: 3.0% (group 1), 2.9% (group 2), 1.9% (group 3), 2.9% (group 4), 2.9% (group 5), and 2.0% (group 6) (P = 0.629), respectively. There were no statistically significant differences in the incidences of neonatal LBW among the six groups. We did not detect an association between peak serum E2 level during ovarian stimulation and neonatal birthweight after IVF-ET. The results of this retrospective cohort study showed that serum E2 peak levels during ovarian stimulation were not associated with birth weight during IVF cycles. In addition, no association was found between higher E2 levels and increased LBW risk. Our observations suggest that the hyper-oestrogenic milieu during COS does not seem to have adverse effects on the birthweight of offspring after IVF. Although this study provides some reference, the obstetric-related factors were not included due to historical reasons. The impact of the high estrogen environment during COS on the birth weight of IVF offspring still needs future research.


QJM ◽  
2021 ◽  
Author(s):  
N W Chew ◽  
J N Ngiam ◽  
S M Tham ◽  
Z Y Lim ◽  
T Y W Li ◽  
...  

Summary Background/Introduction There are little data on outcomes of COVID-19 patients with the presence of fever compared to the presence of symptoms. Aim We examined the associations between symptomology, presence of fever and outcomes of a COVID-19 cohort. Design and Methods Between 23 January and 30 April 2020, 554 COVID-19 patients were admitted to a tertiary hospital in Singapore. They were allocated into four groups based on symptomology and fever—Group 1: asymptomatic and afebrile, Group 2: symptomatic but afebrile, Group 3: febrile but asymptomatic and Group 4: symptomatic and febrile. The primary outcomes were intensive care unit (ICU) admissions and mortality. The composite end-point included ICU admissions, mortality or any COVID-19 related end-organ involvement. Results There were differences in ferritin (P=0.003), C-reactive protein (CRP) levels (P<0.001) and lymphopenia (P=0.033) across all groups, with the most favourable biochemical profile in Group 1, and the least in Group 4. Symptomatic groups (Groups 2 and 4) had higher ICU admissions (1.9% and 6.0%, respectively, P=0.003) than asymptomatic groups (Groups 1 and 3). Composite end-point was highest in Group 4 (24.0%), followed by Group 3 (8.6%), Group 2 (4.8%) and Group 1 (2.4%) (P<0.001). The presence of fever (OR 4.096, 95% CI 1.737–9.656, P=0.001) was associated with the composite end-point after adjusting for age, pulse rate, comorbidities, lymphocyte, ferritin and CRP. Presence of symptoms was not associated with the composite end-point. Discussion/Conclusion In this COVID-19 cohort, presence of fever was a predictor of adverse outcomes. This has implications on the management of febrile but asymptomatic COVID-19 patients.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Janet W Elcano ◽  
Hui Nam Pak

Background: The incidence of atrial fibrillation (AF) is increasing in the elderly population, however, there is paucity of data on the safety outcomes of this patient subgroup thus we sought to investigate on the impact of age on the safety of catheter ablation for AF. Methods and Results: We included 1,293 (male 75%) patients enrolled in Yonsei AF Ablation Cohort database in Seoul, South Korea, from March 2009 to November 2013. We divided the patients into 4 groups according to age (Group 1, aged 17-49, N=295 ; Group 2 50-59, N=421; Group 3 60-69 N=408; and Group 4 ≥ 70, N=169) and evaluated the incidence of procedure related complications. No procedure-related death occurred in this study. There was a trend of increasing incidence of procedure related complications with age noted as follows: Group 1= 3.7%; Group 2= 4.0%; Group 3=6.6%; and Group 4 7.1%, (p= 0.15). There were 28 cases (2.2%) of major complications (Group 1=1.7%, Group 2=1.9%, Group 3=2%, Group 4 4.1%), tamponade being the most common. Major complications in group 4 include: tamponade 4 cases, phrenic nerve palsy 1 case, atrioesophaeal fistula 1 and 3rd degree AV block in 1 patient. Multivariate regression analysis shows ablation time (odds ratio (OR) 1.2 confidence interval (CI)1.0-1.017, p=0.017), procedure time (OR 1.008, CI 1.0-1.15, p=0.04), decreasing eGFR (OR 1.013, CI 1.002-1.026 p=0.018), coronary artery disease (CAD) (OR 1.847, CI 1.003-3.524, p0.04) and age (OR 1.028, CI 1.003-1.055, p=0.03) were associated with increased adjusted risk of total complications. Predictors of major complications include age (OR 1.044, CI 1.003-1.086, p0.02) and ablation time (OR 1.009, CI 0.999-1.000, p=0.033). Conclusion: Our data suggest that incidence of procedural complications in RFA of AF increase with age. Ablation time and age are independent predictors of a major complication.


1988 ◽  
Vol 119 (1) ◽  
pp. 43-50 ◽  
Author(s):  
B. H. Breier ◽  
P. D. Gluckman ◽  
J. J. Bass

ABSTRACT The developmental pattern of plasma insulin-like growth factor-I (IGF-I) and insulin in calves subject to different patterns of weaning was investigated from birth until the age of 6 months. Fifteen male Friesian calves were fed on whole milk (10% of body weight per day) for the first 8 weeks after birth, then allocated into three balanced groups. Group 1 was weaned at 8 weeks; group 2 was weaned at 8 weeks, returned to milk-feeding at 13 weeks to be weaned again at the age of 16 weeks; group 3 was weaned at 12 weeks. After weaning the calves were fed on concentrates and lucerne hay. At birth, circulating concentrations of IGF-I correlated with birth weight (r = 0·78, P< 0·001). There was a significant (P<0·001) fall in plasma IGF-I from birth (40·3 ± 2·5 μg/l) until 5 weeks (23·8± 1·3 μg/l), and then a gradual (P<0·01) rise until week 8 (35·0 ± 2·2 μg/l). Weaning (groups 1 and 2 after week 8) caused a significant (P<0·01) decrease in plasma IGF-I (20·5 ± 1·9 μg/l); thereafter plasma levels of IGF-I rose gradually (P<0·01) in animals fed on concentrates. The milk-fed calves (group 3) showed a progressive increase in plasma IGF-I with age until they were weaned at 12 weeks (51·0 ± 3·4 μg/l); IGF-I levels then decreased to be similar to group 1 (32·5 ± 2·1 μg/l). When group 2 was returned to milk-feeding, plasma IGF-I concentrations increased to 58·2 ±3·8 μg/l within 4 days and then continued to rise gradually until decreasing upon weaning. The age-related increase in the plasma concentration of IGF-I after 6 weeks was parallel in milk- and concentrate-fed calves. Binding of 125I-labelled bovine GH to hepatic membranes of neonatal calves was low at birth (specific binding; 1·56 ±0·29% n=3). Somatotrophic binding was apparent at 6 weeks (6·43 ±0·42%, n = 3) and increased (9·2± 1·1%, n=3) at the age of 12 weeks. Thus the early postnatal changes in plasma IGF-I may reflect the transition from GH-independent to GH-dependent IGF-I secretion. Plasma concentrations of insulin at birth correlated with IGF-I (r = 0·54, P<0·05). However, regression analysis suggested no effect of insulin on birth weight independent of IGF-I. Plasma insulin levels rose gradually until weaning and thereafter were significantly (P<0·01) higher in the milk- than concentratefed calves. Major changes in plasma concentrations of IGF-I related to monogastric (milk feeding) or ruminant (concentrate feeding) nutrition of the young calf are demonstrated. They may be mediated through changing plasma insulin concentrations. An age-dependent prepubertal rise in plasma IGF-I apparently independent of nutritional factors commenced with the appearance of functional somatotrophic receptors in the liver. J. Endocr. (1988) 119, 43–50


2019 ◽  
Vol 2 (3) ◽  
pp. 127-134
Author(s):  
Filipa Sofia Silva ◽  
Joana Tavares ◽  
Sofia O Correia ◽  
Cristina Freitas ◽  
Olivia Santos ◽  
...  

Infection-related complications in patients on peritoneal dialysis (PD) is a leading complication. Our aim was to evaluate the type and natural course of ESI events in a cohort of PD treated in last decade of our PD program. Registry data of ESI events (n=126, in 74 patients) were retrieved. ESI protocols followed standard international guidelines. A systematic quality control is performed.                The median follow-up was 29.1 (14.0-47.4) months. In this population the adverse outcomes of TI rate and peritonitis rate was 0.12 and 0.13 patient/year, respectively.                Male sex (0.048), older age (0.007) and Staphylococcus aureus (SA) agent (0.006) were predictive of TI while non-optional PD and lower levels of albumin were predictive of peritonitis.                 After grouping the ESI events according to the date of the occurrence of infection (group 1: 2008 to 2012, group 2: 2013 to 2017 and group 3: 2018) a substantial increase of TI in 2018 was evident (P <0.001 when comparing group 3 vs 1 and 0.005 when comparing group 2 and 3).               When ESI occurs simultaneous with TI, the probability of not reaching cure is 65%. Drop-out occurred in 50% of ESI without peritonitis vs 86% with peritonitis (P <0.001). SA is the microorganism most implicated in the failure to heal (P 0.002) and drop-out (P 0.010). In spite of a number of efforts to reduce ESI, a regular audit still point to the need for protocols review in order to avoid adverse outcomes. Focused training of patients is mandatory but also prophylaxis and antibiotic protocols deserve improvement.


2020 ◽  
Vol 27 (12) ◽  
pp. 2676-2680
Author(s):  
Wardah Anwar ◽  
Muhammad Hashim Ghouri ◽  
Maria Anwar ◽  
Ambreen Anjum ◽  
Maryam Rao ◽  
...  

Objectives: To determine the impact of exposure to second hand smoking on fetal birth weight and length. Study Design: Comparative Cross Sectional study. Setting: Physiology Department of Shaikh Zayed Postgraduate Medical Institute. Period: December 2015 to May 2016. Material & Methods: Non-probability convenience sampling was used to collect data from 120 women and their neonates, who were further divided in four equal groups based on level of exposure to second hand smoking. A self-administered questionnaire was used to collect data regarding level of exposure of mothers, while weight and length of neonates were measured objectively. Results: Mean birth weight (kg) in group-1 was 3.31 ± 0.50, in group-2 was 3.00 ± 0.28, in group-3 was 2.92 ± 0.48 and in group-4 was 2.66 ± 0.41. The p-value calculated by one way ANOVA was 0.001 which shows that birth weight was significantly different in all the groups. Mean birth weight of neonates showed inverse relation with SHS exposure of the mothers. Mean length (cm) of neonates in group-1 was 49.30 ± 1.70, in group-2 was 48.77 ± 1.47, in group-3 was 49.40 ± 2.12 and in group-4 was 48.53 ± 1.65. It was seen that there was no significant difference in length of neonates belonging to different groups. Incidence of low birth weight among all the groups was 11.6%. Conclusion: Second hand smoking of mothers affects birth weight of neonates which in turn influence the intellectual abilities and developmental milestones of neonates. Awareness should be made in society in this regard to prevent the burden of the disease in silent victims of smoking.


PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 474-480 ◽  
Author(s):  
Jeffrey M. Perlman ◽  
Nancy Rollins ◽  
Dennis Burns ◽  
Rick Risser

The pathogenesis of the periventricular intraparenchymal echodense lesion (IPE) observed in association with germinal matrix-intraventricular hemorrhage (GM-IVH) in premature neonates is unclear. The objectives of this study were to determine (1) the temporal characteristics of GM-IVH and IPE, (2) the basic characteristics of the IPE, and (3) the relationship of clinical events, including surfactant administration, to IPE. One hundred twenty-four neonates of less than 1250 g birth weight were prospectively evaluated. IPE was defined as an echodensity greater than 1 cm in diameter by cranial sonography. Fifteen (12%) neonates developed IPE in association with GM-IVH (group 1); 33 neonates developed GM-IVH only (group 2) and 76 neonates without GM-IVH served as comparison group (group 3). IPE was essentially an asymmetrical lesion; both sides of cerebrum were equally affected. The lesion was diffuse in 9 neonates and focal in 5. IPE occurred both early, at 36 hours or before (n = 8), and later, ie, between 48 and 96 hours (n = 6). In one neonate IPE was diagnosed at autopsy. GM-IVH and IPE were noted simultaneously in neonate with the earlier onset IPE (diagnosed within 36 hours); GM-IVH preceded the IPE by 6 to 48 hours when the lesion was of a later onset. Surfactant was administered to 13 (87%) group 1, 24 (73%) group 2, and 35 (46%) group 3 neonates. Pulmonary hemorrhage developed in 9 (60%) of group 1, 3 (9%) group 2, and no group 3 neonates. Symptomatic patent ductus arteriosus occurred in 12 (75%) group 1, 15 (45%) group 2, and 15 (20%) group 3 neonates. The onset of symptoms associated with patent ductus arteriosus was earlier in group 1 vs group 2 or group 3 neonates, ie, 70 vs 172 hours. Nine (60%) group 1 neonates, 6 (18%) group 2, and 5 (7%) group 3 neonates died. The cranial sonogram was markedly abnormal in all 6 group 1 survivors. Stepwise polytomous logistic regression indicated that birth weight, gestational age, and emergent cesarean section were the best predictors of GM-IVH + IPE. These data indicate that (1) the large IPE observed with GM-IVH remains a major problem of the very low birth weight neonate, despite surfactant administration; (2) complications during labor that lead to emergent cesarean section appear to increase the risk for IPE; and (3) IPE was frequently associated with PH, but the precise mechanism(s) that link these two lesions are unclear. Attempts at prevention of IPE need to consider both perinatal and postnatal provocative factors.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mansi Gaitonde ◽  
Megan Simpson ◽  
Martha Wetzel ◽  
William L Border ◽  
Ritu Sachdeva ◽  
...  

Introduction: Adverse outcomes in hypertrophic cardiomyopathy (HCM) includes arrhythmias, myocardial fibrosis, heart failure, and sudden cardiac arrest (SCA). These are well documented in children. Exercise stress echocardiography (ESE) can identify the severity and mechanism of left ventricular outflow tract (LVOT) obstruction that may not be present at rest. Our aim was to compare clinical outcomes in pediatric patients with varying severity of LVOT obstruction. Methods: We reviewed records of patients < 22 years with HCM who underwent staged ESE Jan 2009 - Dec 2019 at our center. Patients were divided into 3 groups: no resting or exercise LVOT gradient (Group 1), no resting gradient with LVOT gradient > 30 mmHg at peak exercise (Group 2), and resting LVOT gradient > 30 mmHg (Group 3). We assessed echocardiographic indices, advanced imaging, and clinical data. Statistical analysis performed with p-value <0.05. Results: 93 patients met inclusion criteria. 6 SCA events occurred, though not during ESE.. Patients in Group 3 were classified less often as NYHA Class 1 compared to Group 1 or Group 2, (p < 0.01). Group 3 had the highest rate of myectomy (p=0.005) and ICD placement (p=0.003). There was no significant difference in exercise symptoms, peak oxygen consumption, or ischemic changes during ESE between the groups. Peak heart rate was also higher in Group 2 with no difference in blood pressure response. Groups were not associated with family history of disease, positive gene status, SCA, or the presence of fibrosis (Table). LVOT gradients differed as early as Stage 1 in Groups 1 & 2. Inducible LVOT obstruction was most commonly midcavitary in Group 2. Conclusion: The presence of resting versus inducible LVOT obstruction in pediatric HCM does not appear associated with adverse outcomes. This may be hampered by the rarity of events in pediatrics. The predominant mechanism of inducible LVOT obstruction was midcavitary, which has a link to adverse long-term outcomes in adult HCM.


1958 ◽  
Vol 51 (1) ◽  
pp. 84-89 ◽  
Author(s):  
N. T. M. Yeates

The course of pregnancy was followed in three groups of Peppin-strain Merino ewes. Group 1 of seven ewes, maintained on a high plane of nutrition, all lambed; the mean birth weight of lambs was 8 lb. 6 oz. The six ewes in group 2, kept on a low plane of nutrition, all lambed; the mean birth weight of their lambs was 1 lb. 9 oz. lower (P<0·01). The seven ewes in group 3 kept on a low plane of nutrition and subjected daily to temperatures of 112° F. dry bulb, 92° F. wet bulb, produced only four lambs; the mean birth weight was 4 lb. 6 oz. less than those from group 1, and 2 lb. 13 oz. less than those from group 2 (P < 0·001).Scale photographs of the lambs, and X-rays and measurements of their long bones, after dissection, showed that the lambs of group 3 were miniatures: their skeletons were much reduced in size, whereas low nutrition alone (group 2), caused little skeletal reduction.The mechanism of dwarfing is not clear. However, fore-cannon bone lengths and liver weights, considered in relation to lamb birth weights indicated that it was not a nutritional effect.This study was undertaken at the Physiology Department, University of Queensland. It is a pleasure to thank Prof. W. V. Macfarlane for the valuable facilities, and for his help and encouragement.


VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.


Sign in / Sign up

Export Citation Format

Share Document