P–397 Threatened Miscarriage and increase in Perinatal Morbidity

Abstract Study question Are women presenting with bleeding in the first trimester of pregnancy at a higher risk for perinatal complications later in pregnancy? Summary answer Women presenting with bleeding in the first trimester of pregnancy are more likely to experience perinatal and neonatal morbidity in pregnancy. What is known already Observational studies and a previously reported systematic review showed that women who experienced threatened miscarriage are more likely to have still birth, intra uterine growth restriction (IUGR), low birth weight, pre-eclampsia, placental abruption, placenta previa, preterm labour, preterm prelabour rupture of membrane, neonatal asphyxia and congenital anomalies in pregnancy. However, the evidence has been inconclusive and currently the women who experience threatened miscarriage receive low risk care. Study design, size, duration This was a prospective cohort study conducted on 298 women with threatened miscarriage (Cohort A) and 107 asymptomatic women (Cohort B). The women were recruited over a period of 18 months and were followed up for 9 months until delivery. Participants/materials, setting, methods Cohort A were women who presented with bleeding in the early pregnancy assessment unit and had a confirmed heartbeat on ultrasound scan between 6 weeks and 11 + 6 weeks of pregnancy and cohort B were women who were asymptomatic and booked with the community midwives as low risk. Both groups of women were followed up prospectively until delivery and data were collected on any perinatal outcomes and complications for both mother and the neonate. Main results and the role of chance The analysis showed that women who had bleeding in early pregnancy were more likely to have preterm delivery (RR 95% CI; 2.98 (1.07 – 8.27)); IUGR (unable to calculate the RR, as none of the women who continued their pregnancies beyond 24 weeks of gestation, developed IUGR in the asymptomatic control cohort. Nonetheless, IUGR occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)); LBW (RR 95% CI; 6.14 (1.49 – 25.19), neonatal asphyxia (unable to calculate the RR, as none of the babies who were born to women in the asymptomatic control cohort develop neonatal asphyxia. Nonetheless, neonatal asphyxia occurred more frequently in the threatened miscarriage cohort than the asymptomatic cohort (P-value 0.02)). Preterm prelabour rupture of membrane was not significant with a P-value of 0.07. Limitations, reasons for caution The major limitation of this study was lower sample size and hence due to the rarity of many of the perinatal and neonatal outcomes, we were unable to calculate the relative risk. Wider implications of the findings: Current study agrees with the existing literature and reaffirms the association of perinatal and neonatal morbidities with threatened miscarriage and this group of women need to be managed as high-risk group antenatally. Trial registration number Not applicable

Download Full-text

Maternal iron status in early pregnancy and birth outcomes: insights from the Baby's Vascular health and Iron in Pregnancy study

British Journal Of Nutrition ◽

10.1017/s0007114515001166 ◽

2015 ◽

Vol 113 (12) ◽

pp. 1985-1992 ◽

Cited By ~ 44

Author(s):

Nisreen A. Alwan ◽

Janet E. Cade ◽

Harry J. McArdle ◽

Darren C. Greenwood ◽

Helen E. Hayes ◽

...

Keyword(s):

Preterm Birth ◽

Early Pregnancy ◽

Iron Status ◽

First Trimester ◽

Maternal Serum ◽

Fe Deficiency ◽

Vascular Health ◽

Serum Samples ◽

First Trimester Of Pregnancy ◽

In Pregnancy

Fe deficiency anaemia during early pregnancy has been linked with low birth weight and preterm birth. However, this evidence comes mostly from studies measuring Hb levels rather than specific measures of Fe deficiency. The present study aimed to examine the association between maternal Fe status during the first trimester of pregnancy, as assessed by serum ferritin, transferrin receptor and their ratio, with size at birth and preterm birth. In the Baby VIP (Baby's Vascular health and Iron in Pregnancy) study, we recruited 362 infants and their mothers after delivery in Leeds, UK. Biomarkers were measured in maternal serum samples previously obtained in the first trimester of pregnancy. The cohort included sixty-four (18 %) small for gestational age (SGA) babies. Thirty-three babies were born preterm (9 %; between 34 and 37 weeks). First trimester maternal Fe depletion was associated with a higher risk of SGA (adjusted OR 2·2, 95 % CI 1·1, 4·1). This relationship was attenuated when including early pregnancy Hb in the model, suggesting it as a mediator (adjusted OR 1·6, 95 % CI 0·8, 3·2). For every 10 g/l increase in maternal Hb level in the first half of pregnancy the risk of SGA was reduced by 30 % (adjusted 95 % CI 0, 40 %); levels below 110 g/l were associated with a 3-fold increase in the risk of SGA (95 % CI 1·0, 9·0). There was no evidence of association between maternal Fe depletion and preterm birth (adjusted OR 1·5, 95 % 0·6, 3·8). The present study shows that depleted Fe stores in early pregnancy are associated with higher risk of SGA.

Download Full-text

Evaluation of Normal Heart Rate in Early Pregnancy Corresponding to Gestational Age between Six to Eight Weeks

Med Phoenix ◽

10.3126/medphoenix.v2i1.18383 ◽

2017 ◽

Vol 2 (1) ◽

pp. 34-37

Author(s):

Akhilesh Kumar Jha ◽

Bikranta Rimal ◽

Tarannum Khatun

Keyword(s):

Heart Rate ◽

Early Pregnancy ◽

Well Being ◽

Clinical Decision ◽

First Trimester ◽

Normal Heart ◽

Normal Heart Rate ◽

First Trimester Of Pregnancy ◽

Singleton Pregnancies

Background: Ultrasonography is the reliable and safe way for the evaluation of pregnancy. Heart rate can be detected more confidently from the Ultrasonography. Heart rate is an important parameter for the evaluation of early pregnancy. The purpose of this study was to evaluate the normal heart rate in embryos/fetuses between 6 and 8 weeks of gestation.Method: In our region people are poor and most of them do not know the benefit of regular follow up examination during pregnancy. So most of pregnant women come to our centre at late stage of pregnancy. The number of pregnancy cases is good in our centre but the number of early pregnancy cases coming to regular follow up examination is low. Thus the study was conducted in 51 normal singleton pregnancies undergoing routine ultrasound examination during the first trimester of pregnancy. The duration of study was 6 weeks.Result: Out of 51 singleton pregnancies, 20 cases (39.2%) heart rate were between 131-150 beat per minute and 25 cases (49.0 %) heart rate were between 151-170 beat per minute. However 4 cases (7.8%) were between 110-120 beat per minute and 2 cases (3.9%) were more than 171 beat per minute. There were zero cases above the 180 beat per minute.Conclusion: The result of this study will help to evaluate abnormal and normal fetal heart rate so that early clinical decision whether to continue the pregnancy or terminate it can be taken, as Ultrasonography is only the method used in screening fetal well being in most of the region of our country.Med Phoenix Vol.2(1) July 2017, 34-37

Download Full-text

Axial torsion of Meckel’s diverticulum causing acute peritonitis in the first trimester of pregnancy: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0754-y ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Hiromitsu Nagata ◽

Hiroyasu Nishizawa ◽

Susumu Mashima ◽

Yasuyuki Shimahara

Keyword(s):

Clinical Diagnosis ◽

Meckel’S Diverticulum ◽

Ileocecal Valve ◽

First Trimester ◽

Meckel's Diverticulum ◽

Ileocecal Resection ◽

Bowel Loop ◽

Axial Torsion ◽

First Trimester Of Pregnancy ◽

In Pregnancy

Abstract Background Meckel’s diverticulum is considered the most prevalent congenital anomaly of the gastrointestinal tract. Approximately 4% of patients are symptomatic with complications such as bleeding, intestinal obstruction, and inflammation, while axial torsion of Meckel’s diverticulum is rare, particularly in pregnancy. Case presentation A 31-year-old woman in week 15 of pregnancy complained of epigastric pain, nausea and vomiting. Clinical diagnosis was severe hyperemesis gravidarum. Because the symptoms persisted during hospitalization, CT was performed and revealed dilated small bowel loops with multiple air-fluid levels. In the right mid-abdomen, there was a large part of air containing a cavity connected to the small intestine, which was considered a dilated bowel loop. Emergency laparotomy was performed and axial torsion of a large Meckel’s diverticulum measuring 11 cm was found at a few centimeters proximal to the ileocecal valve. Ileocecal resection including Meckel’s diverticulum was performed. The postoperative course was uneventful. At 40 weeks gestation, she had vaginal delivery of normal baby. Conclusion The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. Prompt diagnosis and management were needed in order to avoid significant maternal and fetal risks. The use of imaging examinations, especially CT examination, with proper timing may be helpful to prevent delay in diagnosis and surgical intervention. Here, we report the case of a patient with axial torsion of Meckel’s diverticulum in pregnancy. To our knowledge, axial torsion of Meckel’s diverticulum in the first trimester of pregnancy has not been reported in the English medical literature.

Download Full-text

Spontaneous rupture of an unscarred uterus in early pregnancy: a rare but life-threatening emergency

BMJ Case Reports ◽

10.1136/bcr-2018-228493 ◽

2019 ◽

Vol 12 (5) ◽

pp. e228493 ◽

Cited By ~ 2

Author(s):

Bedayah Amro ◽

Ghassan Lotfi

Keyword(s):

Early Pregnancy ◽

Uterine Rupture ◽

Laparoscopic Approach ◽

First Trimester ◽

Rare Occurrence ◽

Spontaneous Uterine Rupture ◽

First Case ◽

Life Threatening ◽

First Trimester Of Pregnancy ◽

Underlying Risk

Spontaneous uterine rupture during early pregnancy is an extremely rare occurrence and may vary in presentation and course of events, hence the clinical diagnosis is often challenging. We present our experience with two such cases of spontaneous uterine rupture in the first trimester of pregnancy without any identifiable underlying risk factors. The first case was at 12 weeks of gestation and the second case was at 6 weeks gestational age (GA). Both cases were diagnosed and managed by the laparoscopic approach. We are reporting the earliest documented GA in which spontaneous uterine rupture occurred. So far, the earliest GA reported in the literature according to our knowledge was at 7+3 weeks. Access to a laparoscopic facility is crucial in the early definitive diagnosis and prompt management of these cases, since this may significantly reduce the risk of severe morbidity and mortality.

Download Full-text

A STUDY TO ASSESS PREDICTIVE ROLE OF C-REACTIVE PROTEIN IN EARLY PREGNANCY AMONG WOMEN

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i8.2084 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Neeti Mahla ◽

Mukesh Choudhary

Keyword(s):

Early Pregnancy ◽

Quantitative Estimation ◽

First Trimester ◽

Normal Pregnancy ◽

P Value ◽

C Reactive Protein ◽

Reactive Protein ◽

Predictive Role ◽

The Difference

Background: To Assess Predictive Role of C-Reactive Protein In Early Pregnancy among Women Methods: Hospital based comparative analysis was conducted on Women with early pregnancy upto 14 weeks with either abdominal pain or vaginal bleeding or suspected extrauterine pregnancy. C-reactive protein (CRP) quantitative estimation is done by turbi-diametric method. Collected samples were sent to a designated lab of our hospital. Results: The mean c-reactive protein level in cases 2.31 with min-max value ranging from 0.80-3.91mg/dl while in controls mean c-reactive protein value came to be 9.12 with min-max range from 3.21-24.16 mg/dl. The difference between the two groups is significant as p value is less than 0.001. Conclusion: Our results of significantly increased CRP levels in normal pregnancy and a clear association between CRP and normal pregnancy, support the clinical application of this diagnostic tool in early pregnancy, especially as a predictor of abnormal first trimester pregnancies. Keywords: CRP, Pregnancy, Women

Download Full-text

Hazards of vaccination in pregnancy

Drug and Therapeutics Bulletin ◽

10.1136/dtb.11.4.13 ◽

1973 ◽

Vol 11 (4) ◽

pp. 13-15

Keyword(s):

Pregnant Women ◽

Yellow Fever ◽

Early Pregnancy ◽

First Trimester ◽

Childbearing Age ◽

Department Of Health ◽

Chemical Agents ◽

Women And Girls ◽

Yellow Fever Vaccination ◽

In Pregnancy

With the effects of certain chemical agents and rubella in mind, most authorities advise caution in the use of all vaccines during pregnancy and especially during the first trimester. The booklet issued by the Department of Health and Social Security1 lists pregnancy as a contra-indication to rubella, smallpox and polio vaccinations, with certain provisions, and the manufacturers’ literature adds yellow fever vaccination. Pregnant women wishing to travel obviously pose a problem. Neither the doctor nor the patient may be aware of an early pregnancy and this is always a hazard when vaccinating women and girls of childbearing age. However, apart from rubella and smallpox vaccinations, the risks are hypothetical.

Download Full-text

Gestational metabolic syndrome and neonatal anthropometric indices: a prospective cohort study

British Journal of Midwifery ◽

10.12968/bjom.2021.29.7.386 ◽

2021 ◽

Vol 29 (7) ◽

pp. 386-391

Author(s):

Zeinab Hatamian ◽

Lida Moghaddam-Banaem ◽

Samira Mokhlesi ◽

Marzieh Saei Ghare Naz

Keyword(s):

Metabolic Syndrome ◽

Cohort Study ◽

Birth Weight ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Linear Regression Analysis ◽

First Trimester ◽

P Value ◽

Anthropometric Parameters ◽

First Trimester Of Pregnancy

Background and aim There is limited knowledge about the effect of maternal metabolic syndrome (MetS) on the anthropometric parameters of newborns. Therefore, the authors aimed to evaluate the association between MetS in the first trimester of pregnancy with weight and height of the newborn. Methods This prospective cohort study was conducted on 455 pregnant women in Tehran during their first trimester of pregnancy. MetS was defined as the coexistence of three or more of the following criteria: fasting blood sugar (FBS) level ≥92 mg/dl, blood pressure ≥130.85 mm/hg, triglyceride ≥150 mg/dl, high density lipoprotein ≤50 mg/dl, and body mass index (BMI) ≥30 kg/m2. All participants were followed up to childbirth. After birth, the baby's weight and height data were collected from the birth certificate. Results Linear regression analysis showed FBS (ß: 0.100, p-value: 0.038), BMI (ß: 0.139, p-value: 0.004), and MetS (ß: -0.122, p-value: 0.015) were significantly associated with birth weight but no statistically significant results were found for birth height. Conclusion MetS and some of its components in pregnancy can affect birth weight of neonates.

Download Full-text

Provisionally pregnant: uncertainty and interpretive work in accounts of home pregnancy testing

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/1363459317739439 ◽

2017 ◽

Vol 22 (1) ◽

pp. 87-105 ◽

Cited By ~ 2

Author(s):

Emily Ross

Keyword(s):

Positive Result ◽

Early Pregnancy ◽

Reproductive Rights ◽

First Trimester ◽

Pregnancy Test ◽

Early Gestation ◽

Medical Technologies ◽

The United Kingdom ◽

Pregnancy Testing ◽

First Trimester Of Pregnancy

Upon their availability for purchase in the 1970s, home pregnancy testing devices were hailed as a ‘revolution’ for women’s reproductive rights. Some authors, however, have described these technologies as further enabling the medicalisation of pregnancy and as contributing to the devaluing of women’s embodied knowledge. The home pregnancy test is one of many technological devices encountered by women experiencing pregnancy in the United Kingdom today. Existing literature has described how engagement with medical technologies during pregnancy might address uncertainties experienced at this time, providing women with reassurance and alleviating anxieties. Drawing on interviews with women living in Scotland, this article explores accounts of testing for a first pregnancy, and women’s descriptions of the impacts of home pregnancy testing upon experiences of early gestation. Participants engaged with pregnancy tests in varying ways, with uses shaping and shaped by their experiences of early pregnancy more broadly. Particular technical characteristics of the home pregnancy test led many participants to question their interpretation of a positive result, as well as the accuracy of the test itself. Rather than addressing the unknowns of early gestation by confirming a suspected pregnancy, a positive result could thus exacerbate uncertainty. Through participants’ accounts, this article shows how uncertainty is lived out by users of mundane techno-medical artefacts and sheds new light on women’s experiences of the first trimester of pregnancy.

Download Full-text

Pregnancy Sickness

Physiology ◽

10.1152/physiologyonline.1990.5.1.5 ◽

1990 ◽

Vol 5 (1) ◽

pp. 5-10 ◽

Cited By ~ 3

Author(s):

P Andrews ◽

S Whitehead

Keyword(s):

Early Pregnancy ◽

First Trimester ◽

Nausea And Vomiting ◽

Current Understanding ◽

Physiological Changes ◽

Inappropriate Response ◽

First Trimester Of Pregnancy

The majority of women suffer from nausea and vomiting in the first trimester of pregnancy, but the mechanisms and reasons for this are unknown. Based on our current understanding of the emetic response and physiological changes of early pregnancy, hypotheses are put forward to explain this apparently inappropriate response to conception.

Download Full-text

Assessment of Thyroid Function in Early Pregnancy

Bangladesh Journal of Nuclear Medicine ◽

10.3329/bjnm.v19i2.35864 ◽

2018 ◽

Vol 19 (2) ◽

pp. 98

Author(s):

Mohammad Saifur Rahman ◽

Sadia Sultana ◽

Ayesha Nazneen

Keyword(s):

Pregnant Women ◽

Thyroid Function ◽

Early Pregnancy ◽

Correct Diagnosis ◽

First Trimester ◽

Military Hospital ◽

Thyroid Disorders ◽

Thyroid Disorder ◽

Cross Sectional ◽

In Pregnancy

Objectives: Thyroid disorders are commonly observed in pregnancy. Thyroid hormones play an important role in embryogenesis and fetal development. The fetus is completely dependent on the mother for thyroid hormone in first trimester. About 10% of all pregnant women can be affected by thyroid disorders during pregnancy. Thyroid function abnormalities in pregnancy are a challenge for the concerned physicians. The objective of this study was to assess the maternal thyroid function in first trimester of pregnancy.Patients and Methods: A descriptive cross sectional study was carried out at the Combined Military Hospital (CMH), Dhaka over a period of one year from January 2013 to December 2013 to see the serum FT3, FT4, TSH, thyroid antibodies level and common thyroid disorders in pregnancy. A total of 138 pregnant women in their first trimester (up to 12 weeks) of pregnancy with an age range of 18-35 years were enrolled in this study. Pregnant women with known thyroid disorder and on treatment and pregnancy more than three months were excluded. Measurement of serum FT3, FT4, TSH, Anti TPO-Ab and Anti TG-Ab were done in each patient at the time of enrolment. Ultrasonography of each patient was done for confirmation of pregnancy and correlation of gestational age.Results: Among 138 pregnant women, subclinical hypothyroidism was detected in 10 (7.2%) patients and subclinical hyperthyroidism was detected in 3 (2.2%) patients. Mean difference of the investigation findings were not statistically significant among primi and multi gravida. TPO-Ab and TG-Ab difference were statistically significant between two age groups.Conclusion: Subclinical thyroid disorders are fairly high among pregnant women. Correct diagnosis in early pregnancy and prompt treatment will bring an excellent prognosis for both mother and offspring.Bangladesh J. Nuclear Med. 19(2): 98-102, July 2016

Download Full-text