P096 Pregnancy outcomes in women attending a joint obstetric and rheumatology clinic in a tertiary centre over a 2-year period

Abstract Background/Aims The Lupus in Pregnancy Scanning (LIPS) clinic, a joint obstetrics and rheumatology clinic was established in 2010 at Saint Mary’s Hospital, Manchester, UK for women with systemic lupus erythematosus (SLE) and other complex rheumatological conditions. We aimed to describe pregnancy outcomes of women attending this clinic to establish a baseline for future changes aimed at improving the service. Methods Data were collected retrospectively from electronic records of patients who attended the LIPS clinic at least once between 1st January 2018 and 31st December 2019. Results Pregnancy outcomes were available in 105/125 (84%) women (Table). The median age [inter-quartile range] was 30.6 years [IQR 27.7 - 33.6] and 40 (38%) were of non-Caucasian background. Sixty-one (58%) had a connective tissue disease (CTD) of whom 36 (59%) had SLE. Other rheumatological diagnoses included inflammatory arthritis, primary anti-phospholipid syndrome (APS) and systemic vasculitis. Anti-Ro was found in 32 (31%) and anti-phospholipid antibodies in 25 (24%). During pregnancy, 65 (62%) received aspirin and 40 (38%) had low molecular weight heparin (LMWH). In the antenatal period, 43 (41%) took steroids, 52 (50%) had conventional disease modifying anti-rheumatic drugs and 8 (8%) received biologics. Active disease in the antenatal period was noted in 14 (13%) women. Regarding pregnancy outcomes (Table), still-births were low (0.95%). The rate of C-sections (45%) and assisted deliveries (19.6%) was comparable to previously published data from similar clinics. P096 Table 1:Pregnancy outcomes over a 2-year period in women attending the LIPS clinic at St. Mary's HospitalPregnancy Outcomen (%)Miscarriage3 (2.9)Deliveries• Live101 (96.2)• Still-birth1 (0.95)Median Gestation (weeks) [inter-quartile range (IQR)]38 [37 - 39]Sex of Neonate• Female57 (56)• Male45 (44)Mode of Delivery• Normal vaginal36 (35.3)• Assisted20 (19.6)• Elective Caesarean Section15 (14.7)• Emergency Caesarean Section31 (30.4)Median Neonatal Birth Weight (grams) [IQR]3137 [2724 - 3428]• Low Birth Weight <2500g15 (15)Maternal Complications (Antenatal and Peri-Partum)• Infection22 (22)• Pre-Eclampsia1 (1)• Post-Partum Haemorrhage56 (55)Neonatal Intensive Care Admission7 (7)Neonatal Complications• Sepsis1 (1)• Congenital Heart Block2 (2)• Prematurity (<36 weeks)39 (38) Conclusion In this cohort we report a high live birth rate and comparable rates of assisted delivery to similar cohorts. Infection and post-partum haemorrhage are maternal complications that are common, and reflect the complex clinical presentations and therapeutic regimes in these conditions. Overall this specialist clinic achieves favourable maternal and foetal outcomes in this high-risk population. Disclosure T. David: None. R. Hum: None. Y. Lau: None. S. Thornber: None. L. Simcox: None. I. Bruce: None. C. Tower: None. P. Ho: None.

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Outcome of Twin Pregnancy in a Periurban Hospital

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v27i2.29919 ◽

2016 ◽

Vol 27 (2) ◽

pp. 57-62

Author(s):

Saria Tasnim ◽

FM Anamul Haque ◽

Sameena Chowdhury

Keyword(s):

Birth Weight ◽

Twin Pregnancy ◽

Perinatal Death ◽

Post Partum ◽

Mode Of Delivery ◽

Labor Pain ◽

Maternal Complications ◽

Management Options ◽

History Of ◽

Second Twin

Objective: To determine the socio demographic characteristics, clinical presentation and obstetric outcome at delivery and immediate postpartum period of twin gestation in a periurban hospitalMaterial & Methods: An observational study was conducted between January 2000 to December 2004 at Institute of Child and Mother Health. All twin pregnancy irrespective of gestational age admitted in the in-patient department of Institute of Child and Mother Health for delivery and also those undiagnosed cases found to have twin birth were enrolled in the study consecutively from January 2001 to December 2004. Data on socio-demographic factors, predisposing factors for twin gestation and obstetric characteristics was collected using a structured questionnaire. Hospital records were consulted for recording the investigation reports and management options. The outcome variables were maternal complications during antenatal, intranatal and immediate postnatal period, mode of delivery, birth weight and sex of newborn and fetal outcome. All twin pregnancies from the admitted obstetric patients were enrolled consecutivelyResults: During the study period there were 11,185 deliveries and among them 107 were twin gestation. About 22% were primigravida, 78.5% multigravida, 27.1% were illiterate. Most common age group were 24-29 years (39.4%). Antenatal care was availed by 71% of patients and 27.1% twins were not diagnosed till delivery. Family history of twin on maternal side was present in 58.1% and 31.8% had history of taking oral contraceptive immediately before the pregnancy. Ovulation inducing agents were given to 8.3% of twin. Presentations of fetus were both vertex 54.2%, 1st vertex and second breech 16%, and both breech 5.7%. About 55.1% were admitted with labor pain, 6.5% were undelivered second twin. Preterm birth was 27.2% and low birth weight of 1st baby 79.6% and second baby 80.9% respectively. Mode of delivery was vaginal delivery of both fetus 41.6%, caesarean section of both fetus 62.4%, and caesarean for second twin 3.1%. Same sex of both twins was found in 78% and male-male pair was 50%. There was one stillbirth, one conjoined twin and perinatal death was 11.2% Complications encountered during perinatal period were severe abdominal pain 9.3%, retained placenta in 7.3%; and post partum hemorrhage in 4.6% cases.Conclusion: Twin pregnancy is quite common and warrants specialized care during ante partum, intrapartum and postpartum period.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 57-62

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Pregnancy Outcomes in Patients with Sickle Cell Syndromes Managed Antenatally with Exchange Transfusions: A Single Centre Analysis

Blood ◽

10.1182/blood-2018-99-113619 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3666-3666

Author(s):

Evangelia Vlachodimtropoulou Koumoutsea ◽

Hutachok Nuntouchaporn ◽

Perla Eleftheriou ◽

Patrick O'Brien ◽

John Porter

Keyword(s):

Sickle Cell ◽

Pregnancy Outcomes ◽

Post Partum ◽

Age Distribution ◽

High Rate ◽

Complication Rates ◽

National Guidelines ◽

Miscarriage Rate ◽

Maternal Complications ◽

Painful Crisis

Abstract Background/Objectives The optimal management of pregnancy with sickle cell disease (SCD) is controversial (Cohen and O'Brien, Chapter 14, 2012). In particular, the value of prophylactic exchange transfusions in preventing complications from SCD and/or pregnancy itself is unclear. For the past decade at University College London Hospitals (UCLH), UK, we have undertaken prenatal exchange transfusions for most patients with sickle cell syndromes (SCS), HbSS, SC or Sb-thalassaemia. This is due to the poor outcomes we had experienced previously in a proportion of patients in whom prophylactic transfusion was not undertaken. We review the outcome over seven years in all such pregnancies managed at UCLH. Methodology/Patients We undertook a retrospective analysis of pregnancy outcomes of women with SCS delivering between 1 Jan 2011 and 31 Dec 2017. Data were collected from electronic hospital-held records. We recorded 50 pregnancies in 22 women, of which 25 resulted in live births. Most women had HbSS (82%), 14% had HbSC and 4% HbS-bthalassemia. The early pregnancy (<12 weeks) miscarriage rate of 28% was greater than the UK National Guidelines, 2012, which was 22% (Table 1). The median age (range) of our patients was 32 (19-40) years, which might contribute to the increased miscarriage rate. One woman sustained 6 of the 11 recorded miscarriages. Only 4% of pregnancies occurred in women >40, which is similar to national data for England (3.6%) (Centre for Maternal and Child Enquiries [CMACE], 2011). This age distribution is comparable to that in the population of Oteng-Ntim et al, 2015, who looked at pregnancy outcomes in a UK sickle population between 2010 and 2011. Patients were managed antenatally with exchange transfusions where there were no contraindications with respect to prior allo-immunisation, to reduce sickle related complications and improve pregnancy outcomes. Eight All patients were adequately hydrated antenatally. To gain insight into the effect of this management on maternal complications and fetal outcomes, these were compared with a recently reported cohort of SCS in London who did not receive exchange transfusions (Oteng-Ntim et al, 2015). Results Painful crises requiring admission antenatally were 9% compared with 17.6% reported by Oteng-Ntim et al, 2015. There were no admissions with sickle chest syndrome, either antenatally or postnatally, compared with 6.4% (Oteng-Ntim et al.). Preterm labour before 34 weeks' and 37 weeks' gestation occurred in one case (4.5%) and in 38% of cases, compared to 44.2% reported by Serjeant et al, 2004 and 47.1% reported by Oteng-Ntim et al before 37 weeks. There were no late miscarriages or stillbirths in our cohort. By contrast, in Oteng-Ntim et al, the stillbirth rate was 2.8% which is higher than the 0.92% reported in the general population (CMACE, 2011). The Caesarean section (CS) rate was 64%, which is higher than previously reported (39% in Barfield et al, 2010, 52.9% in Oteng-Ntim et al, 2015) (Table 3). One woman sustained a significant post-partum haemorrhage. The following complication rates were similar to those reported by Oteng-Ntim et al, 2015 (Table 3): postnatal pain: 18% vs 21.6%; pre-eclampsia 8% vs 7.8%; intrauterine growth restriction (IUGR): 22% vs 27.3% (Table 4). Four patients had pre-existing allo-antibodies, of whom three had two or more antibodies. No new allo-immunisations developed during pregnancy. Conclusions Although our cohort numbers are small, they suggest a lower rate of painful crisis/chest syndrome than reported in series of SCS in which prophylactic exchange transfusions were typically not practised. While the rate of IUGR was lower than in historic reports, the difference was less clear than for painful crisis. There were no stillbirths in our series, despite the previously documented high incidence in women with SCS. The high rate of CS reflects local practice by clinicians wishing to avoid prolonged labour in this patient population. No serious adverse reactions to transfusion in pregnancy were seen despite one patient having had a previous hyperhaemolytic episode outside pregnancy. This study shows that prophylactic antenatal exchange transfusion is well tolerated and associated with fewer veno-occlusive crisis complications than historically reported with sickle disorders. Randomised studies are indicated in a larger cohort of patients to determine whether other benefits or risks accrue from this approach. Disclosures Porter: Cerus: Honoraria; Novartis: Consultancy; Agios: Honoraria.

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Materanal and neonatal outcomes of triplet gestation in a tertiary care centre: a retrospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194874 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4453

Author(s):

Neeraj Sharma ◽

Deepika Kumari ◽

Sonal Prasad ◽

Akanksha Srivastava

Keyword(s):

Retrospective Study ◽

Birth Weight ◽

Post Partum ◽

Tertiary Care ◽

Significant Rise ◽

Triplet Pregnancy ◽

Tertiary Care Centre ◽

Maternal Complications ◽

Neonatal Complications ◽

The Mean

Background: A significant rise in triplet pregnancy rate has occurred recently. This rise is of concern, as these infants are frequently reported as a risk factor of adverse outcome. The aim of this study was to retrospectively study the outcomes of triplet births.Methods: A retrospective study was undertaken to analyze the clinical data of all patients with triplet gestation admitted to the labour room of Dr. Baba Saheb Ambedkar Hospital, Delhi to study the maternal and fetal outcomes. Authors retrospectively observed and analyzed the database to examine triplet gestations delivered between January 2014 and December 2018.Results: Over the five-year study period, there were total 44,011 deliveries. Out of these, there were 35 (0.079%) triplet pregnancies. Of all the triplet pregnancies studied 80% resulted from ovulation induction and assisted reproductive technology. The mean gestational age at delivery was 31.6±3.0 weeks, and the mean birth weight was 1,594±460 gm. The most common maternal complications were Preterm labour in 32 pregnancies (92%), anemia in 17 (49%), pre-eclampsia in 11 (31%), post-partum hemorrhage in 8 (22%). Of the total deliveries neonatal complications included Respiratory distress syndrome in 44 (42.2%), Hyperbilirubinemia in 41 (39%), Intrauterine growth restriction in 19 (18.1%). The perinatal mortality rate was 10.5%.Conclusions: Higher order pregnancies are associated with maternal and neonatal complications. These high risk women need more care and the neonates require intensive care and monitoring after birth, most commonly due to prematurity and low birth weight.

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HbA1C Level in 2nd and 3rd Trimester with Pregnancy Outcome in Diabetic Patients

BIRDEM Medical Journal ◽

10.3329/birdem.v2i1.12358 ◽

2012 ◽

Vol 2 (1) ◽

pp. 23-28 ◽

Cited By ~ 1

Author(s):

Ruma Sengupta ◽

Soha Jesmen ◽

Laila Arjuman Banu ◽

Samir Humyra Habib

Keyword(s):

Hba1c Level ◽

Post Partum ◽

Birth Asphyxia ◽

Fetal Outcome ◽

Maternal Serum ◽

Normal Vaginal Delivery ◽

Diabetic Patients ◽

Maternal Complications ◽

Neonatal Complications ◽

Antenatal Period

Objective: The present study was undertaken to determine the association of maternal serum HbA1C level with maternal and fetal outcome. Materials and Methods: It was prospective observational study. The study was carried out in the department of Obstetrics and Gynaecology in BIRDEM Hospital during the period of September 2006 to August 2007. During this study period, 100 pregnant patient with diabetes who attended or admitted at BIRDEM Hospital were studied. Estimation of serum HbA1C level was done in all patient in each trimester. From each patient 5 c.c blood was taken & HbA1C level was measured with the help of enzymatic method. HbA1C level < 6 was considered as normal. .The maternal complications in antenatal period, in postpartum period, during labour & fetal outcome were studied in both cases of controlled & uncontrolled HbA1C level. Result: In this study serum HbA1C level was found raised in uncontrolled diabetic patients. The incidence of vulvovaginitis, preterm delivery and polyhydramnios were significantly high in 2nd and 3rd trimester in raised HbA1C level. The rate of normal vaginal delivery was higher in patient with normal HbA1C leve uncontrolled HbA1C level (17.59% Vs 10.84%, p = 0.01), which statistically significant. Post partum haemorrhage (PPH) was significantly higher in raised HbA1C level than normal (0.00% Vs 22.20%, p =0.01) in NVD and (0.00% Vs 16.22%, p = 0.01) in Caesarean section. Neonatal complications were higher in raised HbA1C level than normal. The incidence of Hypoglycemia (5.88% Vs 38.55%, p = 0.02); Hyperbilirubinemia (11.76% Vs 33.73%, p = 0.03) ; RDS (0.00% Vs 12.05%, p = 0.02); Macrosomia (0.00% Vs 18.07%,p = 0.01) and Birth asphyxia (5.88% Vs. 12.05%, p = 0.04). These differences are statistically significant. Conclusion: There is increasing evidence that the raised level of maternal serum HbA1C in antenatal period is associated with maternal & neonatal complications. By investigating HbA1C level in each trimester, blood sugar control can be done. This study was taken out to evaluate the usefulness of HbA1C for good glycaemic control in diabetic pregnancy. DOI: http://dx.doi.org/10.3329/birdem.v2i1.12358 Birdem Med J 2012; 2(1) 23-28

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Pregnancy outcomes in patients with placenta previa on a cesarean scar

10.21203/rs.2.13939/v1 ◽

2019 ◽

Author(s):

Zhiheng Guo ◽

Yanhong Shan ◽

Huiying Xu ◽

Yi Yang

Keyword(s):

Birth Weight ◽

Pregnancy Outcomes ◽

Apgar Score ◽

Placenta Previa ◽

Post Partum ◽

Placenta Praevia ◽

Low Birth Weight Infant ◽

Post Partum Hemorrhage ◽

Cesarean Scar ◽

Minute Apgar Score

Abstract OBJECTIVE: We aimed to examine the clinical features and pregnancy outcomes in patients with placenta previa on a cesarean scar. METHODS: A retrospective review of women who were diagnosed with placenta previa on a cesarean scar in the First Bethune Hospital of Jilin University between December 2011 and December 2017 was performed. Basic patient characteristics and pregnancy outcomes data were collected. Characteristics that are associated with maternal morbidities (post-partum hemorrhage ≥ 2000 ml and nits transfused >4) and adverse neonatal outcomes (5-minute Apgar <7 and Low-birth-weight infant) were evaluated. RESULT ： A total of 183 patients was identified. PAS disorders were observed in 63 cases(34.4%).The median postpartum hemorrhage was 700 ml (range,100-7900).70 patients (38.2%) had a blood loss ≥ 2000 mL.43 subjects(23.4%) required >4 units of blood. The median 1-minute Apgar score and 5-minute Apgar score was 9 and 9.2 respectively. Additionally ， median neonatal birth weight was 1880g (range, 700-4260). Patients with comorbid PAS disorders are more likely subject to post-partum hemorrhage and require units transfused (>4) (p <0.05). Similarly, patients with major placenta praevia had a higher incidence of post-partum hemorrhage and units transfused (>4) than patients with minor placenta praevia (p <0.05). Patients who undertook emergency cesarean due to hemorrhage were more likely to have a low-birth-weight infant than women who undertook planned cesarean. CONCLUSION: PPP is associated with considerable maternal and fetal morbidity, particularly in patients with comorbid PAS disorders. Delayed delivery may be warranted for those without meaningful vaginal bleeding and preterm labor but need further prospective clinical trials to confirm.

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THE EFFECT OF DECREASED HEMOGLOBIN LEVELS AT FIRST TRIMESTER ON MATERNAL AND FETAL OUTCOME – A RETROSPECTIVE STUDY

10.36106/4500798 ◽

2021 ◽

pp. 16-18

Author(s):

Manasa D.R. ◽

Sadananjali Sadananjali ◽

Ramkrishna Yadgude

Keyword(s):

Health Care ◽

Retrospective Study ◽

Birth Weight ◽

Low Birth Weight ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Negative Impact ◽

Post Partum ◽

Fetal Mortality ◽

Post Partum Haemorrhage

Background And Objective: Iron deciency anemia, especially during the rst trimester has a more negative impact on both maternal & fetal well being. Commonly associated conditions are post partum haemorrhage, birth asphyxia, preeclampsia, low birth weight, preterm, abortions, still born and many more. Thus the study was aimed to determine the levels of haemoglobin in early pregnancy and effect of pregnancy outcomes at Primary Health Care, Ankalagi, Belagavi. Methodology: A retrospective study was done from 2017 April to May 2020 April for a period of three years at PHC, Ankalagi, Belagavi. Over 718 pregnant women were enrolled. Regular ANC was done. Data was collected on Maternal Age, Body mass Index (BMI), Number of parity and Socio-economic determinants. Other Demographic characteristics included rst trimester haemoglobin levels, gestational age at delivery & mode, birth weight, and pregnancy outcomes were recorded. Hemoglobin levels were estimated by Sahil's hemoglobinometer method. Categorised into four groups a) Normal :more than11g/L b) Mild anemia :9-10.9g/dl c) Moderate anemia (7-8.9g/dl) and d) Severe anemia (<7.0g/dl) Results: Mean age was 18±39 yrs. Nearly 39.75% were anemic in early pregnancy. Mild anemic were 20.75%(149), moderate anemic were18.10%(130)and severe anemic were 0.4%(3)respectively. The pregnancy outcome of low level haemoglobins duing rst trimester showed miscarriage/abortions of about18.79%, LSCS mode of delivery of about 17.02%, low birth weight of about 9.21%, preterm baby of about 2.12%, neonatal admissions of about 2.12%, still born of about 1.06%, and post partum haemorrhage of 1.77% respectively. Conclusion: The above ndings suggests that anemia in rst trimester denitely has negative impact on both maternal &fetal health. Thus adequate iron intake in early trimester (prior to conception) is crucial for healthy pregnancy. It is one of the preventable causes which can decrease the maternal & fetal mortality. Should reinforce the health education from adolescent girls, with regular antenatal check up and active participation of ASHA workers. Mothers should receive appropriate nutritional advice and supplementation at their rst point of contact with health care professionals

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Pregnancy & Oral Health and Dental Management in Pregnant Patient

Journal of Current Medical Research and Opinion ◽

10.15520/jcmro.v3i11.360 ◽

2020 ◽

Vol 3 (11) ◽

Author(s):

Dr. Vishal Thakur ◽

Dr. Reetika Thakur ◽

Dr. Manpreet Kaur ◽

Dr. Jasleen Kaur ◽

Dr. Atul Kumar ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Oral Health ◽

Human Body ◽

Oral Hygiene ◽

Pregnancy Outcomes ◽

Oral Care ◽

Pregnant Patient ◽

Dental Management ◽

Exciting Time

Pregnancy is a unique, exciting time in a woman's life, and there are so many changes going on in human body during pregnancy and mouth is no exception , so good oral hygiene is extremely important during pregnancy . Usually oral health is often the most neglected form of health during all stages of life & the most important cause for this neglection is lack of awareness among people & this problems also increases when a lady is pregnant because of mis-perceptions and mis-leading information in the society or due to lack of knowledge. But the fact is during pregnancy many complex physiologic changes occur in the women’s body, which can adversely affect oral health and in turn those oral health problems may lead to pregnancy outcomes like preterm birth or low birth weight. Proper oral care is of utmost importance during pregnancy to avoid these complications. Avoiding foods that may cause oral problems, proper brushing and flossing and having dental consultations on a regular basis are steps to ensure good oral health during pregnancy.

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