Successful Vaginal Delivery after External Cephalic Version in a Woman with a Large Partial Uterine Septum

Septate uteri have been associated with adverse pregnancy outcomes including spontaneous abortion, preterm delivery, and malpresentation. It is unclear if uterine septa are associated with infertility. Although some studies have shown improved pregnancy outcomes after septum resection, indications for resection are not well established. We describe a case of a woman with a large partial uterine septum diagnosed during workup for infertility who conceived without septum resection. Both of her subsequent pregnancies were initially breech presentations for which the patient underwent external cephalic version followed by full-term vaginal deliveries. This case adds evidence that an unresected uterine septum should not be considered a contraindication to external cephalic version.

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Association between Thiopurines Use and Pregnancy Outcomes in Female Patients with Inflammatory Bowel Disease: A Meta-analysis

Current Pharmaceutical Design ◽

10.2174/1381612826666200916144249 ◽

2020 ◽

Vol 26 ◽

Author(s):

Yang Zhang ◽

Dandan Li ◽

Heng Guo ◽

Weina Wang ◽

Xingang Li ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Preterm Birth ◽

Spontaneous Abortion ◽

Bowel Disease ◽

Pregnancy Outcomes ◽

Congenital Malformations ◽

Meta Analysis ◽

Adverse Pregnancy Outcomes ◽

Inflammatory Bowel ◽

Adverse Pregnancy

Background: Conflicting data exist regarding the influence of thiopurines exposure on adverse pregnancy outcomes in female patients with inflammatory bowel disease (IBD). Objective: The aim of this study was to provide an up-to-date and comprehensive assessment of the safety of thiopurines in pregnant IBD women. Methods: All relevant articles reporting pregnancy outcomes in women with IBD received thiopurines during pregnancy were identified from the databases (PubMed, Embase, Cochrane Library, and ClinicalTrials.gov) with the publication data up to April 2020. Data of included studies were extracted to calculate the relative risk (RR) of multiple pregnancy outcomes: congenital malformations, low birth weight (LBW), preterm birth, small for gestational age (SGA), and spontaneous abortion. The meta-analysis was performed using the random-effects model. Results: Eight studies matched with the inclusion criteria and a total of 1201 pregnant IBD women who used thiopurines and 4189 controls comprised of women with IBD received drugs other than thiopurines during pregnancy were included. Statistical analysis results demonstrated that the risk of preterm birth was significantly increased in the thiopurine-exposed group when compared to IBD controls (RR, 1.34; 95% CI, 1.00-1.79; p=0.049; I 2 =41%), while no statistically significant difference was observed in the incidence of other adverse pregnancy outcomes. Conclusion: Thiopurines’ use in women with IBD during pregnancy is not associated with congenital malformations, LBW, SGA, or spontaneous abortion, but appears to have an association with an increased risk of preterm birth.

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Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?

Journal of Perinatal Medicine ◽

10.1515/jpm-2014-0207 ◽

2015 ◽

Vol 43 (6) ◽

Cited By ~ 4

Author(s):

Efser Oztas ◽

Kudret Erkenekli ◽

Sibel Ozler ◽

Ali Ozgur Ersoy ◽

Mevlut Kurt ◽

...

Keyword(s):

Logistic Regression ◽

Preterm Delivery ◽

Pregnancy Outcomes ◽

Intrahepatic Cholestasis ◽

Total Bilirubin ◽

Adverse Pregnancy Outcomes ◽

Intrahepatic Cholestasis Of Pregnancy ◽

Apgar Scores ◽

Adverse Pregnancy ◽

Cholestasis Of Pregnancy

AbstractOur aim was to investigate whether any hematological changes readily detectable by simple complete blood count (CBC), as well as fasting and postprandial total serum bile acid (SBA) levels, have diagnostic values for the prediction of adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy (ICP).A prospective, case control study was carried out including 217 pregnant women (117 women with ICP and 100 healthy controls). The main outcome measures investigated were preterm delivery, APGAR scores, and neonatal unit admission. A multivariate logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes.Compared with controls, women with ICP had significantly higher mean platelet volume (MPV) (mean 10.2±1.0 vs. 11.0±1.3; P<0.001) and platelet distribution width (PDW) (mean 13.1±2.3 vs. 14.7±2.8; P<0.001) values. Analysis with logistic regression revealed that the probability of preterm delivery did not increase until MPV levels exceeded 11.2 fL [odds ratio (OR)=2.68, 95% confidence interval (CI)=1.13–6.32, P=0.025], and total bilirubin levels exceeded 0.6 mg/dL (OR=3.13, 95% CI=1.21–8.09, P=0.019). Considering the low APGAR scores, only increased postprandial total SBA levels of ≥51 μmol/L were found to be predictive significantly (OR=3.02, 95% CI=1.07–8.53, P=0.037).Our study suggests that increased MPV and total bilirubin levels are associated with preterm delivery, and increased postprandial total SBA levels are predictive for low APGAR in ICP patients.

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Adverse pregnancy outcomes and long-term risk of maternal renal disease: a systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckz185.440 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

P Barrett ◽

F P McCarthy ◽

K Kublickiene ◽

S Cormican ◽

C Judge ◽

...

Keyword(s):

Kidney Disease ◽

Gestational Diabetes ◽

Renal Disease ◽

Preterm Delivery ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Chronic Hypertension ◽

Hypertensive Disorders ◽

Adverse Pregnancy

Abstract Background Little is known about the long-term risk of renal disease following adverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM) or preterm delivery. We aimed to investigate associations between adverse pregnancy outcomes and maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD), by synthesising results of relevant studies. Methods A systematic search of PubMed, EMBASE and Web of Science was done up to July 2018. Case-control and cohort studies were eligible for inclusion if they provided original effect estimates for associations between adverse pregnancy outcomes (HDP, GDM, preterm) and maternal renal disease (primary outcomes: CKD, ESKD; secondary outcomes: renal hospitalisation, renal mortality). Two independent reviewers extracted data and assessed risk of bias. Random effects meta-analyses were conducted to determine pooled adjusted odds ratio (AOR) and 95% confidence interval (95%CI) for each association. Results Of 5,120 studies retrieved, 21 studies met inclusion criteria (4,483,847 participants). HDP was associated with increased odds of ESKD (AOR 6.58, 95%CI 4.06-10.65), CKD (AOR 2.08, 95%CI 1.06-4.10), renal hospitalisation (AOR 2.29, 95%CI 1.42-3.71). The magnitude of association was dependent on HDP subtype: AOR for preeclampsia and ESKD was 4.87 (95%CI 3.01-7.87); gestational hypertension and ESKD was 3.65 (95%CI 2.34-5.67); other HDP (including chronic hypertension) and ESKD was 14.67 (95%CI 3.21-66.97). Preterm delivery was associated with increased odds of ESKD (AOR 2.16, 95%CI 1.64-2.85). GDM was associated with increased odds of CKD among black women (AOR 1.78, 95%CI 1.18-2.70), but not Caucasian women (AOR 0.81, 95%CI 0.58-1.13) Conclusions Women who experience adverse pregnancy outcomes have increased odds of renal disease, especially after HDP. Risk stratification and preventive interventions may be needed to reduce the risk of clinically significant renal disease in mothers. Key messages This is the first study to summarise the long-term risk of renal disease among women who experience a range of adverse pregnancy outcomes. Women who experience hypertensive disorders in pregnancy, preterm delivery, or gestational diabetes are at increased odds of renal disease.

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Maternal anxiety, depression and asthma and adverse pregnancy outcomes – a population based study

Scientific Reports ◽

10.1038/s41598-019-49508-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Gustaf Rejnö ◽

Cecilia Lundholm ◽

Sara Öberg ◽

Paul Lichtenstein ◽

Henrik Larsson ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Population Based ◽

Adverse Pregnancy Outcomes ◽

Maternal Anxiety ◽

Population Based Study ◽

Vaginal Deliveries ◽

National Patient ◽

Swedish Medical ◽

Adverse Pregnancy ◽

Anxiety Depression

Abstract To evaluate associations between maternal anxiety or depression and adverse pregnancy outcomes, taking possible familial confounding and interaction with asthma into account, we conducted a cohort study of all singleton births in Sweden 2001–2013. We retrieved information about pregnancy, diagnoses of anxiety/depression, asthma, and prescribed medication from the Swedish Medical Birth, National Patient, and Prescribed Drug Registers. We estimated associations with regression models, performed cousin and sibling comparisons, and calculated interactions. In 950 301 identified pregnancies; 5.9% had anxiety/depression and 4.0% had asthma. Anxiety/depression was associated with adverse pregnancy outcomes (e.g. preeclampsia, adjusted Odds Ratio 1.17 (95% Confidence Interval 1.12, 1.22), instrumental delivery (1.14 (1.10, 1.18)), elective (1.62 (1.57, 1.68)) and emergency (1.32 (1.28, 1.35)) caesarean section (CS)). Their children had lower birth weight (−54 g (−59, −49)) and shorter gestational age (−0.29 weeks (−0.31, −0.28)). Associations were not confounded by familial factors and asthma did not modify the effect of anxiety/depression for outcomes other than elective CS, p < 0.001. In women with anxiety/depression diagnosis, untreated women had higher odds of elective CS compared to women on medication (1.30 (1.17, 1.43)). In conclusion, anxiety/depression should be considered when evaluating pregnant women’s risk of complications such as preeclampsia and non-vaginal deliveries.

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Risk of adverse pregnancy outcomes after prior spontaneous abortion

Current Medicine Research and Practice ◽

10.1016/j.cmrp.2015.11.002 ◽

2015 ◽

Vol 5 (6) ◽

pp. 258-261

Author(s):

Kavitha Bakshi ◽

T. Usha Rani ◽

P. Pavan Kumar ◽

G.C. Prabhakar

Keyword(s):

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy

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Comparative study of obstetric outcome in women with one previous spontaneous miscarriage versus women with one previous normal delivery

Indian Journal of Obstetrics and Gynecology Research ◽

10.18231/j.ijogr.2021.072 ◽

2021 ◽

Vol 8 (3) ◽

pp. 346-349

Author(s):

Pallavi R Gangatkar ◽

Sulthana Asma Rafique ◽

Ravikanth G O

Keyword(s):

Birth Weight ◽

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Apgar Score ◽

Pregnancy Loss ◽

Adverse Outcome ◽

Subsequent Pregnancy ◽

Adverse Pregnancy Outcomes ◽

Normal Delivery ◽

Adverse Pregnancy

Spontaneous abortion is unintentional pregnancy loss before 20 weeks of gestation. This study was done to find out the association between one spontaneous pregnancy loss and adverse pregnancy outcomes in the subsequent pregnancy and to compare these pregnancy outcomes in patients with prior one full term normal delivery.: It is a case control study. 70 G2A1 were taken as cases, 70 G2P1L1 were considered as Control. The adverse pregnancy outcomes like preterm labour, PROM, IUGR and oligohydramnios and neonatal outcomes like poor Apgar score, low birth weight, NICU admissions and neonatal complications were noted compared and analysed between the two groups. Chi-square was used to find association between clinical variables. Independent t-test was used to compare the outcome measures between the groups.: Comparing the pregnancy outcomes of the case and control groups case group had a higher number adverse pregnancy or neonatal outcome, compared to the control group (p value = 0.05), adverse outcome were higher in case population, adverse outcomes which were independently associated with initial spontaneous abortion were oligohydramnios (p = 0.02), GDM (p = 0.05), LSCS (p = 0.01), low birth weight (p = 0.03), low Apgar scores 1 minute (p = 0.009), low Apgar score at 5 minute (p = 0.03) and babies requiring NICU care (p = 0.001).: Study shows that there is increase in adverse obstetric and perinatal outcomes in pregnancies which are following a single spontaneous abortion. Hence a prior spontaneous miscarriage is a risk factor for the adverse outcome in subsequent pregnancy, therefore careful prenatal care in such pregnancies are mandatory to avoid adverse pregnancy outcomes.

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Association between maternal pregestational glucose level and adverse pregnancy outcomes: a population-based retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-048530 ◽

2021 ◽

Vol 11 (9) ◽

pp. e048530

Author(s):

Mengyao Zeng ◽

Yang He ◽

Min Li ◽

Liu Yang ◽

Qianxi Zhu ◽

...

Keyword(s):

Cohort Study ◽

Blood Glucose ◽

Glucose Level ◽

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Retrospective Cohort ◽

Induced Abortion ◽

Adverse Pregnancy Outcomes ◽

Increased Risk ◽

Adverse Pregnancy

ObjectiveTo investigate the association between maternal pregestational blood glucose level and adverse pregnancy outcomes.DesignRetrospective cohort study.SettingThis study was conducted in the Chongqing Municipality of China between April 2010 and December 2016.ParticipantsA total of 60 222 women (60 360 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project and had pregnancy outcomes were included.Primary outcome measuresAdverse pregnancy outcomes included spontaneous abortion, induced abortion or labour due to medical reasons, stillbirth, preterm birth (PTB), macrosomia, large for gestational age, low birth weight (LBW) and small for gestational age.ResultsOf the 60 360 pregnancies, rates of hypoglycaemic, normoglycaemia, impaired fasting glycaemia (IFG) and diabetic hyperglycaemic before conception were 5.06%, 89.30%, 4.59% and 1.05%, respectively. Compared with women with normoglycaemia, women with pregestational glucose at the diabetic level (≥7.0 mmol/L) might have a higher rate of macrosomia (6.18% vs 4.16%), whereas pregestational IFG seemed to be associated with reduced risks of many adverse outcomes, including spontaneous abortion, induced abortion due to medical reasons, PTB and LBW. After adjusting for potential confounders, pregestational diabetic hyperglycaemic was remained to be significantly associated with an increased risk of macrosomia (adjusted risk ratio 1.49, 95% CI 1.07 to 2.09). Abnormal maternal glucose levels before pregnancy (either hypoglycaemic or hyperglycaemic) seemed to have no significant negative effect on spontaneous abortion or induced abortion due to medical reasons.ConclusionAlthough without overt diabetes mellitus, women with once diabetic fasting glucose level during their preconception examinations could be associated with an increased risk for macrosomia. Uniform guidelines are needed for maternal blood glucose management during pre-pregnancy care to improve pregnancy outcomes.

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Evaluation of Pregnancy Outcomes in Gestational Diabetes Mellitus

Medical Journal of Pokhara Academy of Health Sciences ◽

10.3126/mjpahs.v1i2.23393 ◽

2018 ◽

Vol 1 (2) ◽

pp. 66-69

Author(s):

Lakshmi Sunar ◽

Zhu Yan

Keyword(s):

Diabetes Mellitus ◽

Retrospective Study ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Preterm Delivery ◽

Pregnancy Outcomes ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy ◽

Medical University

Objectives: To evaluate the pregnancy outcomes in the patients diagnosed with Gestational Diabetes Mellitus. Materials and Methods: A retrospective study conducted on ninety-two patients, delivered in the First Affiliated Hospital of Liaoning Medical University, China from February 2014 to June 2015. Results: The rate of Cesarean section was 36.95%, polyhydramnios 27.17%, macrosomia 21.73% and preterm delivery was14.13% respectively. Conclusion: Gestational Diabetes Mellitus is recognized to be associated with increased rate of adverse pregnancy outcomes. This study demonstrated that the GDM has higher risk for polyhydramnios and macrosomia.

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Preeclampsia Mediates the Association between Advanced Maternal Age and Adverse Pregnancy Outcomes: A Structural Equation Modeling Approach

Iranian Journal of Public Health ◽

10.18502/ijph.v49i9.4092 ◽

2020 ◽

Author(s):

NAW SHERWAN ◽

Sumaira MUBARIK ◽

Ghulam NABI ◽

Suqing WANG ◽

Cuifang FAN

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Delivery ◽

Pregnancy Outcomes ◽

Structural Equation ◽

Advanced Maternal Age ◽

Adverse Pregnancy Outcomes ◽

Equation Modeling ◽

Age Group ◽

Adverse Pregnancy

Background: Advanced maternal age (AMA) is considered a risk factor associated with preeclampsia and adverse pregnancy outcomes. We aimed to assess the mediating role of preeclampsia between AMA and adverse pregnancy outcomes. Methods: A sample of 14646 pregnant women from the tertiary hospital of Hubei Province, China, during the years 2011-2017 were included in this study. Pregnant women were divided into 4 groups according to their age at delivery. Mediated effect of preeclampsia with relation to AMA and adverse pregnancy outcomes was measured using structural equation modeling. Results: Women in the highest age group were significantly associated with preterm delivery [RR 1.37 (95% CI 1.24 - 1.49)] and low birth weight [RR 1.28 (95% CI 1.11 - 1.45)] compared with women in the lowest age group. The indirect effect (mediated effect) of AMA on preterm delivery and low birth weight mediated by preeclampsia was [β 0.053 (95% CI: 0.047, 0.060)], and [β 0.045 (95% CI: 0.038, 0.052)], respectively. The estimated mediation proportion of the effect of AMA due to mediated effect of preeclampsia was (35.5%) for preterm delivery and (23.5%) for low birth weight. Conclusion: Preeclampsia partially mediates the association between AMA and adverse pregnancy outcomes.

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