The Effect of Comprehensive Care on Maternal and Fetal Outcomes in Sickle Cell Disease Pregnancies

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4842-4842
Author(s):  
Kevin H.M. Kuo ◽  
Eiran Warner ◽  
Mathew Sermer ◽  
Richard Ward
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Gestational Age ◽  
Comprehensive Care ◽  
Cell Disease ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Fetal Outcomes ◽  
Vein Thrombosis ◽  
Antepartum Complications

Abstract Abstract 4842 Introduction: Patients with Sickle Cell Disease (SCD) have increased rates of maternal and fetal complications compared to the general population, including premature rupture of membranes, post-partum infection, low birth weight, small for gestational age (SGA), intrauterine growth retardation (IUGR) and preterm delivery. They also experience higher rates of antepartum complications: painful vasoocclusive crises (VOC), infections, PIH/preeclampsia, abruption, antepartum bleeding, cardiomyopathy, pulmonary hypertension, cerebral vein thrombosis, pneumonia, pyelonephritis, deep vein thrombosis (DVT), transfusion and systemic inflammatory response syndrome. Comprehensive care reduces morbidity and mortality in infancy and early childhood and is the cornerstone of care in SCD. However, the effect of comprehensive care on maternal and fetal outcome in patients with SCD has not been examined. We hypothesize that pre-conception comprehensive care improve maternal and fetal outcomes and reduced rates of antepartum complications in patients with SCD. Methods: We conducted a retrospective review of patients with SCD (SS, SC, S/beta-thalassemia) who delivered at the Mount Sinai Hospital (MSH), a high risk obstetrics care institution in Central Ontario, Canada, between 2000 and 2010 based on the Antenatal Database, Delivery Database, electronic and paper-based medical records. Patients were jointly managed by a maternal-fetal medicine (MFM) specialist and hematologist specialized in hemoglobinopathies. We analyzed the maternal and fetal characteristics and outcomes (age at delivery, genotype, gravida, gestational age, birth weight, number of Caesarian sections and vaginal deliveries), antepartum complications (pregnancy induced hypertension (including pre-eclampsia and eclampsia), gestational diabetes mellitus, preterm premature rupture of membranes, oligohydramnios, abruption/previa, venous thromboembolism, urinary tract infection), and SCD-specific complications (painful vaso-occlusive crises, acute chest syndrome, pneumonia, and transfusion) based on the presence or absence of comprehensive care prior to pregnancy by the Red Blood Cell Disorders (RBCD) Clinic at the University Health Network, a SCD comprehensive care centre from the same catchment area as MSH. t-test was used to compare means of two groups, Fisher's exact test and chi-squared tests were used to compare categorical frequency data, where appropriate. Alpha value of 0.05 was chosen as the level of significance. Results and Discussion: We identified 79 deliveries by 64 patients with SCD who received obstetric care at MSH. Mean gestational age at delivery was 37.69 weeks (95% CI 37.00 to 38.37 weeks) and 21 (27%) were preterm (< 37 weeks). Thirty-one deliveries (39%) were by Caesarian section and 48 were delivered vaginally. Seventeen (22%) were low birth weight (< 2500 g) and 11 (14%) were small for gestational age. Maternal and fetal outcomes and rates of antepartum complications were similar to the existing literature (Powars, 1986; Smith, 1996; Serjeant, 2004; Barfield, 2010). Twenty-eight deliveries by 22 of the 64 patients received comprehensive care at the RBCD clinic prior to their pregnancies for a mean duration of 5 years. There was no significant difference in maternal or fetal outcomes or antepartum complications. The results suggest that the role of comprehensive care prior to conception may not be as crucial in pregnancy outcomes of patients with SCD as previously thought. The lack of difference may also be due to the fact that the patients' care was closely monitored during the pregnancy by both specialists in hemoglobinopathies and high risk obstetrics. Limitations of the study include its single-centered and retrospective nature, exclusion of stillbirths and miscarriages, and small sample size. Also, patients who were enrolled in the comprehensive care program may carry more comorbidities and SCD-specific complications, compared to patients referred from the community, but this was not examined in the present study. Further prospective observational studies of SCD patients in the child-bearing age, with attention to the frequency and type of pre-pregnancy SCD-specific complications, as well as standardized application of comprehensive care, will be helpful in determining whether comprehensive care is useful in reducing antepartum complications in patients with SCD. Disclosures: Kuo: Novartis Canada: Research Funding.

The Effect of Comprehensive Care and Degree of Iron Overload on Maternal and Fetal Outcomes in Pregnancies of Transfusion-Dependent Beta-Thalassemia Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5297-5297
Author(s):  
Kevin H.M. Kuo ◽  
Eiran Warner ◽  
Mathew Sermer ◽  
Richard Ward
Keyword(s):  
Birth Weight ◽  
Iron Overload ◽  
Sample Size ◽  
Gestational Age ◽  
Small Sample ◽  
Comprehensive Care ◽  
Potential Confounder ◽  
Beta Thalassemia ◽  
Fetal Outcomes ◽  
Antepartum Complications

Abstract Abstract 5297 Introduction: Iron overload resulting in hypogonadotrophic hypogonadism is the major cause of infertility in patients with beta-Thalassemia Major (bTM). However, in patients who are able to achieve pregnancy, the effects of iron overload and comprehensive care by hematologists specialized in Hemoglobinopathies on maternal-fetal outcomes have not been well-documented. We hypothesize that in patients with transfusion-dependent bTM, lack of comprehensive care prior to conception or elevated ferritin is associated with poor maternal-fetal outcomes and increased rates of antepartum complications. Methods: A retrospective review was conducted on transfusion-dependent bTM patients who delivered at the Mount Sinai Hospital (MSH), a quaternary referral, high risk obstetrics care institution in Central Ontario, Canada, between 2000 and 2010 based on the Antenatal Database, Delivery Database, electronic and paper-based medical records. Patients were jointly managed by a maternal-fetal medicine specialist and hematologist specialized in hemoglobinopathies. All forms of chelation were discontinued during pregnancy. We analyzed the maternal-fetal outcomes and antepartum complications based on the presence or absence of comprehensive care prior to pregnancy by the Red Blood Cell Disorders (RBCD) Clinic at the University Health Network, a hemoglobinopathy comprehensive care centre from the same catchment area as MSH. Components of comprehensive care include regular monitoring of iron burden, screening and treatment of target organ damage from iron overload, genetic counseling from physicians, and psychosocial counseling from a social worker. We also analyzed the relationship between the pre-pregnancy ferritin levels and birth weight, gestational age, and any antepartum complications. Results: We identified 40 singleton deliveries and 3 twin deliveries by 42 patients (40 bTM, 1 Thalassemia Intermedia, 1 Hemoglobin E/beta-Thalassemia). There were no maternal or fetal deaths. The 3 twin pregnancies were excluded from analysis due to being a potential confounder in maternal and fetal outcomes. Mean maternal age at delivery was 33.11 years (95% CI 31.77, 34.45 years). Mean gestational age at delivery was 38.29 weeks (95% CI 37.41, 39.17 weeks) with six (15%) pre-term births (<37 weeks). Fourteen deliveries (35%) were by Caesarian section and 26 were vaginal deliveries. Six (15%) were low birth weight (<2500 g) and 2 (5%) were small for gestational age. Ten of the 39 patients analyzed (11 deliveries) received comprehensive care at RBCD clinic prior to their pregnancies. There was no significant difference in maternal-fetal outcomes or antepartum complications between patients who received comprehensive care prior to conception and those who did not. However, patients who received comprehensive care were significantly younger and had lower parity (P = 0.0072 and 0.0276 respectively). In the 19 deliveries where pre-pregnancy ferritin was available, there was no association between pre-pregnancy ferritin and fetal birth weight, gestational age, or any antepartum complications. Discussion: There was no association between pre-pregnancy ferritin level and maternal-fetal outcomes. Presence of comprehensive care prior to conception did not appear to significantly change the maternal-fetal outcomes in transfusion-dependent beta-Thalassemia patients. We speculate that the lack of difference may be due to a higher proportion of primigravida in the comprehensive care group acting as a potential confounder, given that primigravida in general have higher rates of adverse pregnancy outcome. In addition, patients with higher parity may have less severe complications from iron overload, and consequently are less likely to be referred to a comprehensive care center. Limitations include small sample size and single center study. Further prospective observational studies with larger sample size are required to evaluate whether a) introduction of uniform comprehensive care to all women with bTM in child-bearing age will improve pregnancy outcomes; b) ferritin or liver iron concentration is useful in predicting antepartum complications in bTM patients. Disclosures: Kuo: Novartis Canada: Research Funding.

scholarly journals Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

2019 ◽  
Vol 4 (2) ◽  
pp. 83
Author(s):  
Isam Bsisu ◽  
Alaa Aldalaeen ◽  
Rawan Elrajabi ◽  
Ala AlZaatreh ◽  
Rama Jadallah ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Births ◽  
University Hospital ◽  
High Rate ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Gestational Week ◽  
The Mean

<p><strong><em>Background:</em></strong><em> Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. </em></p><p><strong><em>Materials and methods:</em></strong><em> This retrospective study included 65 patients who were born to mothers with Prolonged PPROM &lt;34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. </em></p><p><strong><em>Results: </em></strong><em>The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P &lt; 0.05). </em></p><p><strong><em>Conclusion:</em></strong><em> Prolonged PPROM before the 34<sup>th</sup> gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.</em></p>

A thinner endometrium is associated with lower newborn birth weight during in vitro fertilization–frozen-embryo transfer: cohort study

2021 ◽  
Author(s):  
Yinfeng Zhang ◽  
Haining Luo ◽  
Ying Han ◽  
Bolun Zhang ◽  
Junfang Ma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Embryo Transfer ◽  
Gestational Age ◽  
Frozen Embryo Transfer ◽  
Fertility Treatment ◽  
Delivery Mode ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture

Abstract BackgroundThe purpose of this study is to explore the influence of endometrial thickness (EMT) before embryo transfer on birth weight after in vitro fertilization–frozen-embryo transfer (IVF–FET).MethodsThis was a retrospective cohort study. We collected the medical records associated with singleton live births from Tianjin Central Obstetrics and Gynecology Hospital from June 2015 to February 2019 after IVF–frozen-embryo transfer (FET). Patients were ≤ 42 years at delivery. Outcomes related to newborns were birth weight, gestational age, delivery mode, low birth weight, and prevalence of macrosomia. Outcomes related to pregnant women were gestational hypertension, gestational diabetes mellitus, premature rupture of membranes and placenta previa.ResultsThe birth weight of singleton newborns was higher for newborns delivered by patients with EMT > 12 mm before embryo transfer than newborns delivered by patients with a thinner endometrium. Regression analysis showed that the EMT ≥ 12 mm group had a gain in mean birth weight of 85.107 g compared with that in the EMT < 8 mm group, whereas the group with EMT of 8–12 mm had an increase in mean birth weight of 25.942 g compared with that in the EMT < 8 mm group. Hypertension during pregnancy, premature rupture of membranes, placenta previa, newborn sex, gestational age, delivery mode, number of implanted embryos, follicle-stimulating hormone (FSH) level, estradiol (E2) level, and pre-pregnancy body mass index (BMI) were all independent predictors of newborn birth weight. The regression model for predicting the newborn birth weight was: Y (birth weight) = 25.942×(EMT of 8–12 mm) + 85.107×(EMT > 12 mm) + 123.483×(hypertension during pregnancy) + 148.859×(premature rupture of membranes) + 182.342×(placental position) − 126.242×(newborn sex) + 23.837×(number of days of pregnancy) + 130.487×(delivery mode) − 55.023×(number of implanted embryos) − 6.215×FSH level − 1.124×E2 level + 22.218×BMI − 4468.101.Conclusion(s)EMT before embryo transfer in patients undergoing their first freeze–thaw embryo transfer cycle is related to the weight of newborn singletons. The newborn birth weight for patients with a thinner endometrium is lower. EMT should be increased before embryo transfer to improve neonatal outcomes after fertility treatment.

scholarly journals Utility of prophylactic cervical cerclage in intra-cytoplasmic sperm injection twins: a prospective study

2020 ◽  
Vol 9 (10) ◽  
pp. 4004
Author(s):  
Manjunath C. S. ◽  
Jyoti Bandi
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Twin Pregnancy ◽  
Preterm Labour ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Cervical Cerclage ◽  
Outcome Parameters ◽  
Gestational Age At Delivery ◽  
Intra Cytoplasmic Sperm Injection

Background: Several interventions have been used to reduce the rate of preterm birth and prolonging gestation in a twin pregnancy and routine usage of cervical cerclage in twin pregnancy conceived after intra-cytoplasmic sperm injection (ICSI) procedure has found to be beneficial.Methods: Prospective case series studies, series of expectant mothers with twin pregnancy conceived by ICSI were studied under tertiary care hospital setting. A total of 108 cases with twin pregnancy were included during a period of 2016 to 2019. Obstetric profile of all the cases was taken; cervical cerclage procedure was done at 14-16 weeks of gestation (McDonald method) after a normal nuchal translucency scan and a double marker test. Pregnancy outcome parameters like abortion, preterm labour/delivery, premature rupture of membranes (PROM), and mode of delivery, gestational age at delivery, birth weight and neonatal complications were assessed.Results: Mean age of the mothers was 30.61±4.45 years, rates of the pregnancy outcome parameters were abortion 0%, preterm labour 11.1%, premature rupture of membranes (PROM) 9.3%, mean gestational age at delivery was at 34.56±1.71 weeks. Neonatal outcome parameters were mean birth weight was at 2279±470 grams, 77.8% of the neonates had normal APGAR scores. The rates of NICU admission was 28%, RDS– 24.1%, 3.7% had sepsis and 92.6% of neonates survived and 7.4% died.Conclusions: In ICSI twin pregnancies with normal cervical measurements, prophylactic cervical cerclage is effective in prolonging pregnancy and preventing preterm delivery and thereby minimizing neonatal morbidity and mortality.

The Use of Somatex Shunt for Fetal Pleural Effusion: A Cohort of 8 Procedures

2021 ◽  
pp. 1-8
Author(s):  
Man Yan Chung ◽  
Wing Cheong Leung ◽  
Wing Ting Tse ◽  
Yuen Ha Ting ◽  
Kwok Ming Law ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Gestational Age ◽  
Single Case ◽  
Perinatal Outcomes ◽  
In Utero ◽  
Good Survival ◽  
Pleural Effusions ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Live Births

<b><i>Introduction:</i></b> Fetal pleural effusion may require in utero shunting which is associated with procedure-related complications. <b><i>Objective:</i></b> To evaluate the efficacy and complications of the newly designed Somatex shunt in treating fetal pleural effusion. <b><i>Methods:</i></b> Consecutive cases with primary fetal pleural effusion who were treated with the Somatex shunt between 2018 and 2019 were evaluated. Perinatal outcomes and complications were retrospectively analyzed. <b><i>Results:</i></b> There were 6 cases of unilateral and 1 case of bilateral pleural effusion, and hence a total of 8 pleuroamniotic shunting procedures were performed. The median gestational age at diagnosis and shunting was 20.7 and 22.6 weeks, respectively. All 8 procedures were successful, achieving complete in utero drainage. All but one were live births (85.7%) with a median gestational age of 38 weeks. The single case of in utero death occurred 4.7 weeks after successful shunting, and no cause could be identified after autopsy. The rates of preterm birth and premature rupture of membranes were 33.3% (2/6) and 16.7% (1/6), respectively. Four of the 8 procedures (50%) had minor shunt-related complications such as dislodgement and entrapment, occurring at a median of 7.7 weeks after shunting. None of the shunts became blocked. <b><i>Conclusions:</i></b> The Somatex shunt is effective in relieving fetal pleural effusions with good survival rate. Overall, it was a safe instrument, though minor shunt complications occurred.

scholarly journals Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae: systematic review and meta-analysis

2021 ◽  
Vol 97 (2) ◽  
pp. 104-111
Author(s):  
Lisa M Vallely ◽  
Dianne Egli-Gany ◽  
Handan Wand ◽  
William S Pomat ◽  
Caroline S E Homer ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Perinatal Mortality ◽  
Low Income ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Middle Income ◽  
Middle Income Countries ◽  
Adverse Pregnancy

Objective To examine associations between Neisseria gonorrhoeae (NG) infection during pregnancy and the risk of preterm birth, spontaneous abortion, premature rupture of membranes, perinatal mortality, low birth weight and ophthalmia neonatorum. Data sources We searched Medline, EMBASE, the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature for studies published between 1948 and 14 January 2020. Methods Studies were included if they reported testing for NG during pregnancy and compared pregnancy, perinatal and/or neonatal outcomes between women with and without NG. Two reviewers independently assessed papers for inclusion and extracted data. Risk of bias was assessed using established checklists for each study design. Summary ORs with 95% CIs were generated using random effects models for both crude and, where available, adjusted associations. Results We identified 2593 records and included 30 in meta-analyses. Women with NG were more likely to experience preterm birth (OR 1.55, 95% CI 1.21 to 1.99, n=18 studies); premature rupture of membranes (OR 1.41, 95% CI 1.02 to 1.92, n=9); perinatal mortality (OR 2.16, 95% CI 1.35 to 3.46, n=9); low birth weight (OR 1.66, 95% CI 1.12 to 2.48, n=8) and ophthalmia neonatorum (OR 4.21, 95% CI 1.36 to 13.04, n=6). Summary adjusted ORs were, for preterm birth 1.90 (95% CI 1.14 to 3.19, n=5) and for low birth weight 1.48 (95% CI 0.79 to 2.77, n=4). In studies with a multivariable analysis, age was the variable most commonly adjusted for. NG was more strongly associated with preterm birth in low-income and middle-income countries (OR 2.21, 95% CI 1.40 to 3.48, n=7) than in high-income countries (OR 1.38, 95% CI 1.04 to 1.83, n=11). Conclusions NG is associated with a number of adverse pregnancy and newborn outcomes. Further research should be done to determine the role of NG in different perinatal mortality outcomes because interventions that reduce mortality will have the greatest impact on reducing the burden of disease in low-income and middle-income countries. PROSPERO registration number CRD42016050962.

scholarly journals Patterns of placental pathology in preterm premature rupture of membranes

2013 ◽  
Vol 4 (3) ◽  
pp. 249-255 ◽  
Author(s):  
J. Armstrong-Wells ◽  
M. D. Post ◽  
M. Donnelly ◽  
M. J. Manco-Johnson ◽  
B. M. Fisher ◽  
...  
Keyword(s):  
Gestational Age ◽  
Pathological Finding ◽  
Neonatal Outcomes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Exact Test ◽  
Preterm Premature Rupture ◽  
Chorionic Plate ◽  
Adverse Neonatal Outcomes ◽  
Insight Into

Inflammation is associated with preterm premature rupture of membranes (PPROM) and adverse neonatal outcomes. Subchorionic thrombi, with or without inflammation, may also be a significant pathological finding in PPROM. Patterns of inflammation and thrombosis may give insight into mechanisms of adverse neonatal outcomes associated with PPROM. To characterize histologic findings of placentas from pregnancies complicated by PPROM at altitude, 44 placentas were evaluated for gross and histological indicators of inflammation and thrombosis. Student's t-test (or Mann–Whitney U-test), χ2 analysis (or Fisher's exact test), mean square contingency and logistic regression were used when appropriate. The prevalence of histologic acute chorioamnionitis (HCA) was 59%. Fetal-derived inflammation (funisitis and chorionic plate vasculitis) was seen at lower frequency (30% and 45%, respectively) and not always in association with HCA. There was a trend for Hispanic women to have higher odds of funisitis (OR = 5.9; P = 0.05). Subchorionic thrombi were seen in 34% of all placentas. The odds of subchorionic thrombi without HCA was 6.3 times greater that the odds of subchorionic thrombi with HCA (P = 0.02). There was no difference in gestational age or rupture-to-delivery interval, with the presence or absence of inflammatory or thrombotic lesions. These findings suggest that PPROM is caused by or can result in fetal inflammation, placental malperfusion, or both, independent of gestational age or rupture-to-delivery interval; maternal ethnicity and altitude may contribute to these findings. Future studies focused on this constellation of PPROM placental findings, genetic polymorphisms and neonatal outcomes are needed.

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