Adverse effects of endometriosis on pregnancy: a case-control study

Abstract Background Endometriosis is a common disease occurring in 1–2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes. Methods This case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31). Results In the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p < 0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56–6.50, p < 0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66–1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11–10.10, p < 0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19–6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups. Conclusion Women who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.

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Effects of the Timing of Labour Induction on Maternal and Neonatal Outcomes in Low-risk Nulliparous Chinese Women

10.21203/rs.3.rs-133412/v1 ◽

2020 ◽

Author(s):

Qiang WEI ◽

Qin-yan CAO ◽

Li ZHANG ◽

Yi XU ◽

Mei-fan DUAN

Keyword(s):

Neonatal Intensive Care ◽

Chinese Women ◽

Low Risk ◽

Neonatal Outcomes ◽

Labour Induction ◽

Control Group ◽

Study Group ◽

Retrospective Case ◽

Maternal And Neonatal Outcomes ◽

Control Study

Abstract Backgroud: When labour induction should be offered to women at or beyond term is unclear. This work aimed to investigate the effects of the timing of labour induction on maternal and neonatal outcomes in low-risk pregnancies. Methods: This retrospective case-control study involved low-risk primigravid pregnant mothers in whom labour was induced at 40-41+6 weeks at our two hospitals between January and December 2017. According to the gestational age at labour induction, participants were categorized into the study group (40-40+6 weeks, n=284) or to the control group (41-41+6 weeks, n=172), and maternal and neonatal outcomes were compared.Results: The study group showed significantly shorter labour in the first stage (391.8±225.7 vs. 472.0±268.9 min, P=0.006), second stage (65.41±38.66 vs. 53.73±31.58 min, P= 0.008) and total stage (453.0±235.8 vs. 535.7±259.8 min, P=0.005). The two groups showed no significant differences in the methods of labour induction or in the rates of failure of labour induction, of caesarean delivery, of postpartum haemorrhage, or of admission to the neonatal intensive care unit.Conclusions: Our retrospective study suggests that inducing labour at 40-40+6 weeks does not increase the risk of adverse maternal or foetal outcomes, and that it shortens labour. These results suggest that labor induction at 40-40+6 weeks was feasible for low-risk primiparas.Trial registration: The research has been approved by the Ethics Committee of West China Second Hospital of Sichuan University and Chengdu Women and Children's Central Hospital, China. Patients gave written informed consent for their anonymized medical data to be analyzed and published for research purposes.

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Association between isolated hypothyroxinaemia in early pregnancy and perinatal outcomes

Endocrine Connections ◽

10.1530/ec-19-0088 ◽

2019 ◽

Vol 8 (4) ◽

pp. 435-441 ◽

Cited By ~ 2

Author(s):

Xiujuan Su ◽

Yan Zhao ◽

Zhijuan Cao ◽

Yingying Yang ◽

Tony Duan ◽

...

Keyword(s):

Pregnancy Complications ◽

Placenta Previa ◽

Perinatal Outcomes ◽

Thyroid Stimulating Hormone ◽

Neonatal Outcomes ◽

Human Beings ◽

Hypertensive Disorders Of Pregnancy ◽

Singleton Pregnancy ◽

Hypertensive Disorders ◽

Increased Risk

Background The effect of isolated maternal hypothyroxinaemia (IMH) on pregnancy complications and neonatal outcomes in human beings is still controversial. Methods This was a retrospective cohort study based on the electronic medical register system. The records of women with a singleton pregnancy who sought antenatal examination between January 2014 and December 2015 at Shanghai First Maternity and Infant Hospital were extracted from the electronic medical records system. Thyroid-stimulating hormone (TSH), free thyroxine (fT4) and anti-thyroperoxidase autoantibody (TPO-Ab) was measured before 20 gestational weeks, and a multiple logistic regression model was used to estimate the odds ratios of pregnancy complications and neonatal outcomes between euthyroid women and those with isolated hypothyroxinaemia. Results A total of 8173 women were included in this study, of whom 342 (4.18%) were diagnosed with IMH. Regression analysis showed that IMH diagnosed in the second trimester (13–20 weeks) was associated with an increased risk of hypertensive disorders of pregnancy (OR = 2.66, 95% CI: 1.38–5.10) and placenta abruption (OR = 3.64, 95% CI: 1.07–12.41), but not with preterm delivery (OR = 1.09, 95% CI: 0.50–2.40), small or large gestational age of infant (OR = 0.91, 95% CI: 0.39–2.12; OR = 1.16, 95% CI: 0.72–1.86), macrosomia (OR = 1.71, 95% CI: 0.95–3.07), gestational diabetes mellitus (OR = 1.36, 95% CI: 0.86–2.15) and placenta previa (OR = 1.62, 95% CI: 0.39–7.37). Conclusion IMH could be a risk factor for hypertensive disorders of pregnancy.

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Maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia: a case-control study

10.1101/2020.03.10.20033605 ◽

2020 ◽

Cited By ~ 14

Author(s):

Na Li ◽

Lefei Han ◽

Min Peng ◽

Yuxia Lv ◽

Yin Ouyang ◽

...

Keyword(s):

Pregnant Women ◽

Vaginal Delivery ◽

Respiratory Symptoms ◽

Case Control Study ◽

Case Control ◽

Neonatal Outcomes ◽

Control Group ◽

Neonatal Complications ◽

Maternal And Neonatal Outcomes ◽

Control Study

AbstractBackgroundThe ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia.MethodsWe conducted a case-control study to compare clinical characteristics, maternal and neonatal outcomes of pregnant women with and without COVID-19 pneumonia.ResultsDuring January 24 to February 29, 2020, there were sixteen pregnant women with confirmed COVID-19 pneumonia and eighteen suspected cases who were admitted to labor in the third trimester. Two had vaginal delivery and the rest took cesarean section. Few patients presented respiratory symptoms (fever and cough) on admission, but most had typical chest CT images of COVID-19 pneumonia. Compared to the controls, COVID-19 pneumonia patients had lower counts of white blood cells (WBC), neutrophils, C-reactive protein (CRP), and alanine aminotransferase (ALT) on admission. Increased levels of WBC, neutrophils, eosinophils, and CRP were found in postpartum blood tests of pneumonia patients. There were three (18.8%) and two (10.5%) of the mothers with confirmed or suspected COVID-19 pneumonia had preterm delivery due to maternal complications, which were significantly higher than the control group. None experienced respiratory failure during hospital stay. COVID-19 infection was not found in the newborns and none developed severe neonatal complications.ConclusionSevere maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had vaginal delivery or caesarean section. Mild respiratory symptoms of pregnant women with COVID-19 pneumonia highlight the need of effective screening on admission.

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Influence of antepartum hemorrhage on placenta previa: A multi-center, retrospective cohort study

10.21203/rs.3.rs-61700/v1 ◽

2020 ◽

Author(s):

Wenjie Qing ◽

Linda Li ◽

Alyssia Venna ◽

Jie Zhou

Keyword(s):

Risk Factor ◽

Neonatal Intensive Care ◽

Independent Risk Factor ◽

Placenta Previa ◽

Perinatal Outcomes ◽

Neonatal Outcomes ◽

Life Threatening ◽

Gestational Week ◽

Maternal And Neonatal Outcomes ◽

The Relationship

Abstract BACKGROUND Placenta previa can be a serious, life-threatening obstetric complication that causes painless but potentially catastrophic bleeding. It is unclear as to whether the frequency of antepartum hemorrhage (APH) relative to the specific gestational week in placenta previa will lead to negative perinatal outcomes. The purpose of the present study was to determine the relationship between APH and gestational week number, and to ascertain the different perinatal outcomes in women with placenta previa. METHODS This was a multi-center, retrospective study in which we enrolled all women with placenta previa between October of 2015 and September of 2018. Patients with placenta previa were divided into two groups: women with APH and women without APH. RESULTS A total of 247 patients were included in this study: 121 women with APH and 126 women without. The incidence of APH was 49.0% (121/247). The mean bleeding frequency was 2.2 ± 1.3 (mean ± SD), with the majority having experienced a one-time bleeding episode (36.4%, 44/121), followed by 26.4% with 2 episodes (32/121), and 23.1% with 3 (28/121). The APH was distinct in every gestational-week category, with bleeding occurring at 31.4 ± 3.3 weeks, ranging from 24 to 37 gestational weeks. The incidence of bleeding varied from 2.6–14.6%, with the highest incidence at 32 gestational weeks. Patients categorized as having complete placental coverage included a greater number of women experiencing bleeding than women who did not bleed (72.9% vs 47.4%, P < 0.001), indicating that a complete placenta was an independent risk factor for APH (odds rations [OR], 4.17; 95% confidence interval [CI], 1.805–9.634). In addition, although APH did not augment the rates of hysterectomy (6.6% vs 7.1%, P = 0.869), it was associated with critical neonatal outcomes that included lower weight, lower Apgar score at 1 minute, preterm age, and more frequent neonatal intensive care unit admissions (P < 0.05). CONCLUSIONS The gestational week and frequency of each APH varied in patients with placenta previa and might result in an increase in adverse maternal and neonatal outcomes. The 32nd gestational week appeared to be the most precarious time—exhibiting the highest incidence of bleeding—and we consider complete placenta previa to be an independent risk factor for APH.

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Elimination of marginal and partial placenta previa from clinical perspective: is it rational?

10.21203/rs.3.rs-17936/v1 ◽

2020 ◽

Author(s):

Shilei Bi ◽

Lizi Zhang ◽

Zhijian Wang ◽

Jingsi Chen ◽

Jingman Tang ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Labor ◽

Placenta Previa ◽

Perinatal Outcomes ◽

Neonatal Outcomes ◽

Classification Method ◽

Clinical Perspective ◽

Maternal And Neonatal Outcomes ◽

Adverse Pregnancy

Abstract Background We aimed to evaluate the difference between the effects of three categories of classifications of placenta previa (PP) on maternal and neonatal outcomes. Methods This study was conducted in the Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Guangzhou Medical University and Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, between January 2009 and 2018. The three categories of PP were the four-classification (low-lying, marginal, partial, and complete PP), three-classification (low-lying, “marpartial,” and complete PP), and two-classification (low-lying PP and PP) methods. We performed multivariate analysis to determine the effects of these classifications on maternal and neonatal outcomes. Results There were 4490 singleton pregnancies complicated with PP, of which 466, 1233, 140, and 2651 were low-lying, marginal, partial, and complete PP, respectively. As per the four-classification method, compared with women with low-lying PP, women with complete PP had a risk of placenta accrete spectrum, postpartum hemorrhage (PPH), hemorrhagic shock, severe PPH, blood transfusion, hysterectomy, puerperal infection, preterm labor, NICU admission, and low birth weight. There was no difference in maternal and perinatal outcomes between marginal and partial PP, except for increased chances of preterm labor and low birth weight in partial PP. In the two-classification method, PP was the risk factor for most of the adverse maternal and perinatal outcomes. Conclusions Complete and low-lying PP were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP. The three-classification method may be practical from the ultrasound and clinical perspective.

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Maternal and Neonatal Outcomes of Pregnant Women With Coronavirus Disease 2019 (COVID-19) Pneumonia: A Case-Control Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa352 ◽

2020 ◽

Vol 71 (16) ◽

pp. 2035-2041 ◽

Cited By ~ 53

Author(s):

Na Li ◽

Lefei Han ◽

Min Peng ◽

Yuxia Lv ◽

Yin Ouyang ◽

...

Keyword(s):

Pregnant Women ◽

Cesarean Delivery ◽

Respiratory Symptoms ◽

Case Control Study ◽

Case Control ◽

Neonatal Outcomes ◽

Control Group ◽

Neonatal Complications ◽

Maternal And Neonatal Outcomes ◽

Control Study

Abstract Background The ongoing pandemic of coronavirus disease 2019 (COVID-19) has caused serious concerns about its potential adverse effects on pregnancy. There are limited data on maternal and neonatal outcomes of pregnant women with COVID-19 pneumonia. Methods We conducted a case-control study to compare clinical characteristics and maternal and neonatal outcomes of pregnant women with and without COVID-19 pneumonia. Results During the period 24 January–29 February 2020, there were 16 pregnant women with confirmed COVID-19 pneumonia and 18 suspected cases who were admitted to labor in the third trimester. Two had vaginal delivery and the rest were cesarean delivery. Few patients presented respiratory symptoms (fever and cough) on admission, but most had typical chest computed tomographic images of COVID-19 pneumonia. Compared to the controls, patients with COVID-19 pneumonia had lower counts of white blood cells (WBCs), neutrophils, C-reactive protein (CRP), and alanine aminotransferase on admission. Increased levels of WBCs, neutrophils, eosinophils, and CRP were found in postpartum blood tests of pneumonia patients. Three (18.8%) of the mothers with confirmed COVID-19 pneumonia and 3 (16.7%) with suspected COVID-19 pneumonia had preterm delivery due to maternal complications, which were significantly higher than in the control group. None experienced respiratory failure during their hospital stay. COVID-19 infection was not found in the newborns, and none developed severe neonatal complications. Conclusions Severe maternal and neonatal complications were not observed in pregnant women with COVID-19 pneumonia who had vaginal or cesarean delivery. Mild respiratory symptoms of pregnant women with COVID-19 pneumonia highlight the need of effective screening on admission.

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Efficacy of corticosteroid therapy in the treatment of long- lasting olfactory disorders in COVID-19 patients

Rhinology Journal ◽

10.4193/rhin20.515 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

L.A. Vaira ◽

C. Hopkins ◽

M. Petrocelli ◽

J.R. Lechien ◽

S. Cutrupi ◽

...

Keyword(s):

Treatment Group ◽

Case Control Study ◽

Spontaneous Recovery ◽

Olfactory Function ◽

Control Group ◽

Initial Control ◽

Group A ◽

Control Study

BACKGROUND: The growing number of COVID-19 patients with long-lasting olfactory disorders makes it necessary to identify effective treatments that enhance the spontaneous recovery of olfactory function. METHODS: Multicentre randomised case-control study that involved 18 patients with COVID-19 related anosmia or severe hyposmia for more than 30 days. Nine patients were prescribed systemic prednisone and nasal irrigation with betamethasone, ambroxol and rinazine for 15 days. The other 9, untreated, patients were used as controls. The olfactory function was evaluated with CCCRC test at 20 and 40 days from the first evaluation. RESULTS: In the control group, a median olfactory score of 20 (IQR 30) was detected at baseline. At the 20-day control there was no significant improvement in olfactory function. The improvement in olfactory performance became significant at the 40-day follow-up compared to baseline scores [60 (IQR 60) versus 20 (IQR 30)]. In the treatment group, patients had a mean olfactory score of 10 (IQR 15) at initial control. At the 20-day control, a significant im-provement in the olfactory scores, compared to the baseline, was detected [70 (IQR 40) versus 10 (IQR 15)]. Olfactory function further improved at 40 days [median score 90 (IQR 50)]. Patients in the treatment group reported significantly higher improvements of the olfactory scores than the controls at both the 20-day [40 (IQR 45) versus 10 (IQR 15)] and 40-day [60 (IQR 40) versus 30 (IQR 25)] evaluations. CONCLUSIONS: Based on the results of this study, the mix of drugs including steroids could represent a useful specific therapy to reduce the prevalence of this long-term morbidity.

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Clinical Stratification of Pregnant COVID-19 Patients based on Severity: A Single Academic Center Experience

American Journal of Perinatology ◽

10.1055/s-0041-1723761 ◽

2021 ◽

Vol 38 (05) ◽

pp. 515-522

Author(s):

Marissa Berry ◽

Amanda Wang ◽

Shannon M. Clark ◽

Hassan M. Harirah ◽

Sangeeta Jain ◽

...

Keyword(s):

Pregnant Women ◽

Disease Severity ◽

Gestational Age ◽

Laboratory Data ◽

Population Characteristics ◽

Neonatal Outcomes ◽

P Value ◽

Asymptomatic Patients ◽

Increased Risk ◽

Maternal And Neonatal Outcomes

Objective This study aimed to describe baseline characteristics of a cohort of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and determine if these correlate with disease severity and perinatal outcomes. Study Design This was a retrospective cohort trial conducted at the University of Texas Medical Branch Galveston, Texas. All pregnant women presented to our medical center, who were screened and tested positive for SARS-CoV-2 virus, were included. We stratified our study population in three groups: asymptomatic, symptomatic not requiring oxygen therapy, and patients requiring oxygen support to maintain oxygen saturation >94%. Relevant population characteristics, laboratory data, and maternal and neonatal outcomes were abstracted. A p-value <0.05 was considered statistically significant. Results Between March and July 2020, 91 women tested positive for SARS-CoV-2 upon admission to our labor and delivery unit. Among these, 61.5% were asymptomatic, 34.1% were symptomatic, and 4.4% required oxygen support. Our population was mainly Hispanic (80.2%), multiparous (76.9%), obese (70.3%), and with a median age of 27 years. Median gestational age at symptom onset or diagnosis was 36 weeks. Significant differences were found between gestational age and disease severity. Maternal characteristics including age, body mass index (BMI), and presence of comorbid conditions did not appear to influence severity of SARS-CoV-2 infection. Significant laboratory findings associated with increasing disease severity included decreasing hemoglobin and white blood cell count, lymphopenia, and increasing levels of inflammatory markers including CRP, ferritin, and procalcitonin. Maternal and neonatal outcomes did not differ among groups. No SARS-CoV-2 was detected by polymerase chain reaction testing in neonates of mothers with COVID-19. Conclusion Pregnant patients with COVID-19 infection are predominantly asymptomatic. Patients appear to be at increased risk for more severe infection requiring oxygen support later in pregnancy. Key Points

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