Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period

2014 ◽  
Vol 42 (4) ◽  
Author(s):  
Boldizsár Horvath ◽  
Ferenc Lakatos ◽  
Csaba Tóth ◽  
Tamás Bödecs ◽  
József Bódis
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Pregnancy Outcomes ◽  
Bacterial Culture ◽  
Uterine Cavity ◽  
Positive Culture ◽  
Amniotic Cavity ◽  
Bacterial Cultures ◽  
Cesarean Deliveries ◽  
Histological Results

AbstractTo assess neonatal outcomes and associated findings in pregnant women identified after delivery as having had underlying subclinical chorioamnionitis by either histology or bacterial culture.In 16 years, 8974 clinical, histological, and bacterial culture data were obtained retrospectively.Placental histology was analyzed in 4237 pregnancies (2785 term and 1452 preterm) and 4737 amniotic cavity cultures were obtained during 5446 cesarean deliveries (3268 term and 1469 preterm). Histological results and bacterial cultures were both available in 1270 of the preterm deliveries. Histology revealed inflammation, suggestive of infection, in 13.6% of placentas. Subclinical acute chorioamnionic inflammation was confirmed in 142 out of 2785 term pregnancies (5.1%) and in 436 out of 1452 preterm pregnancies (30.0%, P<0.001). Bacteriological culture of the intrauterine cavity was obtained from the lower uterine segment of the uterus during cesarean section. A positive culture was found in 19.9% of all cases (941/4737), this proportion was significantly higher in preterm deliveries (343/1273, 26.9%) than in term (17.3%, P<0.001). The lower the birth-weight or gestational age, the higher the frequency of silent infections in the uterine cavity.Our study findings support the association between intra-amniotic infections and preterm delivery.

scholarly journals The implications for advanced maternal age on pregnancy complications and adverse neonatal outcomes

2021 ◽  
Vol 29 (3) ◽  
pp. 200-209
Author(s):  
Zeynep Gedik Özköse ◽  
Süleyman Cemil Oğlak
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Apgar Scores ◽  
Adverse Neonatal Outcomes ◽  
Adverse Pregnancy ◽  
Nicu Admission

Objective This study aimed to determine the effect of advanced maternal age (AMA) on maternal and neonatal outcomes in pregnant women aged ≥35 years compared with patients aged 30–34 years. Also, we aimed to analyze the risk estimates of potential confounders to identify whether these variables contributed to the development of adverse pregnancy outcomes or not. Methods This retrospective cohort study included 2284 pregnant women aged ≥35 years at the time of delivery who was delivered in a tertiary referral hospital from January 1, 2016, to December 31, 2020. We further classified these women into two subgroups: 35–39 years as early AMA (EAMA), and ≥40 years as very AMA (VAMA). Pregnancy complications and adverse neonatal outcomes were recorded. Results Compared to younger women, pregnant AMA women had significantly higher risks of complicated pregnancies, including a higher risk of gestational diabetes mellitus (GDM, p<0.001), polyhydramnios (p<0.001), cesarean section (p<0.001), stillbirths (p<0.001), major fetal abnormality (p<0.001), preterm delivery (p<0.001), lower birth weight (p<0.001), lower 5-minute Apgar scores (p<0.001), lower umbilical artery blood pH values (p<0.001), neonatal intensive care unit (NICU) admission (p<0.001), and length of NICU stay (p<0.001). Conclusion We found a strong and significant association between VAMA and adverse pregnancy outcomes, including an increased risk of GDM, polyhydramnios, cesarean section, and adverse neonatal outcomes, including a higher risk of stillbirths, preterm delivery, lower birth weight, lower 5-minute Apgar scores, and NICU admission.

Effectiveness of Sequential Low Dose Oral Misoprostol Solution for Induction of Labor: An Experience in a Thai Quaternary Hospital

2021 ◽  
Vol 104 (4) ◽  
pp. 645-653
Keyword(s):  
Birth Weight ◽  
Cesarean Section ◽  
Vaginal Delivery ◽  
Pregnancy Outcomes ◽  
Associated Factors ◽  
Low Dose ◽  
Labor Induction ◽  
Cervical Ripening ◽  
Bishop Score ◽  
Oral Misoprostol

Background: Siriraj Hospital has seen remarkably high cesarean section rates during the last decade. A labor induction protocol has been established to reduce cesarean section rate from “failed induction”. Objective: To determine effectiveness of a sequential low dose misoprostol solution protocol for labor induction. Cervical ripening and vaginal delivery rates, pregnancy outcomes, and associated factors of successful vaginal delivery were determined. Materials and Methods: The present study was a retrospective observational study. Medical records of women with a term singleton pregnancy and with Bishop score of 6 or less who underwent labor induction were reviewed. The induction protocol started with series 1 which was 25 mL oral misoprostol solution (1 mcg/mL) every two hours for a maximum of 24 hours. If Bishop score was 6 or less by the end of series 1, then series 2 would follow, comprising 50 mL oral misoprostol solution (1 mcg/mL) every four hours for a maximum of 24 hours. Data of Bishop scores, delivery route by the end of each series, pregnancy outcomes, and possible associated factors were collected. Results: One hundred twenty-eight women were analyzed. The overall rate of cervical ripening, with a Bishop score of more than 6, was 92.2%, and at 88.3% with series 1 only. Successful vaginal delivery was achieved in 70 cases (54.7%), 53 of whom were delivered within 24 hours. Significantly associated factors with successful vaginal delivery were multiparity, and birth weight of 3,200 grams or less; adjusted OR 4.0 (95% CI 1.31 to 12.16, p=0.015) and 3.4 (95% CI 1.48 to 7.63, p=0.004), respectively. No serious adverse pregnancy outcomes were observed. Conclusion: With Siriraj induction protocol, success rates of cervical ripening and vaginal delivery were 92.2% and 54.7%, respectively, without serious adverse outcomes. Significant associated factors of successful vaginal delivery were multiparity and birth weight of 3,200 grams or less. Keywords: Oral misoprostol, Misoprostol solution, Low dose, Labor induction, Cervical ripenting, Vaginal delivery

scholarly journals The Influence of Maternal BMI on Adverse Pregnancy Outcomes in Older Women

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2838 ◽  
Author(s):  
Małgorzata Lewandowska ◽  
Stefan Sajdak ◽  
Barbara Więckowska ◽  
Nevena Manevska ◽  
Jan Lubiński
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Older Women ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Older Age ◽  
Odds Ratios ◽  
Age Related ◽  
Adverse Pregnancy

As mothers age, the risk of adverse pregnancy outcomes may increase, but the results so far are controversial and several issues remain unknown, such as the impact of maternal weight on the effects associated with older age. In a prospective cohort of 912 Polish women with singleton pregnancies (recruited in 2015–2016), we assessed the pregnancy outcomes depending on the mother’s age (18–24, 25–29, 30–34, 35–39, and ≥40 years). Women aged ≥35 years (vs. <35 years) were assessed in terms of body mass index (BMI). Multidimensional logistic regression was used to calculate the odds ratios (with 95% confidence intervals) of the pregnancy results. The risk profiles (using the Lowess method) were applied to determine the threshold risk. We found that both the youngest and the oldest group members displayed higher adjusted odds ratios of preeclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth <37th week (U-shaped risk). In the remaining cases, the age ≥40 years, compared to the youngest age 18–24 years, was associated with a higher adjusted risk of gestational hypertension (GH) (AOR = 5.76, p = 0.034), gestational diabetes mellitus GDM-1 (AOR = 7.06, p = 0.016), cesarean section (AOR = 6.97, p <0.001), and low birth weight LBW (AOR = 15.73, p = 0.033) as well as macrosomia >4000 g (AOR = 8.95, p = 0.048). We found that older age ≥35 years (vs. <35 years) was associated with higher adjusted odds ratios of all the pregnancy outcomes investigated. In obese women, these adverse older age related results were found to be more intense in GH study, as well as (though weaker) in birth <37th week study, small-for-gestational age birth weight (SGA), LBW, large-for-gestational age birth weight (LGA), and macrosomia. In overweight women, these adverse older age related results were found to be more intense in preterm birth study, as well as (though weaker) in SGA and LBW. In underweight women, adverse pregnancy outcomes related to older age were more intense in a study of cesarean section. At the same time, underweight was associated with reversal of some negative effects of older age (we found lower odds ratios of GDM-1 diabetes). The maternal threshold age above which the risk of GH, PE, GDM, caesarean section, and preterm birth increased was 33–34 years (lower than the threshold of 35 years assumed in the literature), and the threshold risk of IUGR, LBW, SGA, LGA, and macrosomia was 36–37 years. Main conclusions: Older maternal age was associated with a higher chance of all kinds of obstetric complications. Older women should particularly avoid obesity and overweight.

scholarly journals Relationship of Oxygen Saturation with Neonatal and Maternal factors in Vaginal and Cesarean Deliveries

2015 ◽  
Vol 53 (199) ◽  
Author(s):  
Shyam Kumar Mahato ◽  
Nagendra Chaudhary ◽  
Susana Lama ◽  
K N Agarwal ◽  
B D Bhatia
Keyword(s):  
Body Mass Index ◽  
Birth Weight ◽  
Cesarean Section ◽  
Body Mass ◽  
Apgar Score ◽  
Pulse Oximeter ◽  
Maternal Factors ◽  
Cesarean Deliveries ◽  
Vaginal Deliveries ◽  
Cesarean Births

Introduction: Hypoxemia is the major cause of neonatal morbidity and mortality. The study aims to determine the influence of birth weight, Apgar score, gestation age, body mass index and hemoglobin of mother on levels of SpO2 in healthy newborns born vaginally and through cesarean section. Methods: A hospital Based, observational study conducted in Department of Pediatrics, Universal College of Medical Sciences-Teaching Hospital, Bhairahawa, Lumbini, Nepal; on 49 vaginal and 49 cesarean deliveries with Apgar Score ≥ 6. SpO2 was estimated by pulse oximeter post-ductally between 1 to 30 minutes of birth. The observed SpO2 values were correlated with neonatal and maternal factors. Results: Vaginal and Cesarean deliveries SpO2 were comparable for birth weight, gestational age, Apgar score of neonates, body mass index and hemoglobin of the mother. Birth weight in vaginally delivered babies and Apgar score in cesarean births showed significant change in SpO2 (P<0.05). At all points of time the SpO2 values were higher in neonates, born by cesarean than those born out of spontaneous vaginal deliveries (P<0.001). Conclusions: SpO2 levels in neonates born through cesarean section were higher in comparison to thoseborn by vaginal route. Birth weight and Apgar score had correlation with SpO2 in vaginal and cesarean births, respectively.Keywords: Apgar score; birth weight; newborn; pulse oximeter; SpO2.

scholarly journals Assisted Reproductive Technology Required to Achieve High Conception Rates, Despite a Low Incidence of Hypogonadotrophic Hypogonadism in Thalassemia and Sickle Cell Disease Patients

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4989-4989
Author(s):  
Jacinta Perram ◽  
Stephanie Anderson ◽  
Stephen Matthews ◽  
Melly Gou ◽  
P. Joy Ho
Keyword(s):  
Birth Weight ◽  
Sickle Cell Disease ◽  
Cesarean Section ◽  
Assisted Reproductive Technology ◽  
Pregnancy Outcomes ◽  
Reproductive Technology ◽  
Cell Disease ◽  
Live Births ◽  
Hypogonadotrophic Hypogonadism ◽  
Spontaneous Conception

Abstract Background Early and effective iron chelation has improved life expectancy and decreased disease complications for people with transfusion dependent thalassemia (TDT) and Sickle Cell Disease (SCD). Fertility challenges and pregnancy complications have historically limited reproductive options in this group, however improved disease management has made subfertility a chronic disease complication requiring attention. Despite this, there are very few reports on rates of conception and pregnancy outcomes in this population. Methods A 20 year retrospective analysis (1997 - 2017) was performed to evaluate fertility outcomes in women with TDT and SCD at an Australian referral centre. Patients with TDT and SCD who tried to conceive during the study period were included. Use of assisted reproductive technologies (ART), as well as pregnancy outcomes and neonatal and maternal complications were assessed. Results Eleven women with TDT and 3 with SCD tried to conceive during the study period. Median age at conception was 28 years (range 21-35). A total of 28 pregnancies and 25 live births were reported, including 2 spontaneous early pregnancy losses, a termination for anencephaly and a reduction of triplets. There was 1 multiple gestation in the cohort. At least 1 live birth occurred in 13 of the 14 women (93%). Spontaneous conception was reported in 9 women, of whom 8 had at least one resulting live birth, with a total of 15 live births from spontaneous conception. Of 5 women who were unable to conceive spontaneously, four had a diagnosis of hypogonadotrophic hypogonadism (HH) - two conceived following ovarian stimulation (OS), one required in vitro fertilization (IVF), and one did not pursue IVF following unsuccessful OS. The cause of subfertility was unknown in one patient, who conceived with IVF following failed OS. Three women who had an initial spontaneous conception required assisted reproductive technology (ART) for subsequent pregnancies, with no cause for subfertility identified. Mean ferritin at conception was 2911 mmol/L (range 164 to 8697mmol/L), and there was no association between ferritin at conception and need for ART. A trend was observed between increasing age and use of ART. Nine of the thirteen (69%) women who achieved pregnancy underwent Cesarean section for their first delivery. Prematurity (birth prior to 37 weeks' gestation) occurred in 5 (20%) of live births. Intrauterine growth restriction (IUGR) evidenced by birth weight &lt;10 th centile for gestational age at birth was observed in 7 of 25 births (28%). This included one very low birth weight neonate delivered following induction for suspected IUGR. Respiratory distress syndrome occurred in two neonates in the setting of prematurity (delivered at 31 and 33 weeks gestation), both from women with TDT. Post partum hemorrhage (PPH) occurred after four deliveries in three women with TDT. There were no neonatal or maternal deaths. Conclusions Our data is the first analysis of fertility and pregnancy outcomes in Australian patients with TDT or SCD. Publications in this area are limited, and primarily report on pregnancy outcomes without capturing failure to conceive. Our findings are encouraging, with high conception rates achieved, with the use of ART where needed. Ferritin level did not predict difficulty with spontaneous conception and few of the women (29%) had HH, despite many having significant hyperferritinemia. Overall, 48% of live births resulted from ART, despite 58% of these patients not having a diagnosis of HH. This indicates that pituitary iron deposition with resultant HH alone does not adequately explain subfertility in this population. Our data also highlight the importance of affordable ART access for this patient population despite the clinical gains achieved with effective chelation therapy. Pregnancies were largely uncomplicated with excellent maternal and foetal outcomes. A high rate of IUGR was observed, supporting classification of pregnancy in this population as high risk. Rates of Cesarean section for first delivery were more than double the Australian average, likely in part due to high IUGR rates. Neonatal complications and PPH occurred at general population rates. Guidelines around pregnancy management in this population abound, however large prospective studies are needed to identify those at risk of sub- and infertility, even in the era of effective chelation. Disclosures No relevant conflicts of interest to declare.

Pregnancy & Oral Health and Dental Management in Pregnant Patient

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.

Advanced Maternal Age and Adverse Maternal and Neonatal Outcomes in Pregnant Women

2020 ◽  
Vol 16 ◽  
Author(s):  
Reza Omani-Samani ◽  
Saman Maroufizadeh ◽  
Nafise Saedi ◽  
Nasim Shokouhi ◽  
Arezoo Esmailzadeh ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Maternal Age ◽  
Unwanted Pregnancy ◽  
Advanced Maternal Age ◽  
Neonatal Outcomes ◽  
Maternal And Neonatal Outcomes

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

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