Delivery characteristics in pregnancies with stillbirth: a retrospective case-control study from a tertiary teaching hospital

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Maria Pekkola ◽  
Minna Tikkanen ◽  
Mika Gissler ◽  
Mikko Loukovaara ◽  
Jorma Paavonen ◽  
...  
Keyword(s):  
Live Birth ◽  
Gestational Age ◽  
Case Control Study ◽  
Case Control ◽  
University Hospital ◽  
Bleeding Complications ◽  
Maternal Complications ◽  
Retrospective Case ◽  
Tertiary Teaching ◽  
Control Study

Abstract Objectives We compared delivery characteristics and outcome of women with stillbirth to those with live birth. Methods This was a retrospective case-control study from Helsinki University Hospital, Finland. The study population comprised 214 antepartum singleton stillbirths during 2003–2015. Two age-adjusted controls giving live birth in the same year at the same institution were chosen for each case from the Finnish Medical Birth Register. Delivery characteristics and adverse pregnancy outcomes were compared between the cases and controls, adjusted for gestational age. Results Labor induction was more common (86.0 vs. 22.0%, p<0.001, gestational age adjusted odds ratio [aOR] 35.25, 95% confidence interval [CI] 12.37–100.45) and cesarean sections less frequent (9.3 vs 28.7%, p<0.001, aOR 0.21, 95% CI 0.10–0.47) among women with stillbirth. Duration of labor was significantly shorter among the cases (first stage 240.0 min [115.0–365.0 min] vs. 412.5 min [251.0–574.0 min], p<0.001; second stage 8.0 min [0.0–16.0 min] vs. 15.0 min [4.0–26.0 min], p<0.001). Placental abruption was more common in pregnancies with stillbirth (15.0 vs. 0.9%, p<0.001, aOR 8.52, 95% CI 2.51–28.94) and blood transfusion was needed more often (10.7 vs. 4.4%, p=0.002, aOR 6.5, 95% CI 2.10–20.13). The rates of serious maternal complications were low. Conclusions Most women with stillbirth delivered vaginally without obstetric complications. The duration of labor was shorter in pregnancies with stillbirth but the risk for postpartum interventions and bleeding complications was higher compared to those with live birth.

P–666 Validating the hypo-androgenic PCOS-like phenotype (H-PCOS), derived from the “lean” PCOS phenotype at younger ages

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Darmon ◽  
E Molinari ◽  
D F Albertini ◽  
P Patrizio ◽  
D H Barad ◽  
...  
Keyword(s):  
Live Birth ◽  
Case Control Study ◽  
Treatment Resistance ◽  
Study Groups ◽  
Case Control ◽  
Clinical Pregnancy ◽  
Retrospective Case ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Control Study

Abstract Study question Is the resistance to standard infertility treatments of the H-PCOS-like phenotype reversed through reconstitution of androgen levels and can principle diagnostic markers of H-PCOS be validated? Summary answer Pre-supplementation with dehydroepiandrosterone (DHEA) eliminated treatment resistance of H-PCOS in comparison to matched infertile controls, also validating previously reported diagnostic features of this condition. What is known already H-PCOS evolves at older ages from a hyper-androgenic “lean” PCOS phenotype at young ages. Its ontogeny diverts from other PCOS phenotype between 20s and mid–30s by going from being hyper- to being hypo-androgenic due to insufficiency in adrenal androgen production, believed to represent an autoimmune process. In contrast to other PCOS phenotypes, the “lean” PCOS phenotype appears highly treatment resistant to standard fertility treatments. Study design, size, duration Retrospective case control study. Participants/materials, setting, methods We investigated 54 H-PCOS patients with qualifying diagnostic criteria1,2 and 50 matched infertility patients without diagnostic H-PCOS criteria as controls. Both study groups underwent routine in vitro fertilization (IVF) cycles, including androgen pre-supplementation in both groups via dehydroepiandrosterone (DHEA) for women diagnosed as hypo-androgenic. Main outcome measures were clinical pregnancy and live birth rates. 1Gleicher et al., J Sterodi Biochem Mol Biol 2017;167:144–152; 2Gleicher N, et al., Endocrine 2018;59(3):661–676 Main results and the role of chance Study groups were similar in age, number of prior IVF cycles and previous live births. H-PCOS patients in contrast to controls, however, demonstrated previously reported characteristics of H-PCOS diagnosis, including a significantly higher DHEA/DHEAS ratio, significantly higher AMH, confirming higher functional ovarian reserve, significantly lower free testosterone and significantly higher sex hormone binding globulin (SHBG), further confirming lower androgens. Finally, H-PCOS patients also demonstrated significantly increased evidence for immune system hyperactivity. Clinical pregnancy and live birth rates were separately assessed in first IVF cycles and cumulatively. Both analyses demonstrated, even after age-adjustments, absolutely no outcome differences in cycle cancellations, numbers of oocytes retrieved, first and cumulative pregnancy and live birth rates. At least one pregnancy was achieved in 12 women in both groups (22.2% and 24.0%) and at least one live birth in 11 (20.4%) vs. 8 (14.8%), respectively. Limitations, reasons for caution As a retrospective case control study, here presented data must be interpreted with caution. The close match between H-PCOS and control patients and the very clear differentiation in patient characteristics between the two groups, however, support the credibility of this study. Wider implications of the findings: This study demonstrated that androgen reconstitution in H-PCOS patients completely reversed treatment resistance compared to well-matched infertile control patients. It also validated previously defined diagnostic criteria of H-PCOS, hopefully facilitating a timelier diagnosis of a, still, widely overlooked condition in female infertility. Trial registration number NA

scholarly journals Does a Hospital Palliative Care Team Have the Potential to Reduce the Cost of a Terminal Hospitalization? A Retrospective Case-control Study in a Czech Tertiary University Hospital

2021 ◽  
Author(s):  
Zuzana Kremenova ◽  
Jan Svancara ◽  
Petra Kralova ◽  
Martin Moravec ◽  
Katerina Hanouskova ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Case Control Study ◽  
Case Control ◽  
Palliative Care Team ◽  
Care Team ◽  
University Hospital ◽  
Insurance Company ◽  
Retrospective Case ◽  
Control Study

Abstract Background: More than 50% of patients worldwide die in hospitals. It is well known that end-of-life hospital care is costly.Our aims were to test whether the support of the palliative team can reduce end-of-life costs and to study the mechanisms of cost reduction.Methods: This was a one-centre descriptive retrospective case-control study. Big data from registries of routine visits were used for case-control matching. We included the expenses billed to the insurance company and added separately charged drugs and materials. We compared the groups over the duration of the terminal hospitalization, ICU days (ICU=intensive care unit), IV antibiotic use (IV=intravenous), MRI/CT scans (MRI/CR=magnetic resonance imaging/computed tomography), oncologic treatment in the last month of life, and documentation of the dying phase.We searched for all in-hospital cases who died in the university hospital in Prague with the support of the hospital palliative team from January 2019 to April 2020 and matched them with similar controls. The controls were matched according to age, sex, Charlson comorbidity index and diagnosis recorded on the death certificate.Results: We identified 213 dyads. The average daily costs were three times lower in the palliative group (4,392.4 CZK per day=171.3 EUR) than in the non-palliative group (13,992.8 CZK per day=545.8 EUR), and the difference was caused by the shorter time spent in the ICU (16% vs 33% of hospital days). This was probably due to better documentation of the dying phase in the medical records.Conclusions: To date, there are sparse hospital data available on the economic aspects of end-of-life care. We showed that the integration of the palliative care team in the dying phase can be cost saving. The evidence that hospital palliative care can save a substantial amount of money can be used to support the integration of palliative care in hospitals in middle- and low-income countries. A multicentre study with the same design is planned in the future to increase the strength of the results.

scholarly journals The Impact of Ovarian Endometrioma(s) on ART Outcomes: Retrospective Case Control Study

2016 ◽  
Author(s):  
Emre Göksan Pabuçcu ◽  
Aslı Yarcı Gürsoy ◽  
Hasan Ulubaşoğlu ◽  
Özgür Doğuş Demirkıran ◽  
Gamze Sinem Çağlar ◽  
...  
Keyword(s):  
Live Birth ◽  
Case Control Study ◽  
Mature Oocyte ◽  
Case Control ◽  
Retrospective Case ◽  
Oocyte Yield ◽  
Ovarian Endometrioma ◽  
The Impact ◽  
Control Study ◽  
End Group

<p><strong>OBJECTIVE:</strong> To compare oocyte yield of women with intact ovarian endometrioma(s) to those without endometrioma undergoing ART. Secondary outcomes were implantation and live birth rates between the two groups.</p><p><strong>STUDY DESIGN: </strong>Retrospective case-control study was conducted to document eligible cases. A total of 165 women with intact endometrioma(s) (END) were included in the final analysis. Controls were 196 cases with tubal disease as the sole cause of their infertility who underwent ART in the same time period. Cases and controls were matched for age, BMI and serum AMH concentrations. Ovarian stimulation characteristics and pregnancy outcomes including live birth data were documented for both groups.</p><p><strong>RESULTS: </strong>Despite similar demographic characteristics, significantly<strong> </strong>longer cycle duration and higher amounts of gonadotropin consumption was observed in END group compared to controls (p&lt;0.001). Significantly lower numbers of retrieved oocytes, mature oocytes and mature oocyte fraction (%, no of retrieved/mature) was detected in END group. There was no statistically significant difference in terms of fertilization, implantation and live birth rate per started cycle among groups. Cycle cancellations were also similar.</p><p><strong>CONCLUSION: </strong>In women with intact ovarian endometrioma(s) undergoing ART, oocyte quantity, especially mature oocyte yield was hampered. However, adequate number of mature oocytes, successful fertilization and satisfactory implantation rates might be possible contributing to acceptable live births. Further randomized controlled trials of patients with different sizes of endometrioma(s) would be needed to confirm our conclusions.</p>

scholarly journals Thin endometrial lining during frozen embryo cycles: a case-control study of risk factors and natural history

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Emily A Jacobs ◽  
Karen M Summers ◽  
Amy E Sparks ◽  
Bradley J Van Voorhis
Keyword(s):  
Natural History ◽  
Live Birth ◽  
Case Control Study ◽  
Case Control ◽  
Frozen Embryo Transfer ◽  
Retrospective Case ◽  
Live Birth Rates ◽  
Lower Weight ◽  
History Of ◽  
Control Study

Objective: To identify predictors of thin endometrial lining in the first frozen embryo transfer cycles and to characterize the natural history of this condition over subsequent cycles. Design: Retrospective case-control study Conclusions: This study shows that prognosis after a diagnosis of thin endometrial lining is favorable. Lower weight and thinner fresh cycle lining are predictors of thin endometrial lining in FET cycles. Most importantly, women with a diagnosis of thin endometrial lining have similar live birth rates as those with adequate endometrial lining, although their time to achieve live birth is slightly longer.

scholarly journals Diet in pregnancy and risk of small for gestational age birth: results from a retrospective case-control study in Italy

2010 ◽  
Vol 6 (4) ◽  
pp. 297-305 ◽  
Author(s):  
Elena Ricci ◽  
Francesca Chiaffarino ◽  
Sonia Cipriani ◽  
Matteo Malvezzi ◽  
Fabio Parazzini
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Case Control Study ◽  
Case Control ◽  
Retrospective Case ◽  
Control Study ◽  
In Pregnancy

scholarly journals Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

2021 ◽  
Vol 10 (6) ◽  
pp. 1153
Author(s):  
Enrique S. Meseguer ◽  
Mikel U. Elizalde ◽  
Alberto M. Borobia ◽  
Elena Ramírez
Keyword(s):  
Valproic Acid ◽  
Liver Injury ◽  
Case Control Study ◽  
Monitoring Program ◽  
Case Control ◽  
University Hospital ◽  
Control Groups ◽  
Retrospective Case ◽  
Drug Induced ◽  
Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring program, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related liver injury but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild liver injury. Mean age for the cases was 45.7 years, 4 (26.7%) were women and 5 (33.34%) were children under 18 years, of them 3 (20%) were fatal. Polytherapy with other antiepileptic drugs (p = 0.047) and alcohol consumption (p < 0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p < 0.001). The cases developed hepatocellular liver injury (p < 0.001), while the mild hepatic damage controls had a higher rate of cholestatic liver injury (p < 0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p = 0.033 and p = 0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

scholarly journals Valproic Acid-Induced Liver Injury: A Case-Control Study from a Prospective Pharmacovigilance Program in a Tertiary Hospital

2021 ◽  
Author(s):  
Enrique Seco Meseguer ◽  
Mikel Urroz Elizalde ◽  
Alberto M. Borobia ◽  
Elena Ramírez
Keyword(s):  
Valproic Acid ◽  
Liver Injury ◽  
Case Control Study ◽  
Tertiary Hospital ◽  
Case Control ◽  
University Hospital ◽  
Control Groups ◽  
Retrospective Case ◽  
Drug Induced ◽  
Control Study

Introduction: Valproic acid (VPA) is an antiepileptic drug extensively used for treating partial and generalised seizures, acute mania and as prophylaxis for bipolar disorder. Drug-induced liver injury (DILI) persists as a significant issue related to fatal outcomes by VPA. The aim of this study was to increase our knowledge about this condition and to better identify patients affected. Methods: We conducted an observational retrospective case-control study that identified cases of DILI by VPA from the Pharmacovigilance Programme from our Laboratory Signals at La Paz University Hospital from January 2007 to December 2019. From the Therapeutic VPA Monitoring Programme, two control groups were assigned, VPA-tolerant patients and the other with patients who developed mild VPA-related hepatitis but who did not meet the DILI criteria, matched for date, age and sex. Results: A total of 60 patients were included in the study: 15 cases of DILI, 30 VPA-tolerant controls and 15 controls with mild hepatitis. Mean age for the cases was 45.7 years, 4(26.7%) were women and 5(33.34%) were children under 18 years, of them 3(20%) were fatal. Polytherapy with other antiepileptic drugs (p=0.047) and alcohol consumption (p&lt;0.001) were associated with a greater risk of developing DILI by VPA. A diagnosis of epileptic seizure was more frequently related to DILI when compared with the VPA-tolerant controls (p&lt;0.001). The cases developed hepatocellular hepatitis (p&lt;0.001), while the mild hepatitis controls had a higher rate of cholestatic hepatitis (p&lt;0.001). The laboratory lactate dehydrogenase values were statistically higher (even at baseline) in patients with DILI than in both control groups (p= 0.033 and p=0.039). Conclusions: VPA hepatotoxicity remains a considerable problem. This study offers interesting findings for characterising VPA-induced liver injury and at-risk patients.

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