scholarly journals The impact of chorionicity on maternal and fetal outcomes

2020 ◽  
Vol 10 (1) ◽  
pp. 39
Author(s):  
Leonor Bivar ◽  
Maria Casteleiro ◽  
Rita Vasconcelos ◽  
Ana Borges ◽  
Cátia Abreu ◽  
...  
Keyword(s):  
Fetal Outcome ◽  
Adverse Outcomes ◽  
Fetal Outcomes ◽  
Monochorionic Twins ◽  
Level 3 ◽  
Observational Cohort ◽  
Maternal Risks ◽  
The Impact ◽  
Twin Pregnancies ◽  
Retrospective Observational Cohort Study

Background: Women carrying twin pregnancies receive extensive antenatal counselling on fetal risks, but less is known about whether the presence of two placentas confers dissimilar maternal risks. We pretend to determine the impact of chorionicity on the maternal and fetal outcome, evaluating the possibility of finding the association between complications and the presence of two placental masses.Methods: We conducted a retrospective observational cohort study of 550 twin pregnancies monitored at a level-3 hospital, between January 2004 and December 2018.Results: Of the 550 pregnancies, 419 (76.2%) were bichorionic and 131 (23.8%) were monochorionic. Caesarean delivery was more frequent in monochorionic group (70.2% vs. 61.8%, p=0.05). There were no statistically significant differences in the proportion of adverse maternal outcomes between bichorionic and monochorionic pregnancies, despite a trend towards higher proportions in bichorionic group. Regarding fetal outcomes, monochorionic twins were delivered earlier (mean gestational age of 34+4 weeks vs. 35+1 weeks, p=0.04) and the proportion of preterm delivery cases between 32+0 and 36+6 weeks was higher in monochorionic pregnancies (72.5% vs. 54.9%, p=0.002). Stillbirth of one or both twins was more frequent in monochorionic group (3.1% vs. 0.5%, p=0.03).Conclusions: The presence of two placental masses does not seems to confer an increase in maternal risks, despite a trend towards higher proportions of adverse outcomes in bichorionic pregnancies. However, monochorionicity is associated with an increase in fetal risks, particularly prematurity. Counselling and monitoring of bichorionic or monochorionic pregnancies may be identical with respect to maternal risks, but chorionicity should be considered when evaluating fetal risks.

scholarly journals Analysis of Frailty in Geriatric Patients as a Prognostic Factor in Endovascular Treated Patients with Large Vessel Occlusion Strokes

2021 ◽  
Vol 10 (10) ◽  
pp. 2171
Author(s):  
Marlena Schnieder ◽  
Mathias Bähr ◽  
Mareike Kirsch ◽  
Ilko Maier ◽  
Daniel Behme ◽  
...  
Keyword(s):  
Adverse Outcomes ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Health Care Outcomes ◽  
Increased Risk ◽  
Observational Cohort ◽  
Care Outcomes ◽  
The Impact ◽  
Retrospective Observational Cohort Study

Frailty is associated with an increased risk of adverse health-care outcomes in elderly patients. The Hospital Frailty Risk Score (HFRS) has been developed and proven to be capable of identifying patients which are at high risk of adverse outcomes. We aimed to investigate whether frail patients also face adverse outcomes after experiencing an endovascular treated large vessel occlusion stroke (LVOS). In this retrospective observational cohort study, we analyzed patients ≥ 65 years that were admitted during 2015–2019 with LVOS and endovascular treatment. Primary outcomes were mortality and the modified Rankin Scale (mRS) after three months. Regression models were used to determine the impact of frailty. A total of 318 patients were included in the cohort. The median HFRS was 1.6 (IQR 4.8). A total of 238 (75.1%) patients fulfilled the criteria for a low-frailty risk with a HFRS < 5.72 (22.7%) for moderate-frailty risk with an HFRS from 5–15 and 7 (2.2%) patients for a high-frailty risk. Multivariate regression analyses revealed that the HFRS was associated with an increased mortality after 90 days (CI (95%) 1.001 to 1.236; OR 1.112) and a worse mRS (CI (95%) 1.004 to 1.270; OR 1.129). We identified frailty as an impact factor on functional outcome and mortality in patients undergoing thrombectomy in LVOS.

Prevalence of Eclampsia and its Maternal-fetal outcomes at Ghandi Memorial Hospital, Addis Ababa Ethiopia, 2019. Retrospective study

2020 ◽  
Author(s):  
Addisu Yeshambel ◽  
Walellign Anmut
Keyword(s):  
Magnesium Sulfate ◽  
Addis Ababa ◽  
Fetal Outcome ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Morbidity And Mortality ◽  
Memorial Hospital ◽  
Fetal Outcomes ◽  
Cross Sectional ◽  
Sub Saharan

Abstract Background: Eclamptic disorder of pregnancy is one of the common problems in sub-Saharan countries and forms one of the deadly triads along with hemorrhage and infection which complicates maternal and fetal outcomes of pregnancy. To assess the prevalence of eclampsia and its maternal and fetal outcome in Ghandi Memorial Hospital, Addis Ababa Ethiopia, 2019.Methods: A descriptive retrospective cross-sectional study was used on randomly selected 185 women who attended delivery at Ghandi memorial Hospital from 1st of September 2017 to –last of August 2018. Data were analyzed using SPSS version 25 software. Descriptive statistics were used to calculate frequencies and percentages and data was presented using texts and, tables. Results: Out of the 2,973 deliveries, the prevalence of eclampsia was found to be 16.1%. About 89.7% had reported a history of prior pregnancy-induced hypertension and 73.5% induced their current pregnancy following eclampsia. From mothers required interventions to terminate the pregnancy by induction, 47.8% ended by cesarean section secondary to non-reassuring fetal status (29.2%). The majority (91.9%) had taken magnesium sulfate for the management of convulsion and 86.5% had taken hydralazine for hypertension management. Abruption of the placenta (96.2%), postpartum-hemorrhage (89.2%), and HEELP syndrome (83.8 %) were major maternal adverse outcomes reported, and 33% of pregnancy was ended as stillbirth followed by low birth weight (28.6%). Over 53.6% of delivered babies had an APGAR score of less 4 and 30.4% of neonates required admission to nursery/NICU referral. Conclusion: The prevalence of eclampsia was high, with corresponding high maternal and perinatal morbidity and mortality. Increasing early detection before pregnancy, antenatal screening, and use of magnesium sulfate to control convulsions will reduce the disorder and associated morbidity and mortality for both mother and fetus.

scholarly journals Burden, associated risk factors and adverse outcomes of gestational diabetes mellitus in twin pregnancies in Al Ain, UAE

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Juma Alkaabi ◽  
Raya Almazrouei ◽  
Taoufik Zoubeidi ◽  
Fatema M. Alkaabi ◽  
Fatima Rashid Alkendi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Adverse Outcomes ◽  
Fetal Outcomes ◽  
Al Ain ◽  
Adverse Pregnancy ◽  
Associated Risk Factors ◽  
The City ◽  
Twin Pregnancies

Abstract Background Gestational diabetes mellitus (GDM) in singleton pregnancies represent a high-risk scenario. The incidence, associated factors and outcomes of GDM in twin pregnancies is not known in the UAE. Methods This was five years retrospective analysis of hospital records of twin pregnancies in the city of Al Ain, Abu Dhabi, UAE. Relevant data with regards to the pregnancy, maternal and birth outcomes and incidence of GDM was extracted from two major hospitals in the city. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and GDM, and the associations between GDM and maternal and fetal outcomes at birth. Results A total of 404 women and their neonates were part of this study. The study population had a mean age of 30.1 (SD: 5.3), overweight or obese (66.5%) and were majority multiparous (66.6%). High incidence of GDM in twin pregnancies (27.0%). While there were no statistical differences in outcomes of the neonates, GDM mothers were older (OR: 1.09, 95% CI: 1.06–1.4) and heavier (aOR: 1.02, 95% CI: 1.00 -1.04). They were also likely to have had GDM in their previous pregnancies (aOR: 7.37, 95% CI: 2.76–19.73). The prognosis of mothers with twin pregnancies and GDM lead to an independent and increased odds of cesarean section (aOR: 2.34, 95% CI: 1.03–5.30) and hospitalization during pregnancy (aOR: 1.60, 95% CI: 1.16–2.20). Conclusion More than a quarter of women with twin pregnancies were diagnosed with GDM. GDM was associated with some adverse pregnancy outcomes but not fetal outcomes in this population. More studies are needed to further investigate these associations and the management of GDM in twin pregnancies.

scholarly journals The association between blood pressure control and Coronavirus Disease 2019 outcomes in 45,418 symptomatic patients with hypertension: An observational cohort study

Hypertension ◽  
2020 ◽  
Author(s):  
James P. Sheppard ◽  
Brian Nicholson ◽  
Joseph Lee ◽  
Dylan McGagh ◽  
Julian Sherlock ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Target Organ Damage ◽  
Pressure Control ◽  
Organ Damage ◽  
Adverse Outcomes ◽  
Observational Cohort ◽  
General Practices ◽  
Using Data ◽  
Stage 1 ◽  
The Impact

Hypertension has been identified as a risk factor for COVID-19 and associated adverse outcomes. This study examined the association between pre-infection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent reading within 24months of the index date (01/01/2020). BP was defined as controlled (<130/80mmHg), raised (130/80-139/89mmHg), stage 1 uncontrolled (140/90-159/99mmHg) or stage 2 uncontrolled ({greater than or equal to}160/100mmHg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19 related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45,418 patients (mean age 67 years; 44.7% male) included, 11,950 (26.3%) had controlled BP. These patients were older, had more co-morbidities and had been diagnosed with hypertension for longer. A total of 4,277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (OR 0.76, 95%CI 0.62-0.92) compared to patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalisation. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social-distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.

scholarly journals The impact of cirrhosis in patients undergoing cardiac surgery: a retrospective observational cohort study

2019 ◽  
Vol 67 (1) ◽  
pp. 22-31
Author(s):  
Sheela Xavier ◽  
Colleen M. Norris ◽  
Amanda Ewasiuk ◽  
Demetrios J. Kutsogiannis ◽  
Sean M. Bagshaw ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
The Impact ◽  
Retrospective Observational Cohort Study

scholarly journals Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

2015 ◽  
Vol 42 (4) ◽  
pp. 209-214 ◽  
Author(s):  
LEONARDO DE SOUZA BARBOSA ◽  
GEIBEL SANTOS REIS DOS JÚNIOR ◽  
RICARDO ZANTIEFF TOPOLSKI CHAVES ◽  
DAVI JORGE FONTOURA SOLLA ◽  
LEONARDO FERNANDES CANEDO ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Night Shift ◽  
Risk Classification ◽  
Trauma Patients ◽  
Degree Of Contamination ◽  
Systemic Error ◽  
Observational Cohort ◽  
The Impact ◽  
Retrospective Observational Cohort Study

ABSTRACTObjective:to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality.Methods:a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome.Results:during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17).Conclusion:the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.

Does Early Artificial Rupture of Membranes Speed Labor in Preterm Inductions?

2017 ◽  
Vol 35 (08) ◽  
pp. 716-720 ◽  
Author(s):  
Spencer Kuper ◽  
Victoria Jauk ◽  
Sima Baalbaki ◽  
Alan Tita ◽  
Lorie Harper ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Optimal Timing ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Observational Cohort ◽  
Secondary Outcomes ◽  
The Impact

Objective In full-term patients, early artificial rupture of membranes (AROMs) decreases time in labor. We assessed the impact of early AROM in preterm patients undergoing indicated induction of labor. Study Design We conducted a retrospective cohort study of all patients undergoing indicated preterm induction (23–34 weeks) at a single tertiary care center from 2011 to 2014. Early AROM was defined as <4 cm and late AROM was defined as ≥4 cm. The primary outcomes evaluated were cesarean delivery and time in labor. Secondary outcomes were chorioamnionitis and a composite of maternal and neonatal adverse outcomes. Results Of the 149 women included, 65 (43.6%) had early AROM. Early AROM was associated with an increased time from the start of induction to delivery (25.7 ± 13.0 vs. 19.0 ± 10.3 hours, p < 0.01) and with an increase in the risk of cesarean (53.4 vs. 22.6%, adjusted odds ratio: 3.5, 95% confidence interval: 1.60–7.74). Early AROM was not associated with an increased risk of chorioamnionitis or adverse maternal or fetal outcomes. Conclusion In this observational cohort, early AROM was associated with an increased risk of cesarean. A randomized controlled trial is necessary to determine the optimal timing of AROM in preterm patients requiring delivery.

scholarly journals Intrahepatic Cholestasis of Pregnancy in Women With Twin Pregnancy

2016 ◽  
Vol 19 (6) ◽  
pp. 697-707 ◽  
Author(s):  
Dan Shan ◽  
Yayi Hu ◽  
Peiyuan Qiu ◽  
Bechu Shelley Mathew ◽  
Yun Chen ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Intrahepatic Cholestasis ◽  
Early Onset ◽  
Onset Time ◽  
Adverse Outcomes ◽  
Active Management ◽  
Intrahepatic Cholestasis Of Pregnancy ◽  
Fetal Outcomes ◽  
Twin Pregnancies ◽  
Cholestasis Of Pregnancy

The aim of the present work was to determine maternal and fetal outcomes of intrahepatic cholestasis of pregnancy (ICP) in twin pregnancies. All twin pregnancies delivered above 28 gestational weeks in West China Second University Hospital from January 2013 to May 2015 were included. Data on maternal demographics and obstetric complications together with fetal outcomes were collected. The risk of adverse maternal and fetal outcomes were determined in relation to ICP by crude odds ratios (OR) and adjusted ORs (aOR) with 95% confidence intervals (CI). Subgroup analysis concentrated on the effect of assisted reproductive technology (ART), ICP severity, and onset time. A total of 1,472 twin pregnancies were included, of which 362 were cholestasis patients and 677 were conceived by ART. Higher rates of preeclampsia (aOR 1.96; 95% CI 1.35, 2.85), meconium-stained amniotic fluid (aOR 3.10; 95% CI 2.10, 4.61), and preterm deliveries (aOR 3.20; 95% CI 2.35, 4.37) were observed in ICP patients. Subgroup analysis revealed higher incidences of adverse outcomes in severe and early onset ICP groups. In conclusion, adverse maternal and fetal outcomes were strongly associated with ICP in twin patients. Active management and close antenatal monitoring are needed, especially in the early onset and severe groups.

scholarly journals The FRAIL-FIT 30 Study – Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study

2021 ◽  
pp. 175114372098516
Author(s):  
David Hewitt ◽  
Michael Ratcliffe ◽  
Malcolm G Booth
Keyword(s):  
Cohort Study ◽  
Single Point ◽  
Observational Cohort Study ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Clinical Frailty Scale ◽  
Icu Admission ◽  
Frail Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Background Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty’s effect on mortality after ICU admission are unclear. This study assessed frailty’s impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14–2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03–1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13–1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01–1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.

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