Pregnancy Outcomes in various Types of Placenta Previa: A Clinical Study

Background: Crohn’s disease (CD) and ulcerative colitis (UC) commonly affect women in their childbearing years. Vedolizumab (VDZ) is approved for treatment of moderate-to-severe CD and UC, but there is a knowledge gap regarding its use during pregnancy. This targeted literature review describes available evidence on safety of VDZ in pregnant patients in order to offer physicians a detailed and balanced view on persistent data during their decision-making process for an individualized treatment concept. Methods: The search included literature from the MEDLINE database and abstracts of five gastroenterological conferences published until November 2019. Publications were included if pregnancy outcomes in women receiving VDZ or neonatal outcomes in newborns of women previously exposed to VDZ were reported. Results: Out of 196 initially identified records, 18 publications reporting results of five different studies were identified. In total, for 213 of 284 VDZ-exposed documented pregnancies the following pregnancy outcomes were reported: 167 live births (172 infants due to twin births), 1 stillbirth, 35 miscarriages, 10 elective terminations (1 due to detected Down syndrome). Furthermore, during pregnancy, the following complications were observed: seven cases of (pre) eclampsia, three cases of premature rupture of membranes and one case each of placenta previa, chorioamnionitis, pneumonia, first-trimester bleeding, cholestasis, sepsis, or neonatal intraventricular hemorrhage. Based on 172 infants, 30 preterm deliveries (17.4%), 9 cases of low birth weight (5.2%), 5 infections (2.9%), and 6 cases (3.8%) with congenital anomalies were reported. Conclusion: There was no evidence for safety concerns regarding pregnancy outcomes associated with VDZ therapy. Due to the limited scope of included records, further research is needed to understand the safety profile regarding the use of VDZ during pregnancy.

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P09.02: Value of ultrasound scoring in assessing the risk of pernicious placenta previa accreta and poor pregnancy outcomes

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.19686 ◽

2018 ◽

Vol 52 ◽

pp. 161-162

Author(s):

L. Xie

Keyword(s):

Pregnancy Outcomes ◽

Placenta Previa

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Clinical study of placenta previa and its effect on maternal health and fetal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20163430 ◽

2016 ◽

pp. 3496-3499

Author(s):

Sarojini Sarojini ◽

Malini V. ◽

Radhika Radhika

Keyword(s):

Clinical Study ◽

Maternal Health ◽

Placenta Previa ◽

Fetal Outcome

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Clinical study of placenta previa in scarred and unscarred uterus

Journal of Dr NTR University of Health Sciences ◽

10.4103/jdrntruhs.jdrntruhs_56_17 ◽

2018 ◽

Vol 7 (1) ◽

pp. 13

Author(s):

B Kavitha ◽

BasantaM Hota

Keyword(s):

Clinical Study ◽

Placenta Previa

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Pregnancy in Paroxysmal Nocturnal Hemoglobinuria

Blood ◽

10.1182/blood.v126.23.4786.4786 ◽

2015 ◽

Vol 126 (23) ◽

pp. 4786-4786

Author(s):

Maria A. Vinogradova ◽

Roman G. Shmakov ◽

Zalina T. Fidarova ◽

Eugenia S. Polushkina ◽

Elena A. Mikhailova

Keyword(s):

Pregnancy Outcomes ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Conflicts Of Interest ◽

Placenta Previa ◽

Clinical Signs ◽

Adverse Outcomes ◽

Special Treatment ◽

Symptomatic Therapy ◽

Transfusion Requirements ◽

Pregnancy And Postpartum

Abstract Pregnancy and childbirth associated with a high risk of severe maternal and fetal complications in women with paroxysmal nocturnal hemoglobinuria (PNH). Recently the management of PNH during pregnancy has been challenging and childbearing was practically contraindicated in these patients. Eculizumab treatment improved the prognosis in PNH and made it possible to minimize complications during pregnancy. Establishment of effective and safe algorithms for the management of pregnancy, delivery and postpartum period in PNH patients is crucial to their lives. Since 1999, we have analyzed 15 pregnancies in six women with PNH. The median age at PNH diagnosis was 22 years (18-27), the median age at the start of pregnancy - 25 years (21-34). All of them were diagnosed with PNH following treatment for aplastic anemia (AA) with antithymocyte globulin, cyclosporine A and splenectomy in two cases before pregnancy. The median of PNH granulocyte clone at the start of pregnancy was 74,7% (17,8-94,1). Pregnancy occurred during complete remission of AA with PNH clinical signs in 5 (33,3%) cases. Most patients were in partial remission at the time of pregnancy-7 (46,7%) or continued to receive immunosuppressive therapy with minimal effect-3 (20%). Progression of aplasia observed during 4 (26,7%) pregnancies, but it was not severe and special treatment delayed until the completion of pregnancy. Two patients exposed to eculizumab before conceiving and remained on the treatment during pregnancy. Other women received only symptomatic therapy. Anticoagulation with low molecular weight heparin was used in 5 (33,3%) pregnancies. No thrombotic events during pregnancy and postpartum have been observed. Skin hemorrhages were revealed in 2 (13,3%) patients. During 4 (26,7%) gestations patients underwent erythrocytes and/or platelets transfusion. Pregnancies resulted in the birth of healthy infants in 7 (46,7%) cases - two girls and five boys. There were no adverse effects in the newborns from PNH patients both on eculizumab and without it. Successful outcomes were in 2/2 pregnancies on eculizumab treatment and in 5/13 (38,5%) cases without the drug. Caesarean sections were performed in all of births, early surgical delivery (30-34 weeks)-in 4/7 cases (preeclampsia-2, placenta previa-1, breakthrough hemolysis-1). Adverse pregnancy outcomes occurred only in patients not receiving eculizumab and amounted to 8/13 (61,5%). Only three patients had planned the pregnancy, other 12 cases were unplanned. Consequently, in 4 (30,8%) cases of pregnancy in the midst of illness was performed the abortion for medical reasons. Spontaneous miscarriage was registered in 2 (15,4%) patients. Two pregnancies (15,4%) ended in fetal death on 27th and 20th gestation weeks. Transfusion requirements increased in two pregnancies with symptomatic therapy, but did not increase on eculizumab. One of patients had first pregnancy without eculizumab and developed complications such as preeclampsia, postpartum severe epistaxis and high transfusion requirement (an average of 1,2 units per month). During second pregnancy on eculizumab she had no obstetric complications and transfusion requirements were less (0,5 units monthly). Second patient continued to have evidence of intravascular hemolysis despite the treatment, and so received eculizumab more frequent (one time in 10 days) in the third trimester. PNH granulocyte clone size decreased in both cases of eculizumab treatment during pregnancy. The risk of complications in PNH patients during pregnancy may be minimized by applying the management algorithm with eculizumab treatment. Despite the small number of observations, we can safely conclude that pregnancy outcomes in PNH patients with eculizumab are better than with only symptomatic therapy. Our experience confirms that eculizumab can be safely used in PNH throughout pregnancy to reduce the risk of complications and adverse outcomes. There is no difference in health between infants born by mothers with PNH and the newborns from general population. Disclosures No relevant conflicts of interest to declare.

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Maternal characteristics and pregnancy outcomes of Chinese women with infertility undergoing in vitro fertilization with embryonic cryopreservation : a retrospective cohort study

10.21203/rs.2.13384/v4 ◽

2020 ◽

Author(s):

jingxue wang ◽

qiwei liu ◽

Boer Deng ◽

fang chen ◽

xiaowei liu ◽

...

Keyword(s):

Male Infertility ◽

Pregnancy Outcomes ◽

Chinese Women ◽

Placenta Previa ◽

Vitro Fertilization ◽

Maternal Characteristics ◽

Tubal Disease ◽

Nicu Admission ◽

Singleton Pregnancies

Abstract Background: To examine differences in the maternal characteristics and pregnancy outcomes of Chinese women with various causes of infertility who underwent in vitro fertilization (IVF) with embryonic cryopreservation treatment.Methods: Cases were pregnancies after IVF-ET with embryonic cryopreservation; controls were spontaneously conceived pregnancies. Subgroup analysis was carried out according to etiology of infertility. The IVF treatment group was divided into 5 subgroups according to infertility etiology as follows: ovulation disorder, tubal disease, male infertility, endometriosis, and mixed infertility. Data on demographic characteristics, medical history, laboratory tests, and delivery were reviewed. Logistic regression analysis was performed for pregnancy and perinatal complications and neonatal outcomes. The multivariable model was adjusted for potential confounders.Results: Among singleton pregnancies, compared with spontaneous pregnancies, IVF pregnancies were associated with significant increases in the rates of the following: gestational diabetes mellitus (GDM) (aOR 1.76[95% CI 1.33-2.33]), preeclampsia (2.60[1.61-4.20]), preterm preeclampsia (4.52[2.03-10.06]), postpartum hemorrhage (1.57[1.04-2.36]), intrahepatic cholestasis of pregnancy (3.84[1.06-13.94]), preterm premature rupture of membranes (2.11[1.17-3.81]), preterm birth (1.95[CI 1.26-3.01]), low birthweight (1.90[1.13-3.20]), macrosomia (1.53[1.03-2.27]), and neonatal intensive care unit (NICU) admission (1.69[1.22-2.34]) in the ovulation disorder group; GDM (1.50[1.21-1.86]), placenta previa (2.70[1.59-4.59]), placenta accreta (1.78[1.10-2.89]), postpartum hemorrhage (1.61[1.19-2.18]), macrosomia (1.60[1.21-2.13]) and 5-minute Apgar score ≤7 (4.09[1.04-16.08]) in the tubal disease group; placenta previa (9.33[4.22-20.62]), small for gestational age (2.29[1.04-5.08]), macrosomia (2.00[1.02-3.95]) and NICU admission (2.35[1.35-4.09]) in the endometriosis group; placenta previa (4.14[2.23-7.68]) and placenta accreta (2.05[1.08-3.87]) in the male infertility group; and GDM (1.85[1.15-2.98]), placenta previa (4.73[1.83-12.21]), placental abruption (3.39[1.20-9.56]), chorioamnionitis (2.93[1.04-8.26]), preterm birth (2.69[1.41-5.15]), and 1-minute Apgar score ≤7 (4.68[1.62-13.51]) in the mixed infertility group. Among multiple pregnancies, most of the differences that were significant in singleton pregnancies were less extensive or had disappeared.Conclusions: Infertility etiology within the IVF population was found to affect maternal and neonatal outcomes among all births. During the perinatal period, infertility etiology appears to be an additional risk factor for abnormal pregnancy outcomes besides the use of IVF techniques compared with spontaneous pregnancies. Higher risk was found for ovulation disorders, and lower risk was found for male infertility.

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The Pregnancy Course and Outcomes during Targeted Therapy of Paroxysmal Nocturnal Hemoglobinuria

Blood ◽

10.1182/blood.v128.22.2397.2397 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2397-2397

Author(s):

Maria A. Vinogradova ◽

Alexandr Kulagin ◽

Roman Shmakov ◽

Tatyana Kirsanova ◽

Elena Mikhailova ◽

...

Keyword(s):

Targeted Therapy ◽

Pregnancy Outcomes ◽

Paroxysmal Nocturnal Hemoglobinuria ◽

Dose Adjustment ◽

Conflicts Of Interest ◽

Placenta Previa ◽

Immunosuppressive Treatment ◽

Clinical Manifestations ◽

Placental Insufficiency ◽

Pregnancy And Postpartum

Abstract Targeted therapy radically changed the prognosis in paroxysmal nocturnal hemoglobinuria (PNH) and made it possible not only to increase the survival rate, but also to improve the quality of life. Therefore issues of reproductive health in PNH patients are becoming very important. Recently the management of PNH during pregnancy has been challenging because of the high risk of maternal morbidity due to thrombosis and frequent pregnancy loss. The aim of our research was an evaluation the efficacy and safety of eculizumab treatment during pregnancy and analysis the pregnancy outcomes. Since 2013 we observed 14 pregnancies in 14 PNH patients receiving eculizumab treatment. Сlinical manifestations of hemolysis significantly regressed during the therapy: normalization of LDH was registered in 71,4% patients before the conceiving. The median age at the start of pregnancy was 29 years (22-37), the median of PNH granulocyte clone at that time was 74,7% (23-99). PNH diagnosed before the pregnancy in all cases. 64,3% of them had previously received immunosuppressive treatment of aplastic anemia. 92,9% of patients had been using eculizumab prior to becoming pregnant, mean duration of therapy was 21 months (4-44). All of patients remained on the treatment during pregnancy and postpartum. 42,9% of patients required a dose adjustment due to breakthrough hemolysis (a dose increase and/or more frequent use of eculizumab). Anticoagulation with low molecular weight heparin was used in 85,7% pregnancies (intermediate or therapeutic doses). Pregnancies before eculizumab therapy were registered in 28,6% patients: then from 10 pregnancy cases on supportive reatment only 2 ended with a childbirth. 28,6% patients registered venous thromboembolism before conception. No maternal death and thrombotic events during pregnancy and postpartum have been observed. Maternal complications during gestation included abortion threat, arterial hypertension, the appendicitis (successful surgical treated during the second trimester of pregnancy), placental insufficiency, placenta previa and two cases of preeclampsia. In 21,4% patients before the birth was registered an increase of transaminases in addition to LDH level rise. During 64,3% gestations patients underwent red cells and/or platelets transfusion. Transfusions rate increased in all these patients from 0.25 units per month to 1,1 units per month during pregnancy. PNH granulocyte clone size decreased during pregnancy in 42,9%, but ut it did not correlate with the clinical manifestations of hemolysis. Pregnancies resulted in the birth of infants in all of 14 cases. No miscarriages or stillbirths have been observed. Caesarean sections were performed in 78,6% of births, early surgical delivery (26-34 weeks)- in 35,7% cases due to preeclampsia, placenta previa, breakthrough hemolysis or placental insufficiency). There were no malformations in the newborns. Mean birth weight 2560 g (450-3550). One preterm infant with extremely low weight and a growth retardation syndrome due to placental insufficiency died on the second day of life due to generalized hemorrhagic complications. One newborn diagnosed with neuroblastoma in the first year of life, the therapy is continuing now. Most of newborns (85,7%) are healthy, 71,4% of them received breastfeeding without complications. Our data demonstrate the possibility of safe therapy with eculizumab in pregnant women. Targeted therapy PNH improves the pregnancy outcomes for both the mother and fetus compared to historical controls. A dose adjustment of eculizumab is often required during pregnancy due to the increased complement activity. Pregnancy does not worsen the prognosis of PNH in the case of targeted and adequate supportive therapy. There is no difference in health between infants born by mothers with PNH and the newborns from general population. Disclosures No relevant conflicts of interest to declare.

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Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer?

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03248-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Meiling Yang ◽

Li Lin ◽

Chunli Sha ◽

Taoqiong Li ◽

Wujiang Gao ◽

...

Keyword(s):

Pregnancy Rate ◽

Pregnancy Outcomes ◽

Current Knowledge ◽

Placenta Previa ◽

Meta Analysis ◽

Blastocyst Transfer ◽

Cochrane Library ◽

Maternal Complications ◽

Ongoing Pregnancy Rate

Abstract Background In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis. Methods A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors. Results Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT. Conclusions At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.

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