scholarly journals Gestational and Neonatal Outcomes of a New Three-Step Procedure for Emergency Cerclage

2021 ◽  
Author(s):  
Manuel Gómez Castellano ◽  
Lorena Sabonet Morente ◽  
Ernesto González Mesa ◽  
Jesús S Jiménez Lopez
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Latency Period ◽  
Perinatal Outcomes ◽  
Cervical Length ◽  
University Hospital ◽  
Cervical Dilatation ◽  
Step Procedure ◽  
The Mean ◽  
Infant Birth

Abstract Background: The objective of our study was to evaluate a new technique for emergency cerclage performed in a cohort of patients with cervical incompetence in the second trimester of pregnancy. Design: Prospective observational study in Regional university hospital. Population: Twenty-four pregnant women at 15 to 24 weeks gestation with cervical dilatation and bursa prolapseMethods: Depending on the clinical condition of the patient, a new emergency cerclage was performed with a technical consisting of a first cerclage in a purse-string and a second occlusive cerclage located inferiorly to the first one. The technique ended with the performance of a cervical cleisis, depending on the presence or absence of prolapse of the vaginal bag. This procedure is called the Three-Step Procedure for Emergency Cerclage (TSEC). Outcome measure: The latency period to deliveryResults: Latency from procedure to delivery, pregnancy duration, infant birth weight, rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of the newborns was 2550 g, and the mean age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis <34 weeks was 8.3% (two cases) with successful perinatal outcomes. There were significant differences (p < 0.05) between groups when we sub-divided the cohort in terms of history of conization, preterm delivery, and bursal prolapse. The multivariate regression model showed that best predictor variables for latency to delivery were cervical dilatation at diagnosis, the use of the three step cerclage, cervical length after the procedure, and gestational age at diagnosis.Conclusion: The excellent results obtained with the TSEC procedure in terms of the latency from procedure to delivery, gestational age at delivery, birth weight, and few reported complications, highlight the importance of collecting new data on this promising novel procedure.

scholarly journals Short Term Outcomes of Neonates Born after Prolonged Premature Rupture of Membranes < 34 Weeks Gestation

2019 ◽  
Vol 4 (2) ◽  
pp. 83
Author(s):  
Isam Bsisu ◽  
Alaa Aldalaeen ◽  
Rawan Elrajabi ◽  
Ala AlZaatreh ◽  
Rama Jadallah ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Births ◽  
University Hospital ◽  
High Rate ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Gestational Week ◽  
The Mean

<p><strong><em>Background:</em></strong><em> Preterm premature rupture of membranes (PPROM) is responsible for one?third of all preterm births worldwide. This aim of this study was to investigate the outcome of neonates born after prolonged PPROM with gestational age below 34 weeks. </em></p><p><strong><em>Materials and methods:</em></strong><em> This retrospective study included 65 patients who were born to mothers with Prolonged PPROM &lt;34 weeks gestation between January 2011 and December 2015 and admitted to the neonatal intensive care unit (NICU) at Jordan University Hospital. </em></p><p><strong><em>Results: </em></strong><em>The mean gestational age of included patients was (31.9 ± 2.5 weeks), mean birth weight was (1840 ± 583 g) and 43 (66.2%) were males. The mortality rate in those infants was 12.3 %. Gestational age, birth weight, and Apgar score were significantly lower among mortality cases compared to surviving cases (P &lt; 0.05). </em></p><p><strong><em>Conclusion:</em></strong><em> Prolonged PPROM before the 34<sup>th</sup> gestational week is associated with high rate of morbidity and mortality, for which early identification of risk factors for developing PPROM can help in reducing the risk for preterm labors and subsequent burden on healthcare system.</em></p>

scholarly journals Comparison of adverse perinatal outcomes between Asians and Caucasians: a population-based retrospective cohort study in Ontario

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Na Zeng ◽  
Erica Erwin ◽  
Wendy Wen ◽  
Daniel J. Corsi ◽  
Shi Wu Wen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Birth Weight ◽  
Preterm Birth ◽  
Cesarean Section ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Population Based ◽  
Adverse Perinatal Outcomes

Abstract Background Racial disparities in adverse perinatal outcomes have been studied in other countries, but little has been done for the Canadian population. In this study, we sought to examine the disparities in adverse perinatal outcomes between Asians and Caucasians in Ontario, Canada. Methods We conducted a population-based retrospective cohort study that included all Asian and Caucasian women who attended a prenatal screening and resulted in a singleton birth in an Ontario hospital (April 1st, 2015-March 31st, 2017). Generalized estimating equation models were used to estimate the independent adjusted relative risks and adjusted risk difference of adverse perinatal outcomes for Asians compared with Caucasians. Results Among 237,293 eligible women, 31% were Asian and 69% were Caucasian. Asians were at an increased risk of gestational diabetes mellitus, placental previa, early preterm birth (< 32 weeks), preterm birth, emergency cesarean section, 3rd and 4th degree perineal tears, low birth weight (< 2500 g, < 1500 g), small-for-gestational-age (<10th percentile, <3rd percentile), neonatal intensive care unit admission, and hyperbilirubinemia requiring treatment, but had lower risks of preeclampsia, macrosomia (birth weight > 4000 g), large-for-gestational-age neonates, 5-min Apgar score < 7, and arterial cord pH ≤7.1, as compared with Caucasians. No difference in risk of elective cesarean section was observed between Asians and Caucasians. Conclusion There are significant differences in several adverse perinatal outcomes between Asians and Caucasians. These differences should be taken into consideration for clinical practices due to the large Asian population in Canada.

scholarly journals Perinatal Outcomes of Small for Gestational Age in Twin Pregnancies: Twin vs. Singleton Charts

2021 ◽  
Vol 10 (4) ◽  
pp. 643
Author(s):  
Veronica Giorgione ◽  
Corey Briffa ◽  
Carolina Di Fabrizio ◽  
Rohan Bhate ◽  
Asma Khalil
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Chi Square ◽  
Increased Risk ◽  
Twin Pregnancies

Twin pregnancies are commonly assessed using singleton growth and birth weight reference charts. This practice has led to a significant number of twins labelled as small for gestational age (SGA), causing unnecessary interventions and increased risk of iatrogenic preterm birth. However, the use of twin-specific charts remains controversial. This study aims to assess whether twin-specific estimated fetal weight (EFW) and birth weight (BW) charts are more predictive of adverse outcomes compared to singleton charts. Centiles of EFW and BW were calculated using previously published singleton and twin charts. Categorical data were compared using Chi-square or McNemar tests. The study included 1740 twin pregnancies, with the following perinatal adverse outcomes recorded: perinatal death, preterm birth <34 weeks, hypertensive disorders of pregnancy (HDP) and admissions to the neonatal unit (NNU). Twin-specific charts identified prenatally and postnatally a smaller proportion of infants as SGA compared to singleton charts. However, twin charts showed a higher percentage of adverse neonatal outcomes in SGA infants than singleton charts. For example, perinatal death (SGA 7.2% vs. appropriate for gestational age (AGA) 2%, p < 0.0001), preterm birth <34 weeks (SGA 42.1% vs. AGA 16.4%, p < 0.0001), HDP (SGA 21.2% vs. AGA 13.5%, p = 0.015) and NNU admissions (SGA 69% vs. AGA 24%, p < 0.0001), when compared to singleton charts (perinatal death: SGA 2% vs. AGA 1%, p = 0.029), preterm birth <34 weeks: (SGA 20.6% vs. AGA 17.4%, p = 0.020), NNU admission: (SGA 34.5% vs. AGA 23.9%, p < 0.000). There was no significant association between HDP and SGA using the singleton charts (p = 0.696). In SGA infants, according to the twin charts, the incidence of abnormal umbilical artery Doppler was significantly more common than in SGA using the singleton chart (27.0% vs. 8.1%, p < 0.001). In conclusion, singleton charts misclassify a large number of twins as at risk of fetal growth restriction. The evidence suggests that the following twin-specific charts could reduce unnecessary medical interventions prenatally and postnatally.

Effect of Maternal Race on Outcome of Preterm Infants in the Military

PEDIATRICS ◽  
1993 ◽  
Vol 91 (3) ◽  
pp. 572-577
Author(s):  
David N. Greenberg ◽  
Bradley A. Yoder ◽  
Reese H. Clark ◽  
Clifford A. Butzin ◽  
Donald M. Null
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Military Hospital ◽  
Free Access ◽  
Multiple Gestation ◽  
Entire Study ◽  
The Mean ◽  
Maternal Race

Previous studies suggest that low birth weight black infants have less morbidity and birth-weight-specific mortality during the perinatal period than low birth weight white infants. We studied the effect of maternal race on outcome in preterm infants born at a military hospital that offers free access to obstetric and neonatal care. Between January 1, 1986, and December 31, 1991, data were prospectively collected on all 667 infants delivered at Wilford Hall USAF Medical Center with an estimated gestational age of less than 35 weeks. Three hundred ninety-two white infants and 165 black infants were included in the data analysis. The mean (±SD) birth weight was 1701 ± 65 g for white infants and 1462 ± 66 g for black infants. The mean estimated gestational age was 31.0 ± 3.2 weeks for white infants and 29.9 ± 3.8 weeks for black infants. Preeclampsia was more frequent in black mothers than in white mothers for the entire study population (21% vs 14%), but the birth weight differential between races remained after correction for preeclampsia. There were no significant differences between races in stillbirths, gender, maternal age, maternal transfer status, number of prenatal visits, or percentages of mothers with small-for-gestational-age infants, multiple-gestation infants, prolonged rupture of membranes, or initial prenatal visit during the first trimester. Intraventricular hemorrhage was more frequent in white infants at 27 through 29 weeks estimated gestational age (50% vs 13%). There were no significant differences between the two groups in survival or in the occurrence of severe infraventricular hemorrhage or bronchopulmonary dysplasia. It is concluded that preterm black infants are smaller than preterm white infants when matched for gestational age despite essentially equal utilization of prenatal care. However, maternal race has little direct effect on the survival of liveborn preterm infants in this population.

scholarly journals Short-term outcomes of extremely preterm infants at discharge: a multicenter study from Guangdong province during 2008–2017

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fan Wu ◽  
Guosheng Liu ◽  
Zhoushan Feng ◽  
Xiaohua Tan ◽  
Chuanzhong Yang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Birth Weight ◽  
Survival Rate ◽  
Gestational Age ◽  
Guangdong Province ◽  
Overall Survival Rate ◽  
Short Term ◽  
Extremely Preterm ◽  
The Mean ◽  
Care Withdrawal

Abstract Background An increasing number of extremely preterm (EP) infants have survived worldwide. However, few data have been reported from China. This study was designed to investigate the short-term outcomes of EP infants at discharge in Guangdong province. Methods A total of 2051 EP infants discharged from 26 neonatal intensive care units during 2008–2017 were enrolled. The data from 2008 to 2012 were collected retrospectively, and from 2013 to 2017 were collected prospectively. Their hospitalization records were reviewed. Results During 2008–2017, the mean gestational age (GA) was 26.68 ± 1.00 weeks and the mean birth weight (BW) was 935 ± 179 g. The overall survival rate at discharge was 52.5%. There were 321 infants (15.7%) died despite active treatment, and 654 infants (31.9%) died after medical care withdrawal. The survival rates increased with advancing GA and BW (p < 0.001). The annual survival rate improved from 36.2% in 2008 to 59.3% in 2017 (p < 0.001). EP infants discharged from hospitals in Guangzhou and Shenzhen cities had a higher survival rate than in others (p < 0.001). The survival rate of EP infants discharged from general hospitals was lower than in specialist hospitals (p < 0.001). The major complications were neonatal respiratory distress syndrome, 88.0% (1804 of 2051), bronchopulmonary dysplasia, 32.3% (374 of 1158), retinopathy of prematurity (any grade), 45.1% (504 of 1117), necrotizing enterocolitis (any stage), 10.1% (160 of 1588), intraventricular hemorrhages (any grade), 37.4% (535 of 1431), and blood culture-positive nosocomial sepsis, 15.7% (250 of 1588). The multivariate logistic regression analysis indicated that improved survival of EP infants was associated with discharged from specialist hospitals, hospitals located in high-level economic development region, increasing gestational age, increasing birth weight, antenatal steroids use and a history of premature rupture of membranes. However, twins or multiple births, Apgar ≤7 at 5 min, cervical incompetence, and decision to withdraw care were associated with decreased survival. Conclusions Our study revealed the short-term outcomes of EP infants at discharge in China. The overall survival rate was lower than the developed countries, and medical care withdrawal was a serious problem. Nonetheless, improvements in care and outcomes have been made annually.

scholarly journals Differential Activation of Fetal Hofbauer Cells in Primigravidas Is Associated with Decreased Birth Weight in Symptomatic Placental Malaria

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Stephanie L. Gaw ◽  
Bethann S. Hromatka ◽  
Sadiki Ngeleza ◽  
Sirirak Buarpung ◽  
Nida Ozarslan ◽  
...  
Keyword(s):  
Birth Weight ◽  
Placental Malaria ◽  
Perinatal Outcomes ◽  
Protective Role ◽  
Cross Sectional ◽  
Macrophage Response ◽  
Hofbauer Cells ◽  
Infant Birth ◽  
First Time

Background. Placental malaria is a leading global cause of low birth weight neonates, especially in first-time mothers. To better understand the role of innate immunity in placental malaria, we investigated the relationships between histopathological markers of placental malaria, fetal and maternal macrophage responses, and perinatal outcomes in a cross-sectional case control study of pregnant women presenting with symptomatic malaria at the time of delivery. Results. Primigravidas showed increased hemozoin deposition in placental villi (p=0.02), syncytiotrophoblasts (p=0.01), and fetal Hofbauer cells (p=0.01). The percentage of hemozoin-positive villi negatively correlated with infant birth weight (regression coefficient [b] = -0.03 kg decrease in birth weight per % increase in hemozoin-positive villi, p=0.035). Malaria-infected placentas showed a twofold increase in Hofbauer cells (p<0.001) and maternal macrophages (p<0.001). Placental malaria was associated with a threefold increase in the percentage of M2 maternal macrophages (19.2% vs 6.4%, p=0.01). Primigravidas showed a significant decrease in the Hofbauer cell M2-percentage in placental malaria (92.7% vs. 97.0%, p=0.04), which was predictive of infant birth weight (b=0.08 kg increase in birth weight per % increase in M2 Hofbauer cells, p=0.001). There was no association between maternal macrophage response and infant birth weights. Conclusions. Placentas with malarial infection had increased numbers of fetal Hofbauer cells in the villous stroma and maternal macrophages in the intervillous space. In primigravidas, decreased anti-inflammatory M2-type Hofbauer cells were predictive of lower birth weight. M2-type maternal macrophages were increased in placental malaria, but there was no association with gravidity or birth weight. These results suggested a protective role of M2 Hofbauer cells in fetal growth restriction.

scholarly journals Maternal risk factors and perinatal outcomes in fetal growth restriction using obstetric Doppler in South Kerala, India

2018 ◽  
Vol 8 (1) ◽  
pp. 6
Author(s):  
Heera Shenoy T. ◽  
Sonia X. James ◽  
Sheela Shenoy T.
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
P Value ◽  
Maternal Risk Factors ◽  
Maternal Risk ◽  
The Mean

Background: Fetal Growth Restriction (FGR) is the single largest contributing factor to perinatal morbidity in non-anomalous foetuses. Synonymous with Intrauterine Growth Restriction (IUGR), it is defined as an estimated fetal weight less than the10th percentile. Obstetric Doppler has helped in early detection and timely intervention in babies with FGR with significant improvements in perinatal outcomes.  Hence, authors evaluated the maternal risk factors and diagnosis-delivery intervals and perinatal outcomes in FGR using Doppler.Methods: This research conducted in a tertiary care hospital in South Kerala included 82 pregnant women who gave birth to neonates with birth weight less than the 10th percentile over a period of1 year (Jan 1, 2017-Dec 31, 2017). Socio-demographic, maternal risk, Diagnosis- delivery interval in FGR and neonatal morbidities were studied.Results: Mean GA at diagnosis in weeks was 34.29 and 35.19 respectively for abnormal and normal Doppler respectively (p value-0.032). The mean birthweight in Doppler abnormal FGR was 272.34 g lesser than in Doppler normal group (p value-0.001). Growth restricted low birth weight neonates had Doppler   pattern abnormalities (p value-0.0009). FGR <3rd percentile and AFI <5 had abnormal Doppler (OR:6.7). Abnormal biophysical profile (OR:14) and Non-Reactive NST (OR:3.5) correlated with abnormal Doppler. Growth restricted with normal Doppler had shorter NICU stays than with abnormalities (p value-0.003). Term FGR went home early than early preterm. (p value-0.001).Conclusions: Abnormal Doppler velocimetry is significantly associated with earlier FGR detection, shorter decision- delivery interval, reduction in the mean birthweight and longer NICU stay. Hence, Umbilical artery Doppler and Cerebroplacental index is an integral part of in-utero fetal surveillance to identify impending fetal hypoxia, appropriate management, optimising the timing of delivery and improve perinatal health in FGR.

scholarly journals Maternal exposure to polybrominated and polychlorinated biphenyls: Infant birth weight and gestational age

Chemosphere ◽  
2007 ◽  
Vol 69 (8) ◽  
pp. 1295-1304 ◽  
Author(s):  
Marjory L. Givens ◽  
Chanley M. Small ◽  
Metrecia L. Terrell ◽  
Lorraine L. Cameron ◽  
Heidi Michels Blanck ◽  
...  
Keyword(s):  
Birth Weight ◽  
Polychlorinated Biphenyls ◽  
Gestational Age ◽  
Maternal Exposure ◽  
Infant Birth

Estimation of fetal weight by ultrasonography after preterm premature rupture of membranes: comparison of different formulas

2017 ◽  
Vol 45 (2) ◽  
Author(s):  
Sertac Esin ◽  
Mutlu Hayran ◽  
Yusuf Aytac Tohma ◽  
Mahmut Guden ◽  
Ismail Alay ◽  
...  
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Fetal Weight ◽  
Percentage Error ◽  
Weight Estimation ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Absolute Percentage Error ◽  
The Mean ◽  
Weight Groups

AbstractObjective:To compare different ultrasonographic fetal weight estimation formulas in predicting the fetal birth weight of preterm premature rupture of membrane (PPROM) fetuses.Methods:Based on the ultrasonographic measurements, the estimated fetal weight (EFW) was calculated according to the published formulas. The comparisons used estimated birth weight (EBW) and observed birth weight (OBW) to calculate the mean absolute percentage error [(EBW–OBW)/OBW×100], mean percentage error [(EBW–OBW)/OBW×100)] and their 95% confidence intervals.Results:There were 234 PPROM patients in the study period. The mean gestational age at which PPROM occured was 31.2±3.7 weeks and the mean gestational age of delivery was 32.4±3.2 weeks. The mean birth weight was 1892±610 g. The median absolute percentage error for 33 formulas was 11.7%. 87.9% and 21.2% of the formulas yielded inaccurate results when the cut-off values for median absolute percentage error were 10% and 15%, respectively. The Vintzileos’ formula was the only method which had less than or equal to 10% absolute percentage error in all age and weight groups.Conclusions:For PPROM patients, most of the formulas designed for sonographic fetal weight estimation had acceptable performance. The Vintzileos’ method was the only formula having less than 10% absolute percentage error in all gestational age and weight groups; therefore, it may be the preferred method in this cohort. Amniotic fluid index (AFI) before delivery had no impact on the performance of the formulas in terms of mean percentage errors.

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