scholarly journals Risk of Recurrent Adverse Outcomes in Gestational Diabetes: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Sue Lynn Lau ◽  
Alex Chung ◽  
Joanna Kao ◽  
Susan Hendon ◽  
Wendy Hawke ◽  
...  
Keyword(s):  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Adverse Outcome ◽  
Subsequent Pregnancy ◽  
Adverse Outcomes ◽  
Instrumental Delivery ◽  
Emergency Caesarean ◽  
Index Pregnancy

Objective: Compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies. Design: Retrospective cohort Setting: Sydney, Australia Population or Sample: 424 pairs of consecutive singleton GDM pregnancies, 2003-2015 Main Outcome Measures:. ADO: instrumental delivery and emergency Caesarean. ANO: large for gestational age (LGA), small for gestational age (SGA), and composite ANO (LGA/SGA/stillbirth/neonatal death/shoulder dystocia). Methods: Using each pregnancy pair (“index” and “subsequent” pregnancy), we calculated ADO and ANO rates and determined risk factors for subsequent pregnancy outcomes (multivariate regression). Results: Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p<0.001) and lower rates of instrumental delivery (5% vs 13.9%, p<0.001), emergency Caesarean (7.1% vs 16.3%, p<0.001) and vaginal delivery (62.3% vs 66.3%, p=0.01). ANO rates in index and subsequent pregnancies did not differ. Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30, 7.34) for instrumental delivery, RR 2.20 (95%CI:1.06, 4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03, 6.82) for LGA, RR 5.01 (95%CI:2.73, 9.22) for SGA and RR 2.10 (95%CI:1.53, 2.87) for composite ANO). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20, 4.47)), SGA (RR 4.71 (95%CI:2.66, 8.36)) or composite ANO (RR 2.01 (95%CI:1.46, 2.78)) was having the same outcome in the index pregnancy. Conclusions: Women with GDM and an adverse outcome are at very high risk of the same complication in their subsequent GDM pregnancy, representing a high-risk group that should be targeted for directed management over routine care.

scholarly journals Maternal Body Mass Index and Ethnicity in Relation to The Adverse Outcomes of Large for Gestational Age and Gestational Diabetes Mellitus in a Retrospective Cohort of Australian Pregnant Women.

2021 ◽  
Author(s):  
Catherine Knight-Agarwal ◽  
Jani Rati ◽  
Meisa Al-Foraih ◽  
Dionne Eckley ◽  
Carrie Ka Wai Lui ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Body Mass Index ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Body Mass ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Adverse Outcomes ◽  
Large For Gestational Age ◽  
Maternal Body Mass Index

Abstract Background: The prevalence of maternal overweight and obesity has been increasing. This research explored the association between maternal body mass index and ethnicity in relation to the adverse outcomes of large for gestational age and gestational diabetes mellitus. Method: A retrospective cohort study was undertaken with 27 814 Australian women of various ethnicities, who gave birth to a singleton infant between 2008 and 2017. Variables were examined using logistic regression. Results: A significantly higher proportion of large for gestational age infants were born to overweight and obese women compared to those who were classified as underweight and healthy weight. Asian-born women with a body mass index of ≥ 40kg/m2 had an adjusted odds ratio of 9.926 (3.859 - 25.535) for birthing a large for gestational age infant whereas Australian-born women had an adjusted odds ratio of 2.661 (2.256 - 3.139) for the same outcome. Women born in Australia were at high risk of birthing a large for gestational age infant in the presence of insulin controlled gestational diabetes mellitus, but this risk was not significant for those with the diet-controlled type. Asian-born women did not present an elevated risk of birthing a large for gestational infant, in either the diet controlled, or insulin controlled gestational diabetes mellitus groups. Conclusion: Large for gestational age and gestational diabetes mellitus are adverse pregnancy outcomes that can lead to significant maternal and neonatal morbidity. Women who are overweight or obese, and considering a pregnancy, are encouraged to seek culturally appropriate nutrition and weight management advice during the periconception period.

scholarly journals Early onset preeclampsia: using population data to assess recurrence risk and adverse pregnancy outcomes

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Christine L. Roberts ◽  
Sean K. Seeho ◽  
Charles S. Algert ◽  
Jane B. Ford
Keyword(s):  
Gestational Age ◽  
Early Onset ◽  
Population Data ◽  
Subsequent Pregnancy ◽  
Adverse Outcomes ◽  
Index Pregnancy ◽  
Nulliparous Women ◽  
Subsequent Birth ◽  
Adverse Pregnancy ◽  
Early Onset Preeclampsia

ABSTRACTObjectiveUse linked perinatal data to determine the subsequent pregnancy rate after a pregnancy with early onset preeclampsia and, among those who have a subsequent pregnancy, the risk of recurrence and adverse pregnancy outcomes. ApproachPreeclampsia is a hypertensive disorder of pregnancy associated with adverse outcomes for the mother and baby. Although rare, when preeclampsia occurs before 34 weeks of gestation, the risk of adverse outcomes is markedly increased primarily due to prematurity. Despite the desire for another child, many women are anxious about becoming pregnant again because of concerns of recurrent complications in a next pregnancy but information for counselling is sparse. We undertook a population-based record linkage cohort study using longitudinally-linked birth and hospital records from New South Wales (Australia) to create medical and obstetric histories. The study population included nulliparous women with a singleton pregnancy and early onset preeclampsia who gave birth between 2001 and 2010 (the index pregnancy), with follow-up for a subsequent birth through 2012. Early onset preeclampsia was defined as a hospital record (antenatal and/or delivery hospitalisations) with a diagnosis of preeclampsia and delivery before 34 weeks gestation. Outcomes included subsequent pregnancy, and among women with a consecutive subsequent birth, the preeclampsia recurrence rate and adverse pregnancy outcome rates. ResultsOf 1473 (4.0/1000) nulliparous women who had early onset preeclampsia in the index pregnancy, 60% had evidence of any subsequent pregnancy compared to 66% for women without preeclampsia (P<0.001). Of 758 women with early onset preeclampsia and a subsequent singleton birth ≥20 weeks gestation, 256 (33.8%) had preeclampsia in the subsequent pregnancy but only 57 (7.5%) had recurrent early onset preeclampsia. Most women (717, 94.6%) progressed to a later gestational age in their subsequent pregnancy. The median overall increase in gestational age at delivery was 6 weeks (interquartile range [IQR] 4 to 8) and among the women with recurrent preeclampsia the median increase in gestation in the subsequent pregnancy was 5 weeks (IQR 2 to 7). Outcomes in the subsequent pregnancy included 4.2% postpartum haemorrhage, 3.4% severe maternal morbidity, 2.6% Apgar <7 at 5 minutes, 16.2% small-for gestational-age and 1.7% perinatal deaths. ConclusionsMost women with early onset preeclampsia had good outcomes in their subsequent pregnancy. For rare conditions, linked population data with accurately recorded information can provide robust estimates of outcomes that can inform clinical counselling.

P5021Hypoperfusion markers identify patients with acute pulmonary embolism at highest risk for an adverse outcome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ebner ◽  
C Sentler ◽  
V P Harjola ◽  
H Bueno ◽  
K Keller ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
High Risk ◽  
Predictive Value ◽  
Odds Ratio ◽  
Adverse Outcome ◽  
A Priori ◽  
Positive Likelihood Ratio ◽  
Adverse Outcomes ◽  
Prognostic Information

Abstract Background/Introduction According to the European Society of Cardiology (ESC) 2014 guideline, systemic hypotension (HT) is the critical variable defining high-risk in patients with pulmonary embolism (PE). However, signs of organ hypoperfusion might more adequately identify PE patients with cardiogenic shock due to right ventricular (RV) failure. Purpose We investigated whether hypoperfusion markers provide superior prognostic information for identifying PE patients at highest risk of early adverse outcomes. Methods Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 03/2018 were included. We analysed the predictive value of symptoms and findings suggesting hypoperfusion for in-hospital adverse outcome (catecholamine treatment, resuscitation or PE-related death) and in-hospital all-cause mortality. Results We analysed 814 patients, including 83 (10.2%) ESC 2014 high-risk patients. Patients presenting with cardiac arrest (CA, 4.5%) were a priori defined as high risk. Markers suggesting hypoperfusion of the brain (altered metal status, odds ratio [OR] 8.2 [95% CI, 4.2–16.0]), lung (respiratory insufficiency, 25.0 [9.4–66.7]) and tissue (venous lactate ≥2.2 mmol/l, 6.4 [3.2–12.9]) as well as HT (13.5 [6.7–27.2]) predicted an adverse outcome. The risk for an adverse outcome increased with the number of positive markers (AUC 0.86 [0.80–0.93]). Patients with ≥3 positive hypoperfusion markers had an OR of 42.9 (11.0–167.3) and patients defined as high-risk by the ESC 2014 an OR of 17.2 (8.8–33.3) with regard to an adverse outcome (Figure 1; Table 1). A new definition of high-risk (CA or ≥3 hypoperfusion markers) was associated with an OR of 73.2 (31.3–171.1) for an in-hospital adverse outcome and 26.2 (12.1–56.7) for in-hospital mortality. Table 1. Prognostic performance of hypoperfusion markers Adverse outcome (if negative) Adverse outcome (if positive) Sensitivity Specificity LR+ OR (95% CI) ≥1 hypoperfusion marker 1.1% 21.0% 91.9% 68.2% 2.9 24.4 (7.3–80.8) ≥2 hypoperfusion markers 4.7% 50.0% 48.6% 95.5% 10.9 20.3 (9.1–45.1) ≥3 hypoperfusion markers 6.5% 75.0% 24.3% 99.3% 32.7 42.9 (11.0–167.3) ESC 2014 high-risk 5.7% 51.1% 35.0% 96.9% 11.4 17.2 (8.8–33.3) Cardiac arrest 8.4% 86.5% 33.0% 99.3% 47.3 70.1 (26.4–186.1) Abbreviations: LR+, positive likelihood ratio; OR, odds ratio; CI, confidence interval. Figure 1. Frequency of adverse outcome Conclusions Markers of organ hypoperfusion have high predictive value for early adverse outcomes in acute PE. Risk increases with the number of positive markers and is critically elevated in patients presenting with CA or ≥3 markers. Acknowledgement/Funding This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

scholarly journals Gestational diabetes mellitus causes dyslipidemia in late trimester: mini review

2019 ◽  
Vol 9 (1) ◽  
pp. 453
Author(s):  
Poonguzhalai S. ◽  
Kalyanikutty K. P.
Keyword(s):  
Diabetes Mellitus ◽  
Lipid Metabolism ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Age ◽  
Significant Risk ◽  
Normal Pregnancy ◽  
Adverse Outcomes ◽  
Peripheral Tissues ◽  
Management Protocol

The incidence of gestational diabetes mellitus (GDM) is increasing rapidly worldwide. Many women with gestational diabetes mellitus are likely to have type 2 diabetes. With the extensive management protocol for GDM we are able to obtain a good glycaemic control but still excess morbidity prevails among GDM pregnancy compared to normal pregnancy. This may be due to the dysfunction of lipid metabolism. Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake. Exaggerated reduction in insulin sensitivity in the peripheral tissues combined with peripheral adipose tissue lipolysis in GDM pregnancy than normal pregnancy results in increased maternal lipoprotein concentrations and elevated lipoprotein triglyceride content. An altered lipid profile on the maternal side would modulate the quantity and quality of lipids being transferred to the fetus. Hypertriacylglycerolemia in gestational diabetes mellitus has been related to a significant risk of having neonates that are large for gestational age and it is considered as a major cause of preeclampsia in the late gestational age. So, the recent researchers emphasize on targeting lipid metabolism in pregnant women with GDM to avoid the adverse outcomes of pregnancy.

Comparison of Risk-Adjusted Outcomes in Medicare Open versus Laparoscopic Cholecystectomy

2018 ◽  
Vol 84 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Donald E. Fry ◽  
Michael Pine ◽  
Susan M. Nedza ◽  
Agnes M. Reband ◽  
Chun-Jung Huang ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
High Risk ◽  
Length Of Stay ◽  
Adverse Outcome ◽  
Adverse Outcomes ◽  
High Risk Population ◽  
Hospital Level ◽  
Prolonged Length ◽  
Medicare Patients ◽  
Open Versus

More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.

Adverse obstetric outcomes in two Brazilian maternity hospitals

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alessa Leila Andrade ◽  
Zenewton André da Silva Gama ◽  
Marise Reis de Freitas ◽  
Wilton Rodrigues Medeiros ◽  
Kelienny de Meneses Sousa ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Adverse Outcome ◽  
Obstetric Care ◽  
Care Quality ◽  
Adverse Outcomes ◽  
Content Type ◽  
Maternity Hospitals ◽  
One Year

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

scholarly journals Infant Mortality and the Risk of Small Size for Gestational Age in the Subsequent Pregnancy: A Retrospective Cohort Study

2012 ◽  
Vol 17 (6) ◽  
pp. 1044-1051 ◽  
Author(s):  
Hamisu M. Salihu ◽  
Euna M. August ◽  
Cara de la Cruz ◽  
Mulubrhan F. Mogos ◽  
Hanna Weldeselasse ◽  
...  
Keyword(s):  
Cohort Study ◽  
Infant Mortality ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Subsequent Pregnancy

Perinatal Outcomes in Women with a History of Recurrent Pregnancy Loss

2020 ◽  
Vol 38 (01) ◽  
pp. 010-015
Author(s):  
Elizabeth B. Ausbeck ◽  
Christina Blanchard ◽  
Alan T. Tita ◽  
Jeff M. Szychowski ◽  
Lorie Harper
Keyword(s):  
Gestational Diabetes ◽  
Gestational Age ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Subsequent Pregnancy ◽  
Gestational Age At Delivery ◽  
History Of ◽  
Nicu Admission

Objective This study aimed to evaluate perinatal outcomes in women with a history of recurrent pregnancy loss. Study Design Retrospective cohort study of singleton and nonanomalous gestations at ≥ 20 weeks who delivered at our academic institution. The exposed group was defined as women with a history of ≥ 2 consecutive spontaneous abortions (SABs) at < 12 weeks. These women were compared with women with a history of ≤ 1 SAB at < 12 weeks. The primary outcome was preterm birth (PTB) at < 37 weeks. Secondary outcomes included gestational age at delivery, gestational diabetes, small for gestational age birth weight, hypertensive diseases of pregnancy, fetal demise, cesarean delivery, and a composite of neonatal complications (5-minute Apgar score < 5, perinatal death, and NICU admission). Multivariable logistic regression was performed to adjust for confounders. Results Of 17,670 women included, 235 (1.3%) had a history of ≥ 2 consecutive SABs. Compared with women with a history of ≤ 1 SAB, women with ≥ 2 consecutive SABs were not more likely to have a PTB (19.6 vs. 14.0%, p = 0.01, adjusted odds ratios (AOR): 0.91, 95% confidence interval [CI]: 0.62–1.33). However, they were more likely to deliver at an earlier mean gestational age (37.8 ± 3.4 vs. 38.6 ± 2.9 weeks, p < 0.01) and to have gestational diabetes (12.3 vs. 6.6%, p < 0.01, AOR: 1.69, 95% CI: 1.10–2.59). Other outcomes were similar between the two groups. Conclusion A history of ≥ 2 consecutive SABs was not associated with an increased incidence of PTB but may be associated with gestational diabetes in a subsequent pregnancy. Key Points

scholarly journals Risk factor assessment of endoscopically removed malignant colorectal polyps

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 669-674 ◽  
Author(s):  
P Netzer ◽  
C Forster ◽  
R Biral ◽  
C Ruchti ◽  
J Neuweiler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Adverse Outcome ◽  
Venous Invasion ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Malignant Polyps ◽  
Grade Iii

Background—Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. Various histological criteria exist for managing these patients.Aims—To determine the significance of histological findings of patients with malignant polyps.Methods—Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps. High risk malignant polyps were defined as having one of the following: incomplete polypectomy, a margin not clearly cancer-free, lymphatic or venous invasion, or grade III carcinoma. Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period (mean 67 months).Results—Malignant polyps were confirmed in 70 cases. In the 32 low risk malignant polyps, no adverse outcomes occurred; 16 (42%) of the 38 patients with high risk polyps had adverse outcomes (p<0.001). Independent adverse risk factors were incomplete polypectomy and a resected margin not clearly cancer-free; all other risk factors were only associated with adverse outcome when in combination.Conclusion—As no patients with low risk malignant polyps had adverse outcomes, polypectomy alone seems sufficient for these cases. In the high risk group, surgery is recommended when either of the two independent risk factors, incomplete polypectomy or a resection margin not clearly cancer-free, is present or if there is a combination of other risk factors. As lymphatic or venous invasion or grade III cancer did not have an adverse outcome when the sole risk factor, operations in such cases should be individually assessed on the basis of surgical risk.

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