scholarly journals Prenatal and neonatal outcomes of pregnancies diagnosed with fetal single umbilical artery

2021 ◽  
Vol 29 (3) ◽  
pp. 217-224
Author(s):  
Mehmet Obut ◽  
Asya Kalaycı Öncü ◽  
Özge Yücel Çelik ◽  
Arife Akay ◽  
Güliz Özcan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Single Umbilical Artery ◽  
Apgar Scores ◽  
Increased Risk ◽  
Structural Abnormalities

Objective To investigate the associated anomalies and outcomes of fetuses diagnosed as having a single umbilical artery (SUA) which were reported inconsistently in previous studies. Methods The data of 82 pregnancies with fetal SUA, 35 of which were complex, and 47 isolated SUA (iSUA) and 100 pregnancies with fetal double umbilical arteries (DUA) between June 2018 and July 2020 were retrieved. We compared the maternal characteristics, and pregnancy and fetal outcomes of the three groups (iSUA, SUA, and DUA). Results Of 82 fetuses with SUA, 35 had 64 major structural abnormalities. 20 of these 35 fetuses (57.1%) had cardiovascular malformations, 12 (34.2%) had central nervous, 10 (28.5%) had genitourinary, and eight (22.8%) had gastrointestinal system malformations. Isolated SUA was present in SUA. Compared with the 100 DUA fetuses, SUA was a risk for intrauterine growth restriction (IUGR), preterm delivery, Apgar scores of <7, and admission to the neonatal intensive care unit. Having fetal chromosomal or structural abnormalities, was a risk for amnion fluid abnormality, pregnancy termination, intrauterine fetal death, early neonatal death, and a low live birth ratio in SUA cases. Conclusion SUA has an increased rate of fetal structural and chromosomal abnormalities. Among them, the most detected one is cardiac and the second most common one is central nervous system malformations. Pregnancies with fetal SUA have increased risk for IUGR, preterm delivery, low Apgar scores, and admission to the neonatal intensive care unit. The presence of additional structural or chromosomal malformations increases the rate of these adverse pregnancy risks. Thus, these cases warrant dedicated fetal ultrasonographic organ screening and close prenatal follow-up.

Obstetric Outcomes in Singleton Pregnancies with Abnormal Placental Cord Insertions

2021 ◽  
Author(s):  
Leilah D. Zahedi-Spung ◽  
Molly J. Stout ◽  
Ebony B. Carter ◽  
Jeffrey M. Dicke ◽  
Methodius G. Tuuli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Cesarean Delivery ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Increased Risk

Objective There is wide variation in the management of pregnancies complicated by abnormal placental cord insertion (PCI), which includes velamentous cord insertion (VCI) and marginal cord insertion (MCI). We tested the hypothesis that abnormal PCI is associated with small for gestational age (SGA) infants. Study Design This is a retrospective cohort study of all pregnant patients undergoing anatomic ultrasound at a single institution from 2010 to 2017. Patients with abnormal PCI were matched in a 1:2 ratio by race, parity, gestational age at the time of ultrasound, and obesity to patients with normal PCIs. The primary outcome was SGA at delivery. Secondary outcomes were cesarean delivery, preterm delivery, cesarean delivery for nonreassuring fetal status, 5-minute Apgar score < 7, umbilical artery pH < 7.1, and neonatal intensive care unit admission. These outcomes were compared using univariate and bivariate analyses. Results Abnormal PCI was associated with an increased risk of SGA (relative risk [RR]: 2.43; 95% confidence interval [CI]: 1.26–4.69), increased risk of preterm delivery <37 weeks (RR: 3.60; 95% CI: 1.74–7.46), and <34 weeks (RR: 3.50; 95% CI: 1.05–11.63) compared with patients with normal PCI. There was no difference in rates of cesarean delivery, Apgar score of <7 at 5 minutes, acidemia, or neonatal intensive care unit admission between normal and abnormal PCI groups. In a stratified analysis, the association between abnormal PCI and SGA did not differ by the type of abnormal PCI (p for interaction = 0.46). Conclusion Abnormal PCI is associated with an increased risk of SGA and preterm delivery. These results suggest that serial fetal growth assessments in this population may be warranted. Key Points

scholarly journals Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michinori Mayama ◽  
Mamoru Morikawa ◽  
Takashi Yamada ◽  
Takeshi Umazume ◽  
Kiwamu Noshiro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Severe Thrombocytopenia ◽  
Relative Risks

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

scholarly journals Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

2018 ◽  
Vol 24 (3) ◽  
pp. 162
Author(s):  
Cetin Kilicci ◽  
Cigdem Yayla Abide ◽  
Enis Ozkaya ◽  
Evrim Bostancı Ergen ◽  
İlter Yenidede ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Preterm Neonates ◽  
Apgar Scores ◽  
Gestational Age At Delivery

<p><strong>Objective:</strong> The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. </p><p><strong>Study Design:</strong> Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.</p><p><strong>Results:</strong> Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.</p><p><strong>Conclusion:</strong> Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.</p>

Labor and Delivery Outcomes with the Sequential Use of Misoprostol Followed by Cervical Foley Catheter

2020 ◽  
Author(s):  
Maeve K. Hopkins ◽  
Rebecca F. Hamm ◽  
Sindhu K. Srinivas ◽  
Lisa D. Levine
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Maternal Morbidity ◽  
Neonatal Intensive Care ◽  
Foley Catheter ◽  
Catheter Placement ◽  
Increased Risk ◽  
Nicu Admission ◽  
Time To Delivery

Objective Studies demonstrate shorter time to delivery with concurrent use of misoprostol and cervical Foley catheter. However, concurrent placement may not be feasible. If misoprostol is used to start an induction, little is known regarding the benefit of sequentially using Foley catheter. We examine obstetrical outcomes in women with Foley catheter placed after misoprostol compared with those only requiring misoprostol. Study design Retrospective cohort study of singleton pregnancies, intact membranes, and an unfavorable cervix (Bishop score of ≤6 and dilation ≤2 cm) undergoing term induction May 2013 to June 2015. We compared obstetrical outcomes between women receiving misoprostol alone versus those that had a Foley catheter placed after misoprostol. Outcomes are mode of delivery, time to delivery, chorioamnionitis, admission to neonatal intensive care unit, and maternal morbidity. Chi-square and Fisher's exact tests were used for categorical variables, Mann–Whitney U-tests compared continuous variables. Results Among 364 women, 281 began induction with misoprostol alone. A total of 135 (48%) subsequently had a Foley catheter placed. Characteristics were similar between the groups, although nulliparity and cervical dilation <1 cm at start of induction were more likely to have subsequent Foley catheter. Women with Foley catheter placement after misoprostol had a longer median time to delivery (15 vs. 11 hours, p < 0.001), twofold higher rate of cesarean (42 vs. 26%, odds ratio: 2.1, 95% confidence interval: 1.26–3.44, p = 0.004), and increased risk of neonatal intensive care unit (NICU) admission (21 vs. 11%, p = 0.024). There was a nonsignificant increased risk of chorioamnionitis (12 vs. 7%, p = 0.1) and maternal morbidity (15 vs. 8%, p = 0.08) in the misoprostol followed by Foley catheter group. Conclusion In women receiving misoprostol for induction, nulliparas and those with dilation <1 cm are more likely to have subsequent Foley catheter placement. Sequential use of cervical Foley catheter after misoprostol is associated with longer labor, higher cesarean rate, and increased NICU admission. Requirement of Foley catheter after misoprostol confers higher risk and may guide counseling. Key Points

scholarly journals Fraturas Ósseas em uma Unidade de Cuidados Intensivos Neonatais

2015 ◽  
Vol 28 (2) ◽  
pp. 204 ◽  
Author(s):  
Ângela Machado ◽  
Gustavo Rocha ◽  
Ana Isabel Silva ◽  
Nuno Alegrete ◽  
Hercília Guimarães
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Neonatal Period ◽  
Bone Fractures ◽  
Clavicle Fracture ◽  
Skull Fracture ◽  
Extremely Low Birth Weight ◽  
Increased Risk

<strong>Introduction:</strong> Fractures during the neonatal period are rare. Some fractures, especially long bones, may occur during birth. Moreover, neonates hospitalized in the Neonatal Intensive Care Unit have an increased risk of fractures for several reasons.<br /><strong>Objective:</strong> To evaluate the incidence and characterize fractures in newborns admitted in a tertiary Neonatal Intensive Care Unit.<br /><strong>Material and Methods:</strong> A retrospective analysis of the newborns admitted to the Neonatal Intensive Care Unit with a diagnosis at discharge of one or more bone fractures from January 1996 to June 2013.<br /><strong>Results: </strong>Eighty neonates had one or more fractures. In 76 (95%) infants the fractures were attributed to birth injury. The most common fracture was the clavicle fracture in 60 (79%) neonates, followed by skull fracture in 6 (8%). In two (2.5%) neonates, extremely low birth weight infants, fractures were interpreted as resulting from osteopenia of prematurity. Both had multiple fractures, and one of them with several ribs.<br /><strong>Conclusion: </strong>A change in obstetric practices allied to improvement premature neonate’s care contributed to the decreased incidence of fractures in neonatal period. But in premature infants the diagnosis may be underestimated, given the high risk of fracture that these infants present.

Treatment with nitric oxide in the neonatal intensive care unit is associated with increased risk of childhood cancer

2018 ◽  
Vol 107 (12) ◽  
pp. 2092-2098 ◽  
Author(s):  
Fiona Dixon ◽  
David S Ziegler ◽  
Barbara Bajuk ◽  
Ian Wright ◽  
Lisa Hilder ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Childhood Cancer ◽  
Neonatal Intensive Care ◽  
Increased Risk

scholarly journals The Association Between Maternal Hypoglycemia on the 75 g Glucose Tolerance Test and Maternal-Neonatal Outcomes: A Matched Case Control Study

2021 ◽  
Author(s):  
Emine Öztürk ◽  
Şükrü Yıldız
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Pregnant Women ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Control Study

Objective: The aim of this study was to determine whether pregnant women who developed maternal hypoglycemia during the 75 g Oral Glucose Test (OGT) were at an increased risk for adverse obstetric and neonatal outcomes. Methods: This case-control study was conducted from computer-based medical records of women who delivered in a tertiary center between January 2015 and December 2018. OGT had been performed with 75 gr glucose for gestational diabetes screening at 24-28 weeks of gestation. The pregnants with 1st-hour blood glucose levels less than 90 mg/dl (low GT) were matched with normoglycemic patients according to age, body mass index (BMI), gravida and gestational weeks. Obstetric and neonatal outcomes were assessed. Results: Of the 1249 pregnant women included in the study, 62 (4.9%) were in the Low GT group. Admission to the neonatal intensive care unit (NICU) showed a rate of 3.48 increase in the Low GT group (95% confidence interval: 1.05-11.47, p=0.04). There was no difference between the two groups in the other obstetric and neonatal parameters such as: preeclampsia, preterm delivery, birth weight, and weight gained during pregnancy and the 5-minute Apgar scores adjusted for gestational age (SGA) of the fetus. Conclusion: Low 75 g OGT results are significantly associated with increased risk of neonatal intensive care unit (NICU) admissions.

Palliative care in a tertiary neonatal intensive care unit: a 10-year review

2018 ◽  
pp. bmjspcare-2018-001538
Author(s):  
Stanley Ka Fai Ng ◽  
Ngaire Keenan ◽  
Sophie Swart ◽  
Mary Judith Berry
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Median Time ◽  
Neonatal Intensive Care ◽  
Best Interests ◽  
Pharmacological Intervention ◽  
Care Plans ◽  
Increased Risk

ObjectivesWhen active treatment is no longer in the best interests of the patient, redirection of care to palliation is an important transition. We review, within a tertiary neonatal intensive care unit (NICU), the journey leading to the decision to redirect care, the means of symptom control and the provision of psychosocial supports.MethodsA retrospective review of all 166 deaths of NICU-affiliated patients during a 10- year epoch. Medical notes were reviewed, and the provision and type of, or barriers to, effective palliative care was defined.ResultsExtreme prematurity accounted for 71/145 (49%) of deaths with relatively high proportions of Māori 17/71 (25%) and Pacific Islanders 9/71 (13%). Almost all eligible infants received some form of palliation. Transition from curative to palliative care was refused by the family in a single case. Median time from decision to redirect care until first recorded action was 80  min, and median time from action until death was 60  min. The majority of infants received some form of comfort cares, (128/166) most commonly morphine (94/128, 73%). Three infants had documented seizure activity or respiratory distress but did not receive any pharmacological intervention. Psychosocial supports were offered in 98/145 (67%) of cases, but only 71/145 (49%) of families were formally offered an opportunity to discuss the infant’s clinical course after their death.ConclusionsClinical documentation of care plans was often incomplete, potentially leading to inconsistent delivery of care, increased risk of symptom breakthrough and/or inadequate psychosocial supports for family. Formal individualised palliative care plans are under development to standardise documentation and improve therapeutic and psychosocial interventions available to the infant and their family.

Epidemiology of Methicillin-SusceptibleStaphylococcus Aureusin the Neonatal Intensive Care Unit

2002 ◽  
Vol 23 (11) ◽  
pp. 677-682 ◽  
Author(s):  
Philip L. Graham ◽  
Anne-Sophie Morel ◽  
Juyan Zhou ◽  
Fann Wu ◽  
Phyllis Della-Latta ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Control Strategies ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Increased Risk ◽  
Endemic Infections

Objective:When the incidence of methicillin-susceptibleStaphylococcus aureus(MSSA) infection or colonization increased in our neonatal intensive care unit (NICU), we sought to further our understanding of the relationship among colonization with MSSA, endemic infection, and clonal spread.Design:A retrospective cohort study was used to determine risk factors for acquisition of a predominant clone of MSSA (clone “B”).Setting:A 45-bed, university-affiliated, level III-IV NICU.Patients:Infants hospitalized in the NICU from October 1999 to September 2000.Interventions:Infection control strategies included surveillance cultures of infants, cohorting infected or colonized infants, contact precautions, universal glove use, mupirocin treatment of the anterior nares of all infants in the NICU, and a hexachlorophene bath for infants weighing 1,500 g or more.Results:During the 1-year study period, three periods of increased incidence of MSSA colonization or infection, ranging from 6.4 to 13.5 cases per 1,000 patient-days per month, were observed. Molecular typing using pulsed-field gel electrophoresis demonstrated two predominant clones, clone “B” and clone “G,” corresponding to two periods of increased incidence. Multivariate analysis demonstrated that length of stay (OR, 1.035; 95% confidence interval [CI95], 1.008 to 1.062;P= .010) (increased risk per day) and the use of H2-blockers (OR, 20.44; CI95, 2.48 to 168.26;P= .005) were risk factors for either colonization or infection with clone “B,” and that the use of peripheral catheters was protective (OR, 0.06; CI95, 0.01 to 0.43;P= .005).Conclusions:Control of MSSA represents unique challenges as colonization is expected, endemic infections are tolerated, and surveillance efforts generally focus on multidrug-resistant pathogens. Future studies should address cost-effective surveillance strategies for endemic infections.

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