Elderly Great Grand Multipara with Gestational Hypertension and Anemia Managed in a Rural Tertiary Hospital: A Case Report

Parity more than five is grand multiparty and more than 10 is great grand multiparity. Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is even higher for great grand multiparous women than grand multiparous women. Grand and Great grand multiparity predispose for adverse maternal and prenatal outcomes such as malpresentation, labor dystocia, caesarean delivery, postpartum hemorrhage, maternal anemia, congenital malformations and perinatal mortality. Grand and Great grand multiparty is also independent risk factor for labor dystocia and perinatal mortality. However, most of the adverse outcomes that have been associated with grand multiparity may actually be confounded by advanced age, less antenatal care and low socioeconomic level. Although pregnancy hypertension is more commonly seen among youngprimigravidas, hypertension is equally common in elderly women. This is a unique case of elderly great grandmultiparous women with moderate anemia who developed gestational hypertension and underwent emergency cesarean section resulting into normal maternal and fetal outcome.

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Severe Acute Respiratory Syndrome Coronavirus 2 Placental Infection and Inflammation Leading to Fetal Distress and Neonatal Multi-Organ Failure in an Asymptomatic Woman

Journal of the Pediatric Infectious Diseases Society ◽

10.1093/jpids/piaa153 ◽

2020 ◽

Author(s):

Sam Schoenmakers ◽

Pauline Snijder ◽

Robert M Verdijk ◽

Thijs Kuiken ◽

Sylvia S M Kamphuis ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Vertical Transmission ◽

Neonatal Intensive Care ◽

Quantitative Polymerase Chain Reaction ◽

Antigen Expression ◽

Fetal Distress ◽

Adverse Outcomes ◽

Placental Infection ◽

Emergency Cesarean ◽

Increased Risk

Abstract Background In general, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy is not considered to be an increased risk for severe maternal outcomes but has been associated with an increased risk for fetal distress. Maternal-fetal transmission of SARS-CoV-2 was initially deemed uncertain; however, recently a few cases of vertical transmission have been reported. The intrauterine mechanisms, besides direct vertical transmission, leading to the perinatal adverse outcomes are not well understood. Methods Multiple maternal, placental, and neonatal swabs were collected for the detection of SARS-CoV-2 using real-time quantitative polymerase chain reaction (RT-qPCR). Serology of immunoglobulins against SARS-CoV-2 was tested in maternal, umbilical cord, and neonatal blood. Placental examination included immunohistochemical investigation against SARS-CoV-2 antigen expression, with SARS-CoV-2 ribonucleic acid (RNA) in situ hybridization and transmission electron microscopy. Results RT-qPCRs of the oropharynx, maternal blood, vagina, placenta, and urine were all positive over a period of 6 days, while breast milk, feces, and all neonatal samples tested negative. Placental findings showed the presence of SARS-CoV-2 particles with generalized inflammation characterized by histiocytic intervillositis with diffuse perivillous fibrin depositions with damage to the syncytiotrophoblasts. Conclusions Placental infection by SARS-CoV-2 leads to fibrin depositions hampering fetal-maternal gas exchange with resulting fetal distress necessitating a premature emergency cesarean section. Postpartum, the neonate showed a fetal or pediatric inflammatory multisystem-like syndrome with coronary artery ectasia temporarily associated with SARS-CoV-2 for which admittance and care on the neonatal intensive care unit (NICU) were required, despite being negative for SARS-CoV-2. This highlights the need for awareness of adverse fetal and neonatal outcomes during the current coronavirus disease 2019 pandemic, especially considering that the majority of pregnant women appear asymptomatic.

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Trisomy 18 Pregnancies: Is there an Increased Maternal Risk?

American Journal of Perinatology ◽

10.1055/s-0037-1603679 ◽

2017 ◽

Vol 34 (11) ◽

pp. 1054-1057

Author(s):

Kayli Senz ◽

Whitney Humphrey ◽

Vanessa Lee ◽

Aaron Caughey ◽

Sarah Dotters-Katz

Keyword(s):

International Classification Of Diseases ◽

Vital Statistics ◽

Trisomy 18 ◽

Trisomy 13 ◽

Obstetric Outcomes ◽

Maternal Risk ◽

Increased Risk ◽

Multiparous Women ◽

Classification Of Diseases ◽

The Impact

Objective Characterize the impact of a trisomy 18 (T18) fetus on maternal and obstetric outcomes in a cohort including T18-affected deliveries. Study Design Retrospective cohort study of singleton deliveries in California from 2005 to 2008 using linked vital statistics and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) data to compare deliveries affected by T18 to those without known aneuploidy. Outcomes of interest included gestational diabetes mellitus (GDM), preterm delivery (PTD), preeclampsia, cesarean delivery (CD), and intrauterine fetal demise (IUFD). The χ2 and paired t-tests were used to compare the outcomes. Multiple logistic regression was used to further characterize these risks and control potential confounders. Results Of 2,029,000 deliveries, 298 involved T18. Compared with unaffected deliveries, T18 was associated with GDM (10.7 vs. 6.5%, p = 0.003), PTD < 37 (40.6 vs. 9.9%, p < 0.001) and < 32 weeks (14.8 vs. 1.4%, p < 0.001), and cesarean section (56 vs. 30.2%, p < 0.001), but not preeclampsia. In adjusted analyses, T18 pregnancies were associated with an increased risk of PTD < 37 and < 32 weeks (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 4.29, 6.99; AOR: 10.4, 95% CI: 7.26, 14.8), and an increased odd of CD for primiparous and multiparous women (AOR: 2.41, 95% CI: 1.48, 3.91; AOR: 5.42, 95% CI: 3.90, 7.53). Risk of GDM did not persist. Conclusion Unlike trisomy 13 (T13), pregnancies complicated by fetal T18 did not appear to result in an increased risk of preeclampsia. However, there is an increased risk of a range of other obstetric complications.

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Are infants born to high-risk patients with grand multiparity at increased risk of adverse outcomes?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.11.512 ◽

2022 ◽

Vol 226 (1) ◽

pp. S304

Author(s):

Olivia Recabo ◽

Alexander J. Gould ◽

Phinnara Has ◽

Nina K. Ayala ◽

Martha B. Kole-White ◽

...

Keyword(s):

High Risk ◽

Adverse Outcomes ◽

High Risk Patients ◽

Grand Multiparity ◽

Increased Risk ◽

Risk Patients

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Placental Growth Factor and Adverse Obstetric Outcomes in a Mixed-Risk Cohort of Women Screened for Preeclampsia in the First Trimester of Pregnancy

Fetal Diagnosis and Therapy ◽

10.1159/000514201 ◽

2021 ◽

pp. 1-9

Author(s):

Charlotte Kvist Ekelund ◽

Line Rode ◽

Ann Tabor ◽

Jon Hyett ◽

Andrew McLennan

Keyword(s):

Growth Factor ◽

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Placental Growth Factor ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

Obstetric Outcomes ◽

Adverse Pregnancy

Objective: The study aimed to investigate the association between placental growth factor (PlGF) and adverse obstetric outcomes in a mixed-risk cohort of pregnant women screened for preeclampsia (PE) in the first trimester. Methods: We included women with singleton pregnancies screened for PE between April 2014 and September 2016. Outcome data were retrieved from the New South Wales Perinatal Data Collection (NSW PDC) by linkage to the prenatal cohort. Adverse outcomes were defined as spontaneous preterm birth (sPTB) before 37-week gestation, birth weight (BW) below the 3rd centile, PE, gestational hypertension (GH), stillbirth, and neonatal death. Results: The cohort consisted of 11,758 women. PlGF multiple of the median (MoM) was significantly associated with maternal sociodemographic characteristics (particularly smoking status and parity) and all biomarkers used in the PE first trimester screening model (notably pregnancy-associated plasma protein A MoM and uterine artery pulsatility index [PI] MoM). Low levels of PlGF (<0.3 MoM and <0.5 MoM) were independently associated with sPTB, low BW, PE, GH, and a composite adverse pregnancy outcome score, with odds ratios between 1.81 and 4.44 on multivariable logistic regression analyses. Conclusions: Low PlGF MoM levels are independently associated with PE and a range of other adverse pregnancy outcomes. Inclusion of PlGF should be considered in future models screening for adverse pregnancy outcomes in the first trimester.

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Fetomaternal outcome in sickle cell disease in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210315 ◽

2021 ◽

Vol 10 (2) ◽

pp. 619

Author(s):

Rahi S. Modi ◽

Srushti S. Patel ◽

Dipti A. Modi ◽

Heena Talesara

Keyword(s):

Sickle Cell Disease ◽

Perinatal Mortality ◽

Sickle Cell ◽

Gestational Hypertension ◽

Tertiary Care ◽

Acute Chest Syndrome ◽

Medical Complications ◽

Cell Disease ◽

Tertiary Care Centre ◽

Increased Risk

Background: Sickle cell disease is a hereditary haematological disorder prevalent in tribal regions of India. Sickle cell disease can increase complications during pregnancy and in turn negatively influence pregnancy outcomes. This study reports the analysis of tribal maternal admissions in the tertiary centre S.S.G. Hospital, Baroda, Gujarat. Hence this study was conducted to assess complications in pregnancy and maternal and perinatal outcome among women with Sickle cell disease.Methods: It was a retrospective observational study including all pregnant women with sickle cell disease after 20 weeks of gestation who delivered at S.S.G. Hospital, Baroda from August 2019 to August 2020.Results: There were 43 antenatal women with Sickle cell disease during the study period. There was increased risk of obstetric complications like gestational hypertension (11.62%), preeclampsia (9.3%), eclampsia (6.97%), HELLP syndrome (4.65%), intrauterine growth retardation (23.25%), and oligohydramnios (11.62%). Medical complications observed were mainly anaemia (53.48%), vaso-occlusive crisis (18.16%), acute chest syndrome (4.65%) and infections like urinary tract infection (6.97%) and pneumonia (4.65%). The incidence of low birth weight babies (56.94%), low APGAR score (11.62%) and neonatal ICU admissions (23.25%) was high. 6.5% cases of maternal mortality and 4.65% cases of perinatal mortality was observed.Conclusions: Pregnancy in Sickle cell disease is associated with an increased maternal morbidity and high perinatal mortality due to obstetric and medical complications.

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INACTIVE HEPATITIS B CARRIER AND PREGNANCY OUTCOMES

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70i6.2909 ◽

2020 ◽

Vol 70 (6) ◽

pp. 1874-79

Author(s):

Rabiah Anwar ◽

Kashif Razzaq

Keyword(s):

Hepatitis B ◽

Gestational Hypertension ◽

Mode Of Delivery ◽

Perinatal Outcomes ◽

Carrier Status ◽

Emergency Cesarean ◽

Increased Risk ◽

Significant Difference ◽

The Impact ◽

Hepatitis B Carrier

Objective: To assess the impact of hepatitis B carrier status on pregnancy and perinatal outcome. Study Design: Cross sectional study. Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship Shifa Hospital,Karachi, from Feb 2017 to Jan 2018. Methodology: A total of 9526 women delivered during study period. 9305 women fulfilling the inclusion criteriawere included in study. Two hundred and twenty one (221) women were excluded because of not fulfilling theinclusion criteria. Out of study group, 9104 women were HBsAg negative while 201 had positive hepatitis Bcarrier status. Antenatal complications (such as gestational diabetes, gestational hypertension, pre eclampsia),mode of delivery (vaginal delivery, elective cesarean, emergency cesarean) and perinatal outcomes (pretermdelivery, low birth weight at delivery, live birth rate, APGAR score at 1 and 5 min) were observed amonghepatitis B carrier and noncarrier. Results: There was no significant difference in point prevalence of major antenatal complications, mode ofdelivery and perinatal outcomes in HBsAg carriers and noncarriers. A slightly higher rate of preterm birth wasobserved in hepatitis B carriers (4.9%) as compared to noncarriers (2.6%). Conclusion: Hepatitis B carriers have slightly increased risk of preterm delivery.

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Adverse Outcomes during Postpartum Readmissions after Deliveries Complicated by Hypertensive Disorders of Pregnancy

American Journal of Perinatology ◽

10.1055/s-0041-1739429 ◽

2021 ◽

Author(s):

Ukachi N. Emeruwa ◽

Cynthia Gyamfi-Bannerman ◽

Timothy Wen ◽

Whitney Booker ◽

Jason D. Wright ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Edema ◽

Gestational Hypertension ◽

Adverse Outcomes ◽

Chronic Hypertension ◽

Linear Regression Models ◽

Adjusted Risk ◽

Increased Risk ◽

Log Linear ◽

Adjusted Model

Objective This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery. Study Design This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect. Results From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks. Conclusion Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes. Key Points

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Impact of the Length of Interpregnancy Interval on Obstetric Outcomes

QJM ◽

10.1093/qjmed/hcaa056.008 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

S S T Mohammed ◽

S A Ashoush ◽

K H Sweedan ◽

R R Ali

Keyword(s):

Risk Factor ◽

Pregnancy Outcomes ◽

Perinatal Death ◽

Perinatal Outcomes ◽

Adverse Outcomes ◽

Obstetric Outcomes ◽

Fetal Survival ◽

Increased Risk ◽

Adverse Pregnancy ◽

The Impact

Abstract Background Inter-pregnancy interval (IPI) is defined as the period between the last delivery and conception of the current pregnancy. Both short and long intervals between pregnancies have been associated with an increased risk of variable adverse outcomes, such as preterm birth, low birth weight (LBW), small size for gestational age, and perinatal death. Aim of the Work To assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Patients and Methods This study was held in Ain Shams University Maternity Hospital on 1719 patients ranging between the ages of 18-35 years. They were divided into three groups according to the length of their IPI [444 patients in group p1 (6-18 months), 847 patients in group p2 (18-48) and 428 patients in group p3 (> 48 months)]. The aim of this study was to assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Results The incidence of LBW among patients with IPI 6-18 months was 11.5%, 12.5% among those with IPI 18-48 months and 16.8% among those with IPI > 48 months. It was also found that the rate of short IPI decreases with age, being more common among the younger age, lower parity groups. The incidence of gestational DM increased with longer IPI. Parity, previous miscarriages, cesarean sections and preterm labor were all significantly associated with the length of IPI. Conclusion This study confirms that both shorter and longer IPIs are associated with increased risks of adverse pregnancy outcomes. This study provides critical information relevant for improving pregnancy outcomes and fetal survival.

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Associations between Maternal Exposure to Bisphenol A or Triclosan and Gestational Hypertension and Preeclampsia: The MIREC Study

American Journal of Perinatology ◽

10.1055/s-0038-1676489 ◽

2018 ◽

Vol 36 (11) ◽

pp. 1127-1135

Author(s):

Louopou Rosalie Camara ◽

Tye Elaine Arbuckle ◽

Helen Trottier ◽

William Donald Fraser

Keyword(s):

Bisphenol A ◽

Gestational Hypertension ◽

First Trimester ◽

Environmental Chemicals ◽

Multinomial Regression ◽

Hypertension In Pregnancy ◽

Nulliparous Women ◽

Increased Risk ◽

Multiparous Women ◽

Liquid Chromatography Tandem Mass

Background Little is known about the association between bisphenol A (BPA) or triclosan (TCS) exposure and hypertension in pregnancy. Objective To investigate potential associations between maternal urinary concentrations of BPA or TCS and gestational hypertension (GH) and preeclampsia. Study Design Among 1,909 pregnant women participating in the maternal-infant research on environmental chemicals (MIREC) study, urinary concentrations of BPA and TCS were measured in the first trimester by liquid chromatography-tandem mass spectrometry using isotope dilution. Blood pressure was measured during each trimester. Multinomial regression was performed to estimate the adjusted odds ratio (aOR) and 95% confidence intervals (CI) for the associations between these phenols and GH and preeclampsia. Results BPA and TCS were not associated with GH or preeclampsia. However, in multiparous women, BPA (0.50–1.30 µg/L) was associated with decreased risk of GH (aOR =0.45; 95%CI: 0.21–0.98) while among nulliparous women, TCS was associated with an increased risk of GH (3.60–32.60 µg/L; aOR = 2.58; 95% CI: 1.09–6.13 and > 32.60 µg/L: aOR = 2.74; 95% CI: 1.15–6.51). Conclusion BPA and TCS urinary concentrations were not associated with GH or preeclampsia; however, our results suggest an association between TCS and GH in nulliparous women. Additional studies are required to confirm our results.

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Pregnancy outcomes among women with thyrotoxicosis a retrospective cohort study

10.21203/rs.3.rs-162247/v1 ◽

2021 ◽

Author(s):

Panwad Harn-a-morn ◽

Prapai Dejkhamron ◽

Theera Tongsong ◽

Suchaya Luewan

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Adverse Outcomes ◽

Low Risk ◽

Obstetric Outcomes ◽

Study Group ◽

Increased Risk ◽

Adverse Pregnancy ◽

Singleton Pregnancies

Abstract Objective: To compare adverse outcomes between: 1) pregnant women with thyrotoxicosis and low risk pregnancies, 2) pregnant women with thyrotoxicosis requiring no anti-thyroid drug (ATD) and low risk pregnancies, and 3) those treated with methimazole (MMI) and propylthiouracil (PTU)Methods: The medical records of singleton pregnancies with thyrotoxicosis were comprehensively reviewed. Low-risk pregnancies matched for age and parity were randomly recruited as controls. The obstetric outcomes were compared between both groups, and the outcomes of various subgroups of the study group were also compared.Results: A total of 408 pregnant women with thyrotoxicosis were recruited. Compared with the controls, the women of the study group had significantly higher rates of low birth weight (LBW) (23.7% vs 17.7%; p:0.036), preterm birth (19.3% vs 12.3%; p:0.007), preeclampsia (8.5% vs 4.4%; p: 0.019) and cesarean section (21.5% vs 16.0%; p:0.046). In the study group (thyrotoxicosis), 67, 127, and 158 patients were treated with MMI, PTU and no anti-thyroid drug (ATD), respectively. All obstetric outcomes were comparable between the women treated with PTU and those with MMI, and between the controlled and uncontrolled groups. However, women who needed ATD had significantly higher rates of LBW and preterm birth than those without medications.Conclusions: Thyrotoxicosis, whether treated or not needing ATDs, was significantly associated with an increased risk of adverse pregnancy outcomes. Also, active disease, indicated by the need for ATD significantly increased the risk of such adverse outcomes, whereas the patients treated with MMI or PTU had comparable adverse outcomes.

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