Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis summarizes the evidence for the association between endometriosis and adverse pregnancy outcome, including gestational hypertension, pre-eclampsia, low birth weight, and small for gestational age, preterm birth, placenta previa, placental abruption, cesarean section, stillbirth, postpartum hemorrhage, spontaneous hemoperitoneum in pregnancy, and spontaneous bowel perforation in pregnancy. Methods: We performed the literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), by searches in PubMed and EMBASE, until 1 November 2020 (PROSPERO ID CRD42020213999). We included peer-reviewed observational cohort studies and case-control studies and scored them according to the Newcastle–Ottawa Scale, to assess the risk of bias and confounding. Results: 39 studies were included. Women with endometriosis had an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth, compared to women without endometriosis. These results remained unchanged in sub-analyses, including studies on spontaneous pregnancies only. Spontaneous hemoperitoneum in pregnancy and bowel perforation seemed to be associated with endometriosis; however, the studies were few and did not meet the inclusion criteria. Conclusions: The literature shows that endometriosis is associated with an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth.

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Pregnancy-Associated Infections

Tutorial Topics in Infection for the Combined Infection Training Programme ◽

10.1093/oso/9780198801740.003.0048 ◽

2019 ◽

Author(s):

Anna Riddell ◽

Michael Millar

Keyword(s):

Preterm Birth ◽

High Risk ◽

Hepatitis B ◽

Bacterial Vaginosis ◽

Pregnancy Outcome ◽

Adverse Pregnancy Outcome ◽

First Trimester ◽

Increased Risk ◽

Adverse Pregnancy ◽

In Pregnancy

An important consideration in pregnancy is the relationship between infection in the mother and the developing foetus. Infections can indirectly impact the foetus through effects on the mother, for example, maternal urinary tract infection is associated with preterm birth, or can infect the foetus. Routes of infection can be ascending from the birth canal through the cervical os, transplacentally, or rarely, contiguously. The effect on the mother is also important: pregnancy is considered an immunosuppressive state and the growing foetus causes significant mechanical and physiological changes. Although the first trimester is the key developmental phase for the growing foetus, during the third trimester the mother is more susceptible to severe respiratory infection and some viral infections such as varicella zoster virus (VZV), due to the mechanical changes produced by the growing foetus. There is a paucity of evidence supporting the safety of drugs in pregnancy. Use of any medicinal drug in pregnancy, including antibiotics, requires good reasons. The optimum choice of antibiotics depends on the trimester of the pregnancy. In general, beta-lactams are safe and tetracyclines should be avoided throughout pregnancy. Nitrofurantoin is safe until after thirty-five weeks gestation and trimethoprim should be avoided in the first trimester but is safe otherwise (perhaps with folic acid supplementation if < 20 weeks). Specific patterns of colonization and infection of the genitourinary tract can be associated with an increased risk of an adverse pregnancy outcome, particularly preterm birth. Sexually transmitted diseases such as gonorrhoea and chlamydia are associated with an increased risk of spontaneous preterm birth, which may extend to infection in the pre-conception period. Bacterial vaginosis is an abnormal pattern of vaginal colonization and is also linked with an increased risk of preterm birth. The US Center for Disease Control recommends screening all pregnant women for chlamydia, gonorrhoea, syphilis, HIV, and hepatitis B, symptomatic women for trichomonas and genital herpes, women considered at high risk of preterm birth for bacterial vaginosis, and women at high risk of blood-borne virus infection for hepatitis C. Treatment is administered to reduce the risk of an adverse pregnancy outcome (syphilis, gonorrhoea, chlamydia, trichomonas, and bacterial vaginosis) or to prevent transmission to the infant (herpes, HIV, hepatitis B, and C).

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Association of first Birth Cesarean Delivery and Placental Abruption or Previa at Second Birth

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1054 ◽

2010 ◽

Vol 2 (1) ◽

pp. 23-26

Author(s):

Mrityunjay Metgud ◽

Pramila Koli ◽

Baburao Nilgar ◽

Maheshwar Mallapur

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Placental Abruption ◽

Placenta Previa ◽

Final Analysis ◽

First Birth ◽

Increased Risk ◽

The Relationship ◽

Strength Of Association ◽

Previous Cesarean

ABSTRACT Objective To evaluate the strength of association of cesarean delivery for first birth with placenta previa and placental abruption in second pregnancy. Design Retrospective cohort study. Setting Hospital based (Birth register)2004-2008. A total of 1638 pregnancies were available for the final analysis after excluding missing information. Methods Multiple logistic regressions were used to describe the relationship between cesarean section for first birth with placenta previa and placental abruption in second birth singletons. Main outcome measures Placenta previa and placental abruption Results Placenta previa was present in 10 per 1000 second-birth singletons whose first births delivered by cesarean section and 9 per 1000 second-birth singletons whose first births delivered vaginally. The corresponding figures for placental abruption were 5 per 1000 in the previous cesarean delivery group and 5 per 1000 in the previous vaginal delivery group. The adjusted odds ratio (95% confidence intervals) of previous cesarean section for placenta previa in following second pregnancies was 1.10 (0.39 to 3.10) after adjusting for confounders including maternal age and interval between births. The corresponding figure for placental abruption was 1.0 (0.24 to 4.19). Conclusion Cesarean section for first birth is associated with 10% increased risk of placenta previa and no risk of placental abruption in second pregnancy with a singleton.

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Perinatal complications of pregnancies complicated by uterine fibroids

Srpski medicinski casopis Lekarske komore ◽

10.5937/smclk2101016s ◽

2021 ◽

Vol 2 (1) ◽

pp. 16-24

Author(s):

Radmila Sparić ◽

Đina Tomašević

Keyword(s):

Cesarean Section ◽

Placenta Previa ◽

Perioperative Complications ◽

Uterine Fibroids ◽

Bed Rest ◽

First Trimester ◽

Reproductive Age ◽

Perinatal Complications ◽

Increased Risk ◽

In Pregnancy

Fibroids (myomas) are the most common tumors of the female reproductive organs, consisting of smooth muscle cells, fibroblasts, and extracellular matrix. They develop from menarche to menopause. They are diagnosed in 10-20% women of reproductive age. Their size varies from barely visible nodules to large tumors. Change in the size of fibroids during pregnancy and after childbirth is the subject of numerous studies. Most studies indicate a significant increase in the size of fibroids during the first trimester, unchanged size during the second and the third trimester, and a decrease in their size after the delivery. The effect of fibroids on pregnancy depends on their number, location, and size. Myomas are associated with numerous perinatal complications: bleeding in pregnancy, miscarriages, pain due to red degeneration, preterm birth, placental abruption, placenta previa, intrauterine growth restriction, fetal malpresentation, prolonged labor, increased cesarean section rate, uterine atony, and postpartum hemorrhage. Treatment of fibroids in pregnancy includes bed rest and follow-up with symp-tomatic therapy in case of pain, as well as intensive monitoring of the fetus. Very rarely, myomectomy may be necessary during pregnancy. Myomectomy during cesarean section has been considered contraindicated for years. Recent research demonstrates that this procedure may not be associated with an increased risk of perioperative complications. Its advantages include performing two operations within one surgical procedure while avoiding the risks of repeated laparotomy and anesthesia. The most common postpartum complications of fibroids are bleeding and infection.

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Preterm Delivery; Who Is at Risk?

Journal of Clinical Medicine ◽

10.3390/jcm10112279 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2279

Author(s):

Dvora Kluwgant ◽

Tamar Wainstock ◽

Eyal Sheiner ◽

Gali Pariente

Keyword(s):

Risk Factors ◽

Preterm Birth ◽

Prenatal Care ◽

Recurrent Pregnancy Loss ◽

Placental Abruption ◽

Placenta Previa ◽

Population Based ◽

Perinatal Morbidity ◽

Multiple Gestations ◽

Extremely Preterm

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Adverse effects of preterm birth have a direct correlation with the degree of prematurity, in which infants who are born extremely preterm (24–28 weeks gestation) have the worst outcomes. We sought to determine prominent risk factors for extreme PTB and whether these factors varied between various sub-populations with known risk factors such as previous PTB and multiple gestations. A population-based retrospective cohort study was conducted. Risk factors were examined in cases of extreme PTB in the general population, as well as various sub-groups: singleton and multiple gestations, women with a previous PTB, and women with indicated or induced PTB. A total of 334,415 deliveries were included, of which 1155 (0.35%) were in the extreme PTB group. Placenta previa (OR = 5.8, 95%CI 4.14–8.34, p < 0.001), multiple gestations (OR = 7.7, 95% CI 6.58–9.04, p < 0.001), and placental abruption (OR = 20.6, 95%CI 17.00–24.96, p < 0.001) were the strongest risk factors for extreme PTB. In sub-populations (multiple gestations, women with previous PTB and indicated PTBs), risk factors included placental abruption and previa, lack of prenatal care, and recurrent pregnancy loss. Singleton extreme PTB risk factors included nulliparity, lack of prenatal care, and placental abruption. Placental abruption was the strongest risk factor for extreme preterm birth in all groups, and risk factors did not differ significantly between sub-populations.

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Women with a History of Recurrent Pregnancy Loss Are a High-Risk Population for Adverse Obstetrical Outcome: A Retrospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10020179 ◽

2021 ◽

Vol 10 (2) ◽

pp. 179

Author(s):

Emma Rasmark Roepke ◽

Ole Bjarne Christiansen ◽

Karin Källén ◽

Stefan R. Hansson

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnancy Complications ◽

Pregnancy Loss ◽

Recurrent Pregnancy Loss ◽

Placental Abruption ◽

Late Pregnancy ◽

High Risk Population ◽

Risk Population ◽

Increased Risk

Recurrent pregnancy loss (RPL), defined as three or more consecutive miscarriages, is hypothesized to share some of the same pathogenic factors as placenta-associated disorders. It has been hypothesized that a defect implantation causes pregnancy loss, while a partially impaired implantation may lead to late pregnancy complications. The aim of this retrospective register-based cohort study was to study the association between RPL and such disorders including pre-eclampsia, stillbirth, small for gestational age (SGA) birth, preterm birth and placental abruption. Women registered with childbirth(s) in the Swedish Medical Birth Register (MFR) were included in the cohort. Pregnancies of women diagnosed with RPL (exposed) in the National Patient Register (NPR), were compared with pregnancies of women without RPL (unexposed/reference). Obstetrical outcomes, in the first pregnancy subsequent to the diagnosis of RPL (n = 4971), were compared with outcomes in reference-pregnancies (n = 57,410). Associations between RPL and placental dysfunctional disorders were estimated by odds ratios (AORs) adjusting for confounders, with logistic regression. RPL women had an increased risk for pre-eclampsia (AOR 1.45; 95% CI; 1.24–1.69), stillbirth <37 gestational weeks (GWs) (AOR 1.92; 95% CI; 1.22–3.02), SGA birth (AOR 1.97; 95% CI; 1.42–2.74), preterm birth (AOR 1.46; 95% CI; 1.20–1.77), and placental abruption <37 GWs (AOR 2.47; 95% CI; 1.62–3.76) compared with pregnancies by women without RPL. Women with RPL had an increased risk of pregnancy complications associated with placental dysfunction. This risk population is, therefore, in need of improved antenatal surveillance.

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Association between maternal sleep duration and quality, and the risk of preterm birth: a systematic review and meta-analysis of observational studies

10.21203/rs.2.12630/v6 ◽

2020 ◽

Author(s):

ling wang ◽

Feng Jin

Keyword(s):

Systematic Review ◽

Preterm Birth ◽

Sleep Quality ◽

Sleep Duration ◽

Meta Analysis ◽

Controlled Study ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Increased Risk ◽

Study Heterogeneity

Abstract Background : To assess the association of sleep duration and quality with the risk of preterm birth. Methods : Relevant studies were retrieved from the PubMed and Web of Science databases up to September 30, 2018. The reference lists of the retrieved articles were reviewed. Random effects models were applied to estimate summarized relative risks (RRs) and 95% confidence intervals (CIs). Results : Ten identified studies (nine cohort studies and one case-controlled study) examined the associations of sleep duration and quality with the risk of preterm birth. As compared with women with the longest sleep duration, the summary RR was 1.23 (95% CI = 1.01–1.50) for women with the shortest sleep duration, with moderate between-study heterogeneity ( I 2 = 57.4%). Additionally, as compared with women with good sleep quality, the summary RR was 1.54 (95% CI = 1.18–2.01) for women with poor sleep quality (Pittsburgh Sleep Quality Index > 5), with high between-study heterogeneity ( I 2 = 76.7%). Funnel plots as well as the Egger’s and Begg’s tests revealed no evidence of publication bias. Conclusions : This systematic review and meta-analysis revealed that short sleep duration and poor sleep quality may be associated with an increased risk of preterm birth. Further subgroup analyses are warranted to test the robustness of these findings as well as to identify potential sources of heterogeneity.

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Assessment of Health Seeking Behavior of Gestational Diabetes in Pregnancy among Elderly Primi Mother

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i59a34270 ◽

2021 ◽

pp. 261-267

Author(s):

Prachi Dhale ◽

Pragati Dhawale ◽

Amrin Dosani ◽

Gaurav Dongare ◽

Bali Thool

Keyword(s):

Blood Glucose ◽

Gestational Diabetes ◽

Adverse Pregnancy Outcome ◽

The Elderly ◽

Diabetes In Pregnancy ◽

Health Seeking ◽

Health Seeking Behavior ◽

Increased Risk ◽

Seeking Behavior ◽

In Pregnancy

Introduction: Gestational diabetes mellitus (GDM) is diagnosed by elevated blood glucose in pregnancy though the definition has changed repeatedly since its first description in the 1960’s. The most frequently reported perinatal consequence of GDM is macrosomia (usually defined as a neonate weighing over 4 kg) which can increase the risk of caesarean section and shoulder dystocia. For the mother, there are also potential longer-term consequences including an increased risk of type 2 diabetes post-pregnancy and/or in later life. The investigators of a large international Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study aimed to identify a cut-point in the continuum to decide the blood glucose level (BGL) thresholds that should be used to define GDM. Objective: To assess the incidence rate of gestational diabetes in pregnancy among the elderly primi mother. To assess the health seeking behavior of gestational diabetes in elderlyprimimothers. To associate the demographic variables of gestational diabetes in elderly primi mothers. Materials and Methods: A Descriptive research study was to assess the incidence and Health seeking behavior of gestational diabetes in pregnancy among the elderly primi mother. The target population for the study includes all antenatal women (12-36 weeks of gestation) who attend the antenatal clinics of AVBRH Out Patient Department. Sample consists of sub set of units that compose accessible population. In this study sample size was 100 elderly primi mother of selected area of community of Wardha. A tool is an instrument or equipment used for collection of data. A blue print was prepared prior to the construction of knowledge questionnaire based on which items were developed. Results: A finding shows that (41%) were having good, (40%) were having very good, (17%) were having average and (2%) were having excellent knowledge score. The minimum score was 05 and maximum score was 14, the mean score for the test was 8.93 ± 2.23 and mean percentage of knowledge was 59.54%. There was no significant association in relation to age, education, occupation, No.of gravida, income etc.

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Abstract P107: Are Sleep Disturbances Associated with the Development of Gestational Diabetes? A Systematic Review and Meta-analysis.

Circulation ◽

10.1161/circ.129.suppl_1.p107 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Michelle A Miller ◽

Ponnusamy Saravanan ◽

Manu Vatish ◽

Francesco P Cappuccio

Keyword(s):

Gestational Diabetes ◽

Publication Bias ◽

Sleep Disturbances ◽

Sleep Disordered Breathing ◽

Meta Analysis ◽

Cochrane Library ◽

Short Sleep ◽

Increased Risk ◽

In Pregnancy ◽

Disordered Breathing

Introduction and objectives: Physiological and hormonal changes occurring in pregnancy increase the risk of sleep disordered breathing (SDB), which, along with short sleep (SS) duration, may be associated with an increased risk of gestational diabetes mellitus (GDM). Exposure to GDM in the mother increases her lifetime risk of type-2 diabetes (T2D) as well as the risk of obesity, metabolic syndrome and, in later life, T2D of her children. The aim of this study was to systematically review the collective published evidence of associations between snoring/sleep-disordered breathing or sleep duration and increased risk of GDM. Hypothesis: We assessed the hypotheses that sleep disturbances, and/or short sleep during pregnancy may be associated with an increased risk of GDM. Materials and Methods: We performed systematic searches using MEDLINE, EMBASE, the Cochrane library and PsycINFO to assess the effect of snoring/sleep disordered breathing (SDB) or short sleep (SS) on the development of gestational diabetes (GDM) and impaired glucose tolerance in pregnancy. Prospective studies with measures of sleep disturbances at baseline and outcome measures of GDM or levels of glucose 1hr post GCT were included in a meta-analysis. We extracted odds ratios (OR) or relative risks (RR) and 95% confidence intervals (CI) and pooled them using a random effect model. Results: Overall, 7 studies met the inclusion criteria. They included 4,292 participants with 311 cases of GDM. In the pooled analysis, snoring/SDB and SS were both associated with a greater risk of GDM (RR: 2·27; 95% CI 1·65 to 3·12; P < 0· 00001) and (3·19 [1·56 to 6·54]; P < 0·002), respectively. There was no evidence of heterogeneity but there was evidence of publication bias and not all studies adjusted for obesity. Sensitivity analyses did not influence the pooled risk estimates. Conclusions: In conclusion, sleep disturbances may represent a risk factor for the development of GDM. Further studies are required to address the issues of publication bias and potential confounding, and to extend these observations to high-risk groups like women of ethnic minority groups whose risk of GDM is the greatest. Prevention, detection and treatment strategies need to be explored.

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SAT-014 Insulin Treatment in Human Pregnancy Mitigates an Increased Risk of Postpartum Psychological Distress with Maternal Obesity in the Absence of a Pre-Existing Mood and Anxiety Disorder

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.442 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Jessica S Jarmasz ◽

Alexandrea Anderson ◽

Margaret E Bock ◽

Yan Jin ◽

Peter A Cattini ◽

...

Keyword(s):

Psychological Distress ◽

Anxiety Disorder ◽

Anxiety Disorders ◽

Maternal Obesity ◽

Gestational Hypertension ◽

Placental Lactogen ◽

Mood And Anxiety Disorders ◽

Increased Risk ◽

Significant Difference ◽

In Pregnancy

Abstract BACKGROUND: Pregnant women with obesity are at increased risk for peripartum depression. Maternal obesity is also associated with reduced human placental lactogen (hPL) levels, and decreased hPL transcripts were reported in women with clinical depression. In addition, hPL production may be rescued in women with obesity that were subsequently diagnosed with gestational diabetes and treated with insulin (INS). Objective: Study the effect of INS treatment in pregnancy on the risk for postpartum psychological distress (PPD) in women with and without obesity. Study Design: Using data housed at the Manitoba Centre for Health Policy (2002–2017), cohorts of women (ages 15+) with a single live birth with and without obesity were developed using weight (≥85 and <65.6 kg, respectively) and an average (1.63 m) height. Pre-existing mood and anxiety disorders within 5 years preceding delivery as well as gestational hypertension were excluded. After randomly selecting 1 birth per mother, cohorts were stratified by INS treatment during the gestational period. The risk of PPD within 1 year of delivery was assessed by Poisson regression analysis. Models were adjusted for maternal age and area-level income at delivery. Results: The risk of PPD was 27% greater among women with obesity versus without (adjusted rate ratio (aRR)=1.27, 95% CI 1.16–1.4, p<0.0001). However, women with obesity treated with INS did not have a significantly different risk of PPD compared to women without obesity whether treated with INS (aRR=0.99, 95%CI 0.48–2.02, p=0.974) or not (aRR=1.16, 95%CI 0.86–1.56, p=0.328). This suggests that the risk of PPD among women with obesity may be reduced by INS treatment; however, our ability to detect a significant difference may be limited by small cohort numbers (46 women with obesity received INS in pregnancy) or confounders for receiving INS in pregnancy. Direct comparison of INS treatment within weight groups faced the same limitations but trended toward a reduction in women with obesity who received INS (aRR=0.91, 95%CI 0.68–1.22, p=0.531). The positive association between INS treatment in pregnancy and decreased risk of PPD in women with obesity was lost when pre-existing mood and anxiety disorder was not excluded. Inclusion of pre-existing diabetes in the adjusted models did not improve model fit or contribute significantly to the differences in PPD rates. Conclusions: Maternal obesity increases the risk for PPD but this risk may be reduced by gestational INS treatment in the absence of a pre-existing mood and anxiety disorders. This correlates with the decrease and increase in hPL levels reported previously with maternal obesity without and with INS treatment (for diabetes) in pregnancy, respectively. Thus, hPL levels may serve as a possible indicator of PPD risk and a potential target for gestational INS treatment.

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Pregnancy outcome in patient who had first trimester bleeding in previous pregnancy: a prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20201223 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1559

Author(s):

Faswila M. ◽

Ramya N. R.

Keyword(s):

Pregnancy Outcome ◽

Preterm Delivery ◽

Spontaneous Abortion ◽

Adverse Pregnancy Outcome ◽

Placenta Previa ◽

Previous History ◽

Fetal Loss ◽

Previous Pregnancy ◽

Increased Risk ◽

History Of

Background: Patient who had history of spontaneous abortion in her previous pregnancy is associated with adverse outcome in her present pregnancy.Methods: A total 63 pregnant women attending OPD and admitted in department of obstetrics and gynecology, Yenepoya Medical College, from April 2017 to September 2017, considered and outcome were studied.Results: Out of 63 patient’s majority (57.1%) of patients belong to the age group 21-29 year. Anemia was found to be very severe in 4.3%, severe in 10% and moderate in 30% patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). The final outcomes were term livebirth 47 (74.3%), abortion 9 (14.3%), preterm delivery 5 (8.6%), and stillbirth 2 (2.8%) caesarean section (23.3%) for various indications. 19.23% had term PROM, 9.09% had PPROM, 5.76% had term IUGR, 3.84% term IUD, preterm IUD accounts for 9.09% and still birth accounted for about 1.92% which was term, pre-eclampsia accounted for 4.76%, malpresentation for 7.93%, total 3 cases of antepartum hemorrhage out of which placenta previa accounts for about 3.1% and abruption for 1.58%, manual removal of placenta 4.7% and low birth weight 7.6%.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss which can be reduced by booking and giving antenatal care.

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