Impact of Co-Existing Placental Pathologies in Pregnancies Complicated by Placental Abruption and Acute Neonatal Outcomes

Placental abruption (PA) is a concern for maternal and neonatal morbidity. Adverse neonatal outcomes in the setting of PA include higher risk of prematurity. Placental pathologies include maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), acute chorioamnionitis, and villitis of unknown etiology (VUE). We aimed to investigate how placental pathology contributes to acute neonatal outcome in PA. A retrospective cohort study of all placentas with PA were identified. Exposures were MVM, FVM, acute chorioamnionitis and VUE. The primary outcome was NICU admission and the secondary outcomes included adverse base deficit and Apgar scores, need for resuscitation, and small-for-gestational age. A total of 287 placentas were identified. There were 160 (59.9%) of placentas with PA alone vs 107 (40.1%) with PA and additional placental pathologies. Odds of NICU admission were more than two times higher in pregnancies with placental pathologies (OR = 2.37, 95% CI 1.28–4.52). These estimates were in large part mediated by prematurity and birthweight, indirect effect acting through prematurity was OR 1.79 (95% CI 1.12–2.75) and through birthweight OR 2.12 (95% CI 1.40–3.18). Odds of Apgar score ≤ 5 was more than four times higher among pregnancies with placental pathologies (OR = 4.56, 95% CI 1.28–21.26). Coexisting placental pathology may impact Apgar scores in pregnancies complicated by PA. This knowledge could be used by neonatal teams to mobilize resources in anticipation of the need for neonatal resuscitation.

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The implications for advanced maternal age on pregnancy complications and adverse neonatal outcomes

Perinatal Journal ◽

10.2399/prn.21.0293005 ◽

2021 ◽

Vol 29 (3) ◽

pp. 200-209

Author(s):

Zeynep Gedik Özköse ◽

Süleyman Cemil Oğlak

Keyword(s):

Birth Weight ◽

Cesarean Section ◽

Pregnancy Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Apgar Scores ◽

Adverse Neonatal Outcomes ◽

Adverse Pregnancy ◽

Nicu Admission

Objective This study aimed to determine the effect of advanced maternal age (AMA) on maternal and neonatal outcomes in pregnant women aged ≥35 years compared with patients aged 30–34 years. Also, we aimed to analyze the risk estimates of potential confounders to identify whether these variables contributed to the development of adverse pregnancy outcomes or not. Methods This retrospective cohort study included 2284 pregnant women aged ≥35 years at the time of delivery who was delivered in a tertiary referral hospital from January 1, 2016, to December 31, 2020. We further classified these women into two subgroups: 35–39 years as early AMA (EAMA), and ≥40 years as very AMA (VAMA). Pregnancy complications and adverse neonatal outcomes were recorded. Results Compared to younger women, pregnant AMA women had significantly higher risks of complicated pregnancies, including a higher risk of gestational diabetes mellitus (GDM, p<0.001), polyhydramnios (p<0.001), cesarean section (p<0.001), stillbirths (p<0.001), major fetal abnormality (p<0.001), preterm delivery (p<0.001), lower birth weight (p<0.001), lower 5-minute Apgar scores (p<0.001), lower umbilical artery blood pH values (p<0.001), neonatal intensive care unit (NICU) admission (p<0.001), and length of NICU stay (p<0.001). Conclusion We found a strong and significant association between VAMA and adverse pregnancy outcomes, including an increased risk of GDM, polyhydramnios, cesarean section, and adverse neonatal outcomes, including a higher risk of stillbirths, preterm delivery, lower birth weight, lower 5-minute Apgar scores, and NICU admission.

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Electronic Fetal Monitoring and Neonatal Outcomes when a Nuchal Cord Is Present at Delivery

American Journal of Perinatology ◽

10.1055/s-0039-1679866 ◽

2019 ◽

Vol 37 (04) ◽

pp. 378-383

Author(s):

Ebony B. Carter ◽

Cheryl S. Chu ◽

Zach Thompson ◽

Methodius G. Tuuli ◽

George A. Macones ◽

...

Keyword(s):

Primary Outcome ◽

Fetal Heart ◽

Neonatal Morbidity ◽

Fetal Monitoring ◽

Neonatal Outcomes ◽

Nuchal Cord ◽

Electronic Fetal Monitoring ◽

Adverse Neonatal Outcomes ◽

Morbidity Index ◽

Singleton Pregnancies

Objective This study aimed to determine the association between nuchal cord, electronic fetal monitoring parameters, and adverse neonatal outcomes. Study Design This was a prospective cohort study of 8,580 singleton pregnancies. Electronic fetal monitoring was interpreted, and patients with a nuchal cord at delivery were compared with those without. The primary outcome was a composite neonatal morbidity index. Logistic regression was used to adjust for confounders. Result Of 8,580 patients, 2,071 (24.14%) had a nuchal cord. There was no difference in the risk of neonatal composite morbidity in patients with or without a nuchal cord (8.69 vs. 8.86%; p = 0.81). Nuchal cord was associated with category II fetal heart tracing and operative vaginal delivery (OVD) (6.4 vs. 4.3%; p < 0.01). Conclusion Nuchal cord is associated with category II electronic fetal monitoring parameters, which may drive increased rates of OVD. However, there is no significant association with neonatal morbidity.

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Timing of Repeat Cesarean Delivery for Women with a Prior Classical Incision

American Journal of Perinatology ◽

10.1055/s-0040-1718576 ◽

2020 ◽

Author(s):

Marwan Ma'ayeh ◽

Paulina Haight ◽

Emily A. Oliver ◽

Mark B. Landon ◽

Kara M. Rood

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cesarean Delivery ◽

Secondary Analysis ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Maternal Outcomes ◽

Adverse Neonatal Outcomes ◽

Nicu Admission ◽

Repeat Cesarean Delivery

Objective This study aimed to compare neonatal outcomes for delivery at 36 weeks compared with 37 weeks in women with prior classical cesarean delivery (CCD). Study Design This was a secondary analysis of the prospective observational cohort of the Eunice Kennedy National Institute for Child and Human Development's Maternal-Fetal Medicine Unit Network Cesarean Registry. Data on cases of repeat cesarean delivery (RCD) in the setting of a prior CCD were abstracted and used for analysis. This study compared outcomes of women who delivered at 360/7 to 366/7 versus 370/7 to 376/7 weeks. The primary outcome was a composite of adverse neonatal outcomes that included neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), hypoglycemia, mechanical ventilation, sepsis, length of stay ≥5 days, and neonatal death. A composite of maternal outcomes that included uterine rupture, blood transfusion, general anesthesia, cesarean hysterectomy, venous thromboembolism, maternal sepsis, intensive care unit admission, and surgical complications was also evaluated. Results There were 436 patients included in the analysis. Women who delivered at 36 weeks (n = 176) were compared those who delivered at 37 weeks (n = 260). There were no differences in baseline characteristics. Delivery at 37 weeks was associated with a reduction in composite neonatal morbidity (24 vs. 34%, adjusted odds ratio [aOR] = 0.61 [0.31–0.94]), including a decrease in NICU admission rates (20 vs. 29%, aOR = 0.63 [0.40–0.99]), hospitalization ≥5 days (13 vs. 24%, aOR = 0.48 [0.29–0.8]), and RDS or TTN (9 vs. 19%, aOR = 0.43 [0.24–0.77]). There was no difference in adverse maternal outcomes (7 vs. 7%, aOR = 0.98 [0.46–2.09]). Conclusion Delivery at 37 weeks for women with a history of prior CCD is associated with a decrease in adverse neonatal outcomes, compared with delivery at 36 weeks. Key Points

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Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020456 ◽

2021 ◽

Vol 18 (2) ◽

pp. 456

Author(s):

Pedro Hidalgo-Lopezosa ◽

Ana María Cubero-Luna ◽

Andrea Jiménez-Ruz ◽

María Hidalgo-Maestre ◽

María Aurora Rodríguez-Borrego ◽

...

Keyword(s):

Pregnant Women ◽

Case Control Study ◽

Neonatal Resuscitation ◽

Case Control ◽

Neonatal Outcomes ◽

Southern Spain ◽

Retrospective Case ◽

Apgar Scores ◽

Primiparous Women ◽

Control Study

Background: Birth plans are used for pregnant women to express their wishes and expectations about childbirth. The aim of this study was to compare obstetric and neonatal outcomes between women with and without birth plans. Methods: A multicentre, retrospective case–control study at tertiary hospitals in southern Spain between 2009 and 2013 was conducted. A total of 457 pregnant women were included, 178 with and 279 without birth plans. Women with low-risk gestation, at full-term and having been in labour were included. Sociodemographic, obstetric and neonatal variables were analysed and comparisons were established. Results: Women with birth plans were older, more educated and more commonly primiparous. Caesarean sections were less common in primiparous women with birth plans (18% vs. 29%, p = 0.027); however, no significant differences were found in instrumented births, 3rd–4th-degree tears or episiotomy rates. Newborns of primiparous women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH and advanced neonatal resuscitation. No significant differences were found on 5 min Apgar scores or other variables for multiparous women. Conclusions: Birth plans were related to less intervention, a more natural process of birth and better outcomes for mothers and newborns. Birth plans can improve the welfare of the mother and newborn, leading to birth in a more natural way.

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Maternal and fetal factors contributing to neonatal outcome in Al-Tibri Medical College and Hospital

Journal of Fatima Jinnah Medical University ◽

10.37018/qbhp7754 ◽

2021 ◽

Vol 15 (1) ◽

pp. 18-22

Author(s):

Erum Saboohi ◽

Nighat Seema ◽

Abdulah Hadi Hassan

Keyword(s):

Risk Factors ◽

Antenatal Care ◽

Preterm Delivery ◽

Neonatal Outcome ◽

Neonatal Outcomes ◽

P Value ◽

Medical College ◽

Adverse Neonatal Outcome ◽

Adverse Neonatal Outcomes ◽

Nicu Admission

Background: The study was done to identify the maternal and fetal factors contributing to neonatal outcome and to evaluate the correlation between risk factors and adverse neonatal outcome. Subjects and methods: This prospective observational study was conducted on 126 mothers and their neonates fulfilling the selection criteria at Al-Tibri Medical College and Hospital. A self-designed Performa was used to enter data of subjects. Sick neonates were referred to neonatal intensive care unit for admission and management. The results were analyzed by using SPSS version 22. A p-values <0.05 was considered as significant. Results: Out of 126 enrolled subjects, 81% mothers were multigravidas, 31% were unbooked, 13.5% had gestational comorbidities, 15% were drug addict, 2% were Hepatitis B positive. 22.2% underwent emergency LSCS while 31.7% delivered babies by elective LSCS. Regarding fetal factors contributing to sick babies, IUGR (20%), twin fetuses (15.4%), prematurity (47.7%) were significant. 65 were sick babies. Adverse neonatal outcomes observed were prematurity in 25.4%, IUGR in 11.1%, NICU admission in 33.3%, and neonatal death in 2%. Risk factors associated with adverse neonatal outcomes were positive maternal drug addiction (p-value = 0.028), preterm delivery (p-value<0.001), NICU admission (p-value<0.001) and low birth weight (p-value <0.001). Conclusion: Compromised maternal antenatal care has profound deleterious effect on fetus and neonate. Obstetricians, perinatologists and neonatologists need to work in concord to improve maternal antenatal care hence improving neonatal outcome. In our study adverse neonatal outcome was associated with unbooked cases, delivery by EmLSCS, addicted mother, preterm delivery, LBW and neonates requiring NICU admission.

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Is There a Benefit of Antenatal Corticosteroid When Given < 48 Hours Before Delivery?

10.21203/rs.3.rs-921511/v1 ◽

2021 ◽

Author(s):

Yoav Siegler ◽

Naphtali Justman ◽

Gal Bachar ◽

Roy Lauterbach ◽

Yaniv Zipori ◽

...

Keyword(s):

Primary Outcome ◽

Neonatal Outcome ◽

Neonatal Morbidity ◽

Time Interval ◽

Outcome Study ◽

Antenatal Corticosteroid ◽

Time Intervals ◽

Corticosteroid Administration ◽

Adverse Neonatal Outcome ◽

Adverse Neonatal Outcomes

Abstract Objective We assessed the association between a short Antenatal Corticosteroid Administration-to-Birth Interval and neonatal outcome. Study design: A retrospective study between 2010- 2020. Eligible cases were singleton preterm live-born neonates born between 24 0/7 and 33 6/7 weeks of gestation and were initiated an ACS course of Betamethasone. We divided the first 48 hours following 1st ACS administration to four-time intervals and compared each time interval to those born more than 48 hours following ACS administration. The primary outcome was a composite of adverse neonatal outcome, including neonatal mortality or any major neonatal morbidity. Results A total of 200 women gave birth less than 48 hours from receiving the first betamethasone injection, and 172 women gave birth within 2-7 days (48-168 hours) from ACS administration. Composite adverse neonatal outcome was higher for neonates born less than 12 hours from initial ACS administration compared to neonates born 2-7 days from first betamethasone injection (55.45% vs. 29.07%, OR 3.45 95% CI [2.02-5.89], p.value<0.0001). However, there was no difference in composite adverse neonatal outcomes between neonates born 12-48 hours following ACS administration and those born after 2-7 days. That was also true after adjusting for confounders. Conclusions 12-24 hours following ACS Administration may be sufficient in reducing the same risk of neonatal morbidities as > 48 hours following ACS administration. It may raise the question regarding the utility of the second dose of ACS.

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Neonatal Outcomes Differ after Spontaneous and Indicated Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0037-1608804 ◽

2017 ◽

Vol 35 (05) ◽

pp. 494-502 ◽

Cited By ~ 2

Author(s):

Devyn Demaree ◽

Emily Merfeld ◽

Methodius Tuuli ◽

Jennifer Wambach ◽

F. Cole ◽

...

Keyword(s):

Preterm Birth ◽

Preterm Labor ◽

Primary Outcome ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Respiratory Morbidity ◽

Preterm Neonates ◽

Medical Complication ◽

Respiratory Outcomes ◽

Preterm Rupture Of Membranes

Objective Preterm birth (PTB) at <37 weeks of gestation complicates 10% of pregnancies and requires accurate counseling regarding anticipated neonatal outcomes. PTB classification as spontaneous or indicated is commonly used to cluster PTB into subtypes, but whether neonatal outcomes differ by PTB subtype is unknown. We tested the hypothesis that neonatal morbidity differs based on subtype of PTB. Methods We performed a retrospective cohort study of live-born, non-anomalous preterm infants from 2004 to 2008. Spontaneous PTB was defined as PTB from spontaneous preterm labor or preterm rupture of membranes. Indicated PTB was defined as PTB from any maternal or fetal medical complication necessitating delivery. The primary outcome was a composite of early respiratory morbidity. Secondary outcomes included late composite respiratory morbidity and other neonatal morbidities. Results Of 1,223 preterm neonates, 60.9% were born after spontaneous PTB and 30.1% after indicated PTB. Composite early respiratory morbidity was significantly higher after indicated PTB versus spontaneous PTB (1.3, 95% confidence interval [CI] 1.2–1.4). Composite late respiratory morbidity (1.8, 95% CI 1.3–2.3) and neonatal death (2.8, 95% CI 1.5–5.1) were also significantly higher after indicated PTB versus spontaneous PTB. Conclusion Neonatal respiratory outcomes and death differ according to PTB subtype. PTB subtype should be considered while counseling families and anticipating neonatal outcomes after PTB.

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Maternal and Neonatal Outcomes of Induction of Labor Compared with Planned Cesarean Delivery in Women with Preeclampsia at 34 Weeks' Gestation or Longer

American Journal of Perinatology ◽

10.1055/s-0037-1606185 ◽

2017 ◽

Vol 35 (01) ◽

pp. 095-102 ◽

Cited By ~ 3

Author(s):

Katherine Bowers ◽

Tetsuya Kawakita

Keyword(s):

Primary Outcome ◽

Neonatal Outcome ◽

Neonatal Outcomes ◽

Icu Admission ◽

Increased Risk ◽

Neonatal Icu ◽

Maternal And Neonatal Outcomes ◽

Nicu Admission ◽

Previous Cesarean ◽

Singleton Pregnancies

Objective This study aims to compare outcomes of induction with planned cesarean in women with preeclampsia. Study Design A retrospective cohort study, including women with singleton pregnancies, preeclampsia (mild, severe, and superimposed), and without previous cesarean at ≥ 34 weeks' gestation was conducted. Outcomes included primary outcome (intensive care unit [ICU] admission, thromboembolism, transfusion, and hysterectomy), composite severe neonatal outcome (asphyxia, arterial cord pH < 7.0, hypoxic–ischemic encephalopathy, and 5-minute Apgar score < 5), neonatal ICU (NICU) admission, transient tachypnea of newborn (TTN), and respiratory distress syndrome (RDS). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were calculated, controlling for confounders. Results Of 5,506 women with preeclampsia at ≥ 34 weeks' gestation, 5,104 (92.7%) women underwent induction. Induction compared with planned cesarean was not associated with an increased risk of the primary outcome but was related to increased risks of ICU admission (aOR: 3.29; 95% CI: 1.02–10.64), and linked to decreased risks of composite neonatal outcome (aOR: 0.32; 95% CI: 0.10–0.99), NICU admission (aOR: 0.60; 95% CI: 0.43–0.84), TTN (aOR: 0.38; 95% CI: 0.22–0.64), and RDS (aOR: 0.44; 95% CI: 0.22–0.86). Conclusion Induction was not associated with an increased risk of the primary outcome but was associated with an increased risk of ICU admission and decreased risks of neonatal outcomes.

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Risks of Adverse Neonatal Outcomes in Early Adolescent Pregnancy Using Group Prenatal Care as a Strategy for Public Health Policies: A Retrospective Cohort Study in Brazil

Frontiers in Public Health ◽

10.3389/fpubh.2021.536342 ◽

2021 ◽

Vol 9 ◽

Author(s):

Danylo José Palma Honorato ◽

Izabela Fulone ◽

Marcus Tolentino Silva ◽

Luciane Cruz Lopes

Keyword(s):

Birth Weight ◽

Prenatal Care ◽

Low Birth Weight ◽

Adolescent Pregnancy ◽

Neonatal Outcomes ◽

Group Prenatal Care ◽

Age Group ◽

Pregnant Adolescents ◽

Apgar Scores ◽

Adverse Neonatal Outcomes

Background: Adolescent pregnancy is a public health concern and many studies have evaluated neonatal outcomes, but few have compared younger adolescents with older using adequate prenatal care.Objective: To compare the risks of adverse neonatal outcomes in younger pregnant adolescents who are properly followed through group prenatal care (GPC) delivered by specialized public services.Methods: This retrospective cohort study followed pregnant adolescents (aged 10–17 years) who received GPC from specialized public services in Brazil from 2009 to 2014. Data were obtained from medical records and through interviews with a multidisciplinary team that treated the patients. The neonatal outcomes (low birth weight, prematurity, Apgar scores with 1 and 5 min, and neonatal death) of newborns of adolescents aged 10–13 years were compared to those of adolescents aged 14–15 years and 16–17 years. Incidence was calculated with 95% confidence intervals (CIs) and compared over time using a chi-squared test to observe trends. Poisson Multivariate logistic regression was used to adjust for confounding variables. The results are presented as adjusted relative risks or adjusted mean differences.Results: Of the 1,112 adolescents who were monitored, 758 were included in this study. The overall incidence of adverse neonatal outcomes (low birth weight and prematurity) was measured as 10.2% (95% CI: 9.7–11.5). Apgar scores collected at 1 and 5 min were found to be normal, and no instance of fetal death occurred. The incidence of low birth weight was 16.1% for the 10–13 age group, 8.7% for the 14–15 age group and 12.1% for the 16–17 age group. The incidence of preterm was measured at 12, 8.5, and 12.6% for adolescents who were 10–13, 14–15, and 16–17 years of age, respectively. Neither low birth weight nor prematurity levels significantly differed among the groups (p > 0.05). The infants born to mothers aged 10–13 years presented significantly (p < 0.05) lower Apgar scores than other age groups, but the scores were within the normal range.Conclusions: Our findings showed lower incidence of neonatal adverse outcomes and no risk difference of neonatal outcomes in younger pregnancy adolescents. It potentially suggests that GPC model to care pregnant adolescents is more important than the age of pregnant adolescent, however further research is needed.

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Fetal and neonatal outcomes in early onset versus late onset pre-eclampsia-a comparative study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20211683 ◽

2021 ◽

Vol 8 (5) ◽

pp. 900

Author(s):

Vikram R.

Keyword(s):

Early Onset ◽

Age Of Onset ◽

Late Onset ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Chi Square ◽

Onset Type ◽

Medical College ◽

Early Onset Preeclampsia ◽

Nicu Admission

Background: Pre-eclampsia is typed as two different entities: early-onset preeclampsia occurring at less than 34 weeks of gestation, and late-onset occurring at 34 or more weeks of gestation. The aim of this study is to compare the fetal and neonatal outcomes in early versus late onset preeclampsia.Methods: 208 patients diagnosed with pre-eclampsia in Shri Sathya Sai medical college and research institute over a period of three years (From January 2016 to January 2019) were retrospectively studied. Patients were classified as early onset and late onset pre-eclampsia based on the gestational age of onset. Data on fetal and neonatal outcomes were collected and analysed using Chi square and Fisher’s test and compared.Results: Early onset and late onset pre-eclampsia were 34.6% and 65.3%. The incidence of oligohydramnios, SGA, low APGAR at 5 minutes of birth were high in early onset type. 64.9% of early onset type required NICU admission whereas only 38.23% new born of mothers with late onset type required NICU admissions.10.8% of babies of patients with early onset type were still born. The incidence of NICU admissions, requirement of respiratory support, duration of NICU stay were significantly high in early onset type.Conclusions: Patients with early onset pre-eclampsia are found to have higher rates of specific fetal and neonatal morbidity when compared to the late onset type. Prudent and close scrutinizing and follow up and delaying delivery in stable and appropriately selected patients with pre-eclampsia would be advantageous for neonates.

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