Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study

Background A history of stillbirth is a risk factor for recurrent fetal death in a subsequent pregnancy. Reported risks of recurrent fetal death are often not stratified by gestational age. In subsequent pregnancies increased rates of medical interventions are reported without evidence of perinatal benefit. The aim of this study was to estimate gestational-age specific risks of recurrent stillbirth and to evaluate the effect of obstetrical management on perinatal outcome after previous stillbirth. Methods A retrospective cohort study in the Netherlands was designed that included 252.827 women with two consecutive singleton pregnancies (1st and 2nd delivery) between 1999 and 2007. Data was obtained from the national Perinatal Registry and analyzed for pregnancy outcomes. Fetal deaths associated with a congenital anomaly were excluded. The primary outcome was the occurrence of stillbirth in the second pregnancy stratified by gestational age. Secondary outcome was the influence of obstetrical management on perinatal outcome in a subsequent pregnancy. Results Of 252.827 first pregnancies, 2.058 pregnancies ended in a stillbirth (8.1 per 1000). After adjusting for confounding factors, women with a prior stillbirth have a two-fold higher risk of recurrence (aOR 1.96, 95% CI 1.07–3.60) compared to women with a live birth in their first pregnancy. The highest risk of recurrence occurred in the group of women with a stillbirth in early gestation between 22 and 28 weeks of gestation (a OR 2.25, 95% CI 0.62–8.15), while after 32 weeks the risk decreased. The risk of neonatal death after 34 weeks of gestation is higher in women with a history of stillbirth (aOR 6.48, 95% CI 2.61–16.1) and the risk of neonatal death increases with expectant obstetric management (aOR 10.0, 95% CI 2.43–41.1). Conclusions A history of stillbirth remains an important risk for recurrent stillbirth especially in early gestation (22–28 weeks). Women with a previous stillbirth should be counselled for elective induction in the subsequent pregnancy at 37–38 weeks of gestation to decrease the risk of perinatal death.

Obstetrical management of cancer in pregnancy and risk of adverse pregnancy and neonatal outcomes: a nationwide cohort study

Objectives. To investigate the obstetrical management of cancer in pregnancy and to determine adverse pregnancy and neonatal outcomes. Design. A register-based nationwide historical prospective cohort study. Setting and population. We assessed all pregnancies (N = 4,071,848) in Denmark from 1 January 1973 to 31 December 2018. Methods. We linked data on maternal cancer, obstetrical, and neonatal outcomes. Exposure was defined as pregnancies exposed to maternal cancer (n = 1,068). The control group comprised pregnancies without cancer. The groups were compared using logistic regression analysis and adjusted for potential confounders. Main outcome Measures. The primary outcome was the iatrogenic termination of the pregnancy (induced abortions/labor induction or elective caesarean section). Secondary outcomes were adverse neonatal outcomes. Results. More women with cancer in pregnancy, as compared to the control group, experienced first-trimester induced abortion; adjusted odds ratio (aOR) 3.7 (95% CI 2.8─4.7), second-trimester abortion; aOR 9.0 (6.4─12.6), iatrogenic preterm delivery; aOR 10.9 (8.1─14.7), and iatrogenic delivery below 32 gestational weeks; aOR 16.5 (8.5─32.2). Neonates born to mothers with cancer in pregnancy had a higher risk of respiratory distress syndrome; aOR 1.5 (1.2─2.0), but not of low birth weight; aOR 0.6 (0.4─0.8), admission to neonatal intensive care unit more than seven days; aOR 1.4 (1.1─1.9), neonatal infection; aOR 0.9 (0.5─1.5) nor neonatal mortality; aOR1.3 (0.6─2.6). Conclusion. Cancer in pregnancy implies an increased risk of iatrogenic termination of pregnancy and iatrogenic premature birth. Neonates born to mothers with cancer in pregnancy had no increased risk of severe adverse neonatal outcomes.

Obstetric A&E unit admission and hospitalization for obstetrical management during COVID-19 pandemic in a third-level hospital of southern Italy

Background The COronaVIrus Disease 2019 (COVID-19) has spread in Italy since February 2020, inducing the government to call for lockdown of any activity, apart primary needs, during the months March–May 2020. During the lockdown, a reduction of admissions and hospitalizations for ischemic diseases was noticed. Purpose of this study was to observe if there has been the same reduction trend in Accident & Emergency (A&E) unit admissions also for obstetric-gynecological conditions. Methods Medical records and electronic clinical databases were searched for all patients who were admitted to the obstetric A&E department or hospitalized at the Gynecology and Obstetrics Unit of University hospital of Naples Federico II, during the quarter March–May in the years 2019 and 2020. The mean ± standard deviation (SD) of monthly admission to the obstetric A&E department and hospitalization of the year 2020 was compared with that of the year 2019, using the unpaired T test with α error set to 0.05 and 95% confidence intervals (95% CI). Results Admissions were 1483 in the year 2020 and 1786 in 2019. Of total, 1225 (37.5%) women were hospitalized: 583 in the year 2020, 642 in 2019. Mean ± SD of patients monthly admitted to our obstetric A&E department was 494 ± 33.7 in the year 2020, and 595.3 ± 30.9 in 2019, with a mean difference of − 101.3 (95% CI − 103.5 to − 99.1; p < 0.0001). Mean ± SD of patients monthly hospitalized to our department was 194 ± 19.1 in the year 2020, 213.7 ± 4.7 in 2019, with a mean difference of − 19.7 (95% CI − 23.8 to − 15.6; p < 0.0001). Conclusion A significant decrease in the mean of monthly admissions and hospitalizations during the COVID-19 pandemic when compared to the previous year was found also for obstetric–gynecological conditions. Further studies are necessary to assess COVID-19 impact and to take the most appropriate countermeasures.

A CLINICAL STUDY OF EVALUATE THE CASES OF THIRD TRIMESTER BLEEDING PER VAGINA

Aims and Objectives: To nd out the incidence of third trimester bleeding in our institution. To evaluate the patients with full medical, surgical and obstetrical history clinical examination, relevant investigations and obstetrical management. Maternal and perinatal outcome. Evaluation of preventive measures to reduce the complications of third trimester bleeding and to improve perinatal and maternal outcome. Materials and methods: The present study was conducted among the patients admitted in the Department of Obstetrics and Gynaecology of DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI, BIHAR. During this study from December 2018 to November 2020 a total number of 9334 mother were delivered among which 112 were diagnosed as having third trimester bleeding per vagina. Result: Perinatal and maternal mortality much higher in the third trimester bleeding per vagina cases. Majority of perinatal mortality occurs in abruptio placentae (47.5%) and only one maternal death occurred in abruption placental. 62.29% of cases were major degree of placenta praevia of which dangerous type II posterior variety was found in 19.67% cases. Conclusion: Blood transfusion facility and round the clock operative facility are very much needed. All efforts are to be made for motivating the mother for acceptance of family planning and to reduce unwanted pregnancy and to encourage small-family norms. The transportation system should be improved for referral of the patients to the next level of care. Liberal and judicious use of caesarean section is also important to achieve the goal of better maternal and perinatal outcome. Finally, the provision of a well equipped neonatal care unit should be available throughout the country

Mystery of perinatal outcomes by COVID-19

Background: The coronavirus disease is continuously affecting the lives of all people and it has grown into a pandemic. Understanding the impact of COVID-19 on pregnancy in terms of morbidity, mortality as well as perinatal-maternal and foetal outcomes is essential to propose strategies for prevention and infection control. In this study, an attempt has been made to assess the impact of COVID-19 on perinatal outcomes.Methods: It was a retrospective analytical study. The case-files of 47 antenatal mothers who were RT-PCR positive & delivered during the course of treatment were taken for the study.Results: Out of all samples, 91.49% were asymptomatic, 10.63% had pregnancy induced hypertension (PIH) as comorbidity, 88.10% had anaemia, 40.43% had WBC count more than 10,000/mm3. 97.87 % of the samples recovered from COVID-19 with routine obstetrical management and only one case was kept on BIPAP support. Perinatal complications like preterm deliveries (27.66%), foetal distress (27.66%), NRNST (19.15%), PROM (4.26%), decreased foetal movement (2.13 %), LBW (6.38%), APGAR<7 at 5 min (15.55%), still birth (4.26%), NICU admission (31.11%), neonatal death (2.13%) were identified. 68.89% neonates were breastfed. The RT-PCR of all neonates came negative on first day of delivery which indicates that there was no vertical transmission. In this study, the results show that the perinatal outcomes are mildly affected by COVID-19.Conclusions: Although COVID-19 doesn’t directly affect perinatal outcomes, it has indirect adverse effects on MCH services. Hence, emergency obstetric and neonatal care is an essential service to be continued with awareness of people while maintaining social distancing and personal hygiene.