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antepartum hemorrhage [keywords]
- Obstetric outcomes of booked teenage pregnancies at University of Calabar Teaching Hospital, Nigeria. [Journal Article]
- Adolesc Health Med Ther 2012.:105-9.
Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH) in Nigeria.A retrospective comparative analysis of teenage pregnancies and mature mothers at UCTH was carried out from January 2011 to December 2011. A total of 82 teenage pregnancies and 72 mature pregnancies were compared.There were 145 teenage deliveries from a total of 2313 deliveries, ie, 6.3% of total deliveries. There was no statistically significant difference in the mode of delivery (cesarean section, spontaneous vaginal delivery, instrumental delivery) between the groups of mothers. There was also no difference in risk of complications, including obstructed labor, retained placenta, uterine atony, pre-eclampsia/eclampsia, and antepartum hemorrhage. However, teenage mothers had more perineal lacerations (P = 0.02) and more preterm labor (P = 0.05), and delivered more low-birth-weight babies (P = 0.02).Supervised teenage pregnancy may not be as hazardous as previously thought.
- Immediate and long-term outcomes of assault in pregnancy. [JOURNAL ARTICLE]
- Aust N Z J Obstet Gynaecol 2014 Feb 18.
We examined the immediate and long-term health outcomes of hospitalised pregnancy-related assault.A retrospective review of hospital records was conducted using data from the New Zealand Ministry of Health's National Minimum Data Set of hospital discharges. The hospital records of pregnant women admitted to a public hospital in New Zealand between 2001 and 2006 were included in this investigation. Unique identifiers were used to identify the index pregnancy event, subsequent discharge events and mortality for five years after the index event. Discharge records were grouped as follows: pregnancy-related hospital admission, but no associated or subsequent assault recorded (pregnant only); an assault-related hospital admission event after the pregnancy, but within five years of the index pregnancy (assault after pregnancy); an assault recorded within the same hospital admission event as the pregnancy (assault during pregnancy). Generalised linear models for the binomial family were conducted to explore increased risk ratios of adverse maternal, fetal and subsequent injury outcomes depending on group assignment.Compared with the pregnancy-only group, the assault after pregnancy and assault during pregnancy groups had increased risk ratios for death, preterm labour, antepartum haemorrhage, infectious complication, spontaneous abortion and stillbirth.Assault during pregnancy substantially increased the risks for a number of adverse maternal and fetal outcomes. The identification of women who live in a violent relationship and the provision of adequate social support to these women may reduce the risks of subsequent injury and adverse maternal and fetal outcomes.
- Prediction of postpartum hemorrhage in women with gestational hypertension or mild preeclampsia at term. [JOURNAL ARTICLE]
- Acta Obstet Gynecol Scand 2014 Feb 14.
To assess whether postpartum hemorrhage (PPH) can be predicted in women with gestational hypertension or mild preeclampsia at term. Design A cohort study in which we used data from our multicentre randomized controlled trial (HYPITAT-trial).The study was conducted in 38 hospitals in the Netherlands between 2005 and 2008. Population Women with gestational hypertension or mild preeclampsia at term (n=1,132). Methods An antepartum model (model A) and an antepartum/ intrapartum model (model B) were created using logistic regression. The predictive capacity of the models was assessed with receiver-operating-characteristic (ROC) analysis and calibration.PPH, defined as blood loss >1000 ml within 24h after delivery.PPH occurred in 118 (10.4%) women. Maternal age (OR 1.03), pre-pregnancy body mass index (OR 0.96) and women with preeclampsia (OR 1.5) were independent antepartum prognostic variables of PPH. Intrapartum variables incorporated in the model were gestational age at delivery (OR 1.2), duration of dilatation stage (OR 1.1) and episiotomy (OR 1.5). Model A and model B showed moderate discrimination, with an area under the ROC-curve of 0.59 (95% CI 0.53-0.64) and 0.64 (95% CI 0.59-0.70). Calibration was moderate for model A (Hosmer-Lemeshow p-value=0.26) but better for model B (Hosmer-Lemeshow p-value=0.36). The rates of PPH ranged from 4% (lowest 10 percent) to 22% (highest 10 percent).In the assessment of performance of a prediction model, calibration is more important than discriminative capacity. Our prediction model shows that for women with gestational hypertension or mild preeclampsia at term distinction between low and high risk of developing PPH is possible when antepartum and intrapartum variables are combined. This article is protected by copyright. All rights reserved.
- Pregnancy outcomes of placenta previa with or without antepartum hemorrhage. [Journal Article]
- J Med Assoc Thai 2013 Nov; 96(11):1401-7.
To compare pregnancy outcomes between antepartum hemorrhage (APH) and no APH in women with a diagnosis of placenta previa (PP).A retrospective cohort study was conducted in 60 gravidas diagnosed with PP. The study group (n = 30) consisted of women with APH while the control group (n = 30) comprised those without. The pregnancy outcomes were compared between the two groups. They included preterm birth, emergency cesarean section (CS), peripartum hysterectomy, requirement for blood transfusion, low birth weight (LBW), and birth asphyxia. Uni- and multivariable analyses were used for statistical analysis.Data of all 60 women were obtained. In univariable analysis, the study group had significantly higher risks ofearly, late, and overall preterm birth, emergency CS, blood transfusion, and LBW than the control group; odds ratio (95% confidence intervals) = 6.1 (1.5-25.0), 3.9 (1.1-21.2), 4.3 (1.6-11.2), 5.2 (2.3-11.7), 2.6 (1.4-4.6) and 3.7 (1.1-11.8) respectively. When multivariable analysis adjusted for potential confounders, these risks remained in the study group. The highest risk was an emergency CS with an adjusted odds ratio of 30.5 (4.1-227.3).Women with PP complicated by APH had significantly higher risks ofadverse pregnancy outcomes than women without APH.
- Maternal and perinatal risk factors for childhood cancer: record linkage study. [Journal Article]
- BMJ Open 2014; 4(1):e003656.
To investigate maternal and perinatal risk factors for childhood cancer.Case-control analysis of linked records from the Aberdeen Maternity and Neonatal Databank with the Scottish Cancer Registry and the General Registry of Births and Deaths in Scotland was carried out.Aberdeen, Scotland.Cases (n=176) comprised children diagnosed with cancer under 15 years or recorded as having died of cancer. Four controls per case were matched by age and gender.Maternal age, body mass index, social class, marital status and smoking as well as pre-eclampsia, antepartum haemorrhage and previous miscarriage, gestational age, birth weight and Apgar scores were compared between groups to test for association with cancer. ORs with 95% CIs were calculated using conditional logistic regression in univariable and multivariable models.Of the maternal characteristics tested, mother's age at delivery (cases mean 28.9 (SD 5.6) years vs controls mean 30.2 (SD 4.6), p=0.002) and smoking status (38.6% smokers among cases, 29.7% among controls, p=0.034) were found to be different between groups. Of the perinatal factors tested, low Apgar score at 5 min (adjusted OR (AOR) 4.59, 95% CI 1.52 to 13.87) and delivery by caesarean section (AOR 1.95, 95% CI 1.30 to 2.92) showed statistically significant associations with childhood cancer in the multivariable model.Younger maternal age, maternal smoking, delivery by caesarean section and low Apgar score at 5 min were independently associated with increased risk of childhood cancer. These general findings should be interpreted with caution as this study did not have the power to detect any association with individual diagnostic categories of childhood cancer.
- Comparison of estimation of volume of fetomaternal hemorrhage using Kleihauer-Betke test and microcolumn gel method in D-negative nonisoimmunized mothers. [Comparative Study, Journal Article]
- Immunohematology 2013; 29(3):105-9.
In this study we assessed the efficay of the microcolumn gel method in the detection and quantification of the volume of fetomaternal hemorrhage (FMH) in comparison with the Kleihauer-Betke test (KB) in nonisoimmunized D- mothers. We collected blood samples from 80 D- indirect antiglobulin test-negative mothers over a span of more than 1 year. FMH was determined by KB and microcolumn gel method, and the results were compared. FMH was recorded as less than 4 mL by KB if no fetal cells were seen after examining 25 fields using 10x objective. If fetal cells were seen, slides were examined furhter to quantify FMH. By microcolumn gel method, FMH was reported as less than 0.1 percent, 0.1 percent, 0.2 percent, and 0.4 percent or greater. None of the patients had FMH greater than 15 mL by KB . Sixty-two patients (77.5%) had FMH less than 4mL by KB. In all these cases , FMH was less than or equal 0.2 percent (approximately 4mL) by microcolumn gel method. The mean volume of FMH in the remaining 18 (22.5%) cases by KB was 8.3 ± 1.7 mL. Fifteen (83.3%) of these 18 cases had FMH of at least 0.4 percent (approximately 8 mL) by gel technology. Three cases (16.7%) that differed from KB results had FMH of 0.2 percent by microcolumn gel method with a maximal FMH of 6.4 mL by KB. FMH was significanlty increased in cesarean delivery (mean FMH 9.5 ± 0.8 mL, range 7.9-10.4 mL, p=0.001) abd abtepartum hemorrahge (mean FMH 9.5 ± 0.9 mL, range 7.9-10.4 mL, p< 0.001). Microcolumn gel method is an effective screening test . Technologies like KB and flow cytometry are better options for detecting a large volume of FMh. Antepartum hemorrhage and cesarean delivery are risk factors for FMH. the 300-µg dose of cases. We need to analyze the relative cost-effectiveness of universal administration of 300µg of Rh immune globulin vs. FMH quantitation with subsequent administration of titrated doses.
- Recognising serious umbilical cord anomalies. [Journal Article]
- BMJ Case Rep 2013.
Umbilical vessel catheterisation is a common intervention in neonatal care. Many complications are recognised, some of which are life-threatening. We report the case of a term neonate who was compromised at birth following antepartum haemorrhage with evidence of multiorgan ischaemic injury. Following resuscitation and umbilical vessel catheterisation, she developed pneumoperitoneum. At laparotomy, a patent vitellointestinal duct was identified and resected. Intestinal perforation was found in the duct wall, most plausibly explained by the unintentional catheterisation of the duct via the umbilicus. Learning to recognise umbilical cord anomalies, such as patent vitellointestinal duct, can be simple and could prevent potentially serious complications.
- Postnatal pyomyoma: a diagnostic dilemma. [Journal Article]
- BMJ Case Rep 2013.
Pyomyoma is a rare, yet potentially fatal complication of uterine leiomyoma. Clinically difficult to diagnose as a result of non-specific symptoms, its presentation is commonly confused with fibroid degeneration. Late diagnosis has severe implications, with the mortality of the condition remaining high. Despite the availability of powerful antibiotics, surgical intervention is frequently required for the curative treatment of the critically ill patient. Here, we report a case of postpartum pyomyoma developing after a complicated antenatal course of placenta praevia resulting in recurrent antepartum haemorrhage, preterm prelabour rupture of membranes and eventual emergency caesarean section for cord prolapse. We highlight the diagnostic difficulty and delay in definitive surgical intervention. Using this case, we have emphasised the importance of strong clinical suspicion when faced with a triad of pain, sepsis without an obvious source and a known diagnosis of leiomyoma to prevent fatalities.
- Short-term Morbidities of Moderate and Late Preterm Infants. [JOURNAL ARTICLE]
- Klin Padiatr 2013 Oct 24.
To determine (1) the association between neonatal morbidity and gestational age and (2) the impact of pre-existing maternal medical conditions, pregnancy and birth complications on neonatal outcome in moderate and late preterm infants (32-36 completed weeks).Retrospective single-centre cohort study including all moderate and late preterm infants without congenital anomalies born at the Children's and Maternity Hospital Linz, Austria, between January 2007 and June 2010. Stepwise regression analysis was used to determine significant associations between morbidities, maternal and perinatal complications and the gestational age.Of 870 infants included the incidence of neonatal morbidities increased from 24% at 36 weeks to 43% at 35 weeks', 55% at 34 weeks', 75% at 33 weeks' and 93% at 32 weeks' gestation. Infants at 32 weeks had a 4-fold (RR: 3.88; 95% CI: 1.87-8.06) increased risk compared with those at 36 weeks, and infants of 32 weeks were 16 times (RR: 16.01; 95% CI: 9.82-26.09) more likely to be admitted to the NICU than infants of 36 weeks'. Hyperbilirubinaemia (29%) and respiratory morbidity (14.3%) were the most common neonatal diagnoses. Intrauterine growth restriction, preeclampsia, preterm premature rupture of the membranes, lack of antenatal steroid administration, antepartum haemorrhage, multiple pregnancy and male gender were all associated with any kind of neonatal morbidity, admission rate to the NICU and length of hospital stay (p<0.05).Nearly half of all infants suffered from any morbidity, and several risk factors were identified being significantly associated with NICU admission rate and length of hospitalization.
- Type and location of placenta previa affect preterm delivery risk related to antepartum hemorrhage. [Journal Article]
- Int J Med Sci 2013; 10(12):1683-8.
To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated.Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups.Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.