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antepartum hemorrhage [keywords]
- Adverse Obstetric and Perinatal Outcomes following Treatment of Adolescent and Young Adult Cancer: A Population-Based Cohort Study. [Journal Article]
- PLoS One 2014; 9(12):e113292.
To investigate obstetric and perinatal outcomes among female survivors of adolescent and young adult (AYA) cancers and their offspring.Using multivariate analysis of statewide linked data, outcomes of all first completed pregnancies (n = 1894) in female survivors of AYA cancer diagnosed in Western Australia during the period 1982-2007 were compared with those among females with no cancer history. Comparison pregnancies were matched by maternal age-group, parity and year of delivery.Compared with the non-cancer group, female survivors of AYA cancer had an increased risk of threatened abortion (adjusted relative risk 2.09, 95% confidence interval 1.51-2.74), gestational diabetes (2.65, 2.08-3.57), pre-eclampsia (1.32, 1.04-1.87), post-partum hemorrhage (2.83, 1.92-4.67), cesarean delivery (2.62, 2.22-3.04), and maternal postpartum hospitalization>5 days (3.01, 1.72-5.58), but no excess risk of threatened preterm delivery, antepartum hemorrhage, premature rupture of membranes, failure of labor to progress or retained placenta. Their offspring had an increased risk of premature birth (<37 weeks: 1.68, 1.21-2.08), low birth weight (<2500 g: 1.51, 1.23-2.12), fetal growth restriction (3.27, 2.45-4.56), and neonatal distress indicated by low Apgar score (<7) at 1 minute (2.83, 2.28-3.56), need for resuscitation (1.66, 1.27-2.19) or special care nursery admission (1.44, 1.13-1.78). Congenital abnormalities and perinatal deaths (intrauterine or ≤7 days of birth) were not increased among offspring of survivors.Female survivors of AYA cancer have moderate excess risks of adverse obstetric and perinatal outcomes arising from subsequent pregnancies that may require additional surveillance or intervention.
- Comparison of maternal morbidity and medical costs during pregnancy and delivery between patients with gestational diabetes and patients with pre-existing diabetes. [JOURNAL ARTICLE]
- Diabet Med 2014 Dec 4.
To evaluate the effects of gestational diabetes and pre-existing diabetes on maternal morbidity and medical costs, using data from the Korea National Health Insurance Claims Database of the Health Insurance Review and Assessment Service.Delivery cases in 2010, 2011 and 2012 (459 842, 442 225 and 380 431deliveries) were extracted from the Health Insurance Review and Assessment Service database. The complications and medical costs were compared among the following three pregnancy groups: normal, gestational diabetes and pre-existing diabetes.Although, the rates of pre-existing diabetes did not fluctuate (2.5, 2.4 and 2.7%) throughout the study, the rate of gestational diabetes steadily increased (4.6, 6.2 and 8.0%). Furthermore, the rates of pre-existing diabetes and gestational diabetes increased in conjunction with maternal age, pre-existing hypertension and cases of multiple pregnancy. The risk of pregnancy-induced hypertension, urinary tract infections, premature delivery, liver disease and chronic renal disease were greater in the gestational diabetes and pre-existing diabetes groups than in the normal group. The risk of venous thromboembolism, antepartum haemorrhage, shoulder dystocia and placenta disorder were greater in the pre-existing diabetes group, but not the gestational diabetes group, compared with the normal group. The medical costs associated with delivery, the costs during pregnancy and the number of in-hospital days for the subjects in the pre-existing diabetes group were the highest among the three groups.This study showed that the rates of pre-existing diabetes and gestational diabetes increased with maternal age at pregnancy and were associated with increases in medical costs and pregnancy-related complications. This article is protected by copyright. All rights reserved.
- Risk score comprising maternal and obstetric factors to identify late preterm infants at risk for neonatal intensive care unit admission. [JOURNAL ARTICLE]
- J Obstet Gynaecol Res 2014 Nov 25.
The aim of this study was to develop and validate an antepartum risk score based on maternal and obstetric characteristics to predict the requirement for neonatal intensive care unit (NICU) admission among late preterm infants.A chart review was performed of 455 singleton late preterm deliveries at our institution between July 2010 and December 2011. Logistic regression analysis was used to develop a risk score, which was derived from β coefficients of the significant variables. A receiver-operator curve was plotted to determine the optimal cut-off score for predicting NICU admission. Validation of the score was tested in another cohort of 450 women who delivered a singleton late preterm infant between January 2012 and June 2013.A total of 98 infants (21.5%) in the development cohort were admitted to the NICU. The significant factors for NICU admission included: premature rupture of membranes, antepartum hemorrhage, medical disorders during pregnancy, prenatal estimation of fetal weight, gestational age at delivery, and mode of delivery. These six variables were integrated into a risk-scoring model, which ranged from -2 to 9 points. A cut-off score of ≥1 produced the maximum area under the receiver-operator curve of 0.764. At this cut-off point, the sensitivity was 79.6% and specificity was 73.1%. When the risk score was tested in the validation cohort, similar results were demonstrated.An antepartum risk score was developed to predict the requirement for NICU admission among late preterm infants and was validated in an independent cohort.
- A report from #BlueJC: How should we manage antepartum haemorrhage of unknown origin? [Letter]
- BJOG 2014 Dec; 121(13):1757.
- Maternal mortality in Central Province, Kenya, 2009-2010. [Journal Article]
- Pan Afr Med J 2014.:201.
Maternal mortality for Kenya was 488/100,000 live births in 2009. Maternal mortality estimate for Central Province is unknown. We retrospectively reviewed data between 1st July 2009 and 30th June 2010 to estimate the hospital based maternal mortality ratio, characterize deaths by time, place and person and describe possible causes of deaths in Central province, Kenya.We abstracted data using a standard form from maternal death notification and review forms and the district reproductive health reports. Data was entered and analyzed using Microsoft Excel.There were 89,512 live births and 111 deaths. The facility-based maternal mortality ratio was 124/100,000 live births. Seventy-three (66%) deaths had been audited. Thirty seven (33%) were aged 25 to 34 years. The mean age was 31years (±6). Thirty seven (33%) had a parity of less or equal to 2. Most case deaths (19%, n = 21) had attended 2 or less antenatal visits. The main gestation was below 37 weeks with 48% (n = 53). The main mode of delivery was vaginal (26%, n = 29). Majority (35%, n = 32) case deaths had delivered a live birth. Thirty seven (33%) mothers had been stable on admission. The main reason for admission waslabor with 12% (n = 13). Thirty-eight (34%) died within 24 hours after admission. Majority (27%, n = 30) were admitted antepartum but 39% (n = 43) were postpartum at the time of death. Thirty-five (32%) died of hemorrhage and 8(7%) Eclampsia.Maternal mortality is of public health importance in the region. Most deaths occurred within 24 hours after admission. Third delay was important. Bleeding and Eclampsia were the main causes of death. A third (34%) of notified deaths were not reviewed.
- Interventions for preventing or reducing domestic violence against pregnant women. [Journal Article, Research Support, Non-U.S. Gov't]
- Cochrane Database Syst Rev 2014.:CD009414.
Domestic violence during pregnancy is a major public health concern. This preventable risk factor threatens both the mother and baby. Routine perinatal care visits offer opportunities for healthcare professionals to screen and refer abused women for effective interventions. It is, however, not clear which interventions best serve mothers during pregnancy and postpartum to ensure their safety.To examine the effectiveness and safety of interventions in preventing or reducing domestic violence against pregnant women.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2014), scanned bibliographies of published studies and corresponded with investigators.We included randomised controlled trials (RCTs) including cluster-randomised trials, and quasi-randomised controlled trials (e.g. where there was alternate allocation) investigating the effect of interventions in preventing or reducing domestic violence during pregnancy.Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.We included 10 trials with a total of 3417 women randomised. Seven of these trials, recruiting 2629 women, contributed data to the review. However, results for all outcomes were based on single studies. There was limited evidence for the primary outcomes of reduction of episodes of violence (physical, sexual, and/or psychological) and prevention of violence during and up to one year after pregnancy (as defined by the authors of trials). In one study, women who received the intervention reported fewer episodes of partner violence during pregnancy and in the postpartum period (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.43 to 0.88, 306 women, moderate quality). Groups did not differ for Conflict Tactics Score - the mean partner abuse scores in the first three months postpartum (mean difference (MD) 4.20 higher, 95% CI -10.74 to 19.14, one study, 46 women, very low quality). The Current Abuse Score for partner abuse in the first three months was also similar between groups (MD -0.12 lower, 95% CI -0.31 lower to 0.07 higher, one study, 191 women, very low quality). Evidence for the outcomes episodes of partner abuse during pregnancy or episodes during the first three months postpartum was not significant (respectively, RR 0.50, 95% CI 0.25 to 1.02, one study with 220 women, very low quality; and RR 0.60, 95% CI 0.35 to 1.04, one study, 271 women, very low quality). Finally, the risk for low birthweight (< 2500 g) did not differ between groups (RR 0.74, 95 % CI 0.41 to 1.32, 306 infants, low quality).There were few statistically significant differences between intervention and control groups for depression during pregnancy and the postnatal period. Only one study reported findings for neonatal outcomes such as preterm delivery and birthweight, and there were no clinically significant differences between groups. None of the studies reported results for other secondary outcomes: Apgar score less than seven at one minute and five minutes, stillbirth, neonatal death, miscarriage, maternal mortality, antepartum haemorrhage, and placental abruption.There is insufficient evidence to assess the effectiveness of interventions for domestic violence on pregnancy outcomes. There is a need for high-quality, RCTs with adequate statistical power to determine whether intervention programs prevent or reduce domestic violence episodes during pregnancy, or have any effect on maternal and neonatal mortality and morbidity outcomes.
- HCV and pregnancy: prevalence, risk factors, and pregnancy outcome in north Indian population: a case-control study. [Journal Article]
- J Obstet Gynaecol India 2014 Oct; 64(5):332-6.
The study was carried out to investigate the prevalence, risk factors, and Pregnancy outcome in anti-HCV-positives pregnant women admitted for delivery in the Department of Obstetrics & Gynecology of Guru Gobind Singh Medical College and Hospital, Faridkot between January 2010 and January 2013.Department of obstetrics and Gynaecology of GGS Medical College and Hospital, Faridkot.A case-control study design was selected for the study. A total of 1412 pregnant women presenting in the labor room of our hospital between January 2010 and January 2013 were subjected to anti-HCV testing by third generation ELISA. Age, parity, and gestational age-matched controls were taken from the women delivering during the same time frame who tested negative for hepatitis C. All the subjects and controls were non-reactive for HIV and HBsAg as well. Risk factors and pregnancy outcome were compared with the control group. Approval was taken from ethic committee of the institute. The women who consented to participate in the study were evaluated on the basis of a questionnaire for the presence of risk factors of hepatitis C and pregnancy outcome. Women with the known previous liver disease were excluded from the study. Data were analyzed using SPSS for Windows version 16.0. p < 0.05 was considered significant.Forty patients tested positive for anti-HCV antibodies among 1,412 patients subjected to anti-HCV testing during study period. 40 patients were taken as controls, who were negative for anti-HCV antibodies. Prevalence of HCV during pregnancy was 2.8 % in our study. Among the risk factors studied, previous surgery and blood transfusion were the statistically significant risk factors. There was history of previous major surgery in 16 cases versus 4 controls and was statistically significant (p value 0.002) at p < 0.05. History of blood transfusion was present in 4 versus 2 among cases and controls, respectively, and statistically significant (p value 0.004) at p < 0.05. Sexual transmission was not the risk factor as none of the spouse of the pregnant women was positive for HCV antibodies. Neonatal outcome was similar in both groups. Pregnancy complications i.e., Pregnancy-induced hypertension and antepartum hemorrhage were significantly higher in study group compared to control group.Incidence of hepatitis C virus infection in pregnancy is 2.8 %. Surgical procedures, blood transfusion, are the major risk factors for transmission. There are no identifiable risk factors in 35 % of cases. Pregnancy complications like Pregnancy-induced hypertension and antepartum hemorrhage are more common in HCV-positive mothers. Neonatal outcome is not affected. Universal screening of all pregnant women should be done for HCV as many patients may not have any risk factor.
- Perinatal Mortality in a Northwestern Nigerian City: A Wake up Call. [Journal Article]
- Front Pediatr 2014.:105.
In Nigeria, of the over 900,000 children under the age of 5 years that die every year, perinatal mortality is responsible for a little over 20%. Previous reports are largely from the southern part of the country. This is the first report of perinatal data from the northwest of Nigeria.A case control study of perinatal deaths in the three major public hospitals in Katsina metropolis was carried out to determine the pattern of perinatal deaths in the metropolis. Data were collected over a 6 week period on maternal socio-demographic, antenatal, and delivery variables. Data were similarly obtained on neonatal profile and morbidities.There were 143 perinatal deaths (94 stillbirths and 49 early neonatal deaths) out of 1104 live and stillbirths during the study period. The perinatal mortality rate was thus 130 per 1000 births with a stillbirth rate of 85 per 1000 births and an early neonatal mortality rate of 49 per 1000 live births. Stillbirths during the intrapartum period were twice as frequent as macerated stillbirths (2:1). Maternal factors significantly associated with perinatal deaths included chorioamnionitis, ruptured uterus, multiple gestation, medically induced delivery, prolonged labor, unbooked pregnancies, antepartum hemorrhage, and prolonged rupture of membranes. Antepartum hemorrhage was the strongest determinant of perinatal death. Significant neonatal determinants were multiple gestation, severe birth asphyxia, apnea, and necrotizing enterocolitis. Apnea was the strongest neonatal determinant. The majority (83.2%) of perinatal deaths were due to severe perinatal asphyxia (SPA) (54.5%), normally formed macerated stillbirths (20.3%), and immaturity (8.4%).In conclusion, Perinatal Mortality in Katsina metropolis in northwest Nigeria is unacceptably high as we approach the timeline for the millennium development goals. Antepartum hemorrhage and SPA are major determinants.
- Contribution of antepartum and intrapartum hemorrhage to the burden of maternal near miss and death in a national surveillance study. [JOURNAL ARTICLE]
- Acta Obstet Gynecol Scand 2014 Oct 18.
To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.Multicenter cross-sectional study.Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.A total of 9555 women categorized as having obstetric complications.The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.