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antepartum hemorrhage [keywords]
- Authors' reply: Unexplained antepartum haemorrhage - a risk factor for preterm labour and delivery. [Letter]
- BJOG 2014 Oct; 121(11):1447.
- Unexplained antepartum haemorrhage - a risk factor for preterm labour and delivery. [Letter]
- BJOG 2014 Oct; 121(11):1446.
- Asymptomatic "placental prolapse" with cervical funneling in a patient with complete placenta previa. [JOURNAL ARTICLE]
- J Clin Ultrasound 2014 Sep 15.
We describe the transvaginal sonographic findings in a patient with complete placenta previa and increased risk of preterm birth owing to a prior history of mid-trimester pregnancy loss in whom we observed a short cervix and prolapse of the placenta and fetal membranes into the endocervical canal. We believe that this could lead to antepartum hemorrhage and mandate close observation when diagnosed. We introduced the term "placental prolapse" to describe our finding. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014.
- Evaluating the Safety of Labour in Women With a Placental Edge 11 to 20 mm From the Internal Cervical Os. [Journal Article]
- J Obstet Gynaecol Can 2014 Aug; 36(8):674-7.
The purpose of this study was to evaluate pregnancy outcomes in a cohort of women with a placental edge between 11 and 20 mm from the internal cervical os, and to determine the likelihood of a successful vaginal delivery when trial of labour is attempted in these women.We carried out a prospective observational study of women with singleton pregnancies and a placental edge between 11 and 20 mm from the internal cervical os (identified by transvaginal sonography) who underwent a trial of labour.Fourteen women with the above characteristics underwent a trial of labour during the study period. The mean interval (± SD) from ultrasound to delivery was 17.2 ± 9.6 days. Thirteen women (92.9%) delivered vaginally with no complications, and only one woman (7.1%) required an emergency Caesarean section for intrapartum bleeding. The risks of antepartum and postpartum hemorrhage were 21.4% and 14.3%, respectively.Having a placental edge more than 10 mm from the internal os, measured by transvaginal sonography near term, justifies allowing a trial of labour and carries a low risk of subsequent obstetrical hemorrhage.
- Elderly primigravidae versus young primigravidae: a review of pregnancy outcome in a low resource setting. [Journal Article]
- Niger J Med 2014 Jul-Sep; 23(3):220-9.
The elderly primigravida is defined as a woman who goes into pregnancy for the first time at the age of 35 years or older. Progressively, this has become more common in our contemporary society and traditionally such pregnancy is regarded as high risk.This was to determine and compare the pregnancy outcomes in elderly primigravidae aged 35 years and above with those of young primigravidae aged 20-25 yearsThe pregnancy outcomes of 82 elderly primigravidae (study group) with a singleton gestation, who delivered in the Teaching Hospital from 1st July, 2005 to 30th June, 2010 were compared with those of 131 young primigravidae (control group) who delivered during the same period in the same hospital.During the study period, there were 3,189 deliveries, given an incidence of elderly primigravidity as 2.6% or 1 in 39 deliveries. The mean age of the study group and control group were 36.4 +/- 0.9 years and 23.1 +/- 1.6 years respectively. The incidence of anaemia, antepartum haemorrhage, hyperemesis gravidarum, malpresentation, intrauterine growth restriction, diabetes mellitus and fibroid were statistically higher in the elderly primigravidae than in the control (p < 0.05). Cephalopelvic disproportion, prolonged second stage, fetal distress and primary post partum haemorrhage were also statistically higher (p < 0.05) including the caesarean section (53.7%) and episiotomy rates (94.6%).Elderly primigravida remains a high risk pregnancy and the incidence is high. They were significantly associated with adverse pregnancy outcomes and operative obstetric interventions. Early booking and more obstetric vigilance shall improve their pregnancy outcomes.
- Stillbirth rates among indigenous and non-indigenous women in Queensland, Australia: is the gap closing? [JOURNAL ARTICLE]
- BJOG 2014 Sep 3.
To determine whether the disparity gap is closing between stillbirth rates for indigenous and non-indigenous women and to identify focal areas for future prevention efforts according to gestational age and geographic location.Population-based retrospective cohort study.Queensland, Australia.All singleton births of at least 20 weeks of gestation or at least 400 g birthweight.Routinely collected data on births were obtained for the period 1995 to 2011. Indigenous and non-indigenous stillbirth rates and percent reduction in the gap were compared over time and by geographic location and gestational age.All-cause and cause-specific stillbirth rates (per 1000 ongoing pregnancies).Over the study period there was a 57.3% reduction in the disparity gap. Although marked reductions in the gap were shown for women in regional (57.0%) and remote (56.1%) locations, these women remained at increased risk compared with those in urban regions. There was no reduction for term stillbirths. Major conditions contributing to the disparity were maternal conditions (diabetes) (relative risk [RR] 3.78, 95% confidence intervals [95% CI] 2.59-5.51), perinatal infection (RR 3.70, 95% CI 2.54-5.39), spontaneous preterm birth (RR 3.08, 95% CI 2.51-3.77), hypertension (RR 2.22, 95% CI 1.45-3.39), fetal growth restriction (RR 1.78, 95% CI 1.17-2.71) and antepartum haemorrhage (RR 1.58, 95% CI 1.13-2.22).The gap in stillbirth rates between indigenous and non-indigenous women is closing, but indigenous women continue to be at increased risk due to a number of potentially preventable conditions. There is little change in the gap at term gestational ages.
- Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae. [Journal Article]
- J Nat Sci Biol Med 2014 Jul; 5(2):425-8.
Abruptio placentae (AP) which is a major cause of maternal morbidity and perinatal mortality globally is of serious concern in the developing world. We retrospectively analyzed the AP cases and evaluated its impact on fetal and maternal outcomes.The present study was undertaken from September 2007-August 2009 at a tertiary care center attached to medical college; patients of AP were selected from all cases with minimum of 28 weeks of gestation, presenting with antepartum hemorrhage. Patients underwent complete obstetrical investigations and were managed according to maternal and fetal condition.4.4% incidence rate of AP was documented accounting for 318 cases during the study period. Most of cases were unbooked, with an average age of 34.5 years (range, 18-44) and nearly two-third of the patients were from lower socioeconomic class. Anemia was observed in 96% of patients, with 3.5 and 68% incidence of maternal and fetal mortality, respectively.We observed a higher than expected frequency of AP and neonatal mortality in our study population, which is of major concern. We envisage need for mass information regarding the importance of antenatal maternal care and improvement in nutritional status, which may reduce the frequency of maternal and fetal morbidity and mortality associated with AP.
- Pregnancy Complications and Adverse Birth Outcomes Among Women With Celiac Disease: A Population-Based Study From England. [JOURNAL ARTICLE]
- Am J Gastroenterol 2014 Aug 5.
OBJECTIVES:Evidence-based information about adverse birth outcomes and pregnancy complications is crucial when counseling women with celiac disease (CD); however, limited population-based data on such risks exist. We estimated these for pregnant women with CD diagnosed before and after delivery.METHODS:We included all singleton pregnancies between 1997 and 2012 using linked primary care data from the Clinical Practice Research Datalink and secondary care Hospital Episode Statistics data. Risks of pregnancy complications (antepartum and postpartum hemorrhage, pre-eclampsia, and mode of delivery) and adverse birth outcomes (preterm birth, stillbirth, and low birth weight) were compared between pregnancies of women with and without CD using logistic/multinomial regression. Risks were stratified on the basis of whether women were diagnosed or yet undiagnosed before delivery.RESULTS:Of 363,930 pregnancies resulting in a live birth or stillbirth, 892 (0.25%) were among women with CD. Diagnosed CD was not associated with an increased risk of pregnancy complications or adverse birth outcomes compared with women without CD. However, the risk of postpartum hemorrhage and assisted delivery was slightly higher among pregnant women with diagnosed CD (adjusted odds ratio (aOR)=1.34). We found no increased risk of any pregnancy complication among those with undiagnosed CD. We only observed a 1% absolute excess risk of preterm birth and low birth weight among undiagnosed CD mothers corresponding to aOR=1.24 (95% confidence interval (CI)=0.82-1.87) and aOR=1.36 (95% CI=0.83-2.24), respectively.CONCLUSIONS:Whether diagnosed or undiagnosed during pregnancy, CD is not associated with a major increased risk of pregnancy complications and adverse birth outcomes. These findings are reassuring to both women and clinicians.Am J Gastroenterol advance online publication, 5 August 2014; doi:10.1038/ajg.2014.196.
- Consecutive cervical length measurements as a predictor of preterm cesarean section in complete placenta previa. [JOURNAL ARTICLE]
- J Clin Ultrasound 2014 Jul 5.
To evaluate whether consecutive cervical length measurements can predict preterm cesarean section in women with complete placenta previa.Seventy-one women with complete placenta previa were retrospectively categorized into women who delivered preterm due to massive hemorrhage (the preterm cesarean section group, n = 28) and those delivered at term (the control group, n = 43). Maternal characteristics, delivery outcomes, and cervical lengths serially measured at least every 2 weeks from 24 weeks' gestation until delivery were compared. The relationship between cervical length and preterm cesarean section was analyzed.Cervical length gradually decreased with advancing gestational age. After 26 weeks' gestation, this decrease was significantly more rapid in the preterm cesarean section group. Cervical length before cesarean section in the preterm cesarean section group was significantly shorter than that in the control group. Just before cesarean section, 71.4% of the preterm cesarean section group presented with cervical lengths of ≤35 mm, whereas only 34.9% of the control group had cervical lengths of ≤35 mm (odds ratio 4.67, 95% confidence interval 1.66-13.10, p = 0.006).In women with complete placenta previa, decrease in cervical length to ≤35 mm was associated with increased risk of preterm cesarean section due to massive hemorrhage. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound, 2014.
- Intrapartum obstetric management. [Journal Article]
- Semin Perinatol 2014 Aug; 38(5):245-51.
Maternal cardiac disease complicates approximately 1-2% of all pregnancies in the United States. Just as during the antepartum period, in the immediate period surrounding delivery, obstetrical patients with cardiac disease (both congenital and acquired) will have specialized needs, tailored to the patient and her specific lesion. While the basic principles of labor and delivery management protocols are relevant to this subgroup of patients, there are certain areas in which adjustments must be made. These include endocarditis prophylaxis, recent anticoagulation, fluid management, and the need for increased maternal cardiac monitoring. Awareness of the challenges of the intrapartum period combined with a multi-disciplinary approach from anesthesia, cardiology, and the obstetrical provider will optimize the patient for a safe delivery.