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antepartum hemorrhage [keywords]
- 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.
- PMM.73 Arteriovenous Malformation of the Vulva Presenting in Pregnancy: A Case Report. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A146.
We present a rare case of arteriovenous malformation of the vulvaA woman presented at 28 weeks gestation with recurrent episodes of antepartum haemorrhage seen on her clothes. On pelvic examination, there was no evidence of bleeding and the vagina and cervix were found to be completely normal. Multiple examinations by different doctors over 48 h revealed no source of bleeding. A large episode of painless active bleeding of approximately 500ml of blood prompted a decision to proceed to caesarean section as blood was pooling within the vagina. Following spinal anaesthetic and reassessment, a pulsatile 3 × 3mm vulval lesion was seen "spurting" blood and was excised. A caesarean section was not carried out. Histology confirmed an arteriovenous malformation.Vulval Arteriovenous malformations are very rare and only a handful of cases have been presented in the literature. Due to their rarity and atypical presentation, diagnosis can be very difficult and easily missed, especially when complicated by pregnancy. This case clearly demonstrates this.
- 8.10 Cranial ultrasound findings suggest that the injury pathway may begin many hours before delivery in encephalopathic infants in Uganda. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A14-5.
: In sub-Saharan Africa, the timing and nature of brain injury and their relation to mortality in neonatal encephalopathy (NE) is unknown.To evaluate cranial ultrasound (cUS) scans from term Ugandan infants with NE and unaffected controls for evidence of established/evolving brain injury.Infants were recruited to a case-control study at Mulago Hospital, Kampala. Cases had NE (score(1) >5). Controls were randomly selected unaffected term infants. All had cUS scans <36 h; surviving cases had day 4/5 scans. Minimally 11 views were reported blind to NE status. Scan injury definitions were evolving: extensive white matter (WM) and/or bilateral basal ganglia-thalamic (BGT) echogenicity and established: parenchymal cysts, atrophy, organising haemorrhage.Early scans showed significant abnormality in 20.4% (35/172) cases vs 1.0%(1/99) controls (p < 0.0001, mean age 11.2 h/8.1 h, respectively). Case scans at <18 h (120) still showed a high prevalence of abnormalities (16.7%). Case infants had 9.3% WM injury alone, 6.4% BGT injury alone and 4.7% BGT/WM injury. No established injury was seen. Fatality was significantly higher in cases with early cUS abnormalities vs those without (57.1%(20/35) vs 25.9%(35/135); OR 3.81(95% CI 1.76-8.25)). Serial scans were done in 88 mostly surviving NE infants; 74 had normal early scans with 35(47.3%) becoming abnormal by day 4/5.The high proportion of infants with early cUS abnormality plus absence of established antepartum injury implies the injury pathway often begins several hours before delivery in this population, with implications for therapeutic interventions considered effective early in the injury pathway. Early cUS abnormality in NE was a significant predictor for death.Thompson, et al. Acta Paediatr 1997 van Wezel-Meijler, et al. Neuropediatrics 2007.
- Rates and indicators for amniotomy during labor--a descriptive cross sectional study between primigravidas and gravida 2 and above. [Journal Article]
- Med Arch 2014; 68(2):110-2.
Artificial rupture of membranes (Amniotomy) is a common obstetric intervention. Its rates and indications had been subjected to criticism in medical literature. The current practices recommend to reduce its rate and keep the birthing process as natural as possible.This observational study aimed to describe the rates and indicators for practice of artificial rupture of membranes (Amniotomy) during normal labor and to determine if any significant differences existed between women who have had one pregnancy (PG) and women who have already delivered two or more children (G2 and above) on this obstetric interventions: artificial rupture of membranes (ARM).There were no PG participants with ruptured membranes whereas slightly more than half of the G2 and above participants (n = 88) had ruptured membranes. The most frequent cause for ARM was active management of latent phase of labor (PG n = 20 and G2 and above n = 9). Furthermore, slow progress of labor (PG n = 17 and G2 and above n = 7) and concerns with fetal heart rate (PG n = 13 and G2 and above n = 5) had the next highest number of occurrences. Results from the proportions tests revealed that there was one significant difference between gravidity groups on the frequency of APH (p = 0.039). That is, G2 and above participants had amniotomy done for APH (5 of 32 = 15.63%) significantly more often than PG participants (4 of 89 = 4.49%). And although not statistically significant (p = 0.084), there were 21 cases within the PG group where ARM was performed for no specific reason (21 of 89 = 23.6%) compared to three cases within the G2 and above group (3 of 32 = 9.4%).Although ARM is a commonly performed procedure during labor, there is not much difference between its indications between PG and G2 and above. The only significantly different indication was antepartum hemorrhage which was higher in G2 and above. Amniotomy was also performed without any clear indication in 26.4% of PG and 9.4% of G2 and above. Considering ARM as obstetric intervention efforts should be done to reduce its rates. There is a need for arranging normal labor workshops to revise the indications and reviewing the rates after these workshops to reduce the rates of ARM.
- Uterine artery embolization: exploring new dimensions in obstetric emergencies. [Journal Article]
- Oman Med J 2014 May; 29(3):217-9.
The role of transcatheter arterial embolization in the management of obstetric emergencies is relatively new and not so commonly used. In the following series, the efficacy of this technique in situations such as scar site ectopic pregnancy, antepartum and postpartum obstetric hemorrhage, especially in the presence of coagulation derangement is presented.
- Anesthetic practice for Caesarean section and factors influencing anesthesiologists' choice of anesthesia: a population-based study. [JOURNAL ARTICLE]
- Acta Anaesthesiol Scand 2014 Jun 4.
We examined the change in anesthetic practice for Caesarean section (CS) during the past decade and determined factors influencing anethesiologists' decisions.The cases were identified from data retrieved from Longitudinal Health Insurance Database released by the Taiwan National Health Research Institute in 2008. Trend analysis was performed using logistic regression models. The decision tree analysis was performed using the chi-squared automatic interaction detector method and multivariable logistic regression analysis was performed to identify predictors of general anesthesia.A total of 25,606 women undergoing CS were studied. Logistic regression analyses revealed an upward trend of spinal anesthesia from 2000 to 2008 [57.8-67.5%, adjusted odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.05-1.07, P < 0.001] and a decreasing trend across time for both general and epidural anesthesia (5.5-3.9% and 36.7-28.6%; both OR < 1, both P < 0.001). Patterns of change in anesthetic practice across time for emergency and non-emergency CS were similar (all P < 0.05). Our data further demonstrated that early or threatened labor, a history of preeclampsia, antepartum hemorrhage, emergency CS, and previous CS were important predictors that influenced the anesthesiologists' choice of general anesthesia versus neuraxial anesthesia for women undergoing CS.Spinal anesthesia was the most common mode of anesthesia for CS deliveries in Taiwan during the past decade. Early or threatened labor, antepartum hemorrhage, emergency CS, previous CS, and preeclampsia are significant determinants of general anesthesia in CS deliveries.
- Outcome of singleton preterm small for gestational age infants born to mothers with pregnancy induced hypertension. A population based-study. [JOURNAL ARTICLE]
- J Matern Fetal Neonatal Med 2014 May 29.:1-26.
Abstract Background: Pregnancy induced hypertension (PIH) has been associated with a decreased risk of infant mortality in small for gestational age (SGA) preterm infants. Objective: To evaluate the influence of PIH on mortality and major neonatal morbidities in singleton preterm SGA infants, in the presence and absence of acute pregnancy complications. Methods: Population-based observational study of singleton SGA infants, born at 24 to 32 weeks gestation in the period 1995-2010 (n=2139). Multivariable logistic regression analyses were used to assess the independent effect of PIH on mortality and neonatal morbidities. Acute pregnancy complications comprised premature labour, premature rupture of membranes >6 hours, antepartum haemorrhage and clinical chorioamnionitis. Results: In the absence of pregnancy complications the odds ratio (95% confidence interval) for mortality (0.77; 0.50-1.16), survival without severe neurological morbidity (1.14; 0.79-1.65) and survival without bronchopulmonary dysplasia (BPD) (0.85; 0.59-1.21) were similar in the PIH vs. no-PIH groups. In the presence of pregnancy complications, mortality (0.76; 0.40-1.44), survival without severe neurological morbidity (1.16; 0.64-2.12) and survival without BPD (1.04; 0.58-1.86) were also similar in the PIH vs. no-PIH groups. Conclusions: PIH was not associated with improved outcome in preterm SGA infants, both in the presence and absence of acute pregnancy complications.