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antepartum hemorrhage [keywords]
- Time-to-Delivery after Maternal Transfer to a Tertiary Perinatal Centre. [Journal Article]
- Biomed Res Int 2014.:325919.
Objectives.To determine, in women transferred antenatally for acute admission with high risk pregnancies, the numbers who deliver, the average time from transfer to delivery, and whether the reason for transfer influences the time-to-delivery. Methods. A retrospective analysis of time-to-delivery was performed in a population of women transferred to the Royal Brisbane and Women's Hospital, QLD. Data were obtained from the hospital obstetric, neonatal, and admission databases.
Results.A total of 941 women were transferred antenatally with high risk pregnancies where delivery was deemed potentially imminent. Of these 821 (87%) delivered at RBWH. The remaining 120 women (13%) were discharged prior to delivery and then delivered elsewhere. Of the 821 maternal transfers that delivered, the median time to delivery was 24.4 hrs. There were 43% who delivered within 24 hours of admission and 29% who either delivered after 7 days or delivered elsewhere. Most transfers for fetal abnormality delivered in the first 24 hours while most transfers for antepartum haemorrhage and preterm prelabour membrane rupture delivered beyond 24 hours.
Conclusion.There are significant differences in time-to-delivery following transfer depending on the reason for transfer and many infants transferred in utero will not deliver imminently.
- [Clinical analysis and follow-up of neonatal purulent meningitis caused by group B streptococcus]. [English Abstract, Journal Article]
- Zhonghua Er Ke Za Zhi 2014 Feb; 52(2):133-6.
To study the clinical characteristics, antibiotics sensitivity and outcome of group B streptococcus (GBS) meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.A retrospective review was performed and a total of 13 cases of neonatal purulent meningitis caused by GBS were identified in the Neonatal Intensive Care Unit of Yuying Children's Hospital of Wenzhou Medical University from January 1, 2005 to May 31, 2013. The clinical characteristics, antibiotics sensitivity test results and outcome were analyzed.Fever, poor feeding, seizure and lethargy were common clinical signs of neonatal purulent meningitis caused by GBS. Three cases of early onset GBS meningitis received prepartum antibiotics. All 13 cases had abnormal C-reactive protein (CRP) level, and 11 cases had increased CRP within hours after admission. Of the 13 patients, 7 were cured, 4 discharged with improvement, 2 patients died during hospitalization after being given up because of serious complication. The average length of stay for recovered patients was (47 ± 21)d. Acute complications mainly included hyponatremia (5 cases), intracranial hemorrhage (3 cases) , ventriculomegaly (3 cases) , subdural collection (2 cases) , hydrocephalus (2 cases), septic shock (2 cases), cerebral hernia (1 case), encephalomalacia (1 case). One preterm patient with early onset GBS meningitis died 1 month after hospital discharge. Among 7 survivors with 10-24 months follow-up, 3 were early onset GBS meningitis, 2 with normal results of neurologic examination, 1 with delayed motor development, 4 were late onset GBS meningitis, 1 with normal results of neurologic examination, 3 were neurologically impaired with manifestations including delayed motor development (2 cases) and seizures (1 case). All the GBS strains were sensitive to penicillin and linezolid (13/13, 10/10), the susceptibility to levofloxacin, ampicillin and vancomycin were 11/12, 9/10, 8/13 respectively.The clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific. It is associated with long hospitalization, neurological impairments and sequelae. Monitoring of serum CRP level is valuable for early diagnosis. Antepartum prophylaxis, early diagnosis and therapy are vital. Large dose penicillin is the priority choice to treat the neonatal purulent meningitis caused by GBS, linezolid should be used in intractable cases.
- An audit to review the characteristics and management of placenta praevia at Aberdeen Maternity Hospital, 2009-2011. [JOURNAL ARTICLE]
- J Obstet Gynaecol 2014 Apr 4.
Placenta praevia (PP) is an important cause of maternal and fetal morbidity. We reviewed the characteristics and management of PP at the Aberdeen Maternity Hospital (AMH) to evaluate performance. In the years 2009-2011, a total of 60 cases with confirmed PP underwent caesarean section (CS) at the AMH. Two-fifths of cases had previous CS and two-thirds were posterior praevias. Four-fifths were major praevias. Diagnosis was mostly by trans-abdominal scanning (TAS). A little less than two-thirds underwent hospital admission (half of them for antepartum haemorrhage). Most received steroid and ferrous sulphate as appropriate. The majority were delivered at greater than 36 weeks' gestation. There was good support in theatre by senior obstetricians and anaesthetists. Cell salvage was used in theatre. Overall, the outcomes were good. Improvements could be made on documentation of counselling preoperatively and practice of trans-vaginal scans (TVS) to confirm low lying placentae even at ta 20-week scan for better diagnosis, as per the RCOG guidelines.
- Advanced maternal age and obstetric outcome. [Journal Article]
- Nepal Med Coll J 2013 Jun; 15(2):87-90.
Advanced maternal age defined as age 35 years or more at estimated date of delivery is considered to have higher incidence of obstetric complications and adverse pregnancy outcome than younger women. The objective of this study was to compare the obstetric and perinatal outcome of pregnancies in women with advanced maternal age > or = 35 years with that of younger women < 35 years. A prospective comparative study was carried out in department of obstetrics and gynecology at Nepal Medical College and Teaching Hospital over the period of one year from October 2012 to September 2013. The obstetric and perinatal outcome of 90 women with advanced maternal age (study group) were compared with those of 90 younger women aged 20-34 years (control group). Among antenatal complications, women of advanced maternal age had increased incidence of hypertensive disorder of pregnancy (26.6% vs 4.4%; p = 0.00009) and breech presentation (8.8% vs 1.1%; p = 0.04). There were no significant difference between two groups in incidence of antepartum hemorrhage, gestational diabetes mellitus, prelabor rupture of membrane and preterm delivery. The rate of caesarean delivery was significantly higher in advanced maternal age (28.8% vs 17.7%; p = 0.05). In perinatal outcome, older women had significantly higher incidence of perinatal death (7.7% vs 0%; p = 0.01). There were no significant differences in low birth weight rate and apgar score less than 7 at five minutes of life in two groups. Thus from this study, it can be concluded that advanced age women had higher incidence of hypertensive disorder of pregnancies and malpresentation, were more likely to deliver by caesarean section and had increased incidence of perinatal death.
- [Application of three kinds of non-invasive positive pressure ventilation as a primary mode of ventilation in premature infants with respiratory distress syndrome: a randomized controlled trial]. [English Abstract, Journal Article]
- Zhonghua Er Ke Za Zhi 2014 Jan; 52(1):34-40.
Non-invasive positive pressure ventilation has increasingly been chosen as the primary ventilation mode in respiratory distress syndrome (RDS) in preterm infants. In order to further understand the application of various non-invasive positive pressure ventilation modes, we compared the advantages and disadvantages of three modes as a primary mode of ventilation in premature infants with RDS.From December 2011 to March 2013, 107 preterm infants with RDS who received intubation-pulmonary surfactant (PS) -extubation in our NICU were randomly divided (by means of random number table) into three groups based on the primary mode of ventilation: nasal continuous positive airway pressure [NCPAP, n = 39, male/female ratio was 27/12, mean gestational age (GA) was (32.0 ± 2.1)weeks, mean birth weight (BW) was (1752 ± 457)g], bi-level positive airway pressure [BiPAP, n = 35, male/female ratio was 25/10, GA was (31.4 ± 2.0) weeks, BW was (1530 ± 318) g], and synchronized bi-level positive airway pressure [SBiPAP, n = 33, male/female rate was 25/8, GA was (31.5 ± 2.2) weeks, BW was (1622 ± 447) g]. Ventilation settings including FiO(2) were adjusted according to transcutaneous SPO(2) monitoring or blood gas analysis. Various settings and adverse events were recorded as well. The main parameter was the FiO(2) at 24 h post-positive-pressure ventilation. Statistical analyses were performed using χ(2) test, rank sum test, one-way analysis of variance for least-significant difference value, paired-sample t-test, two related sample Wilcoxon signed rank sum test and Logistic regression.The PaCO(2) (mmHg, 1 mmHg = 0.133 kPa), oxygen index (OI) at 12-24 h, and FiO(2) at 24 h post-ventilation in BiPAP and SBiPAP groups were lower than that in NCPAP groups with significant difference (44 ± 9 and 45 ± 9 vs. 50 ± 9, 2.76 ± 0.96 and 2.79 ± 0.60 vs. 3.24 ± 0.72, 0.34 ± 0.10 and 0.35 ± 0.07 vs. 0.39 ± 0.07; F = 4.456, 5.146 and 4.123; P = 0.014, 0.007 and 0.019, respectively). There was no significant difference between BiPAP and SBiPAP groups. There was no significant difference among three groups (all P > 0.05) in the following events: respiratory index (RI) at 12-24 h post-ventilation, abdominal distension, period of non-invasive ventilation, ratio of intubation for invasive ventilation if failed noninvasive ventilation, air-leak syndrome, neonatal necrotizing enterocolitis, periventricular-intraventricular haemorrhage, bronchopulmonary dysplasia, retinopathy of prematurity, mortality rate after 36 h of age or rate of abandon for discharge. The independent risk factors for failure of non-invasive positive pressure ventilation were gender, gestational age, antepartum steroid at 24 h before birth to 7 d, and birth weight, with the OR (95% confidence interval) being 14.120 (1.135, 175.662), 2.862 (1.479, 5.535), 61.084 (3.115, 1 198.031), and 8.306 (1.488, 46.383), respectively.As the primary mode of ventilation in premature infants with RDS, both BiPAP and SBiPAP are more beneficial than NCPAP in improving oxygenation and reducing CO(2) retention without increasing the incidence of adverse events.
- Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea. [JOURNAL ARTICLE]
- Trop Doct 2014 Mar 25.
We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea.
- The relationship between umbilical cord estrogens and perinatal characteristics: implications for early life origins of reproductive cancers. [JOURNAL ARTICLE]
- Cancer Epidemiol Biomarkers Prev 2014 Mar 17.
Background:Prenatal estrogen exposure is thought to contribute to later life diseases such as breast cancer. However, few studies have directly measured prenatal estrogens and most have relied on proposed "markers" of estrogen exposure. We used a large population-based birth cohort to directly measure the relationship between prenatal estrogens and perinatal characteristics, including putative markers of estrogen exposure. Methods:Total estrone (E1), estradiol (E2), estriol (E3) and estetrol (E4) were assayed by LC-MS/MS from archived mixed arterial and venous serum from 860 umbilical cord blood samples. Results:Values for all estrogens were strongly intercorrelated. Cord estrogen concentrations did not differ between males and females. Levels of all estrogens were reduced in twins and concentrations increased with gestational age. Neither E1 nor E2 were correlated with birth weight, but E3 and E4 levels correlated weakly, while onset of labor was associated with higher estrogen concentrations. E1 and E2 concentrations were not associated with preeclampsia in the current pregnancy, but E3 and E4 concentrations were lower in pregnancies complicated by preeclampsia and antepartum hemorrhage. Conclusions:Umbilical cord estrogen concentrations vary with gestational age, mode of delivery, pregnancy complications and twinning, but not with infant sex. Putative markers of prenatal estrogen exposure, preeclampsia and birth weight, did not correlate with direct fetal measures of the most potent estrogen (E2) but were associated with weaker estrogens (E3 and E4). Twins had lower concentrations of all estrogens.
- Intimate partner violence and the association with very preterm birth. [Journal Article]
- Birth 2013 Mar; 40(1):17-23.
Intimate partner violence is a major public health problem. It occurs commonly in pregnancy, resulting in adverse events for women and their fetus or children. The objective of this study was to examine the association between intimate partner violence and very preterm birth.This population-based, case-control study was conducted in Victoria, Australia, from 2002 to 2004. Interviews were conducted with 603 women who had a singleton very preterm birth (20-31 weeks' gestation), 770 women who had a singleton term birth (37 or more completed weeks' gestation), 139 women who had a very preterm twin birth, and 214 women who had a term twin birth. Intimate partner violence was measured using the Composite Abuse Scale, and questions were also asked about fear of partners and violence from others.Prevalence of intimate partner violence in the past 12 months was 14.9 percent in singleton case women, 11.7 percent in singleton control women, 9.5 percent in twin case women, and 14.7 percent in twin control women. Fear of a previous partner and reporting similar violence experience with someone else were more likely in singleton births (AOR = 1.36; 95% CI 1.03, 1.79) and (AOR = 1.44; 95% CI 1.12, 1.86), respectively. No differences between twin case women and twin control women were observed. When the precipitating cause of very preterm birth was investigated, antepartum hemorrhage was significantly associated with intimate partner violence and all its subscales.The heterogeneity of causes of very preterm birth may explain the lack of association found with intimate partner violence in pregnancy. Pregnant women have a significant risk of intimate partner violence, which should be a serious concern for all care providers. (BIRTH 40:1 March 2013).
- Acute renal failure in pregnancy: our experience. [Journal Article]
- Saudi J Kidney Dis Transpl 2014 Mar; 25(2):450-5.
Acute renal failure (ARF) is a serious medical complication during pregnancy, and, in the post-partum period, is associated with significant maternal morbidity and mortality as well as fetal loss. The objective of our study is to find the etiology and maternal outcome of ARF during pregnancy. The study was conducted at the Obstetrics and Gynecology Department of the Institute of Kidney Disease and Research Center, Ahmedabad, India from January 2009 to January 2011. Fifty previously healthy patients who developed ARF, diagnosed on oliguria and serum creatinine >2 mg%, were included in the study. Patients with a known history of renal disease, diabetes and hypertension were excluded from the study. All patients were followed-up for a period of six months. Patient re-cords, demographic data, urine output on admission and preceding history of antepartum hemorrhage (APH), post-partum hemorrhage (PPH), septicemia, operative interventions and retained product of conception were noted and need for dialysis was considered. Patients were thoroughly examined and baseline biochemical investigations and renal and obstetrical ultrasound were performed on each patient and bacterial culture sensitivity on blood, urine or vaginal swabs were performed in selected patients. The age range was 19-38 years (mean 26 ± 3.8). The first trimester, second trimester and puerperal groups comprised of four (8%), 25 (50%) and 21 patients (42%), respectively. Hemorrhage was the etiology for ARF in 15 (30%), APH in ten (20%) and PPH in five (10%) patients. Eleven (22%) patients had lower segment cesarian section (LSCS) while 36 (78%) patients had normal vaginal delivery. In 20 (40%) patients, puerperal sepsis was the etiological factor, while pre-eclampsia, eclampsia and HELLP syndrome accounted for 18 (36%) patients. Two (4%) patients had disseminated intravascular coagulation on presentation while one (2%) patient was diagnosed with hemolytic uremic syndrome. Maternal mortality was 12% (n = 6). Of the 38 (88%) surviving patients, 21 (42%) had complete recovery of renal function, eight (16%) patients had partial and 15 (30%) patients required dialysis on a long-term basis. ARF in pregnancy is associated with poor maternal and renal outcome if not detected and treated in time.
- Maternal pre-gravid body mass index and obstetric outcomes in twin gestations. [JOURNAL ARTICLE]
- J Perinatol 2014 Mar 6.
Objective:The aim of this study is to evaluate the impact of maternal pre-gravid and/or first trimester overweight and obesity, and the adverse obstetrics outcome in twin pregnancies.Study design:This is a retrospective study of women who delivered viable twins after 23 weeks of gestation with available prepregnancy body mass index (BMI) and/or were at their earliest visit during the first trimester of pregnancy in the period 2007-2011. The patients were divided into four subgroups according to their BMI (underweight, normal weight, overweight and obese) according to the WHO classification and their outcomes were compared. Obstetrical outcomes of interest including gestational diabetes, gestational hypertension, preterm birth, antepartum hemorrhage, intrahepatic cholestasis of pregnancy, method of delivery and neonatal intensive care unit (NICU) admission were all studied and compared.Result:Electronic records of 1228 pregnant subjects who delivered twins were abstracted. Five hundred and four patients with twin gestations with available BMI were identified (underweight BMI<18.5% (n=22), normal weight BMI 18.5-24.9% (n=260), overweight 25-29.9% (n=114) and obese 30% (n=108)). Obstetric complications occurred more often in the overweight and obese groups as compared with the normal weight group. There was an increased risk of gestational diabetes in overweight and obese women (odds ratio (OR), 3.3; 95% confidence interval (CI) 1.52-7.3; P=0.001) and (OR, 3.2; 95% CI, 1.41-7.1; P=0.002), respectively. There was an increased risk of gestational hypertension in the obese group compared with the normal weight group (OR, 2.29; 95% CI, 1.1-4.7; P=0.02) but not in the overweight group (OR, 1.71; 95% CI, 0.8-3.6; P=0.1). In addition, an increased risk of very preterm delivery (<32 weeks) in the overweight group and obese groups was seen when compared with the normal weight group (OR, 2.2; 95% CI, 1.18-4.20; P=0.014 and OR, 2; 95% CI, 1.024-3.91; P=0.04, respectively). Increased rate of cesarean section in the obese group was seen when compared with the normal weight group (OR, 2; 95% CI, 1.2-3.4; P=0.006). Risks of antepartum hemorrhage, intrahepatic cholestasis and NICU admission were similar between the groups.Conclusion:In addition to the known obstetrics complications associated with twin gestations, the pregnancy outcomes in twins are further adversely influenced by increased maternal prepregnancy BMI.Journal of Perinatology advance online publication, 6 March 2014; doi:10.1038/jp.2014.29.