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antepartum hemorrhage [keywords]
- 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.
- The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register-based cohort study in Aberdeen, Scotland. [JOURNAL ARTICLE]
- BJOG 2013 Oct 22.
To determine whether termination of pregnancy (TOP), including the method used or gestational age at termination, affects future obstetric and perinatal outcomes.Register-based cohort.Aberdeen Maternity Hospital, Scotland, UK.From the Aberdeen Maternity and Neonatal Databank (AMND) we identified 3186 women who had terminated their first pregnancy and then had a second pregnancy of beyond 24 weeks of gestation between 1986 and 2010. We identified 42 446 women who had their first delivery in the same time period, for comparison.Univariate and multivariate logistic regression was used to compare outcomes between groups. Complete case analysis with adjustment of confounding factors was carried out, and adjusted odds ratios (aORs) with 99% confidence intervals are presented.The primary outcome was spontaneous preterm delivery (SPTD).No statistically significant association was found between TOP in the first pregnancy and SPTD in the next pregnancy (aOR 1.05; 99% CI 0.83-1.32). Neither medical (aOR 1.03; 99% CI 0.72-1.46) nor surgical (aOR 1.06; 99% CI 0.78-1.44) termination appeared to affect the risk of spontaneous preterm delivery in the subsequent pregnancy. Late termination (≥13 weeks of gestation) did not appear to increase the risk of spontaneous preterm delivery compared with early termination (<13 weeks of gestation) (aOR 1.65; 99% CI 0.94-2.92), nor compared with primigravid women (aOR 1.25; 99% CI 0.97-1.62). There was an associated increased risk of antepartum haemorrhage in the next pregnancy following TOP (P < 0.01; aOR 1.26; 99% CI 1.10-1.45).Evidence on obstetric and perinatal outcomes following TOP remains conflicting. This study suggests that TOP is not associated with an increased risk of spontaneous preterm delivery. Neither the method nor the gestational age of TOP has any effect on this lack of association.
- Maternal and perinatal consequences of antepartum haemorrhage of unknown origin. [JOURNAL ARTICLE]
- BJOG 2013 Oct 15.
To explore the risk of adverse maternal and perinatal outcomes in women with antepartum bleeding of unknown origin (ABUO).Cohort study based on data extracted from the Aberdeen Maternity and Neonatal Databank. Exposure was antepartum haemorrhage occurring after the first trimester not attributable to placenta praevia or placental abruption.Aberdeen Maternity Hospital, Aberdeen, Scotland, UK.All primigravidae delivering between 1976 and 2010.Data were analysed using univariate and multivariate statistical methods.Pre-eclampsia, induced labour, mode of delivery, preterm delivery, postpartum haemorrhage, admission to neonatal unit, perinatal death.Between 1976 and 2010, there were 7517 women with ABUO and 68 423 women without ABUO in the cohort. Women with ABUO were more likely to be non-smokers, belong to a lower social class, and have a higher body mass index. ABUO was a significant risk factor for induced labour (adjusted odds ratio, aOR, 1.23; 95% CI 1.16-1.31), preterm delivery at <37 weeks of gestation (aOR 2.30; 95% CI 2.11-2.50), and postpartum haemorrhage (aOR 1.15; 95% CI 1.06-1.25). There was no significant association detected with pre-eclampsia (aOR 0.93; 95% CI 0.83-1.05). Whereas there was an increased risk of low birthweight (aOR 0.90; 95% CI 0.79-1.03) and stillbirth (aOR 0.92; 95% CI 0.66-1.30) with ABUO on univariate analysis, once adjusted for confounding factors this risk was non-significant.Pregnancies complicated by ABUO are at a greater risk of preterm delivery and induced labour. There was no increase seen in perinatal mortality after adjusting for preterm birth.
- The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. [JOURNAL ARTICLE]
- J Matern Fetal Neonatal Med 2013 Oct 22.
Abstract Objective: To investigate if maternal asthma is associated with an increased risk of maternal and placental complications in pregnancy. Methods: Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Cohort studies published between January 1975 and March 2012 were considered for inclusion. Forty publications met the inclusion criteria, reporting at least one maternal or placental complication in pregnant women with and without asthma. Relative risk (RR) with 95% confidence intervals (CIs) was calculated. Results: Maternal asthma was associated with a significantly increased risk of cesarean section (RR = 1.31, 95%CI = [1.22-1.39]), gestational diabetes (RR = 1.39, 95%CI = [1.17-1.66]), hemorrhage (antepartum: RR = 1.25, 95%CI = [1.10-1.42]; postpartum: RR = 1.29, 95%CI = [1.18-1.41]), placenta previa (RR = 1.23, 95%CI = [1.07-1.40]), placental abruption (RR = 1.29, 95%CI = [1.14-1.47]) and premature rupture of membranes (RR = 1.21, 95%CI = 1.07-1.37). Moderate to severe asthma significantly increased the risk of cesarean section (RR = 1.19, 95%CI = [1.09-1.31]) and gestational diabetes (RR = 1.19, 95%CI = [1.06-1.33]) compared to mild asthma. Bronchodilator use was associated with a significantly lowered risk of gestational diabetes (RR = 0.64, 95%CI = [0.57-0.72]). Conclusions: Pregnant women with asthma are at increased risk of maternal and placental complications, and women with moderate/severe asthma may be at particular risk. Further studies are required to elucidate whether adequate control of asthma during pregnancy reduces these risks.
- Blood Glucose in Multiparous Women Influences Offspring Birth Size but not Size at 2 years of Age. [Journal Article]
- J Clin Endocrinol Metab 2013 Dec; 98(12):4916-22.
Background:Gestational diabetes is associated with increased birth size. Blood glucose concentrations within the nondiabetic range affect birth size but whether this influences postnatal growth is unclear.
Methods:We measured fasting blood glucose concentrations (FBG) in 1650 singleton Caucasian pregnancies at 12 and 28 weeks' gestation and related values to birth weight and weight at 12 and 24 months of age. Pregnancies complicated by antepartum hemorrhage, gestational diabetes, preeclampsia, and prematurity were excluded.
Results:Mean maternal age was 30 years and 49% were primiparous. There was a weak relationship between birth weight (z score) and FBG at 12 (r = 0.1; P = .006) and 28 (r = 0.1; P < .001) weeks. FBG at 12 and 28 were correlated (r = 0.3; P < .001). Mothers at 12 and 28 weeks of pregnancy with higher FBG were shorter and heavier. The relationship between FBG at 12 and 28 weeks and birth weight was not observed in primiparous women and FBG was not associated with weight at any postnatal time point.
Conclusions:These data suggest that in a low-risk United Kingdom pregnancy cohort FBG concentrations in the nondiabetic range affect birth weight in multiparous women. The effect is small (50 g change in birth weight/1 mmol/L FBG change) and does not persist into postnatal life. This implies a limited role for maternal glucose status within the normal range in determining size in infancy.
- Congenital factor XIII deficiency in women: a systematic review of literature. [Journal Article]
- Haemophilia 2013 Nov; 19(6):e349-57.
Factor XIII (FXIII) deficiency is a rare congenital bleeding disorder. There is a paucity of data in the literature about obstetrics and gynaecological problems in women affected by FXIII deficiency. The aim of this study was to examine gynaecological problems and obstetric complications and outcome in women with congenital FXIII deficiency. An electronic search was performed to identify the published literature on PUBMED, MEDLINE, EMBASE, Journals @OVID and CINAHL Plus databases using the following keywords: 'congenital factor XIII deficiency' AND 'women OR Pregnancy'. A total of 39 relevant articles were found and included in this systematic review; 27 case reports and 12 case series dating from 1964 to 2012. A total of 121 women were identified. Menorrhagia (26%) was the second most common bleeding reported after umbilical bleeding. Ovulation bleeding reported in 8% of women. Among 63 women, 192 pregnancies were reported; of these, 127 (66%) resulted in a miscarriage and 65 (34%) reached viability stage. In 136 pregnancies without prophylactic therapy, 124 (91%) resulted in a miscarriage and 12(9%) progressed to viability stage. Antepartum haemorrhage occurred in 5/65 (8%) pregnancies reaching viability stage while postpartum haemorrhage (PPH) seen in 16 (25%) cases. Women with congenital FXIII deficiency suffer significant bleeding complications. Menorrhagia and ovulation bleeding are common gynaecological problems and more prevalent than reported. Pregnancies in women with FXIII deficiency have a significant risk of miscarriage, placental abruption and PPH if not on prophylaxis treatment.
- Retrospective cohort study of the effects of obesity in early pregnancy on maternal weight gain and obstetric outcomes in an obstetric population in Africa. [Journal Article]
- Int J Womens Health 2013.:501-7.
The purpose of this study was to compare maternal weight gain in pregnancy and obstetric outcomes between women with obesity in early pregnancy and those with a normal body mass index (BMI) in early pregnancy.This was a retrospective cohort study of women with obesity in early pregnancy and those with a normal BMI who were seen at three teaching hospitals in South-East Nigeria. Statistical analysis was performed using Statistical Package for the Social Sciences version 17.0 software, with descriptive and inferential statistics at the 95% level of confidence.The study sample consisted of 648 women (324 obese and 324 healthy-weight). The mean age of the obese women was 26.7 ± 5.1 years and that of the healthy-weight women was 26.6 ± 4.9 years. Although both excessive weight gain (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.23-0.54) and inadequate weight gain (OR 0.08, 95% CI 0.04-0.15) were less common in women with early pregnancy obesity than in healthy-weight women, a significantly higher proportion of obese women with excessive weight gain had adverse fetomaternal outcomes. Also, a significantly higher proportion of obese women had specific complications, such as premature rupture of membranes (OR 2.36, 95% CI 1.12-5.04), gestational hypertension/pre-eclampsia (OR 2.31, 95% CI 1.12-5.04), antepartum hemorrhage (OR 2.78, 95% CI 1.02-7.93), gestational diabetes (OR 4.24, 95% CI 1.62-11.74), cesarean delivery (OR 2.3, 95% CI 1.2-5.44), macrosomia (OR 4.08, 95% CI 1.06-8.41), severe birth asphyxia (OR 2.8, 95% CI 1.2-6.63), abnormal Apgar scores (OR 2.67, 95% CI 1.46-4.93), and newborn special care admissions (OR 1.18, 95% CI 1.0-3.29).Early pregnancy obesity was associated with a wide range of adverse fetomaternal outcomes, and could be a genuine risk factor for increased pregnancy-related morbidity and/or mortality in this population. Interventions to reduce prepregnancy obesity could therefore be useful in this low-resource African setting.