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PubMed2000

Profile of maternal smokers and their pregnancy outcomes in south western Sydney.

OBJECTIVE: The prevalence of maternal smoking remains high in New South Wales. In order to better understand the profile of maternal smokers, a study has been conducted to examine the social and demographic characteristics and pregnancy outcomes of women who smoked during their pregnancy in south western Sydney. METHODS: Women and babies of a retrospective cohort of 7,191 singleton births between March 1996 and December 1998, at Liverpool Hospital were analyzed. RESULTS: The prevalence of maternal smoking for the study population was 18.8%. The study found that the sociodemographic factors, such as marital status, ethnic origin, English speaking background, working status during pregnancy, and private health insurance status were independent risk factors for maternal smoking, but maternal age was not. Women who smoked during their pregnancy had higher rates of abruptio placenta, threatened premature labour, and premature labour. The adverse neonatal outcomes due to maternal smoking were low birth weight and increased neonatal morbidity. Smoking appears to have a protective effect on pregnancy induced hypertension. CONCLUSION: The findings of this study suggests that future smoking cessation programs should pay more attention to addressing sociodemographic and cultural factors that influence the behaviour of maternal smokers.

Adolescent↗
PubMed1978

Alcohol consumption in pregnant women and the outcome of pregnancy.

A prospective study of more than 9000 women shows that during pregnancy, women consuming alcoholic beverages in excess of 40 cl of wine per day have an increased risk of the following unfavorable pregnancy outcomes: (1) the risk of stillbirth is elevated, especially for death from abruptio placentae: (2) mean birth weight is lower, and the risk of a small-for-date infant is increased; (3) placental weight is also decreased. Although heavier drinkers differ from lighter drinkers in a certain number of variables that are risk factors for the outcome of pregnancy, the increase in risk with increased alcohol consumption remains evident after adjustment for these confounding variables. The increase in risk for heavier drinkers appears to be due to beer consumption, in spite of the lower average amount of ethanol consumed by beer drinkers as compared to wine drinkers.

Adult↗
PubMedDate not supplied

Diagnosis and management of hypothyroidism in pregnancy.

Hypothyroidism is not a common occurrence in pregnancy, but it is important that nurse practitioners recognize it early. Complications of hypothyroidism in pregnancy are pregnancy-induced hypertension, preeclampsia, abruptio placentae, low birth weight and stillbirth, and fetal distress in labor. Careful monitoring of pregnant women for hypothyroidism and correction with levothyroxine therapy can prevent these complications. During pregnancy, the thyroxine needs of women with hypothyroidism are increased, and their dosage of levothyroxine should be individualized. Nurse practitioners can provide holistic care to the woman with hypothyroidism to ensure optimal maternal and fetal health.

Female↗
PubMed1981

Amniotic fluid phospholipid profile determined by two-dimensional thin-layer chromatography as index of fetal lung maturation.

A phospholipid profile, the main features of which were the lecithin/sphingomyelin (L/S) ratio and the presence or absence of phosphatidylglycerol (PG), was determined in amniotic fluid from 188 patients. There was a mature profile (L/S ratio of at least 2 . 0 and detectable PG) in 145 patients, including seven insulin-dependent diabetics, and noe of their babies developed respiratory distress syndrome (RDS). The L/S ratio was less than 2 . 0 and PG absent in 12 patients, nine of whose babies developed RDS, whereas only three small babies (delivered between 28 and 35 weeks because of fulminant pre-eclampsia or severe abruptio placentae) out of 31 developed RDS when the L/S ratio was less than 2 . 0 but PG was present. When amniotic fluid was collected from the vagina only one out of 69 babies developed RDS when PG was present (regardless of the L/S ratio), while all of seven babies developed RDS when PG was absent. It is concluded that the amniotic fluid phospholipid profile, particularly the presence or absence of PG, gives an accurate assessment of fetal lung maturation. The profile may prove a useful adjunct to the management of high-risk pregnancies, especially after premature membrane rupture and perhaps also when the mother is diabetic.

Amniotic Fluid↗
PubMed2000

Maternal thyroid deficiency and pregnancy complications: implications for population screening.

OBJECTIVE: To examine the relation between certain pregnancy complications and thyroid stimulating hormone (TSH) measurements in a cohort of pregnant women. METHODS: TSH was measured in sera obtained from women during the second trimester as part of routine prenatal care. Information was then collected about vaginal bleeding, premature delivery, low birthweight, abruptio placentae, pregnancy induced hypertension, need for cesarean section, low Apgar scores, and fetal and neonatal death. RESULTS: Among 9403 women with singleton pregnancies, TSH measurements were 6 mU/l or greater in 209 (2.2%). The rate of fetal death was significantly higher in those pregnancies (3.8%) than in the women with TSH less than 6 mU/l (0.9%, odds ratio 4.4, 95% confidence interval 1.9-9.5). Other pregnancy complications did not occur more frequently. CONCLUSION: From the second trimester onward, the major adverse obstetrical outcome associated with raised TSH in the general population is an increased rate of fetal death. If thyroid replacement treatment avoided this problem this would be another reason to consider population screening.

Adult↗
PubMed2004

Neonatal outcome in pregnancies after preterm delivery for HELLP syndrome.

OBJECTIVE: To compare neonatal outcome after preterm delivery of infants where pregnancy had been complicated by the HELLP syndrome. STUDY DESIGN: The maternal and neonatal charts of 475 consecutive pregnancies complicated by hypertensive disorders at our perinatal unit were reviewed. The HELLP syndrome was defined by previously published laboratory criteria. 93 women fulfilled the criteria and constituted our HELLP syndrome study group. 188 normotensive patients who were delivered because of preterm labor comprised the control group. Results were compared by means of chi2 analysis and Student's t test where appropriate. RESULTS: There were 518 pregnancies complicated by hypertensive disorders and 93 by HELLP syndrome. The incidence of HELLP syndrome among women with severe preeclampsia was 19.5%. We found a significant difference in the incidence of intrauterine growth restriction (61.2 vs. 5.8%, p < 0.0001), intrauterine fetal death (13.9 vs. 6.9%, p = 0.035), abruptio placenta (13.9 vs. 2.6%, p = 0.001), and fetal distress (35.4 vs. 12.2%, p < 0.0001) between the two groups. There were no significant differences in complications (respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis and sepsis) between the HELLP syndrome group and controls. However, the neonatal death rate and the need for mechanical ventilation and neonatal intensive care were greater in the HELLP syndrome group. CONCLUSIONS: Our study suggests an increased mortality and morbidity in newborns of mothers complicated with HELLP syndrome that can be partly attributed to increased rates of intrauterine growth restriction and fetal distress, particularly beyond 32 weeks of gestation.

Adolescent↗
PubMedDate not supplied

Doppler ultrasound as an additional parameter for the evaluation of myomas and the indication of myomectomy during pregnancy.

OBJECTIVE: Pregnancies with myomas are known to have an increased risk for complications such as abruptio placentae, dysfunctional labor, growth of the tumor, necrosis and delivery problems, but prediction is still difficult based on clinical and real-time ultrasound evaluations alone. METHODS: We evaluated 15 patients with submucosal, intramural and subserous myomas, respectively. RESULTS: We found that in the submucosal myomas, the resistance index in the spiral and radial arteries decreased from 0.80-0.95 to 0.60-0.75 when choriogonadin and aspirin were given. In 3 cases in whom the resistance index increased before delivery, intrauterine growth retardation and the need for surgical delivery occurred. In 9 cases with intramural myomas, a normal decrease in the resistance indexes was seen, but 6 cases had a sharper drop related to necrosis. In 3 of the 5 cases with myomectomies, there were not only signs of necrosis but also of sarcomatous degenerations on histology. The cases with subserous myomas had no complications and the classical physiologic conversion pattern on Doppler evaluations. CONCLUSION: We feel that the Doppler results helped us with the management issues and gave insights into the typical pathophysiologic sequences, but the clinical role of Doppler flow analysis in pregnancies with myomas needs to be further evaluated.

Blood Flow Velocity↗
PubMed2004

Perinatal outcomes in severe preeclampsia-eclampsia with and without HELLP syndrome.

OBJECTIVE: Our purpose was to find out and compare perinatal outcomes in pregnancies complicated by severe preeclampsia-eclampsia with and without HELLP syndrome. METHODS: Clinical and laboratory findings, and perinatal-neonatal outcomes of all pregnants with severe preeclampsia, eclampsia and HELLP have been prospectively recorded. Results were compared by means of Student's t test, chi2 analysis and Fisher's exact test as appropriate. RESULTS: Among 367 consecutive severe preeclampsia, 106 (29%) had HELLP syndrome, 261 (71%) had severe preeclampsia and eclampsia. Mean gestational age and birth weight at delivery in severe preeclampsia without HELLP syndrome and in HELLP syndrome were 34.1 +/- 6.1 vs. 33.0 +/- 5.8 weeks (p = 0.119) and 1,886 +/- 764 vs. 1,724 +/- 776 g (p = 0.063), respectively. Comparing overall fetal mortality (4.6 vs. 10.3%, p = 0.009) and perinatal mortality (8.0% vs. 16.8%, p = 0.026) in severe preeclampsia-eclampsia and HELLP syndrome, respectively, there were statistically significant differences. But when analyses were performed according to gestational age before and after 32nd gestational week, the difference of perinatal mortality between the two groups was non-significant (p = 0.644 and p = 0.250), suggesting borderline difference. The most common contributing factor for fetal death after 32nd week was due to abruptio placenta without prenatal follow-up. Neonatal morbidity and neonatal mortality (4.8 vs. 6.3%, p = 0.905) in severe preeclampsia-eclampsia and HELLP syndrome respectively were similar and the difference was statistically nonsignificant. CONCLUSIONS: Perinatal mortality and neonatal morbidity-mortality according to gestational age before and after the 32nd week were similar in HELLP syndrome compared with severe preeclampsia-eclampsia without HELLP but overall fetal mortality was higher in HELLP syndrome with no regular prenatal care.

Adult↗
PubMed1996

Validity in nulliparas of increased beta-human chorionic gonadotrophin at mid-term for predicting pregnancy-induced hypertension complicated with proteinuria and intrauterine growth retardation.

The objective of the present study was to investigate whether increased beta-human chorionic gonadotrophin (beta HCG) plasma concentrations in an unselected population of nulliparas could predict the occurrence of complicated pregnancy-induced hypertension (PIH). The design was that of a prospective population study. It was conducted at the obstetric departments of Amiens University Hospital and Creil General Hospital on 434 consecutive nulliparas with singleton pregnancies after natural fertilization who accepted the systematic offer of trisomy 21 screening but for whom this disorder was finally estimated. Measurement of plasma concentration of beta HCG (ELISA method) was carried out between 14 and 20 weeks (mean: 17 weeks) of amenorrhea, and measurement of blood pressure and proteinuria (> 300 mg/24 h or Albustix +2) during the first, second and third term and 2-3 months after the delivery, as well as measurement of birth weight for determination of small for gestational age (SGA) babies, 37 women developed PIH, 10 without other complication, 16 with proteinuria (5 of which with SGA babies) and 11 with SGA babies. Furthermore 2 patients presented abruptio placentae without PIH. 395 women did not develop PIH including 389 normotensive women and 6 chronic hypertensive patients without superimposed toxemia. Only 1 was diabetic. None had chronic renal disease. Mean (+/- SD) levels of beta HCG were higher in PIH than in controls: 46,805 +/- 19,068 versus 23,479 +/- 13,463 IU. A pathologic threshold was chosen as the mean for the whole population + 1 SD: 25,613 + 15,479 = 41,082 IU. Elevated levels (above this value) were significantly associated with isolated PIH or PIH complicated with proteinuria and/or with SGA babies. The positive predictive value of this criterion was respectively 11, 15 and 12% for each of these complications. The relative risk (and 95% confidence limit) of women with elevated beta HCG for each of these complications was 20 (6-79), 11 (4-43) and 22 (7-93). Elevated plasma beta HCG found around 17 weeks of amenorrhea predicts PIH complicated with either proteinuria or SGA babies with a positive predictive value comparable to that of the best and earliest test proposed up to now to select nulliparas at high risk of preeclampsia, namely the abnormalities of the Doppler waveforms of the uterine arteries. Since this test is simpler to perform, it represents the most convenient method to screen a population of nulliparas for evaluation of the benefits of low-dose aspirin.

Adult↗
PubMedDate not supplied

Poor pregnancy outcome and anticardiolipin antibodies.

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

Abortion, Habitual↗
PubMed1985

Amniotic fluid embolism in Sweden, 1951-1980.

Amniotic fluid embolism is one of the least frequent complications of parturition, but the most dangerous of all. 38 cases of fatal amniotic fluid embolism were diagnosed in Sweden during the years 1951-1980, i.e. 1 case for every 83,000 live births. The proportion of amniotic fluid embolism in maternal mortality as a whole increased from 1.2 to 16.5% during this period. Predisposing factors identified were gemini/polydyramnios, abruptio placentae, hypertonic labor, rupture of the birth canal, macrosomia, and obstetrical interventions such as administration of oxytocin and fundal pressure. The main symptoms were cardiovascular shock with right heart strain, and hemorrhage with pathologic proteolysis. Four cases of presumed amniotic fluid embolism with survival of the patient were diagnosed during the years 1972-1980--a case fatality rate of 66% (4/12).

Adult↗
PubMed2003

Left ventricular concentric geometry as a risk factor in gestational hypertension.

In the past, an adverse prognostic significance of an altered left ventricular geometry in essential hypertension has been demonstrated. There are no data on the prognostic significance of an altered cardiac structure during pregnancy. The present study was designed to evaluate the prognostic impact on the outcome of pregnancy of an altered geometry of the left ventricle in mild gestational hypertension. One hundred forty-eight consecutive, pregnant, mild gestational hypertensive women (systolic and diastolic blood pressure, 140 to 150 mm Hg and 90 to 99 mm Hg, respectively) were included in the study. Patients were monitored until term to detect subsequent fetal and/or maternal adverse outcomes (preeclampsia, preterm delivery, abruptio placentae, other maternal medical problems, fetal distress, neonatal low birth weight, admittance to neonatal intensive care unit). One hundred one gestational hypertensive patients (68.2%) had an uneventful pregnancy; 47 patients (31.8%) showed a subsequent development of maternal and/or fetal complications. Concentric geometry was prevalent among patients with the subsequent development of complicated gestational hypertension (37 out of 47 patients) compared with the uneventful gestational hypertensive patients (31 out of 101 patients; 78.7% versus 30.1%; P=0.0001). The multivariate analysis showed concentric geometry as an independent predictor of adverse outcomes (odds ratio, 3.65; 95% confidence interval, 1.30 to 10.27; P=0.014). In patients with gestational hypertension, blood pressure values alone appear to be insufficient to identify the effective risk of adverse events. Ventricular geometry gives additional prognostic information, possibly improving our clinical ability to follow and eventually treat these patients.

Arteries↗
PubMed2005

Thrombophilia is significantly associated with severe preeclampsia: results of a large-scale, case-controlled study.

The role of thrombophilia in the pathogenesis of preeclampsia is controversial. The aim of this case-controlled study was to determine whether thrombophilia increases the risk of preeclampsia or interferes with its clinical course. A total of 808 white patients who developed preeclampsia (cases) and 808 women with previous uneventful pregnancies (controls) matched for age and parity were evaluated for inherited and acquired thrombophilia (factor V Leiden; factor II G20210A; methylenetetrahydrofolate reductase C677T; protein S, protein C, and antithrombin III deficiency; anticardiolipin antibodies; lupus anticoagulant; and hyperhomocysteinemia). Odds ratios (ORs) with 95% confidence intervals (CIs) for risk of being carriers of thrombophilia in cases compared with controls and for risk of maternal life-threatening complications and adverse perinatal outcomes in preeclamptic patients with or without thrombophilia were calculated. Women with severe preeclampsia (406 cases) had a higher risk (OR, 4.9; 95% CI, 3.5 to 6.9) of being carriers of either an inherited or acquired thrombophilic factor, except for protein S, protein C, and antithrombin deficiency. In women with mild preeclampsia (402 cases), only prothrombin and homozygous methylenetetrahydrofolate reductase gene mutations were significantly more prevalent than in the controls. Thrombophilic patients with severe preeclampsia are at increased risk of acute renal failure (OR, 1.8; 95% CI, 1.5 to 2.2), disseminated intravascular coagulation (OR, 2.7; 95% CI, 1.1 to 6.4), abruptio placentae (OR, 2.6; 95% CI, 1.2 to 6.0) and perinatal mortality (OR, 1.7; 95% CI, 1.5 to 2.2) compared with nonthrombophilic preeclamptic patients. Our study demonstrates a significant association between maternal thrombophilia and severe preeclampsia in white women. Thrombophilia also augments the risk of life-threatening maternal complications and adverse perinatal outcomes in preeclamptic patients.

Case-Control Studies↗
PubMed2002

Congenital bilateral perisylvian syndrome associated with congenital constriction band syndrome.

We report a 7-year-old boy with congenital bilateral perisylvian syndrome and congenital constriction band syndrome. The former is a congenital neurologic syndrome characterized by pseudobulbar palsy, mental retardation, epilepsy, and bilateral perisylvian polymicrogyria The latter is a malformative disorder with digital ring constrictions and amputations, probably caused by early amnion rupture resulting in entanglement of fetal parts by amniotic strands. We believe that the combination of these two malfornative disorders was not coincidental; instead, fetal circulatory disturbance related to chronic abruptio placentae could account for this combination.

Amniotic Band Syndrome↗
PubMed2002

ProC Global assay in the evaluation of women with history of severe preeclampsia or HELLP syndrome.

Preeclampsia/HELLP syndrome has been associated with a high incidence of defects in the protein C pathway and increased anticardiolipin-antibodies/lupus anticoagulants. It is also apparent that thrombophilia is responsible for other pregnancy complications, such as recurrent spontaneous abortion, fetal growth restriction, intrauterine fetal death, and abruptio placentae. ProC Global is a new global dotting assay designed to evaluate the abnormalities in the protein C anticoagulant pathway. It is based on the ability of endogenous activated protein C, generated by activation of protein C by Protac, to prolong an activated partial thromboplastin time. A total of 61 patients with a history of severe preeclampsia or HELLP syndrome and 61 normal pregnant women (controls) were evaluated, 15 of whom had factor V Leiden mutation, 12 had protein C/S deficiency, 30 had a repeated lupus anticoagulants, and 27 increased anticardiolipin antibodies (ACA). All carriers of factor V Leiden mutation (N=15) as well as all the patients with low activated protein C (APC) resistance ratio (N=15) had a ProC Global normalized ratio (NR) less than 0.80 (sensitivity 100%). Twenty-four patients positive for the lupus anticoagulants (LA) and 19 patients positive for ACA (>5.0 IgG U/mL) had a ProC Global NR less than 0.8, while six and eight, respectively, had a ProC Global NR greater than 0.8 (sensitivity, 70%-80%). The detection of a reduced protein C/protein S activity (<70%) was low (sensitivity, 33%-44%). In 25 cases with pathologic ProC Global results, a thrombophilic defect (protein S/LA/ACA without APC resistance) was diagnosed in 18 women; but in 7 cases, no known thrombophilic defect was present. ProC Global is a new screening test to identify patients with defects of the protein C system and an activated dotting system in preeclampsia but cannot correctly cover each thrombophilic component.

Adult↗
PubMed2003

Thrombophilia and pregnancy.

Pregnancy is hypercoagulable state. The field of thrombophilia; the tendency to thrombosis, has been developed rapidly and has been linked to many aspects of pregnancy. It is recently that severe pregnancy complications such as severe preeclampsia intrauterine growth retardation abruptio placentae and stillbirth has been shown to be associated with thrombophilia. Recurrent miscarriage and has also been associated with thrombophilia. Finally, thromboembolism in pregnancy as in the non-pregnant state is linked to thrombophilia. In this review all aspects of thrombophilia in pregnancy are discussed, and also all prophylactic and therapeutic implications.

Antiphospholipid Syndrome↗
PubMed1980

Creatine kinase isoenzymes in high-risk infants.

Serial measurements of serum creatine kinase isoenzymes were done from birth to 15 days of age in healthy premature infants, infants with perinatal or neonatal asphyxia and infants without asphyxia but with miscellaneous problems. Serum brain-specific fraction of creatine kinase (CK-BB) activity was higher in cord than in maternal serum (P < 0.01). In healthy infants, the serum activity of heart- and muscle-specific fractions of creatine kinase increased after birth, reached a plateau between 12 and 48 hr, and then declined, whereas the serum CK-BB decreased rapidly after birth and remained stable between 6 hr and 15 days. Compared to controls, infants with severe asphyxia and neurologic damage had a significant rise in serum CK-BB (P < 0.001). When the peak CK-BB level exceeded 35 IU/liter the mortality was high (83%). The increase in CK-BB was not observed in infants who received pentobarbital shortly after the episode of asphyxia. Diseases of the lung, kidneys, gastrointestinal tract, and abruptio placentae were not associated with increases of serum creatine kinase isoenzymes.

Asphyxia Neonatorum↗
PubMed1994

The effect of epidural anesthesia on safety and success of external cephalic version at term.

The purpose of this study was to assess the effect of epidural anesthesia on the success and safety of external cephalic version (ECV) performed at term. A retrospective record review of all pregnant women > 36 wk gestation who had attempts at ECV at Arnold Palmer Hospital for Children and Women between April 2, 1992, and April 30, 1993, was performed. The standard contraindications to ECVs were observed, and the use of tocolytics and lumbar epidural anesthesia was based on personal preference of the patient's physician. Sixty-one patients underwent 69 attempts, with eight patients having two attempts. There were 37 attempts without epidural and 32 with epidural. Four (10%) and 11 (34%) of the no epidural and epidural groups, respectively, were either in labor or had a cervical dilation > 3 cm at the time of the attempt. The other major patient variables likely to affect the success of ECV were not different between the groups, with the exception of a higher percentage of attempts by the housestaff in the epidural group. The success rate was 59% and 24% for the epidural group and no epidural group, respectively (P < 0.05). The incidence of abruptio placentae, fetal bradycardia, low Apgar scores, and low umbilical artery pH was similar. In our patient population, regional anesthesia increased the success rate of ECV and decreased the cesarean delivery rate with no apparent ill effect on perinatal or maternal morbidity or mortality.

Adult↗