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, such as spontaneous abortion, intrauterine fetal demize, preterm prelabor rupture of the membranes, preterm labor, intrauterine growth restriction, gestational hypertensive disorders, placenta previa, chromosomal abnormalities and fetal structural anomalies, were identified and compared with the 2097 women who screened negative for Down's syndrome.Pregnancies with a positive screen had a significantly higher risk of adverse outcomes than those with negative screens (30.5% versus 15.3%; odds ratio 2.4; p < 0.001
complications, and neonatal outcome were recorded and compared by chi2 test. The one-way analysis of variance (anova) was used to compare the means of groups.Mean maternal age, the proportion of nulliparous women, and the incidence of prematurerupture of membranes, cesarean section, and premature delivery were significantly higher in the study group. The mean birthweight was significantly lower, the frequency of admission to the intensive care unit and the duration of hospitalization were significantly
and matched by age and parity. Outcome measures were perinatal mortality, length of gestation, birth weight and pretermprematurerupture of membranes (pPROM).There was no significant difference in perinatal mortality among women treated with LCL or LEEP compared to controls, 6/742 versus 2/742: odds ratio (OR)=3.1 (95% CI: 0.6-15.2). Excluding second trimester miscarriages, ORs for giving birth before week 37, 32 and 28 after conisation compared to the controls were 3.4 (95% CI: 2.3-5.1), 4.6 (95% CI (...) : 1.7-12.5), and 12.4 (95% CI: 1.6-96.1), respectively, after adjusting for smoking habits during pregnancy, marital status and educational level. Adjusted ORs of birth weight <2,500, <1,500 and <1,000 g after conisation compared to controls were 3.9 (95% CI: 2.4-6.3), 4.4 (95% CI: 1.5-13.6), and 10.4 (95% CI: 1.3-82.2), respectively. The adjusted OR for pPROM was 10.5 (95% CI: 3.7-29.5).Treatment by CLC and LEEP increases the risk of preterm delivery, low birth weight and pPROM in subsequent
]), (3) prematurity (preterm prelabour rupture of membranes, preterm labour, cervical dysfunction, iatrogenous and NOS), (4) infection (transplacental, ascending, neonatal and NOS), (5) other (fetal hydrops of unknown origin, maternal disease, trauma and out of the ordinary) and (6) unknown. Overall kappa coefficient for agreement for cause was 0.81 (95% CI 0.80-0.83). Six mechanisms were drawn up: cardio/circulatory insufficiency, multi-organ failure, respiratory insufficiency, cerebral
(TTTS) after laser treatment or serial amniodrainage (n= 22). The procedure resulted in six intrauterine fetal demise (IUFD, 13%), with a rate of 41% and 3% when performed at 16-17 weeks or later, respectively (Fisher P= 0.002). Pretermrupture of the membranes (PROM) before 28 weeks and between 28 and 34 weeks occurred in 9% and 14% of the cases, respectively. All neonatal deaths (four) occurred in cases with PROM at 28 weeks or earlier. Paediatric follow up showed that all infants discharged alive (...) but one were neurologically normal at 3-42 months, which corresponds to 70% of the 46 cases.This technique is effective when the natural history is likely to severely affect the development of the normal co-twin. The overall intact survival rate was 70% and our results support justification of later surgery. Prematurity remains a significant complication of the procedure.
, 3.15-4.23), bleeding in association with vaginal delivery (1.40, 1.38-1.50) and prematurerupture of membranes (PROM) (2.54, 2.34-2.76). Interventions including caesarean sections (1.38, 1.32-1.43) and induction of labour (1.37, 1.29-1.46) in singleton pregnancies was more frequent. The type of IVF method had little effect on these results, but there was a tendency for women who had received intra-cytoplasmatic sperm injection (ICSI) to have slightly fewer complications than women having standard (...) IVF. There was a significant decrease in cancer risk after IVF (0.79, 0.69-0.91) but a suggested increase in the risk of ovarian cancer both before (2.70, 1.49-4.91) and after (2.08, 1.15-3.76) IVF. No change in mortality was observed.Women treated with IVF had an increased obstetric morbidity. This seems to contribute little to the well-known increased risk of preterm delivery.
) the whey acidic protein motif containing proteins, secretory leukocyte protease inhibitor (SLPI) and elafin. Human beta-defensins (HBD) 1-3 are expressed by placental and chorion trophoblast, amnion epithelium and decidua in term and preterm pregnancy. Elafin shows a similar pattern of localisation while SLPI is produced only by amnion epithelium and decidua. Evidence suggests that there is aberrant production of some natural antimicrobials in pathologic conditions of pregnancy. In pretermpremature (...) rupture of membranes (PPROM) levels of SLPI and elafin are reduced in amniotic fluid and fetal membranes, respectively. Elafin and HBD3 increase in chorioamnionitis and levels of the alpha-defensins, HNP1-3, increase in maternal plasma and amniotic fluid in women affected by microbial invasion of the uterus. In vitro culture studies have suggested a mechanism for increased production of natural antimicrobials in chorioamnionitis. Elafin, SLPI, HBD2 and 3 are all upregulated by inflammatory molecules
the liveborn infants, 27 infants were delivered preterm (71%), of whom 7 infants (15%) had pretermprematurerupture of membranes and 4 infants (8.5%) had chorioamnionitis. Perinatal death (23/54 infants; 43%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (9 cases). All 31 survivors had chylothorax; for 28 of the survivors, the chylothorax was primary, and for 3 survivors, the chylothorax was the result (...) of right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome.After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.
urealyticum detection and the concentration of any cytokine. Detection of M hominis was associated with elevated intra-amniotic concentrations of interleukin-4 ( P = .01). Pretermprematurerupture of membranes that was followed by preterm birth occurred in 5 women (2.8%); 5 women (2.8%) had a spontaneous preterm birth with intact membranes. All 5 of the women with pretermprematurerupture of membranes (100%) tested positive for either U urealyticum or M hominis , as opposed to none of the women (...) with spontaneous preterm birth and to 27 of 161 women (16.8%) with a term birth ( P = .0002).The detection of M hominis or U urealyticum in midtrimester amniotic fluid by polymerase chain reaction-enzyme-linked immunosorbent assay may be a risk factor for subsequent pretermprematurerupture of membranes.
of membranes associated with intrauterine blood transfusion. Complications were categorized by two independent obstetricians as procedure-related (PR) or not procedure-related (NPR). Logistic regression analysis was used to identify risk factors for complications.Overall survival was 225/254 (89%). Fetal death occurred in 19 cases (7 PR) and neonatal death in 10 cases (5 PR). There were two cases of intrauterine infection with Escherichia coli (both PR) and two other cases of pretermprematurerupture (...) Complications of intrauterine intravascular transfusion for fetal anemia due to maternal red-cell alloimmunization. The purpose of this study was to establish the true procedure-related complication rate of intrauterine transfusion therapy.A cohort study of 254 fetuses treated with 740 intrauterine blood transfusions for red-cell alloimmunization in a single center in the years 1988 to 2001. Our database was searched for perinatal deaths, emergency deliveries, infections, and pretermrupture
for the periods 1979 through 1981 and 1999 through 2001. Clinical determinants of abruption that were evaluated included hypertensive diseases, anemia, gestational diabetes mellitus, preterm labor, pretermprematurerupture of membranes, chorioamnionitis, oligohydramnios, obstetric shock/trauma, uterine tumors, short umbilical cord, and velamentous cord insertion. Temporal trends in abruption were examined before and after adjustment for determinants through multivariable logistic regression.The rate (...) of abruption increased 92% (95% CI, 88, 96) among black women between 1979-1981 (0.76%; n = 13,584 women) and 1999-2001 (1.43%; n = 18,960 women). Among white women, the rate increased by 15% (95% CI, 14,16) over the same period, from 0.82% (n = 66,186 women) in 1979-1981 to 0.94% (n = 59,284 women) in 1999-2001. The determinants that were associated with trends in abruption included anemia, gestational diabetes mellitus, preterm labor, short umbilical cord, and velamentous cord insertion, although
for inherited thrombophilia, cervical cerclage for a shortened cervix, treatment of pretermprematurerupture of membranes, magnesium sulfate seizure prophylaxis, and dexamethasone therapy for HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome.A total of 298 obstetric care providers attended the postgraduate course. By report, most attendees were maternal-fetal medicine specialists (60.7% of respondents) who were >10 years out from specialty training (56.3% of respondents) and who (...) Defining standards of care in maternal-fetal medicine. The purpose of this study was to describe current practice patterns for 7 controversial topics in Maternal-Fetal Medicine.An interactive survey of obstetric treatment was performed as part of a postgraduate course at the 2004 Annual Meeting of the Society for Maternal-Fetal Medicine. Seven controversial topics were addressed, which included tocolytic therapy, progesterone supplementation for the prevention of preterm birth, screening
confirmation of viability in the threatened miscarriage group, was 9.3%. Compared with controls, women presenting with threatened miscarriage were more likely to deliver prematurely, 5.6% compared with 11.9%, respectively, (relative risk 2.29, 95% confidence interval 1.4-4.6), and this was most likely to be between 34 and 37 weeks. They were also more likely to have preterm prelabor rupture of membranes, 1.9% compared with 7%, respectively, (relative risk 3.72, 95% confidence interval 1.2-11.2). Overall (...) , there was no difference in mean birth weight and in the incidence of other obstetric complications between the 2 groups; however, women in the threatened miscarriage group were more likely to deliver neonates between 1,501 g and 2,000 g (P = .04).Women with threatened miscarriage in the first trimester are at increased risk of premature delivery, and this risk factor should be taken into consideration when deciding upon antenatal surveillance and management of their pregnancies.II-0.
infant. In univariate analyses, HIV-infected pregnant women with clinical diagnosis of genital HSV infection during pregnancy had a significantly increased risk of perinatal HIV transmission (odds ratio 3.4, 95% confidence interval 1.3-9.3; P = .02). When other factors associated with perinatal HIV transmission were included in a logistic regression model (lack of zidovudine therapy during pregnancy or delivery, prolonged rupture of membranes, and preterm delivery), clinical diagnosis of genital HSV
presentation (AOR 1.64, 95% CI 1.11-2.40), malposition (AOR 1.59, 95% CI 1.18-2.15), preterm delivery (AOR 1.45, 95% CI 1.08-1.96), placenta previa (AOR 1.86, 95% CI 1.02-3.39), and severe postpartum hemorrhage (AOR 2.57, 95% CI 1.54-4.27). Prematurerupture of membranes, operative vaginal delivery, chorioamnionitis, and endomyometritis were not associated with leiomyomata. Median length of labor was not different between the 2 groups. When compared with leiomyomata less than 10 cm in size, leiomyomata 10 (...) cm or larger were associated with rates of cesarean delivery that were not statistically different (25% compared with 31%, P = .49).Pregnant women with leiomyomata are at increased risk for cesarean delivery, breech presentation, malposition, preterm delivery, placenta previa, and severe post partum hemorrhage. Women with leiomyomata 10 cm or larger achieve a vaginal delivery rate of nearly 70%. These results are useful for preconception and prenatal counseling of women with leiomyomata.II-2.
for this analysis. The timing of perinatal loss was assessed. The following intervals were evaluated: fetal demise at less than 24 weeks of gestation, fetal demise at 24 or more weeks of gestation, and neonatal demise. Perinatal mortality was defined as the sum of these three intervals.The study population was 5% black, 22% Hispanic, 68% white, and 5% other. All minority races experienced higher rates of intrauterine growth restriction, preeclampsia, pretermprematurerupture of membranes, gestational diabetes (...) , placenta previa, preterm birth, very-preterm birth, cesarean delivery, light vaginal bleeding, and heavy vaginal bleeding compared with the white population. Overall perinatal mortality was 13 per 1,000 (471/35,529). The adjusted odds ratios (95% confidence intervals) for perinatal mortality (utilizing the white population as the referent race) were: black 3.5 (2.5-4.9), Hispanic 1.5 (1.2-2.1), and other 1.9 (1.3-2.8).Racial disparities in perinatal mortality persist in contemporary obstetric practice
monochorionic twin pregnancies were managed with serial vesicocenteses. In both cases, the prenatal course was complicated, 1 by prematurerupture of the membranes and the other by cord entanglement, requiring delivery at 29 and 31 weeks, respectively. Among the 4 continuing pregnancies with complete perinatal outcome, none of the affected twins survived, and the structurally normal twins were delivered between 29 and 36 weeks and discharged from the hospital in good condition.Twin pregnancies discordant (...) for lower urinary tract obstruction are at high risk of perinatal death and premature delivery. Prenatal intervention seems not to be associated with an improved perinatal outcome of the affected twin, but it may be beneficial in selected cases to attain viability of the unaffected twin.
pregnancy complicated by uterine synechiae in a patient with a history of an endometrial ablation (MEDLINE search, January 1985 to June 2004, key words "pregnancy," "obstetric," "endometrial ablation," "complications," and "hysteroscopy").A 34-year-old multigravida was referred to labor and delivery at 24 and weeks after ultrasound findings of a shortened cervix, multiple uterine synechiae, and multiple fetal anomalies. Two weeks after admission, she experienced pretermprematurerupture of membranes
should take into account the risks of prematurerupture of the membranes and preterm delivery. (...) was considered to have transmitted if at least one of the twins was infected. Univariate and multivariate analyses of risk factors for MTCT were performed for deliveries in the periods up to 1996.Overall, 2.1% (192/9262) of all the deliveries were twins. The rate of prematurity was greater in twins than in singletons (54% and 13%, respectively). Up to 1996 the rate of MTCT of HIV-1 was 28.3% (15/53) in twin pregnancies, versus 13.5% (414/3077) in singletons [odds ratio (OR), 2.5; 95% confidence interval (CI
). Heavy vaginal bleeding subjects were more likely to have intrauterine growth restriction (odds ratio, 2.6), preterm delivery (odds ratio, 3.0), pretermprematurerupture of membranes (odds ratio, 3.2), and placental abruption (odds ratio, 3.6).First-trimester vaginal bleeding is an independent risk factor for adverse obstetric outcome that is directly proportional to the amount of bleeding. (...) patients: 14,160 patients without bleeding, 2094 patients with light bleeding, and 252 patients with heavy bleeding. Patients with vaginal bleeding, light or heavy, were more likely to experience a spontaneous loss before 24 weeks of gestation (odds ratio, 2.5 and 4.2, respectively) and cesarean delivery (odds ratio, 1.1 and 1.4, respectively). Light bleeding subjects were more likely to have preeclampsia (odds ratio, 1.5), preterm delivery (odds ratio, 1.3), and placental abruption (odds ratio, 1.6