Validation of Tamil Version of Cranley’s 24-Item Maternal–Fetal Attachment Scale in Indian Pregnant Women

Background

Maternal–fetal attachment has not been formally studied among pregnant Indian women using Cranley’s 24-item maternal–fetal attachment scale.

Objective

The purpose of this study was to validate the Cranley’s 24-item maternal–fetal attachment scale (MFAS-24).

Methods

Consecutive pregnant Indian women of all trimesters were studied in Pondicherry, India.

Statistical Analysis

The mean, standard deviation (SD), Cronbach’s alpha, content validity index (CVI), correlation coefficient, and simple correlation analyses were calculated.

Results

230 pregnant women of various sociodemographic, religious and educational background formed the sample. Mean age of sample was 23 (SD ± 3) years, mean MFAS scores was 87.4 (SD ± 10), mean GHQ scores was 14 (SD ± 1.2), and mean gestational age was 27.2 (SD ± 7) weeks. Cronbach’s reliability alpha of MFAS was high (0.71). There was no correlation between MFAS scores and gestational age or the pregnancy trimester. CVI of the scale, for the Tamil version was 0.72 and for the English version was 0.78.

Conclusions

This study shows applicability of MFAS-24 in Indian settings also for measuring maternal–fetal attachment.     

First trimester pregnancy volumes and subsequent small for gestational age fetuses

Objective

To examine whether in the first trimester, placental, gestational sac and fetal volumes are different in pregnancies that result in small for gestational age (SGA) compared to average for gestational age (AGA) neonates.

Methods

Case–control study comparing first trimester 3D volumes of the placenta, the fetus and the gestational sac between SGA and AGA pregnancies. 3D volumes were acquired for quality assurance and documentation. Pregnancy volumes were calculated by the virtual organ computer-aided analysis technique. Linear regression analysis was used to compute a normal range for the placental, gestational sac and fetal volume based on the crown rump length (CRL) in AGA pregnancies. Multiple regression analysis was used to examine significant influencing covariates. A Student’s t test was used to compare the difference between the SGA and AGA group.

Results

The study population consisted of 19 first trimester pregnancies with subsequent SGA neonates and 105 control pregnancies. In the AGA group, all pregnancy volumes were significantly dependent on the CRL. After controlling the CRL effect, the placental, gestational sac and fetal volumes were not significantly different between the SGA and AGA group.

Conclusion

First trimester 3D pregnancy volume measurements are not different in SGA or AGA pregnancies.     

Role of Ultrasonographic Placental Thickness in Prediction of Fetal Outcome: A Prospective Indian Study

Background Information

Placenta is the connecting organ between the mother and the fetus. It supplies oxygen and all the necessary elements for the growth and development of the fetus. In normal pregnancy, the growth of the placenta remains concordant with the growth of the fetus. The sonographic assessment of placenta can give information about the nutritional status of the fetus. It is known that normal placental thickness approximately equals gestational age. It is historically documented that placental weight is one-fifth of the fetal weight and abnormally thin or thick placenta is associated with increased incidence of perinatal morbidity and mortality. However, there are very few studies correlating placental thickness with Neonatal outcome.

Objectives

To correlate ultrasonographic placental thickness at 32 and 36 weeks pregnancy with neonatal outcome. To propose placental thickness as a simple test for prediction of neonatal outcome.

Methods

Placental thickness at 32 and 36 weeks was measured by ultrasound, in 130 pregnant mothers with confirmed dates and uncomplicated singleton pregnancy. Placental thickness was categorized as normal (10th–95th percentile), thin (<10th percentile) and thick (>95th percentile) at each stage and was correlated with birth weight and neonatal outcome.

Results

Neonatal outcome was good in women with normal placental thickness (10th–95th percentile) at 32 and 36 weeks and was compromised in women with thin (<10th percentile) and thick (>95th percentile) placentae.

Conclusion

Placental thickness at 32 and 36 weeks corresponds well with gestational age and is a good prognostic factor in assessing neonatal outcome. Therefore, placental thickness should be measured in addition to biometric parameters in antenatal women undergoing ultrasound.

     

MR angiography demonstrates a positive correlation between placental blood vessel volume and fetal size

Purpose

While intrauterine growth restriction is often associated with placental dysfunction or abnormal morphology, the link between fetal weight and the placental delivery capacity of blood has not been studied in detail. The purpose of this study was to investigate the relationship between the fetal placental blood volume (FPBV) and fetal length, fetal weight and fetal head circumference using a non-invasive approach.

Methods

Placentas from normal pregnancies terminated with elective cesarean section were included. The entire fetal-side placental vasculature was filled with a solution of a gadolinium-containing contrast agent, followed by magnetic resonance angiography. FPBV was calculated from the complete 3D dataset as the sum of high-intense voxels. Areas that appeared different than the main part of the placenta were marked and evaluated by histology. FPBV of each placenta was compared to the fetal measures at birth: weight, length and head circumference. FPBV was also compared to placental weight at birth.

Results

We found that FPBV correlated linearly with fetal weight (p = 0.02) and fetal head circumference (p = 0.03), but found no correlation between the calculated placental blood vessel volume and the placental weight at birth. Histology revealed no pathophysiological findings in any cases. The marked areas were all those of infarctions or fibrinous sedimentation.

Conclusion

Interestingly, we found a positive correlation between FPBV and fetal size. Fetal size was measured in fetal weight and fetal head circumference. Fetal length did not correlate with FPBV. Further studies are warranted to investigate this relationship in pregnancies with intrauterine growth restriction, and whether MRI angiography (without gadolinium-containing agents) is suitable as a novel diagnostic modality for placental dysfunction.     

An Analysis of Pregnancy Outcome in Dichorionic and Monochorionic Twins Given Special Antenatal and Intranatal Care: A Four-Year Survey

Objective

The present study aims to analyze perinatal outcomes in twins given special care during pregnancy and labor and to compare fetal and neonatal outcomes in dichorionic twins with monochorionic twins.

Study Design

Eighty eight (88) twin pregnancies booked for care at a tertiary care Fetal Medicine centre were included in this study. The maternal demographic variables, course of pregnancy, fetal problems, and specialized fetal therapeutic and diagnostic interventions were noted. The above parameters were compared in the sub-groups of dichorionic and monochorionic twin pregnancies and related to the perinatal outcome. Statistical analysis was done using the student’s t test and the two-tailed chi sqaure tests with Yate’s continuity correction. A p value <0.05 was considered as significant.

Results

Mean maternal age was 30.34 + 4.81 years (range 19–48). 81 % of the twins were DCDA, and 19 % were MCDA. The mean gestational age at delivery was 34.4 ± 3.5 weeks, and this was not significantly different in MCDA and DCDA groups. Serious fetal problems warranting intervention at the time of initial referral were significantly higher in MCDA twins although overall perinatal outcome in both groups were not different.

Conclusion

Specialized care during pregnancy and labor including active fetal surveillance and therapeutic intervention when indicated improves the perinatal outcome in twin pregnancies and ensured at least one healthy live birth in over 90 % cases, although with an increase in late prematurity.     

Relationship between periodontal inflammation and fetal growth in pregnant women: a cross-sectional study

Purpose

Periodontal disease in pregnant women, evaluated by probing pocket depth (PPD) or clinical attachment level (CAL), significantly increases the risk of subsequent preterm birth (PB) and/or low birth weight (LBW). However, PPD and CAL do not always reflect current periodontal tissue inflammation. Therefore, assessment of bleeding on probing index (BOP), an indicator of periodontal inflammation, may be appropriate. The objective of this cross-sectional study was to investigate the relationship between periodontal inflammation and fetal growth in pregnant women after periodontal treatment.

Methods

We recruited 203 pregnant women (mean age 31.8 ± 4.5 years), including 20 subjects with periodontal inflammation and 183 periodontally healthy controls, after periodontal treatment. Fetal growth parameters as well as periodontal conditions were recorded.

Results

Perinatal gestational age was 39.4 ± 1.3 weeks; 8 subjects had a PB and 12 had an infant with a LBW. Results of multiple stepwise regression analysis indicated that birth length was negatively correlated with BOP% (β = ?0.175; p = 0.002). Fetal femur length, and birth length and weight among mothers with low periodontal inflammation were significantly higher than those among mothers with high periodontal inflammation (p < 0.05). The LBW rate in the high periodontal inflammation group was significantly higher than that in the low periodontal inflammation group (p < 0.05).

Conclusions

These results suggest that periodontal inflammation is correlated with fetal femur length, birth weight, and birth length.     

The Risk Factors for Failure of Labor Induction: A Cohort Study

Purpose

To assess how some factors may influence the failure of labor induction.

Methods

We conducted a prospective observational study from January 2009 to December 2011 with 248 patients who were admitted to the Obstetrics Unit of Ferrara University for labor induction. We selected only patients with unfavorable characteristics such as nulliparity, maternal and gestational age, and Bishop score and specific obstetric conditions such as mild preeclampsia, isolated oligohydramnios, premature rupture membrane, gestational diabetes, and hypertension for the success of labor induction.

Results

The induction was carried out by rapid-release gel dinoprostone. 200 patients (80.6 %) delivered vaginally (Group A), while 48 (19.4 %) underwent a cesarean section (Group B). Maternal age was one independent significant variable (p = 0.01, OR 1.08) determining the risk of cesarean delivery. Patients affected by mild preeclampsia had a three times higher risk for cesarean section. Despite the several unfavorable characteristics of the patients, the cesarean section rate was comparable to that of the normal population.

Conclusions

Several factors and clinical conditions historically considered as negative predictors of induction result should be reassessed. The success of labor induction is determined by many maternal and fetal variables, which must all be taken into account to avoid unnecessary cesarean sections.     

Study of the molecular variation in pre-eclampsia placenta based on micro-Raman spectroscopy

Purpose

Study of the molecular variation in pre-eclampsia placenta based on micro-Raman spectroscopy.

Methods

Five pregnant women with pre-eclampsia from Nanfang hospital were selected as study group whose average age is 28.5 years and 38 ± 2 weeks gestation. The same period of healthy pregnant women, whose average age is 27.6 years and pregnant 39 ± 1 weeks, as control group (n = 5). The normal and pre-eclamptic placental tissues are detected by micro-Raman spectroscopy with the spectrum resolution of 1 cm^?1.

Results

We find that the protein structure of α-helix, β-pleated sheet and β-turn is overlying in pre-eclamptic placenta, which lead to a disorder of protein structure. The Raman peaks assigned to tryptophan indole ring and phenylalanine in pre-eclamptic placental tissue are more higher than that in normal tissue.

Conclusions

Results suggest that the ordered structures of the main chain in protein molecules are reduced significantly, and the amino acid of side chains is damaged obviously. And a principal component analysis is used to classify the Raman spectra between normal and pre-eclamptic placental tissues. This study presents that Raman spectroscopy has a great potential on the mechanism research and diagnosis of placental lesions.     

The role of a personalized dietary intervention in managing gestational weight gain: a prospective,controlled study in a low-risk antenatal population

Purpose

To compare the efficacy of a personal dietary intervention on gestational weight gain control with a general intervention promoting healthy eating.

Methods

Prospective, controlled study including 154 low-risk pregnant women randomly allocated to two groups: 77 receiving a personalized diet plan and a close follow-up by a dietician (intervention group), 77 receiving standard dietary care by means of a brochure on healthy eating during pregnancy (control group). Pre-pregnancy weight, gestational age, height, weight and BMI at baseline, weight at term, gestational age at delivery and newborn weight were recorded for all participants. The primary end-point was the difference in body weight between baseline and term. Secondary end-points were the difference in body weight between pre-pregnancy and term and in newborn weights.

Results

Maternal weight gain at term was significantly lower both as compared to pre-pregnancy weight (8.2 ± 4.0 vs. 13.4 ± 4.2 kg; p < 0.001) and to weight at baseline (7.7 ± 3.8 vs. 13.7 ± 4.3 kg; p < 0.001) in the intervention group as compared to controls. A positive, significant correlation between the delta weight between baseline and term and newborn weight was observed in both groups, but stronger in patients from the intervention group (intervention group R = 0.76, p < 0.001; control group R = 0.35, p = 0.01).

Conclusions

This study suggests that a personalized nutritional intervention, in which the dietician plays an active role within the obstetric team, may represent a successful approach in limiting weight gain in pregnant women.     

An Induced Abortion Complicated by Fallopian Tube Incarceration in the Uterine Cavity

Objective(s)

We aimed to evaluate the predictive value of amniotic fluid index (AFI) (<5) for adverse perinatal outcome in terms of cesarean section for fetal distress, birth weight, meconium staining, Apgar scores, and cord pH at birth.

Method(s)

This was a prospective study of 200 antenatal women booked at Ram Manohar Lohia (RML) Hospital during the years 2009–2011 with gestational age between 34 and 41 weeks. The women’s history, clinical examination recorded, and AFI were measured and the perinatal outcome was compared between two groups, i.e., AFI < 5 and >5.

Result(s)

The cesarean section rate for fetal distress and low birth weight babies, <2.5 kg, was higher in patients with oligohydramnios (p = 0.048, 0.001, respectively). There was no significant difference in meconium staining, Apgar score at 5 min <7, and cord pH at birth between the two groups (p = 0.881, 0.884, 0.764, respectively).

Conclusions

Oligohydramnios has a significant correlation with cesarean section for fetal distress and low birth weight babies.     

Comparative Study of Efficacy and Safety of Oral Versus Vaginal Misoprostol for Induction or Labour

Objective

To compare the efficacy of oral with vaginal misoprostol for induction of labour.

Design

A randomized trial.

Setting

Tertiary care hospital.

Participants

Two hundred women requiring induction of labour.

Methods

Group A received oral misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients and Group B received vaginal misoprostol 50 mcg 6 hourly maximum 4 doses to 100 patients. When the patient entered active stage of labour i.e. clinically adequate constractions of 3/10 min of >40 s duration, and cervical dilatation of with 4 cm, further doses of misoprostol were not administered. Statistical analysis was done using chi-square test and t test.

Result

Both groups were comparable with respect to maternal age, gestational age, indication of induction and initial modified Bishops score Mean number of dosage required for successful induction were significantly less in vaginal group than oral group (in oral groups A were 2.73 + 0.58, and in vaginal Group B 2.26 + 0.52, P value < 0.0001 highly significant). The induction delivery interval was significantly less in vaginal group than oral group (Group A 15.24 + 3.47 h Group B 12.74 + 2.60 h, P < 0.0001 highly significant). Oxytocin augmentation required was less in vaginal group. 26 caesarean sections were performed in oral group and 17 caesarean sections were done in vaginal group (P value 0.06 NS). APGAR score, birth weight, NICU admissions showed no difference between the two groups.

Conclusion

This study shows that vaginal route of administration of misoprostol is preferable to oral route for induction of labour when used in equivalent dosage of 50 mcg 6 hourly.     

Luteal phase clomiphene citrate for ovulation induction in women with polycystic ovary syndrome

Purpose

The aim was to test a new protocol of luteal phase administration of clomiphene citrate (CC) for ovulation induction in women with polycystic ovary syndrome (PCOS).

Methods

This was a prospective, randomized, controlled trial. Two hundred and fifty-two women (cycles) with PCOS were utilized to create two groups. Patients in Group 1 (126 patients) received 100 mg of CC daily for 5 days starting on day 5 of menses, and patients in Group 2 (126 patients) received 100 mg of CC daily for 5 days starting the next day after finishing medroxyprogesterone acetate (MPA) (before withdrawal bleeding). The main outcome measures were the number of growing and mature follicles, serum E2 (in pg/mL), serum progesterone (in ng/mL) levels, endometrial thickness (in mm), pregnancy, and miscarriage rates.

Results

The total number of follicles and the number of follicles ≥14 mm during stimulation were significantly greater in Group 2. The endometrial thickness at the time of human chorionic gonadotrophin (hCG) administration was significantly greater in Group 2 as compared to Group 1 (7.84 ± 1.22 and 8.81 ± 0.9, respectively). Serum E2 levels were also significantly higher (p < 0.05) in Group 2 as compared to Group 1 (449.61 ± 243.45 vs. 666.09 ± 153.41 pg/mL). Pregnancy occurred in 13 patients (10.3 %) in Group 2 and in 11 patients (8.7 %) in Group 1. The difference was not statistically significant.

Conclusion

Luteal phase administration of CC in patients with PCOS leads to increased follicular growth and endometrial thickness, which might result in a higher pregnancy rate.     

The effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ovarian ultrasonographic markers, body fat mass index, leptin, and ghrelin

Purpose

Polycystic ovary syndrome (PCOS) is considered as the most common endocrinopathy among women of reproductive age. Oral contraceptives (OCs) and metformin are one of the main drug groups in the long-term treatment of PCOS. This study was undertaken to investigate the effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ultrasonographic markers, body fat mass (BFM) index, leptin–ghrelin.

Methods

This was a prospective clinical study conducted at Kocaeli University Department of Obstetrics and Gynecology on 42 PCOS patients. Patients were randomly allocated into two groups [Group I (n = 22): drospirenone-ethinyl estradiol (DEE); Group II (n = 20): drospirenone-ethinyl estradiol + metformin (M)] according to Body Mass Index (BMI) findings. Patients were evaluated in terms of leptin–ghrelin, ultrasound, and body fat distribution before and 6 months after therapy. Main outcome measures were to investigate the effects of drospirenone-ethinyl estradiol and drospirenone-ethinyl estradiol + metformin on ovarian ultrasonographic markers, BFM index, leptin, and ghrelin.

Results

In patients with higher BMI, ovarian volume, numbers of follicles, stromal area, and echogenicity have been reported to be larger. In group II, a negative correlation between ghrelin and abdominal fat mass after treatment has been noted, whereas in group I a positive correlation between leptin and abdominal fat mass after treatment has been observed.

Conclusions

Addition of metformin could have beneficial effects on abdominal fat mass. Stromal area measurement and assessment of fat mass with Dual X-ray Absorptiometry could be helpful as a quantitative way of measurement.     

Obstetric outcomes and prognostic factors of lupus pregnancies

Purpose

To determine maternal and fetal outcomes in pregnancies with Systemic Lupus Erythematosus (SLE), and to evaluate the prognostic factors that may affect obstetrical outcomes.

Methods

Sixty-five consecutive cases of SLE and pregnancy were included in this retrospective clinical study, performed in a university hospital which is also a reference center for SLE. Lupus pregnancies followed and delivered during the period from 2002 to 2011 in our department are evaluated. Obstetric outcomes and prognostic factors were main outcome measures.

Results

The mean patient age was 28.8 years and the nulliparity rate was 43.1 %. Disease flare-up occurred in 7.7 % of patients. Lupus anticoagulants, anticardiolipin IgG and IgM antibodies were positive in 27.6, 15.3 and 13.8 % of patients, respectively. Mean gestational age at delivery was 36.6 ± 4.2 and mean birth weight was 2,706 ± 927 g. Stillbirth, fetal growth restriction, preeclampsia and preterm delivery rates were 4.6, 18.5, 9.2 and 27.6 %, respectively. Cases with uterine artery Doppler abnormalities had significantly poorer obstetric outcomes.

Conclusions

Multidisciplinary approach to the care of pregnant women with SLE is mandatory for good maternal and fetal outcomes. Uterine artery Doppler seems to be a good prognostic factor for adverse obstetric outcomes.     

The assessment of the relationship between amniotic fluid matrix metalloproteinase-9 and zinc levels with adverse obstetric outcomes

Objective

To examine the relationship between the amniotic fluid MMP-9 and zinc levels during 16–19th gestational weeks and perinatal outcomes.

Method

One hundred and seventeen singleton pregnancies that underwent genetic amniocentesis from January 2005 through November 2009 were evaluated. Subjects were divided into two main groups: a control group (group 1) (n: 74), and an adverse obstetric outcomes group (group 2) (n: 43). Group 2 consisted of the following: preterm birth group, gestational hypertension and preeclampsia group, gestational diabetes group, fetal growth restriction group, macrosomia group, and pregnancy loss group. MMP-9 and zinc (Zn) values in the amniocentesis materials sampled between the 16th and 19th gestational weeks were analyzed retrospectively in terms of perinatal outcomes. Any significant difference among the groups was assessed by unpaired samples t test and the Mann–Whitney U test. Statistical significance was defined as p < 0.05.

Results

A comparison among groups showed no significant difference in terms of Zn results between the group 1 and 2 (p = 0.879). MMP-9 levels were significantly lower in both the preterm birth group (p = 0.043) and group 1 (p = 0.015).

Conclusion

We found that the amniotic fluid MMP-9 levels of patients who delivered preterm were significantly lower between the 16th and 19th gestational weeks.     

Sublingual misoprostol versus intravenous oxytocin in prevention of post-partum hemorrhage

Background

Post-partum hemorrhage (PPH) is the most common direct cause of maternal mortality and timely intervention can save many lives.

Objective

To compare the effectiveness of sublingual misoprostol to intravenous oxytocin in preventing post-partum hemorrhage in low risk vaginal birth.

Methods

One hundred patients with no risk factor for PPH were randomly allocated to receive 600 μg misoprostol administered sublingually or 10 IU of intravenous oxytocin immediately after the delivery of baby. Main outcome measures were post-partum blood loss, drop in hemoglobin in 24 h, duration of third stage of labor, and drug-related adverse effects.

Results

Mean age, parity and gestational age were similar in both groups. Mean blood loss was significantly lower in oxytocin group (114.28 ± 26.75 versus 149.50 ± 30.78 ml; p = 0.00). Drop in hemoglobin was 0.31 ± 0.16 versus 0.49 ± 0.21 g% (p = 0.01) in oxytocin and misoprostol group, respectively. Duration of third stage labor was shorter in oxytocin group (median 5 min, IQR: 4.5–5.5 versus 5.5 min, IQR: 5–6 min, p < 0.01). Although fever and shivering were common adverse effects with misoprostol but were not clinically significant.

Conclusion

Intravenous oxytocin is more efficacious than sublingual misoprostol in preventing PPH in institutional deliveries.     

A comparison of pregnancy outcome of modified transvaginal cervicoisthmic cerclage performed prior to and during pregnancy

Purpose

To compare the pregnancy outcome of the modified transvaginal cerclage performed preconception and during pregnancy.

Methods

A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China. A total of 604 women with cervical incompetence underwent the cerclage, and the time of the operation was decided by the patients or depended on when the patient presented. Main outcome measures were the gestational age and the fetal outcome.

Results

After the cerclage, the mean gestational age at delivery and the term delivery rate were significantly higher in history-indicated conception cerclage compared to preconception cerclage (36.8 ± 3.7 vs 35.8 ± 4.7, p < 0.01; 76.1 vs 66.9%, p < 0.05). The mean gestational age at delivery and the term delivery rate were significantly higher in ultrasound-indicated compared to physical examination-indicated conception cerclage (35.0 ± 5.7 vs 31.0 ± 5.5, p < 0.01; 63.2 vs 23.3%, p < 0.001). The fetal survival rate had no difference in these two comparisons, respectively.

Conclusions

The modified transvaginal cervicoisthmic cerclage is a promising and safe technique to improve obstetric outcomes in women with cervical incompetence in different cerclage indications, and history-indicated conception cerclage appears to have better pregnancy outcome.

     

Outcomes of pregnancies complicated by hyperemesis gravidarum

Objectives

To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG).

Methods

In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth.

Results

There were no statistical differences in the mean of age, parity, the number of artificial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5?±?595.4 vs. 3,164?±?664.5?g) and gestational age (38.1?±?2.3 vs. 38.1?±?2.6?weeks), relative to infants from the control group (p?=?0.67 and 0.91, respectively). In addition, no statistical significant differences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p?>?0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p?=?0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5?min, there were no statistically significant differences between two groups (p?=?0.16 and 0.42, respectively).

Conclusion

Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.     

The effects of gestational transient thyrotoxicosis on the perinatal outcomes: a case–control study

Purpose

To study the effects of gestational transient thyrotoxicosis (GTT) on pregnancy outcomes.

Methods

This case–control study retrospectively analyzed 7976 women with singleton pregnancies whose thyroid function was measured before 16 weeks of gestation and who delivered at ≥22 weeks of pregnancy. GTT was defined as hyperthyroidism (free thyroxine [FT4] level: ≥95th percentile) in the early pregnancy, which normalized in mid-pregnancy without thyroid-stimulating hormone receptor antibodies. Using data extracted from electronic records, we examined the association between GTT and the pregnancy outcomes (preterm delivery, gestational age at delivery, pregnancy induced hypertension (PIH), preeclampsia, placental abruption, caesarian section, birth weight, low birth weight, Apgar score, cord pH, stillbirth at gestational week ≥22, and neonatal death). We classified the cases into quartiles according to their FT4 values during the early pregnancy and investigated the association with the gestational age at delivery.

Results

Two hundred and eight cases of GTT and 6317 cases with normal thyroid assessments were reviewed. GTT was associated with hyperemesis gravidarum, but not with stillbirth, preterm delivery, PIH, preeclampsia, placental abruption, or low birth weight. The gestation period was shorter in patients with GTT than in those with a normal thyroid function (38.69 ± 1.79 vs. 39.07 ± 1.64 weeks, p < 0.01). Higher FT4 levels during the early pregnancy were associated with earlier delivery (p = 0.02).

Conclusions

GTT was associated with a lower gestational age at delivery but not with adverse pregnancy outcomes. There was a negative correlation between the FT4 values in the early pregnancy and the gestational period.

     

Signal quality of non-invasive fetal electrocardiogram in vaginal breech delivery: a case–controlled study

Objective

Recently, a non-invasive fetal electrocardiogram monitor has been approved for clinical usage in labour and delivery. To determine the fetal signal quality of vaginal breech deliveries in comparison with a case–controlled cephalic group during labour.

Study design

This case–control study was carried out at the Department of Obstetrics and Gynecology of the University Hospital Frankfurt between 1st July 2012 and 30th September 2012. A total of seven breech deliveries were evaluated. A case–controlled cephalic group with same gestational age and parity were selected from a previous trial.

Results

During first stage of labour, vaginal breech and cephalic delivery had no significant different fetal signal success rates (mean 87.8 vs. 85.7 %; p > 0.05). There was a trend of higher fetal signal success rates in the vaginal breech delivery group during second stage of labour (78.4 vs. 55.4 %; p = 0.08).

Conclusion

Similar fetal signal success rates in vaginal breech delivery in comparison to cephalic presentation were demonstrated using the new commercially available non-invasive abdominal fECG device (the Monica AN24^TM).