Emergency Cerclage: Improvement of Outcomes by Standardization of Management

2015 ◽  
Vol 39 (2) ◽  
pp. 134-139 ◽  
Author(s):  
Mariona Rius ◽  
Teresa Cobo ◽  
Raúl García-Posadas ◽  
Sandra Hernández ◽  
Irene Teixidó ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Postoperative Management ◽  
Standard Protocol ◽  
Delivery Time ◽  
Cervical Cerclage ◽  
Maternal Characteristics ◽  
Tertiary Referral Center ◽  
Gestational Age At Delivery ◽  
Selection Of

Introduction: Cervical dilatation followed by prolapse and ballooning of membranes into the vagina at mid-gestation is a critical situation. The aim of this study was to describe the outcome of emergency cerclage in a tertiary referral center during a 10-year period (2001-2010) in which a defined selection of women and standard protocol were introduced. Subjects and Methods: Thirty-nine cases of emergency cervical cerclage performed before 24 completed weeks were retrospectively reviewed. Data related to maternal history, diagnosis, procedure details, postoperative management and perinatal outcome were recorded. Maternal characteristics and perinatal outcomes are described. Results: Gestational age at cerclage (mean ± SD) was 22.1 ± 2.0 weeks with 61% (24/39) of women presenting bulging membranes. Gestational age at delivery and cerclage-to-delivery time (mean ± SD) were 28.6 ± 6.2 weeks and 49.1 ± 36.5 days, respectively. Only 38.5% (15/39) of the whole group and 44.1% (15/34) of those who reached 24.0 weeks delivered beyond 28 weeks of gestational age. Neonatal survival before discharge was 82.4% (28/34). Discussion: Perinatal outcomes after emergency cerclage are still poor with more than half of the cases delivering before 28 weeks. A standard protocol may help in the management of these rare cases.

scholarly journals Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yuka Sato ◽  
Nobuhiro Hidaka ◽  
Takahiro Nakano ◽  
Saki Kido ◽  
Masahiro Hachisuga ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Cervical Length ◽  
Cervical Cerclage ◽  
Extremely Preterm ◽  
Term Delivery ◽  
Gestational Age At Delivery ◽  
Full Term Delivery

Introduction. Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods. We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results. Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions. Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

Reduced Growth in Non-Small for Gestational Age Fetuses from 35 Weeks of Gestation to Birth and Perinatal Outcomes

2021 ◽  
pp. 1-10
Author(s):  
Peña Dieste Pérez ◽  
Luis M. Esteban ◽  
Ricardo Savirón-Cornudella ◽  
Faustino R. Pérez-López ◽  
Sergio Castán-Mateo ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Perinatal Outcomes ◽  
Entire Study ◽  
Birth Weight Percentile ◽  
Gestational Age At Delivery ◽  
Study Population ◽  
The Difference ◽  
Relationship Of ◽  
The Relationship

<b><i>Objective:</i></b> This study aimed to assess reduced fetal growth between 35 weeks of gestation and birth in non-small for gestational age fetuses associated with adverse perinatal outcomes (APOs). <b><i>Material and Method:</i></b> It is a retrospective cohort study of 9,164 non-small for gestational age fetuses estimated by ultrasound at 35 weeks. The difference between the birth weight percentile and the estimated percentile weight (EPW) at 35 weeks of gestation was calculated, and we studied the relationship of this difference with the appearance of APO. APOs were defined as cesarean or instrumental delivery rates for nonreassuring fetal status, 5-min Apgar score &#x3c;7, arterial cord blood pH &#x3c;7.10, and stillbirth. Fetuses that exhibited a percentile decrease between both moments were classified into 6 categories according to the amount of percentile decrease (0.01–10.0, 10.01–20.0, 20.01–30.0, 30.01–40.0, 40.01–50.0, and &#x3e;50.0 percentiles). It was evaluated whether the appearance of APO was related to the amount of this percentile decrease. Relative risk (RR) was calculated in these subgroups to predict APOs in general and for each APO in particular. Receiver operating characteristic and area under curves (AUC) for the difference in the percentile was calculated, used as a continuous parameter in the entire study population. <b><i>Results:</i></b> The median gestational age at delivery in uncomplicated pregnancies was 40.0 (39.1–40.7) and in pregnancies with APOs 40.3 (49.4–41.0), <i>p</i> &#x3c; 0.001. The prevalence of APOs was greater in the group of fetuses with a decrease in percentile (7.6%) compared to those with increased percentile (4.8%) (<i>p</i> &#x3c; 0.001). The RR was 1.63 (95% CI: 1.365–1.944, <i>p</i> &#x3c; 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were &#x3e;40 points (RR: 2.036, 95% CI: 1.581–2.623, <i>p</i> &#x3c; 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> Fetuses with a decrease in the EPW between the ultrasound at 35 weeks of gestation and birth have a higher risk of APOs, being double in fetuses with a decrease of &#x3e;40 percentile points.

Gestational age at delivery and perinatal outcomes of twin gestations

2012 ◽  
Vol 207 (5) ◽  
pp. 410.e1-410.e6 ◽  
Author(s):  
Amy E. Doss ◽  
Melissa S. Mancuso ◽  
Suzanne P. Cliver ◽  
Victoria C. Jauk ◽  
Sheri M. Jenkins
Keyword(s):  
Gestational Age ◽  
Perinatal Outcomes ◽  
Gestational Age At Delivery

scholarly journals Perinatal Outcomes of Babies Born with Fresh or Frozen-Thawed Testicular Sperm in Patients with Azoospermia

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Mehmet AK ◽  
Nur Dokuzeylul Gungor
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Gestational Age ◽  
Neonatal Death ◽  
Perinatal Outcomes ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Testicular Sperm ◽  
Significant Difference ◽  
Gestational Age At Delivery

Aim: To compare the perinatal outcomes of pregnancies obtained with fresh or frozen-thawed sperm in patients who underwent surgical sperm extraction for the diagnosis of azoospermia. Materials and Methods: In this retrospective study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved fresh or frozen-thawed sperm. Participants were divided into two equal groups as follows. Group 1 (n = 100) consisted of patients who underwent ICSI and subsequent embryo transfer using fresh testicular sperm and Group 2 (n = 100) consisted of patients who underwent ICSI by using frozen-thawed testicular sperm. Perinatal outcome was compared according to the use of fresh or frozen-thawed sperm. Primary outcome measures included clinical pregancy, miscarriage, live birth, congenital abnormality, birthweight, gestational age at delivery, stillbirth and neonatal death. Results: Live birth and clinical pregnancy rates were found to be significantly higher in patients who underwent ICSI/ET with frozen-thawed testicular sperm compared to fresh sperm group. The miscarriage rates were significantly lower in the frozen-thawed sperm group compared to the fresh testicular sperm group. Clinical pregnancy was detected in 18 cases, while no pregnancy was detected in 82 cases undergoing ICSI with fresh sperm. In the group where ICSI/ET was applied with frozen sperm, clinical pregnancy was detected in 51 cases, whereas pregnancy was not detected in 49 cases. In the frozen sperm group, in addition to C/S and multiple pregnancy rates, the number of babies with a birth weight below 2500 g was significantly higher than in the fresh sperm group. There was no significant difference between the groups in terms of minor and major congenital anomalies, birth weight, gestational age at delivery, stillbirth and neonatal death. Conclusion: Using fresh or frozen testicular sperm does not have a significant effect on perintal outcome in patients with azoospermia.

scholarly journals Effects and outcomes of septostomy in twin-to-twin transfusion syndrome after fetoscopic laser therapy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wen-Fang Li ◽  
An-Shine Chao ◽  
Shuenn-Dyh Chang ◽  
Po-Jen Cheng ◽  
Lan-Yan Yang ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Gestational Age ◽  
Odds Ratio ◽  
Case Series ◽  
Perinatal Outcomes ◽  
Neonatal Brain ◽  
Brain Image ◽  
Fetal Survival ◽  
Gestational Age At Delivery ◽  
Adverse Perinatal Outcomes

Abstract Background To evaluate the incidence and outcomes of septostomy in twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser therapy. Methods A retrospective analysis of TTTS postlaser septostomy between 2005 and 2018 was performed. Postlaser septostomy was diagnosed using both (1) a free-floating intertwin membrane flap visible on ultrasound examination and (2) the rapid equalization of amniotic fluid maximum vertical pocket in the donor and recipient amniotic sacs observed after laser therapy. Perinatal survival, neonatal brain image anomaly, gestational age at operation and birth, incidence of premature rupture of membranes (PROM) within 3 weeks after operation, pseudoamniotic band syndrome, and cord entanglement were evaluated. Results In the 159 TTTS cases included, 12 had postlaser septostomy. Relative to the group without septostomy, the septostomy group had a lower total fetal survival rate (54.2% vs 73.6%, p = 0.041), an earlier mean gestational age at delivery (27.8 vs 34.4 weeks, p = 0.009), a higher risk of PROMs within 3 weeks after operation (33.3% vs 5.4%, p = 0.004), a higher cord entanglement rate (16.7% vs 0%, p = 0.005), and a higher brain image anomaly rate (23.0% [3/13] vs 5.0% [11/218], p = 0.035). After considering the severe Quintero stages (stage III and IV), postlaser septostomy was the only variable [p = 0.003, odds ratio = 5.1] to predict neonatal brain image anomaly. Postlaser septostomy combined with severe Quintero stages could predict PROMs within 3 weeks after laser therapy [p = 0.001, odds ratio = 14.1 and p = 0.03, odds ratio = 5.4, respectively] and delivery before the gestational age of 28 weeks [p = 0.017, odds ratio = 4.5 and p = 0.034, odds ratio = 2.3, respectively]. The risk of pseudoamniotic band syndrome was not increased by postlaser septostomy in this case series. Conclusions Postlaser septostomy in TTTS was associated with poorer fetal survival and more adverse perinatal outcomes even after considering severe Quintero stages before laser therapy. Efforts should be made to prevent septostomy during laser therapy, and septostomy as the primary method to treat TTTS is not advisable.

Perinatal Outcomes in Women with a History of Recurrent Pregnancy Loss

2020 ◽  
Vol 38 (01) ◽  
pp. 010-015
Author(s):  
Elizabeth B. Ausbeck ◽  
Christina Blanchard ◽  
Alan T. Tita ◽  
Jeff M. Szychowski ◽  
Lorie Harper
Keyword(s):  
Gestational Diabetes ◽  
Gestational Age ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Subsequent Pregnancy ◽  
Gestational Age At Delivery ◽  
History Of ◽  
Nicu Admission

Objective This study aimed to evaluate perinatal outcomes in women with a history of recurrent pregnancy loss. Study Design Retrospective cohort study of singleton and nonanomalous gestations at ≥ 20 weeks who delivered at our academic institution. The exposed group was defined as women with a history of ≥ 2 consecutive spontaneous abortions (SABs) at < 12 weeks. These women were compared with women with a history of ≤ 1 SAB at < 12 weeks. The primary outcome was preterm birth (PTB) at < 37 weeks. Secondary outcomes included gestational age at delivery, gestational diabetes, small for gestational age birth weight, hypertensive diseases of pregnancy, fetal demise, cesarean delivery, and a composite of neonatal complications (5-minute Apgar score < 5, perinatal death, and NICU admission). Multivariable logistic regression was performed to adjust for confounders. Results Of 17,670 women included, 235 (1.3%) had a history of ≥ 2 consecutive SABs. Compared with women with a history of ≤ 1 SAB, women with ≥ 2 consecutive SABs were not more likely to have a PTB (19.6 vs. 14.0%, p = 0.01, adjusted odds ratios (AOR): 0.91, 95% confidence interval [CI]: 0.62–1.33). However, they were more likely to deliver at an earlier mean gestational age (37.8 ± 3.4 vs. 38.6 ± 2.9 weeks, p < 0.01) and to have gestational diabetes (12.3 vs. 6.6%, p < 0.01, AOR: 1.69, 95% CI: 1.10–2.59). Other outcomes were similar between the two groups. Conclusion A history of ≥ 2 consecutive SABs was not associated with an increased incidence of PTB but may be associated with gestational diabetes in a subsequent pregnancy. Key Points

170: Impact of gestational age at delivery on perinatal outcomes and hospital costs in pregnancies complicated by gastroschisis

2014 ◽  
Vol 210 (1) ◽  
pp. S97
Author(s):  
Mary Cain ◽  
Jason Salemi ◽  
Jean Paul Tanner ◽  
Mulubrhan Mogos ◽  
Russell Kirby ◽  
...  
Keyword(s):  
Gestational Age ◽  
Hospital Costs ◽  
Perinatal Outcomes ◽  
Gestational Age At Delivery

scholarly journals Outcomes in emergency versus elective cases of placenta accreta spectrum disorder managed by caesarean-hysterectomy within a dedicated multidisciplinary care team: retrospective cohort study.

2021 ◽  
Author(s):  
Homero Flores Mendoza ◽  
Anjana Chandran ◽  
Carlos Hernandez-Nieto ◽  
Ally Murji ◽  
Lisa Allen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Gestational Age ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Placenta Accreta ◽  
Perinatal Outcomes ◽  
Elective Delivery ◽  
Gestational Age At Delivery ◽  
Placenta Accreta Spectrum ◽  
Caesarean Hysterectomy

Objective: Compare maternal and perinatal outcomes between emergency and elective caesarean-hysterectomy for placenta accreta spectrum (PAS) disorders managed by a multidisciplinary team. Design and setting: Single-centre retrospective cohort study Population: 125 cases of antenatally suspected and pathologically confirmed PAS disorder. Methods: Maternal and perinatal outcomes were analyzed. Multivariate logistic regression was used to test associations, adjusting for potential confounders. Survival curves exploring risk factors for emergency delivery were sought. Main Outcome Measures: Maternal outcomes including hemorrhagic morbidity, operative complications. Perinatal outcomes included gestational age at delivery, birthweight, Apgar scores and perinatal death. Results: 25 (20%) and 100 (80%) patients had emergency and elective delivery, respectively. Emergency delivery had a higher estimated blood loss (median IQR 2772 [2256.75] vs. 1561.19 [1152.95], p<0.001), with a higher rate of coagulopathy (40 vs. 6%; p<0.001) and bladder injury (44 vs. 13%; p<0.001). Emergency delivery was associated with increased rates of blood transfusion (aOR 4.9, CI95% 1.3-17.5, p=0.01), coagulopathy (aOR 16.4, CI95% 2.6-101.4, p=0.002) and urinary tract injury (aOR 6.96, CI95% 1.5-30.7, p=0.01). Gestational age at delivery was lower in the emergency group (mean SD 35.19 [2.77] vs. 31.55 [4.75], p=0.001), no difference in perinatal mortality was found (aOR 0.01, CI95% <0.001-17.5, p=0.53). A sonographically short cervix and/or history of APH had an increased cumulative risk of emergency delivery with advancing gestational age. Conclusions: Patients with PAS disorders managed in a tertiary centre by a multidisciplinary team requiring emergency delivery have increased maternal morbidity and poorer perinatal outcomes than those with elective delivery.

scholarly journals Maternal Characteristics, Pregnancy, and Neonatal Outome in Preeclampsia and HELLP Syndrome: a Comparative Study

2021 ◽  
Vol 9 (1) ◽  
pp. 7
Author(s):  
Ali Sungkar ◽  
Rima Irwinda ◽  
Raymond Surya ◽  
Andrew Pratama Kurniawan
Keyword(s):  
Risk Factor ◽  
Gestational Age ◽  
Hellp Syndrome ◽  
Neonatal Outcome ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Previous Pregnancy ◽  
Maternal Characteristics ◽  
Gestational Age At Delivery ◽  
History Of

HELLP syndrome is a complication in pregnancy which may increase maternal morbidity and mortality risk. This study aims to compare maternal characteristics, pregnancy and neonatal outcome between preeclampsia and HELLP syndrome. All preeclampsia without or with severe features and HELLP syndrome using ACOG criteria coming to dr. Cipto Mangunkusumo Hospital from January 2015 to December 2017 were recruited into this cross-sectional study. Demographic, clinical, laboratories parameters, and neonatal outcomes were compared between HELLP and preeclampsia patients. The SPSS 20 for Windows was used for all analyses. There were 676 deliveries which was complicated by preeclampsia without or with severe features and 113 patients with HELLP syndrome. Gestational age, history of hypertension systolic and diastolic blood pressure, hemoglobin, hematocrit, urea, creatinine, uric acid, and albumin are different significantly between HELLP and preeclampsia patients. History of hypertension in previous pregnancy is considered as a significant risk factor for HELLP syndrome (p=0.001); RR 2.33 (95% CI 1.41–3.9). Based on data of gestational age at delivery which lower in HELLP syndrome, it showed lower median birth weight in HELLP syndrome (1442.5 g) compared with preeclampsia (1442.5 g vs 2400 g, p=; 95%CI There is significant difference in gestational age at delivery, nullipara, blood pressure, and laboratory findings (urea, creatinine, uric acid, albumin) between preeclampsia and HELLP syndrome group. History of hypertension in previous pregnancy is a significant risk factor for HELLP syndrome. Regarding neonatal outcome, baby born from HELLP syndrome has lower median birth weight. Keywords: HELLP syndrome, preeclampsia, risk factor, neonatal outcome.   Karakteristik Maternal, Luaran Kehamilan, dan Neonatal pada Preeklamsia dan Sindrom HELLP: Studi Komparatif Abstrak Sindrom HELLP merupakan komplikasi kehamilan yang meningkatkan morbiditas dan mortalitas maternal. Studi ini bertujuan untuk mengetahui perbedaan karakteristik antara sindrom HELLP dan preeklamsia serta luaran neonatus. Studi potong lintang ini melibatkan seluruh pasien preeklamsia dengan atau tanpa perburukan dan sindrom HELLP berdasarkan kriteria ACOG yang datang ke RS dr. Cipto Mangunkusumo pada bulan Januari 2015 sampai Desember 2017. Analisis bivariat digunakan untuk mengetahui hubungan karakteristik demografi, klinis, laboratorium antara pasien HELLP dan preeklamsia sedangkan analisis multivariat untuk mengetahui karakteristik yang memengaruhi sindrom HELLP. Data dianalisis menggunakan SPSS 20. Terdapat 676 persalinan pada kelompok preeklamsia dengan atau tanpa perburukan dan 113 pasien dengan sindrom HELLP. Usia kehamilan, tekanan darah sistolik dan diastolik, hemoglobin, hematokrit, ureum, kreatinin, asam urat, dan albumin berbeda bermakna antara pasien sindrom HELLP dan preeklamsia. Riwayat hipertensi pada kehamilan sebelumnya dianggap sebagai faktor risiko terhadap sindrom HELLP (p=0,001); RR 2,33 (IK 95% 1,41-3,9). Berdasarkan usia kehamilan saat persalinan yang lebih awal dan bayi lahir lebih rendah pada sindrom HELLP (1442,5 g) dibandingkan preeklamsia (2400 g). Terdapat perbedaan bermakna pada usia kehamilan saat persalinan, tekanan darah, dan parameter laboratorium (ureum, kreatinin, asam urat, albumin) antara kelompok preeklamsia dan sindrom HELLP. Berdasarkan luaran neonatus, bayi dari sindrom HELLP lebih rendah berat lahirnya. Kata kunci: sindrom HELLP, preeklamsia, faktor risiko, luaran neonatus

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