Prediction of adverse effects of preeclampsia

Background: To predict the adverse maternal, perinatal and combined (both maternal and perinatal) outcome in preeclampsia by using various clinical and laboratory variables. Methods: Five hundred fifty women diagnosed with preeclampsia were included and twenty-four women were excluded from the study due to exclusion criteria, six women decline to participate, twenty women were lost to follow up, three women withdrew consent, so a total of 497 women were followed up in the study.Results: Mean age of study population was 26.82±4.48 years. Majority of women with preeclampsia delivered vaginally. Forty-five (9.05%) developed neurological complication. Mean gestational age at delivery (weeks) in patients who developed adverse outcome was 34.58±3.74 weeks and in patients with normal outcome is 38.62±1.59 weeks. Mean birth weight of newborns were 2.1±0.73 kg and 1.85±0.61 kg for newborns with adverse outcomes. Majority of perinatal complication was small for gestational age 267 (54.37%) followed by prematurity 262 (53.36%). Total number of adverse perinatal events was six hundred seventy-seven as multiple neonates had more than one perinatal outcome. In combined (both maternal and perinatal) adverse outcome-374 (75%) developed adverse outcome, 123 (25%) developed normal pregnancy outcome.Conclusion: This study found out simple clinical, biochemical tools for monitoring pregnant women and accurately identifying who was at greatest risk of severe complications. By identifying those women at highest risk of adverse maternal outcomes well before that outcome occurs, transportation and treatment can be targeted to those women most in need. This clinical prediction tool found to be an important contributor as it offers the potential to improve health outcomes of women for a condition that is at the root of a large amount of morbidity and mortality in the developing world.

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Soluble fms-Like Tyrosine Kinase 1 Is Increased in Preeclampsia But Not in Normotensive Pregnancies with Small-for-Gestational-Age Neonates: Relationship to Circulating Placental Growth Factor

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2004-1955 ◽

2005 ◽

Vol 90 (8) ◽

pp. 4895-4903 ◽

Cited By ~ 178

Author(s):

Eiji Shibata ◽

Augustine Rajakumar ◽

Robert W. Powers ◽

Robert W. Larkin ◽

Carol Gilmour ◽

...

Keyword(s):

Growth Factor ◽

Tyrosine Kinase ◽

Gestational Age ◽

Small For Gestational Age ◽

Vascular Dysfunction ◽

Normal Pregnancy ◽

Maternal Serum ◽

Placental Growth Factor ◽

Gestational Age At Delivery ◽

Placental Protein

Context: An excess of the soluble receptor, fms-like tyrosine kinase 1 (sFlt-1) may contribute to maternal vascular dysfunction in women with preeclampsia by binding and thereby reducing concentrations of free vascular endothelial growth factor and placental growth factor (PlGF) in the circulation. The putative stimulus for increased sFlt-1 during preeclampsia, placental hypoxia due to poor perfusion, is common to both preeclampsia and idiopathic intrauterine growth restriction. However, the latter condition occurs without maternal vascular disease. Objective: We asked whether, as with preeclampsia, sFlt-1 is increased and free PlGF is decreased in villous placenta and maternal serum of normotensive women with small-for-gestational-age (SGA) neonates. Study Design: This was a case-control study using banked samples. Groups of women with SGA neonates (birth weight centile < 10th) and women with preeclampsia were matched to separate sets of normal pregnancy controls based on gestational age at blood sampling (serum) or gestational age at delivery (placenta). Results: sFlt-1 levels were higher in preeclamptics than controls (serum, P < 0.0001; placental protein, P = 0.03; placental mRNA, P = 0.007) but not increased in SGA pregnancies. PlGF was lower in both preeclampsia (serum, P < 0.0001; placental protein, P = 0.05) and SGA (serum, P = 0.0008; placental protein, P = 0.03) compared with their controls. PlGF in preeclampsia and SGA groups did not differ. Conclusions: These data are consistent with a role for sFlt-1 in the maternal manifestations of preeclampsia. In contrast to preeclampsia, sFlt-1 does not appear to contribute substantially to decreased circulating free PlGF in SGA pregnancies in the absence of a maternal syndrome.

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

Fetal Diagnosis and Therapy ◽

10.1159/000519639 ◽

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

Objective: 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). Material and Method: 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 <7, arterial cord blood pH <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 >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. Results: 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), p < 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%) (p < 0.001). The RR was 1.63 (95% CI: 1.365–1.944, p < 0.001). Although the differences were significant in all decreased percentile groups, RRs were significantly higher when decreased growth values were >40 points (RR: 2.036, 95% CI: 1.581–2.623, p < 0.001). The estimated value of the AUC for percentile decrease was 0.58 (0.56–0.61, p < 0.001). Conclusion: 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 >40 percentile points.

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Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1072-5161 ◽

2020 ◽

Cited By ~ 1

Author(s):

Danilo Buca ◽

Giuseppe Rizzo ◽

Sarah Gustapane ◽

Ilenia Mappa ◽

Martina Leombroni ◽

...

Keyword(s):

Logistic Regression ◽

Prospective Study ◽

Gestational Age ◽

Perinatal Outcome ◽

Primary Outcome ◽

Adverse Outcome ◽

Perinatal Morbidity ◽

Acid Base ◽

Appropriate For Gestational Age ◽

Acid Base Status

Abstract Objective To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term. Material and Methods Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10th and 90th percentile, at 36 + 0–37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data. Results 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor. Conclusion Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

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Gestational diabetes mellitus causes dyslipidemia in late trimester: mini review

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195600 ◽

2019 ◽

Vol 9 (1) ◽

pp. 453

Author(s):

Poonguzhalai S. ◽

Kalyanikutty K. P.

Keyword(s):

Diabetes Mellitus ◽

Lipid Metabolism ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Gestational Age ◽

Significant Risk ◽

Normal Pregnancy ◽

Adverse Outcomes ◽

Peripheral Tissues ◽

Management Protocol

The incidence of gestational diabetes mellitus (GDM) is increasing rapidly worldwide. Many women with gestational diabetes mellitus are likely to have type 2 diabetes. With the extensive management protocol for GDM we are able to obtain a good glycaemic control but still excess morbidity prevails among GDM pregnancy compared to normal pregnancy. This may be due to the dysfunction of lipid metabolism. Changes in carbohydrate and lipid metabolism occur during pregnancy to ensure a continuous supply of nutrients to the growing fetus despite intermittent maternal food intake. Exaggerated reduction in insulin sensitivity in the peripheral tissues combined with peripheral adipose tissue lipolysis in GDM pregnancy than normal pregnancy results in increased maternal lipoprotein concentrations and elevated lipoprotein triglyceride content. An altered lipid profile on the maternal side would modulate the quantity and quality of lipids being transferred to the fetus. Hypertriacylglycerolemia in gestational diabetes mellitus has been related to a significant risk of having neonates that are large for gestational age and it is considered as a major cause of preeclampsia in the late gestational age. So, the recent researchers emphasize on targeting lipid metabolism in pregnant women with GDM to avoid the adverse outcomes of pregnancy.

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Intertwin estimated fetal weight or crown rump length discordance and adverse perinatal outcome

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0242 ◽

2016 ◽

Vol 44 (8) ◽

Cited By ~ 3

Author(s):

Apostolos Kaponis ◽

Nikolaos Thanatsis ◽

Vassilis Papadopoulos ◽

George Decavalas

Keyword(s):

Perinatal Outcome ◽

Adverse Outcomes ◽

Fetal Weight ◽

Crown Rump Length ◽

Adverse Perinatal Outcome ◽

Structural Abnormalities ◽

Gestational Age At Delivery ◽

Review Study ◽

Estimated Fetal Weight ◽

Threshold Range

AbstractAim:In the current review study, we present recent data regarding the importance of intertwin estimated fetal weight (EFW) and crown rump length (CRL) discordance for the prediction of adverse perinatal outcome both in monochorionic and in dichorionic diamniotic gestations.Results:Twins with significant weight disparity are associated with higher rates of perinatal morbidity and mortality, regardless of gestational age at delivery. However, there is no agreement regarding as to the cut off value above which the perinatal outcome is unfavorably affected and the threshold range from 10 to 30%. On the other hand, CRL discrepancy has proved to be a weak predictor of adverse outcomes, such as fetal or neonatal death in fetuses without chromosomal and structural abnormalities. In clinical practice, decisions about obstetric surveillance of discordant twin gestations, frequency of fetal sonographic monitoring and time of delivery are usually based on amniotic fluid volume and Doppler assessments on a weekly basis.Conclusion:Significant EFW discordance leads to adverse perinatal outcome, although the cut-off value has not yet been estimated. CRL discrepancy is not correlated well with adverse perinatal outcome. However, increased monitoring of women with EFW and CRL discrepancy is suggested.

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CORRELATION BETWEEN CEREBROPLACENTAL RATIO AND ADVERSE OUTCOMES IN INTRAUTERINE GROWTH RESTRICTION

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.3.13 ◽

2018 ◽

Vol 8 (3) ◽

pp. 82-89

Author(s):

Tran Thao Nguyen Nguyen ◽

Van Duc Vo ◽

Ngoc Thanh Cao

Keyword(s):

Gestational Age ◽

Intrauterine Growth Restriction ◽

Adverse Outcomes ◽

Growth Restriction ◽

Fetal Weight ◽

Intrauterine Growth ◽

Cerebroplacental Ratio ◽

Gestational Age At Delivery ◽

The Mean ◽

Estimated Fetal Weight

Objectives: To identify the values of CPR in intrauterine growth restriction and evaluate the correlation between cerebroplacental ratio and adverse outcomes in intrauterine growth restriction. Material and methods: A prospective study was conducted on 74 cases of intrauterine growth restriction with an estimated fetal weight less than 10th percentile, at Departement of Obstetric and Gynecology of Hue University of Medicine and Pharmacy from 05/2016 – 05/2017. CPR was calculated by PIMCA/PIUA.. The adverse outcomes included gestational age at delivery, methods used to delivery, APGAR score below 7 at 1 minutes and 5 minutes, admission at NICU, perinatal deaths, neonatals deaths. Results: The mean of CPR in group of early IUGR and late IUGR were 0.55 ± 0.14, 1.59 ± 0.69, respectively. The mean of CPR in group IUGR with an estimated fetal weight under the 3th percentile was 1.49 ± 0.76, lower than the mean of CPR in group IUGR with an estimated fetal weight from 3th percentile to 10th percentile. With cut – off at 1, CPR < 1 had the higher prevalence in group of early IUGR, in group IUGR with the estimated fetal weight below the 3th percentile, in group IUGR with hypoamniotic or oligohydramnios. The mean of gestational age at delivery of group IUGR with CPR < 1 and CPR >1 were 37.00 ± 3.18, and 38.59 ± 1.76, respectively. The rate of emergency cesarean section deliveries in the CPR < 1 and CPR > 1 group were 68.75% and 39.65%, respectively (p <0.05). Percentage of neonatal with APGAR ≤ 7 at 1 minute in the group with CPR < 1 and CPR > 1 were 56.25% and 22.41%, respectively. Rate of prenatal death was 12.5 in group IUGR with CPR < 1. Conclusion: There was a strong correlation between CPR and adverse outcomes in intrauterine growth restriction. Key words: intrauterine growth restriction, CPR ratio, middle cerebro artery, umbilical artery

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apoA2 correlates to gestational age with decreased apolipoproteins A2, C1, C3 and E in gestational diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001925 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001925

Author(s):

Manjunath Ramanjaneya ◽

Alexandra E Butler ◽

Mohammed Bashir ◽

Ilham Bettahi ◽

Abu Saleh Md Moin ◽

...

Keyword(s):

Gestational Diabetes ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Gestational Age ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcome ◽

Adverse Outcomes ◽

Bivariate Analysis ◽

Premature Delivery ◽

Gestational Age At Delivery

IntroductionPregnant women with gestational diabetes mellitus (GDM) are at risk of adverse outcomes, including gestational hypertension, pre-eclampsia, and preterm delivery. This study was undertaken to determine if apolipoprotein (apo) levels differed between pregnant women with and without GDM and if they were associated with adverse pregnancy outcome.Research design and methodsPregnant women (46 women with GDM and 26 women without diabetes (ND)) in their second trimester were enrolled in the study. Plasma apos were measured and correlated to demographic, biochemical, and pregnancy outcome data.ResultsapoA2, apoC1, apoC3 and apoE were lower in women with GDM compared with control women (p=0.0019, p=0.0031, p=0.0002 and p=0.015, respectively). apoA1, apoB, apoD, apoH, and apoJ levels did not differ between control women and women with GDM. Pearson bivariate analysis revealed significant correlations between gestational age at delivery and apoA2 for women with GDM and control women, and between apoA2 and apoC3 concentrations and C reactive protein (CRP) as a measure of inflammation for the whole group.ConclusionsApoproteins apoA2, apoC1, apoC3 and apoE are decreased in women with GDM and may have a role in inflammation, as apoA2 and C3 correlated with CRP. The fact that apoA2 correlated with gestational age at delivery in both control women and women with GDM raises the hypothesis that apoA2 may be used as a biomarker of premature delivery, and this warrants further investigation.

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CERVICAL CERCLAGE;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.05.3491 ◽

2019 ◽

Vol 26 (05) ◽

Author(s):

Uzma Manzoor ◽

Uzma Shahzad ◽

Nadia Sharif ◽

Sadia Bano ◽

Raheela Farhat ◽

...

Keyword(s):

Gestational Age ◽

Normal Pregnancy ◽

Fetal Outcome ◽

Clinical Findings ◽

Cervical Cerclage ◽

Trimester Abortion ◽

Live Births ◽

Fetal Survival ◽

Cervical Incompetence ◽

Gestational Age At Delivery

Introduction: In Pakistan, cervical incompetence has been recognized as the leading cause of recurrent abortions in mid trimester. The elective cerclage based on history and clinical findings applied in second trimester overcomes the risk of emergency procedure. This problem is quite common in patients visiting IUH Faisalabad. Objectives: Assess gestational age at delivery after elective cervical cerclage application in mothers with recurrent mid trimester abortions. List the immediate and late complications of cerclage. Assess the fetal outcome after cerclage. Outcome Measures: 1. Percentage of mid trimester abortion in current pregnancy. 2. Frequency of prolongation of gestational age at delivery. 3. Complications of the procedure. 4. Birth weight of the baby. 5. Percentage of live births. 6. Fetal survival rate. Study Design: Interventional: Quasi experimental study. Setting: Department of Obstetrics and Gynaecology, Teaching Hospital IUH FSD. Period: Oct 2016 to July 2018. Subjects: Fifty patients with recurrent mid trimester miscarriage due to cervical incompetence. Methods: Patients were admitted through outdoor with history of previous mid trimester abortions possibly due to cervical incompetence. USG evidence of normal pregnancy with no obvious congenital anomaly was a pre requisite for cervical cercalge. Technique used was MCDonald’s suture under general anaesthesia. Results: Effectiveness of cerclage was 90%; 78% had term deliveries, 12% preterm delivery and 5 spontaneous mid trimester abortions. There were 81% live births. The complications included cervical trauma after delivery (2%), spontaneous abortions (10%), pre term delivery (13%) and pre prom (2%). Conclusion: Elective cerclage at 12-14 wks of gestation in recurrent mid trimester abortions results in good fetomaternal outcome with almost no complications.

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Antenatal Detection of True Knot in the Umbilical Cord – How Accurate Can We Be?

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-1205-0411 ◽

2020 ◽

Author(s):

Alina Weissmann-Brenner ◽

Noam Domniz ◽

Tal Weissbach ◽

Shalev Mazaki-Tovi ◽

Reuven Achiron ◽

...

Keyword(s):

Umbilical Cord ◽

Gestational Age ◽

Detection Rate ◽

Normal Pregnancy ◽

Control Group ◽

High Detection Rate ◽

Level Ii ◽

Increased Risk ◽

Gestational Age At Delivery

Abstract Background Umbilical cord knot (UCK) is associated with increased risk of fetal death, but is usually diagnosed only after delivery. Our objective was to examine the accuracy of prenatal ultrasound in the diagnosis of UCK and the outcomes of these pregnancies. Methods A prospective study was performed on 56 patients in which UCK was suspected during a routine level-II anatomical scan (study group). Data included demographics, pregnancy outcome, and short-term neonatal follow-up. The control group included pregnant women with normal pregnancy without UCK in a 4:1 ratio matched for gestational age at delivery. Results True knot was observed postnatally in 54 out of 56 fetuses (detection rate of 96.4 %). Gestational age at diagnosis of UCK was 22.1 ± 3.1 weeks. The female to male ratio was 1:1 in both groups. Maternal age and parity were significantly higher in pregnancies with UCK compared to controls. The mean gestational age at delivery was 37.1 weeks of gestation in the UCK group. There was no difference in the birthweight percentile. 47 patients (87 %) underwent induction of labor. There were no differences in the rate of cesarean section or Apgar scores. No neonate with UCK needed ventilation. None suffered from seizures and none needed brain imaging. There were no cases of fetal or neonatal death in the pregnancies with UCK. Conclusion There is a high detection rate of UCK during targeted scan of the umbilical cord performed during the level-II anatomical scan. Careful pregnancy follow-up and early term delivery may result in excellent obstetrical outcomes.

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Risk of Recurrent Adverse Outcomes in Gestational Diabetes: a Retrospective Cohort Study

10.22541/au.162454733.37753521/v1 ◽

2021 ◽

Author(s):

Sue Lynn Lau ◽

Alex Chung ◽

Joanna Kao ◽

Susan Hendon ◽

Wendy Hawke ◽

...

Keyword(s):

High Risk ◽

Gestational Diabetes ◽

Gestational Age ◽

Retrospective Cohort ◽

Adverse Outcome ◽

Subsequent Pregnancy ◽

Adverse Outcomes ◽

Instrumental Delivery ◽

Emergency Caesarean ◽

Index Pregnancy

Objective: Compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies. Design: Retrospective cohort Setting: Sydney, Australia Population or Sample: 424 pairs of consecutive singleton GDM pregnancies, 2003-2015 Main Outcome Measures:. ADO: instrumental delivery and emergency Caesarean. ANO: large for gestational age (LGA), small for gestational age (SGA), and composite ANO (LGA/SGA/stillbirth/neonatal death/shoulder dystocia). Methods: Using each pregnancy pair (“index” and “subsequent” pregnancy), we calculated ADO and ANO rates and determined risk factors for subsequent pregnancy outcomes (multivariate regression). Results: Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p<0.001) and lower rates of instrumental delivery (5% vs 13.9%, p<0.001), emergency Caesarean (7.1% vs 16.3%, p<0.001) and vaginal delivery (62.3% vs 66.3%, p=0.01). ANO rates in index and subsequent pregnancies did not differ. Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30, 7.34) for instrumental delivery, RR 2.20 (95%CI:1.06, 4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03, 6.82) for LGA, RR 5.01 (95%CI:2.73, 9.22) for SGA and RR 2.10 (95%CI:1.53, 2.87) for composite ANO). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20, 4.47)), SGA (RR 4.71 (95%CI:2.66, 8.36)) or composite ANO (RR 2.01 (95%CI:1.46, 2.78)) was having the same outcome in the index pregnancy. Conclusions: Women with GDM and an adverse outcome are at very high risk of the same complication in their subsequent GDM pregnancy, representing a high-risk group that should be targeted for directed management over routine care.

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