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Purpose: To allocate parameters associated with significant deviations in sonographic estimated fetal weight (EFW) and evaluate labor outcomes in such circumstances. Methods: Retrospective case–control study of women with a singleton gestation who underwent sonographic EFW within a week prior to delivery in a single tertiary university-affiliated medical center (2012–2018). The study group was comprised of 177 pregnancies in which sonographic EFW was at least ± 20% of actual birth weight, matched to 354 pregnancies with an accuracy of ± 1% of sonographic EFW to actual birth weight. Matching was based on age, gravidity, parity, and gestational age at delivery. Placental location, fetal presentation, spine position and amniotic fluid volumes during the ultrasound evaluation, as well as pregnancy outcomes, were compared between groups. Results: Median gestational age at delivery (37.0 vs. 38.0 weeks, p < 0.001), median estimated fetal weight (2591 vs. 3198 g, p < 0.001) and median birth weight (2916 vs. 3158 g, p = 0.001) were all lower in the non-accurate compared to the accurate weight estimation group. Ultrasound parameters significantly differed between groups. Women in the non-accurate, compared to accurate weight estimations group, presented higher rates of breech presentation (20.34 vs. 9.89%, p = 0.001), lower rates of anterior placenta (44.6 vs. 53.67%, p = 0.002) and lateral spine position (80.23 vs. 88.42%, p < 0.021). Multivariate analysis was utilized to control potential confounders, non-lateral spine position was found to be an independent risk factor for inaccuracies in EFW [OR = 2.505, 95% CI 1.159–5.416, p = 0.0196]. Obstetric parameters did not differ between groups. Higher rates of neonatal intensive care unit admission (20.34 vs. 11.02%, p = 0.003) and neonatal respiratory complications (7.34 vs. 3.39%, p = 0.042) were observed in the non-accurate EFW subgroup. Multivariate analysis demonstrated that inaccuracy in sonographic EFW was an independent risk factor for NICU admission (OR = 2.4, 95% CI 1.034–5.577, p = 0.041). Conclusion: Accuracy in sonographic EFW depends on fetal presentation, spine position and placental location. Non-accuracy is associated with adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical outcomes after fresh transfer of blastocysts cultured from vitrified-thawed cleavage embryos (VTCE) compared with conventional frozen-thawed blastocysts transfer (FBT), or with the usual fresh blastocysts transfer (FRBT).Methods: A total of 155 cycles undergoing fresh transfer of VTCE blastocysts, 4904 cycles undergoing FBT, and 1014 cycles undergoing FRBT were retrospectively analyzed from August 2014 to July 2017. Pregnancy, delivery, and neonatal outcomes were compared after propensity score matching.Results: VTCE blastocysts' transfer resulted in a lower risk of early miscarriage (8.82% versus 19.70%, P < 0.05) and a decreased fetal birth weight (2611.90 ± 618.65 g versus 2931.86 ± 546.52 g, P < 0.01) compared to FBT. No significant difference was found regarding live birth rate, gestational age, and cesarean section. Correspondingly, VTCE blastocysts' transfer led to significantly compromised pregnancy outcomes regarding clinical pregnancy rate and implantation, and even a slightly compromised live birth rate when compared with FRBT. Moreover, a higher occurrence of cesarean Section (88.89% versus 71.29%, P < 0.05) and a shorter gestational age (262.04 ± 14.99 days versus 268.06 ± 14.07, P < 0.05) were also found. Nevertheless, the risk of small for gestational age and large for gestational age, and the neonatal birth weight were comparable.Conclusions: VTCE blastocysts' transfer results in a comprehensively moderate outcome, which is an acceptable option for patients. Our results can provide efficient value for patients' counseling. Furthermore, these findings indicate directions for exploring the mechanisms of low birth weight and short gestational age. [ABSTRACT FROM AUTHOR]

Purpose: Due to the high number of multiple embryo transfers into the uterus performed in assisted reproductive technology treatment (ART), the incidences of twin pregnancy and of vanishing twin syndrome (VTS) are correspondingly high. A number of studies have described the obstetric outcomes of the remaining fetus produced after the other twin had vanished compared with a singleton at the start following ART, but the results are mixed and contradictory. We performed a systematic review of the existing studies to explore the actual obstetric outcome of VTS to allow physicians to adequately advise their patients.Methods: A detailed search strategy was used to conduct electronic literature searches (spanning 1978-2015) on Medline, EMBASE, the Cochrane library and Web of Science. As randomized trials are not feasible in this aspect, we included observational (cohort and case-control) studies which compared the obstetric outcomes of the VTS group and singleton at the start control group after ART. The outcomes were evaluated by two aspects, the duration of pregnancy (gestational age, preterm delivery rate, extremely preterm delivery rate) and the birth weight of the fetus [mean birth weight, low birth weight rate, very low birth weight rate and small for gestational age (SGA)].Results: 1271 publications were identified by the initial search. 499 studies were excluded following duplication checks. 760 were excluded after reviewing the abstracts. Of the remaining 12 articles, 7 were excluded after a detailed full-text review. Two case-control studies and three cohort studies were included in the final analysis. The pooled mean gestational age difference (95% confidence intervals) was -0.27 (-0.60, 0.06) and failed to demonstrate a difference between the two groups. A similar result was found in the preterm delivery rate, with a pooled risk ratio of 1.33 (0.91, 1.94). The prevalence of extremely preterm delivery rate was higher in the VTS group, with a pooled risk ratio of 3.5 (1.72, 7.12). The mean birth weight was lower in the VTS group, with a mean difference of -0.3 (-0.59, -0.01). No difference was found in low birth weight rate, very low birth weight rate and rate of small for gestational age, with risk ratio of 1.85 (0.88, 3.86), 4.86 (0.91, 25.91) and 1.29 (0.52, 3.18), correspondingly.Conclusions: There is a slight adverse effect of VTS on the remaining fetus for birth weight and extremely preterm delivery rate, but sensitivity analysis shows these effects to be statistically unstable. It is too early to draw conclusions for adverse obstetric outcomes for VTS patients. It could reduce much of the anxiety of couples who experience early embryonic loss of one of their twins. More research with rigorously designed and standardized methodologies are required that include larger, better clinically defined populations. Studies that show no correlation should be published in the future to avoid any possible impact of publication bias. After that, patients can receive the most accurate information. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to compare the clinical characteristics and pregnancy outcomes in women who are Syrian refugees and Turkish women who are non-refugees at a maternity center in Istanbul, Turkey.Methods: A total of 600 singleton pregnancies who delivered at Sisli Hamidiye Etfal Training and Research Hospital were included in the study. Demographic data, obstetrical history, clinical findings, obstetrical and neonatal outcomes were compared between 300 Syrian refugees and 300 control patients.Results: The Syrian refugee patients were significantly younger than Turkish patients. The percentage of adolescents aged 12-19 years were significantly higher in the Syrian patients (14.3 vs. 5.3 %, p < 0,001). 41.3 % of the refugee patients had no antenatal care. However, this ratio was only 7.7 % for the control group (p < 0.001). Preterm birth rates showed no difference between the groups, however, postterm birth rates were significantly higher in the control group. Low Birthweight (<2500 gr), oligohydramnios, stillbirth and fetal anomaly rates were not different between the two groups.Conclusions: In comparison to non-refugee control patients, refugee women in our study had poor antenatal care but no adverse perinatal outcomes were observed. Further larger multicenter studies may provide more convincing data about obstetric outcomes in the Syrian refugee population as well as adolescent pregnancies in this population. [ABSTRACT FROM AUTHOR]

Purpose: To compare the intervention rates associated with labor in low-risk women who began their labor in the 'home-like birth centre' (HLBC) and the traditional labor ward (TLW). Methods: This retrospective study used data that were collected from January 2005 to June 2008, from women admitted to the HLBC ( n = 316) and compared to a group of randomly selected low-risk women admitted to the TLW ( n = 890) using the Baysian information criterion to select the best predictive model. Results: Women in the HLBC had spontaneous vaginal deliveries more often (88.6 vs. 82.8 %, p value 0.034) and perineal lesions less often (60.1 vs. 62.5 %, p value 0.013). The frequency of adverse neonatal outcomes did not differ statistically between the two groups, although the mean clamped at birth umbilical arterial pH level was higher in the HLBC group. The transfer rate from HLBC to TLW was 31.3 % of which 75.8 % were nulliparae. Conclusions: It appears that women could benefit from HLBC care in settings such as the one studied. Larger observational studies are warranted to validate these results. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence, indications and the risk factors of emergency peripartum hysterectomy (EPH). Methods: We analyzed retrospectively 30 cases of emergency peripartum hysterectomy performed at the Obstetrics Department of a tertiary, research and education hospital between the years of 2006 and 2010. Demographic, medical and clinical data of the patients were recorded. Data stored were expressed as mean ± standard deviation. Results: There were 30 cases of EPH among 82,363 deliveries. The overall incidence of EPH was 0.364 per 1,000 deliveries from 2006 to 2010. Nine hysterectomies were performed after vaginal delivery (0.16/1,000 vaginal deliveries) and the remaining 21 hysterectomies were performed after cesarean section (0.78/1,000 cesarean sections). Two cases (6.7 %) were performed as subtotal and remaining 28 cases (93.3 %) were performed as total hysterectomy. Indications of EPH were uterine atony (43.3 %, 13/30), placenta accreta (40.0 %, 12/30) and uterine rupture (16.7 %, 5/30). All patients [7/7 (100 %)] with placenta previa and 11 of 12 patients (91.7 %) with placenta accreta had previously cesarean sections. There were two maternal deaths due to coagulopathy and pulmonary embolism. Two stillbirths (6.6 %) and 2 early neonatal deaths (6.6 %) were recorded. Conclusions: It should be kept in mind that cases of placenta previa and/or placenta accreta with previous cesarean sections have a very high probability of EPH. The delivery should be performed in suitable clinical settings with experienced surgeons when the risk factors like placenta previa and/or placenta accreta are determined so as to achieve optimal outcome. [ABSTRACT FROM AUTHOR]

Objectives: To study the outcome of pregnancies complicated by malignant disease, in particular neonatal morbidity and mortality after in utero exposure to chemotherapy. Methods: This prospective study included 118 patients diagnosed with malignant disease for the first time during pregnancy over an 8-year period (March 2003-March 2011). Outcome of neonates born to mothers who received chemotherapy during pregnancy was studied and compared with a control group. Results: The commonest cancer type diagnosed during pregnancy (56/118 = 47.45 %) was breast carcinoma followed by lymphoma/leukemia (32 = 27.12 %). Gynecological tumors (all ovarian) represented 10.16 %, soft tissue tumors 5.08 %, colorectal 4.23 %, thyroid 2.54 % and others 3.38 %. Sixty-one (51.64 %) women received chemotherapy (average 3 ± 2 cycles) during the second and third trimesters. The incidence of neonatal survival, preterm birth, small for gestational age and congenital malformations was not significantly different between women who received chemotherapy during pregnancy and the control group. Five (4.23 %) women with advanced disease died during or shortly after termination of pregnancy. Conclusion: In utero exposure to chemotherapy during the second and third trimesters of pregnancy carries minimal morbidity to the unborn fetus. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare obstetric and perinatal outcome in teenage and non-teenage pregnancies. Methods: We analyzed retrospective data of 15,498 pregnant patients who delivered from March 2008 to April 2009 in Jawaharlal Institute of Postgraduate Medical Education and Research, a referral tertiary care and teaching hospital in Pondicherry, South India. Girls aged ≤ 19 years were compared with pregnancy outcomes in women aged > 19 years who delivered in the same hospital during the study period. A total of 620 teenage pregnancies were compared with 14,878 non-teenage women. The obstetric and perinatal outcome was compared in the study and control groups using t test with Yates correction. We calculated Odds ratio (OR), 95% confidence intervals(CI) and p values; p < 0.005 was considered significant. Results: The incidence of teenage pregnancy in the study was 4%. A signicant proportion of teenage mothers were in their first pregnancies and their mean age was 18.04 years. Our study showed a significantly higher incidence of anaemia, past dates, premature rupture of membranes (PROM), normal vaginal delivery, episiotomy, low birth weight, and a significantly lower incidence of caesarean sections/perineal tears in teenage mothers compared to other mothers. In contrast, the incidence of hypertension, intrauterine growth restriction of fetus, pre-term labour and postpartum haemorrhage were similar in both the groups. Conclusion: The data in our study should throw more light on the current thinking of the obstetrical problems facing teenage mothers, in which some of our results support and others refute several long held beliefs about the risks in teenage pregnancy. Early booking, adequate antenatal care and delivery by trained people should improve the obstetric and perinatal outcome in teenage pregnancies, which is still an unresolved problem inspite of various government programmes in developing countries. [ABSTRACT FROM AUTHOR]

The presence of uterine myomas during pregnancy is considered a risk factor for gestation and delivery. In literature, myomas are related to spontaneous abortion, bleeding, PPROM, preterm delivery, placenta previa, placental abruption, fetal malpresentations, mechanical dystocia and high incidence of cesarean section. Laparotomic myomectomy done during pregnancy is indicated when symptoms related to uterine myomas, as acute pelvic pain or gastroenteric or urinary symptoms, persist despite the pharmacological therapy. The purpose of this study is to show a successful surgical management of uterine myomas at 15.5 weeks of pregnancy, which allowed the continuation of gestation and a delivery without major complications. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations.Study Design: A historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older. Obstetric and perinatal outcomes in AMA versus women younger than 35 years (non-AMA) were compared for both nulli- and multiparae with Student's t-test and Chi-square test in univariate analysis. Multiple logistic regression analysis was performed to examine the independent effect of AMA.Results: Out of 6,619 singleton pregnancies, the frequency of nulliparity was 42.7 and 33.4% of the parturients were of AMA. Among nulliparous women, AMA was significantly associated with a higher frequency of caesarean section both before labour (OR 2.26 with 95% CI 1.74-2.94), in labour (OR 1.44 with 95% CI 1.07-1.93), and more instrumental vaginal deliveries (ORs 1.49 with 95% CI 1.13-1.96). Among multiparous women, AMA was only significantly associated with a higher caesarean section rate before labour (ORs 1.42, 95% CI 1.19-1.69). There were no significant differences between the two age groups in the prevalence of other adverse obstetric outcomes and adverse perinatal outcomes.Conclusions: Operative delivery is increased in AMA, including caesarean sections, as well as instrumental vaginal deliveries in nulliparous women. In multiparous women, however, only the rate of caesarean section before labour was increased. AMA had no significant effect on other adverse obstetric and perinatal outcomes irrespective of parity. [ABSTRACT FROM AUTHOR]

To compare the outcome of pregnancy between HIV positive pregnant women on highly active antiretroviral therapy (HAART) and HIV negative controls. A prospective matched case–control study. HIV positive women were significantly more likely to have anaemia in pregnancy [ p < 0.001, odds ratio (95% CI) 5.66 (3.0–10.5)], intrauterine growth restriction [ p = 0.002, odds ratio (95%CI) 13.82 (1.8–106.7)], preterm labour [ p = 0.03, odds ratio (95% CI) 2.89 (1.2–7.0)] and birth weight less than 2,500 g [ p < 0.0001, odds ratio (95% CI) 5.43 (2.4–12.0)]. The 5-min apgar score less than 7, admission into neonatal unit, stillbirth and perinatal mortality were comparable between the two groups. Anaemia in pregnancy, intrauterine growth restriction, preterm labour and birth weight less than 2,500 g are important complications among HIV positive pregnant women. This information is vital for strategic antenatal care planning to improve obstetric and perinatal outcome in these women. [ABSTRACT FROM AUTHOR]

To determine whether pregnant women with amphetamine abuse developed more obstetric complications than non-drug abuser pregnant women. A retrospective case control study was undertaken. Pregnant women with amphetamine abuse who delivered between January 2002 and December 2003 were compared to control pregnant women. Pregnant women who abused amphetamine were more likely to develop anemia, preterm delivery, thick meconium stained amniotic fluid, and delivered small for gestational age neonates. However, cephalopelvic disproportion was less frequently found in the amphetamine abuse group. Pregnant women who abuse amphetamine experience more obstetric complications than the non-drug abuser. This information may be useful to medical personnel who are caregivers of these pregnant women to provide adequate perinatal care. [ABSTRACT FROM AUTHOR]

Objective: To determine whether adolescent pregnancies are associated with increased risk of adverse obstetrical outcome. Materials and methods: This is a retrospective study comparing the obstetric outcome of 267 adolescent pregnancies to 500 adult women pregnancies during the same period at a university hospital. Results: Medical and obstetric complications including pregnancy-induced hypertension, diabetes mellitus, anemia, placenta praevia, abruptio placenta and multiple pregnancy were not different in both groups, where there was a significant increase of preterm labor in adolescent pregnancies compared to adult pregnancies (14.6 and 8%, respectively). Moreover, adolescent pregnancies when compared to adult pregnancies, were associated with a significantly higher incidence of forceps delivery (4.5 and 1.4%, respectively), neonatal intensive care unit admission (22.7 and 13.5%, respectively) and a lower incidence of caesarean section (7.1 and 16.8%, respectively). Conclusion: Adolescent pregnancies are associated with a favorable obstetric outcome apart from the higher incidence of preterm labor. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate obstetric outcomes of nulliparous teenagers and to compare selected variables of their course and outcome of pregnancy with controls.Methods: A review of hospital records from 1997-1999 was done to compare the obstetric outcome in 760 teenage first pregnancies (study group) with that in control group i.e. 20 years to 29 years selected from the first women in the birth registry who delivered after each study case and satisfying the criteria for controls.Results: Revealed that incidence of complications of pregnancy like anemia, pregnancy induced hypertension and antepartum hemorrhage were similar in study and control groups. Pregnancy weight gain, prelabour rupture of membranes and gestational diabetes were significantly lower among teenage mothers. The normal mode of delivery was commoner in teenagers (89.5%) in comparison to control group (72%), probably because of higher number of low birthweight babies. Although in study group the mean birthweight was lower and the incidence of preterm labour and small for gestational age infants higher, there was also increased incidence of large for gestational age infants. While there was no difference in the types of labour, there were lower caesarean and instrumental deliveries. A statistically non-significant higher incidence of perinatal deaths was observed in teenagers.Conclusions: These results indicated that the course and outcome of pregnancy in teenage mothers had in most respects better obstetric outcomes, despite the higher incidence of preterm labour. [ABSTRACT FROM AUTHOR]