Search

Aim: This study aimed to investigate the association between placental implantation abnormalities (PIAs) and gestational hypertension‐preeclampsia (GH‐PE) in pregnant women. Methods: Patients were recruited from 2010 to 2019 into this retrospective study at the International Peace Maternity & Child Health Hospital. PIAs were classified as follows: placenta previa (PP), low‐lying placenta (LP), placenta accreta, and placenta adherence (PA). Logistic regression models were constructed to analyze the associations between placental abnormalities and GH‐PE. Propensity score matching (PSM) was conducted to reduce confounders. The relationship between PP with placenta accreta spectrum (PAS) and GH‐PE were assessed. Results: In total, 5527 women were recruited, and 2614 women had an abnormal placenta (992 with LP; 749 with PP 839 and PA; and 34 with placenta accreta). There were 296 patients with GH‐PE in those groups. After adjustments for confounding factors, women with PP had a lower risk of PE (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.19–0.86, p = 0.025) than those in the control group. Women with PA had a higher risk of GH‐PE (OR: 1.45; 95% CI: 1.05–1.99, p = 0.022). In addition, we categorized PP into marginal, complete, and partial PP and investigated these associations. We found a lower risk of PE in complete PP (OR: 0.09, 95% CI: 0.01–0.44, p = 0.020) than in marginal or partial PP. There was no significant difference regarding GH‐PE in the PP with PAS group (OR = 0.67, 95% CI: 0.82–2.34, p = 0.525). Conclusion: PP, especially complete PP, is associated with a lower risk of PE. PA is associated with higher risks of GH‐PE. [ABSTRACT FROM AUTHOR]

Objective  We aimed to describe changes in cesarean delivery (CD) rates after the change of the one-child policy in China by using the Robson classification in a large Chinese population. Study Design  This retrospective cohort study included 91,015 women who delivered at ≥24 weeks of gestation at a large tertiary obstetric center in Shanghai, China from 2011 to 2016. We analyzed CD rate trend and CD contribution trend in each Robson group. Logistic regression was used to calculate the odds of CD while adjusting for confounding variables. Results  The overall CD rate decreased from 49.0% in 2011 to 40.6% in 2016. In nulliparous women with singleton cephalic term pregnancy and planned CD, the CD contribution rate was reduced significantly from 29.3% in 2011 to 16.4% in 2016 (p  < 0.001). In multiparous with a scarred uterus, the CD contribution rate began to increase from 3.8% in 2011 to 9.1% in 2016 (p  < 0.001). Compared with delivery in 2011, delivery in 2016 was associated with a 37% (adjusted odds ratio [aOR]: 0.63; 95% confidence interval [CI]: 0.60–0.66) reduction in CD. This reduction was observed in both nulliparous women with singleton cephalic term pregnancy (aOR: 0.57; 95% CI: 0.54–0.60), and multiparous women with singleton cephalic term pregnancy without scar (aOR: 0.41; 95% CI: 0.30–0.55). Conclusion  The rate of cesarean delivery in our Chinese population has declined significantly in the past few years. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the relationship between mode of first delivery with subsequent placenta previa, placenta accreta/increta, and significant postpartum hemorrhage (PPH).Method: This retrospective cohort study included women with two consecutive singleton deliveries between 2007 and 2017 at our institution if the women were nulliparous and delivered at term at the time of first delivery. The first pregnancy delivery mode was classified as (1) vaginal delivery, (2) antepartum cesarean delivery (CD) without labor, or (3) intrapartum CD after the onset of labor. Within these three groups, rates of placenta previa, placenta accreta/increta, and significant PPH at the time of the second delivery were compared. Significant PPH was defined as hemorrhage requiring a blood transfusion.Results: A total of 8208 women were analyzed. Most first deliveries were vaginal (n = 5210, 63.5%), followed by antepartum CD (n = 2432, 29.6%) and intrapartum CD (n = 566, 6.9%). The incidence of placenta previa in subsequent deliveries differed by previous delivery mode: vaginal, 0.9%; antepartum CD, 2.0%; intrapartum CD, 1.6% (p < .001). Similar differences were also observed with respect to placenta accreta/increta (0.5 versus 1.5 versus 0.9%, p < .001) and PPH (0.6 versus 1.2 versus 0.4%, p = .017). Compared to the previous vaginal delivery group, the antepartum CD group had increased risks of placenta previa (aORs 2.02, 95% CI 1.35-3.05), placenta accreta/increta (aOR 2.52; 95% CI 1.53-4.14) and PPH (aOR 1.78, 95% CI 1.14-2.98) in subsequent pregnancies. However, the previous intrapartum CD was not significantly associated with increased risks of these complications.Conclusion: Previous antepartum CD was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery compared to women with a prior vaginal delivery. The increased risks of subsequent abnormal placentation following primary antepartum CD may be important for counseling concerning nonmedically indicated elective cesarean.Condensation: Previous antepartum cesarean delivery (CD) was associated with two-fold increased risks of placenta previa, placenta accreta/increta, and significant PPH in the second delivery. [ABSTRACT FROM AUTHOR]

Early-onset preeclampsia (PE) is a severe condition with highest risk of perinatal complications. In current study, we compared PE severity, laboratory results and placental pathological lesions between early-onset PE with fetal growth restriction (PE + FGR) and appropriate gestational age (PE + AGA) neonates, with the aim to identify potential maternal risk factors associated with FGR. A retrospective case study was conducted in 304 PE women, and 31 cases with mild PE were excluded. 276 patients with severe PE were divided into PE + FGR (163, 59.1%) and PE + AGA (113, 40.9%) groups and underwent clinical analysis. 244 cases were further submitted for pathologic examinations to compare the differences of placental lesions between these two groups. As compared to PE + AGA, the maternal pre-pregnancy BMI (P = 0.003) and the rate of anemia (P = 0.004) were lower in PE + FGR; while the rate of severe low serum albumin (P = 0.020) was higher. Moreover, severe low serum albumin level (aOR = 2.43, P = 0.046) and abnormal uric acid (aOR = 2.19, P = 0.033) were positively correlated to the incidence of FGR, while pre-pregnancy BMI (aOR = 0.39, P = 0.001) and anemia (aOR = 0.33, P = 0.001) showed negative correlation. The placental examinations further showed positively correlation between chronic villitis (aOR = 4.32, P = 0.028) and FGR. Surprisingly, general measures of maternal illness severity failed to present any significant correlation to FGR, except for blood pressure, which showed negative correlation. For the first time, we studied a relatively large case series of Chinses early-onset PE women, and identified multiple factors associated with FGR incidence. Our study provided some opinions on clinal diagnosis and treatment for early-onset PE with FGR. [ABSTRACT FROM AUTHOR]

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP).Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups.Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05).Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition. [ABSTRACT FROM AUTHOR]

Objective: To describe perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis of pregnancy (ICP).Methods: We conducted a retrospective cohort study of women delivered at a large tertiary obstetric center in Shanghai, China from January 2006 to May 2014. Delivery data were abstracted from medical records of all twin gestations delivered at the hospital.Results: A total of 129/1922(6.7%) twin and 1190/92 273 singleton (1.3%) pregnancies were complicated by ICP. An increased risk of stillbirth among twin pregnancies was observed (3.9% and 0.8% in the ICP and non-ICP groups, respectively; aOR 5.75, 95% CI 2.00-16.6). Stillbirths with ICP and twins occurred between 33 and 35 weeks gestation compared to 36-38 weeks gestation among singletons. ICP in twins was also associated with an increased risk of preterm birth (<37 weeks) with an aOR of 4.17 (95% CI 2.47-7.04) and an aOR of 1.89 (95% CI 1.26-2.85) for delivery <35 weeks. Twin pregnancies complicated by ICP also had increased meconium staining of amniotic fluid and lower birth weight.Conclusions: Twin pregnancies with ICP have significantly increased risks of adverse perinatal outcomes including stillbirth and preterm birth. Stillbirth occurs at an earlier gestational age in twin gestation compared to singletons, suggesting that earlier scheduled delivery should be considered in these women. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical differences between multiple and singleton pregnancies with early-onset pre-eclampsia.Methods: The present retrospective cohort study included patients with early-onset pre-eclampsia diagnosed at a tertiary hospital in China between January 2012 and June 2014. The patients were divided into a multiple pregnancy group (MP group) and a singleton pregnancy group (SP group). Differences in maternal and fetal outcomes before and after birth were compared between the two groups.Results: Overall, 100 patients were included (21 MP group; 79 SP group). The systolic and diastolic blood pressure values at admission were significantly lower in the MP group than in the SP group (P=0.032 and P=0.015, respectively), and the incidence of pregnancy edema was significantly higher (P=0.015). Moreover, the mean neonatal birth weight in the MP group was significantly higher than that in the SP group (P<0.001). The frequencies of abnormal umbilical arterial resistance score, abnormal fetal heart rate, low birth weight, low Apgar score, neonatal cardiovascular abnormalities, and neonatal infections were significantly lower in multiple pregnancies (P<0.05 for all).Conclusion: Early-onset pre-eclampsia in multiple pregnancies seems to have a protective effect on neonatal survival and improves maternal and fetal outcomes. Disease progression might be delayed when compared with early-onset pre-eclampsia in singleton pregnancies. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to describe the risks and benefits of cesarean delivery on maternal request (CDMR) in a Chinese population. Study Design A retrospective cohort study of mode of delivery was conducted at the largest obstetric center in Shanghai, China, from 2007-2013. Eligibility criteria included singleton term nulliparous women with vertex presentation; women with major fetal anomalies or stillbirth before labor were excluded. Results A total of 66,226 women were included in the analysis: 40,560 women (61.2%) had planned vaginal birth, with 32,833 spontaneous vaginal deliveries (80.9%), 4990 intrapartum CDs (12.3%), and 2737 assisted vaginal deliveries (6.7%). A total of 16,333 women (24.7%) underwent CDMR. We observed no significant difference between the CDMR and planned vaginal delivery groups in the frequencies of maternal intensive care unit admission (0.2% vs 0.2%), severe postpartum hemorrhage (0.5% vs 0.5%), maternal infection (1.3% vs 1.3%), organ injuries (0.4‰ vs 0.5‰), and thromboembolic disorders (0.1‰ vs 0.1‰). The perinatal mortality rate was similar in the 2 groups (0.4‰ vs 0.6‰; adjusted odds ratio, 0.51; 95% confidence interval, 0.20–1.30; P = .159). The frequencies of birth trauma (0.2‰ vs 1.1‰), neonatal infection (0.4% vs 0.7%), hypoxic ischemic encephalopathy (0.4‰ vs 1.8‰), and meconium aspiration syndrome (0.2‰ vs 0.6‰) were lower; the frequency of respiratory-distress syndrome (0.6% vs 0.4%) was higher in the CDMR group. Conclusion Compared with nulliparous women who tried vaginal delivery, women who underwent CDMR had similar short-term maternal outcomes with some neonatal benefit. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the detection rate of chromosomal microarray analysis (CMA) in prenatal fetuses compared with conventional karyotype and to assess the additional diagnostic yields of CMA in groups of different indications.Study Design: A total of 217 fetuses were divided into seven groups according to different indications. All cases were tested by both CMA and karyotype. The detection rates of CMA and karyotype were evaluated. The increased value of CMA in each group was also calculated.Results: A total of 35 cases were detected to have a pathogenic result by CMA, indicating the overall detection rate of 16.1%. Nine more cases were detected only by CMA, indicating an incremental diagnostic yield of 4.2%. The highest incremental value was observed in fetuses with structural defects (6.6%). In 11 cases with known abnormal chromosome anomalies, CMA revealed additional information over conventional karyotyping in 4 fetuses.Conclusions: The present study convincingly demonstrated the efficiency of CMA in detecting feal chromosomal rearrangements. CMA significantly improves the detection rate in fetuses with structural defects and provides helpful information for fetuses with known abnormal chromosomes but without clear diagnosis. [ABSTRACT FROM AUTHOR]