https://www.fertstert.org/article/S0015-0282(15)02202-5/pdf

Increased incidence of gestational hypertension and preeclampsia after assisted reproductive technology treatment

A number of studies have reported an association between low concentrations of serum folate and preterm birth. Folate supplementation during pregnancy increased the length of pregnancy in some but not all clinical trials. This cohort study investigated whether preconceptional folate supplementation (as ascertained by patient questionnaire in the first trimester of pregnancy) lowers the risk of spontaneous preterm birth. The investigators analyzed data collected from a cohort of 34,480 low-risk singleton pregnancies in women enrolled in a previous prospective cohort study on Down syndrome screening conducted at 15 US centers between 1999 and 2002. Duration of pregnancy was estimated by ultrasound measurement in the first trimester. Spontaneous preterm birth was defined as preterm birth between 20 and 37 weeks with no medical or obstetrical complications that constituted indications for delivery. The effects of the duration of preconceptional folate supplementation of ≥1 year (long-term), < year and the effect of no supplementation on risk of spontaneous preterm birth were compared using time-to-event analysis. Data were subjected to analysis with multivariable logistic regression. Compared to women who did not take a folate supplement, the risk of spontaneous preterm delivery between 20 and 28 weeks was 70% lower in women who took folate supplements for a year or longer before pregnancy (0.27% vs 0.04%); the hazard ratio was 0.22, with a 95% confidence interval of 0.08 to 0.61, P = 0.004. Long-term folate supplementation reduced the risk between 28 and 32 weeks by over 50% (0.38% vs 0.18%) (hazard ratio, 0.45; 95% confidence interval, 0.24-0.83, P = 0.010). Supplementation had no significant effect on the risk of spontaneous preterm birth beyond 32 weeks. Adjustment for maternal variables (age, body mass index, race and ethnicity, educational level, marital status, smoking, parity and history of prior preterm birth) did not affect the association between long-term folate and risk of spontaneous preterm birth but did eliminate the association found in unadjusted analysis between duration of preconceptional folate supplementation less than one year and risk. These findings suggest that preconceptional folate supplementation for a year or longer may substantially reduce the risk of early spontaneous preterm birth. The risk is lower with longer duration of folate supplementation before pregnancy. The beneficial effect of folic acid does not appear to be associated with other complications of pregnancy such as preeclampsia, small for gestational age infant, placental abruption, or nonspontaneous preterm birth.

Preconceptional folate supplementation and the risk of spontaneous preterm birth: A cohort study

Background: Pre-eclampsia (PE) is an important public health menace in both developed and developing countries with high maternal and perinatal morbidity and mortality globally. A major goal towards improving antenatal management of PE is to develop accurate prediction models that identify women at high risk of this disease for appropriate interventions. Methodology: In a longitudinal cohort study, high-risk singleton pregnant women enroled between April 2015 and February 2016 had uterine and umbilical artery Doppler sonography at 22–24 weeks and 32–34 weeks gestation and had their delivery outcomes documented by the obstetrician and gynaecologist. The peak systolic velocity (PSV), end-diastolic velocity (EDV), Resistivity Index (RI), Pulsatility Index (PI) and the systolic-diastolic ratio (S/D) were recorded. Results: Among the ninety-eight high-risk pregnant women, 61 (62.2%) developed PE and 32 (32.8%) did not have PE. In the PE cases, 15 (24.5%) were mild and 46 (74.5%) were severe PE. The uterine artery PI was significantly associated with PE. A unit increase in uterine PI in high-risk pregnancies, increases the odd of PE by 37.37 times (95% confidence interval; odds ratio = 6.09, 241.9; P < 0.001). The combination of the uterine and umbilical PSV predicted 80.3% of severe PE. All three spontaneous abortions were in women who developed PE, more caesarean section (48.4%) and 69.2% of 45 pre-term deliveries occurred in women with severe PE. Conclusion: The findings from this study show significantly lower uterine and umbilical arteries PSV and EDV but higher RI, PI and S/D in cases that developed PE. The uterine artery PI is the best predictor of PE, whereas the combinations of uterine and umbilical arteries PSV best predict severity of PE among high-risk pregnant Nigeria women.

Uterine and umbilical artery doppler in women with pre-eclampsia and their pregnancy outcomes

Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely <37 weeks) and 302 pregnant women who gave birth to a full-term newborn in the control group. Stata software version 12.2 was used. The Chi-square test was used in bivariate analysis and logistic regression was used in multivariate analysis, from which Odds Ratios (OR) and Confidence Intervals (CI) of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy (adjusted OR= 2.4; p= 0.02), inadequate prenatal care (< 6 controls) (adjusted OR= 3.2; p <0.001), absent prenatal care (adjusted OR= 3.0; p <0.001), history of premature birth (adjusted OR= 3.7; p <0.001) and preeclampsia (adjusted OR= 1.9; p= 0.005). Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and receiving inadequate prenatal care were risk factors for premature birth.

/pdf/risk-factors-for-premature-birth-in-a-hospital-re6ofdxov7.pdf

Risk Factors for premature birth in a hospital

Obstetric and perinatal outcomes in women ≥40years of age: Associations with fetal growth disorders.

Worldwide preeclampsia (PE) is the leading cause of maternal death and affects 5 to 8% of pregnant women. PE is characterized by elevated blood pressure and proteinuria. Doppler Ultrasound (US) evaluation has been considered a useful method for prediction of PE; however, there is no complete data about the most frequently altered US parameters in the pathology. The aim of this study was to evaluate the uterine, umbilical, and the middle cerebral arteries using Doppler US parameters [resistance index (RI), pulsatility index (PI), notch (N), systolic peak (SP) and their combinations] in pregnant women, in order to make a global evaluation of hemodynamic repercussion caused by the established PE. A total of 102 pregnant Mexican women (65 PE women and 37 normotensive women) were recruited in a cases and controls study. Blood velocity waveforms from uterine, umbilical, and middle cerebral arteries, in pregnancies from 24 to 37 weeks of gestation were recorded by trans-abdominal examination with a Toshiba Ultrasound Power Vision 6000 SSA-370A, with a 3.5 MHz convex transducer. Abnormal general Doppler US profile showed a positive association with PE [odds ratio (OR) = 2.93, 95% confidence interval (CI) = 1.2 - 7.3, P = 0.021)], and a specificity and predictive positive value of 89.2% and 88.6%, respectively. Other parameters like N presence, RI and PI of umbilical artery, as well as the PI of middle cerebral artery, showed differences between groups (P values < 0.05). General Doppler US result, as well as N from uterine vessel, RI from umbilical artery, and PI from umbilical and middle cerebral arteries in their individual form, may be considered as tools to determine hemodynamic repercussion caused by PE.

/pdf/doppler-ultrasound-evaluation-in-preeclampsia-6lmjhd81s8.pdf

Doppler ultrasound evaluation in preeclampsia

Background Traditionally an advanced maternal age have been associated with a higher risk of unfavorable perinatal results. Objective to know the perinatal outcomes in women giving birth at age 40 or older during a year in a concentration hospital located at Monterrey, Nuevo Leon. Patients and methods In a retrospective, cross-sectional, study. Results 163 women and 170 newborn were included. A newborn death (5.8 x 1000 RN) and no one maternal death was observed. The most frequent maternal associated disease was gestational diabetes (16%) followed by the hypertensive disorders (10%). The cesarean rate was 71.1% and the most frequent indication was previous cesarean. The most frequent hospitalization cause was early premature labour (4.2%). Premature membrane was observed in 11% of patients. The mean delivery time was at 38 weeks with a mean body weight of 3032 g. There were 5 newborn with congenital malformations (2.9%). 21 newborns were hospitalized (12%) and the most frequent indication was prematurity. Conclusion Women giving birth at age 40 or older observed a higher gestational diabetes incidence followed by the pregnancy-induced hypertension. The cesarean delivery was the most frequent mode of delivery. We consider that the perinatal outcomes in this study were favorable for both mother and child.

/pdf/hallazgos-perinatales-de-embarazos-en-edad-materna-avanzada-3g4x7lxnvi.pdf

Hallazgos perinatales de embarazos en edad materna avanzada

Background: Prematurity is the most frequent cause of perinatal morbidity and mortality, and is responsible with 75% of neonantal deaths not related to congenital defects. Objective: The aim of this study was to know risk factors that influence premature delivery in a third level attention in a Gyneco-Obstetric Unit. Material and methods: In a case-control study, was conducted an interview with 300 mothers who had their delivery at 28 and 36 gestational weeks in group of cases and 600 mothers from 37 to 41 weeks in controls, who assisted for attention from April to September 2011. Results: The factors associated eighth higher risk for prematurity were: maternal age above 35 years was more frequent in cases (14.6%), previous placenta occurred more frequent in Articulo original cases (9.3%), Infectious disease were highly present in cases such as: urinary tract infection (46%). But association of 2 or more factors such as premature rupture of membranes and cervicovaginitis, were more frequent significantly in study group (76%). Conclusions: The prematurity risk factor more freqeunt were: infectouse disease in study group. A deficient prenatal attention can be increased in order to prevent premature delivery. When 2 or more factors associated in a gestation the risk also increase, and should increase the following and medical attention to reduce premature risk.

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Risk factors of prematurity. A case control study

INTRODUCTION Brain tumors are present in 2.9 per 100,000 newborn. Craniopharyngioma is a benign and slow growing brain tumor, frequently localized in the sellar and suprasellar region. There are few reports of pituitary tumor detected prenatally. CASE REPORT We report a neonate with a craniopharyngioma detected prenatally as a pituitary tumor. In a 23 year old mother, second gestation, with no important history, was detected a sellar tumor at 31 gestation weeks, the obstetric ultrasound reported a suprasellar tumor of 2 per 3 cm diameter. Pregnancy ended in a vaginal delivery at 39 weeks, and obtained a 3.9 kg female, with cephalic diameter of 37.5 cm, the Apgar score was 8-9 at 1st and 5th minutes. In early neonatal period was scanned and confirmed a 3.2/2.3/2.9 cm suprasellar tumor with calcium deposits. The Paediatric Oncology department suggested a surgery and was realized a craniotomy at 3rd week of age. The surgery allowed to obtain 30% of the tumor and confirmed by histology craniopharyngioma. Patient had favourable evolution and was discharged at 3 months of age. CONCLUSIONS We report a neonate in who was detected by prenatal ultrasound the presence of a suprasellar solid tumor, scan and magnetic resonance images in neonatal period defined its size and location and a craniopharyngioma was confirmed by histology. Patient had a satisfactory postsurgical evolution and was discharged at 3 months of age.

/pdf/pituitary-tumor-detected-prenatally-33h22aow9h.pdf

René Ramos-González

Papers

Doppler ultrasound evaluation in preeclampsia

Hallazgos perinatales de embarazos en edad materna avanzada

Risk factors of prematurity. A case control study

Pituitary tumor detected prenatally