DOCSLIB.ORG

Perinatal Morbidity and Mortality in Late-Term and Post-Term Pregnancy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Perinatal Morbidity and Mortality in Late-Term and Post-Term Pregnancy Journal of Perinatology (2011) 31, 789–793 r 2011 Nature America, Inc. All rights reserved. 0743-8346/11 www.nature.com/jp ORIGINAL ARTICLE Perinatal morbidity and mortality in late-term and post-term pregnancy. NEOSANO perinatal network’s experience in Mexico AM De los Santos-Garate1, M Villa-Guillen1, D Villanueva-Garc´ıa1, ML Vallejos-Ru´ız1 and MT Murgu´ıa-Peniche2 and the NEOSANO’s Network 1Department of Neonatology, Hospital Infantil de Mexico Federico Gomez, Me´xico City, Me´xico and 2National Center for Child and Adolescent Health (CeNSIA), Me´xico City, Me´xico Keywords: perinatal outcomes; pregnancy X40 weeks; Mexican Objective: The objective of this study is to identify adverse perinatal population outcomes associated with pregnancies at or beyond 40 weeks. Study Design: Retrospective cohort study conducted in Mexico, with information obtained from the NEOSANO’s Perinatal Network Database Post-term pregnancy is defined as gestation that extends beyond from April 2006 to April 2009. Multiple births, babies with inaccurate 42 weeks.1 The relative perinatal mortality is higher in post-term gestational age or babies with congenital malformations were excluded. delivery compared with delivery at term and has been associated Logistic regression models were used to analyze perinatal complications with an increased frequency of neonatal morbidity (meconium associated with pregnancies X40 weeks. aspiration, fetal distress, asphyxia in the neonatal period, Result: A total of 21 275 babies were analyzed; of these, 4545 (21.3%) were pneumonia, malformations, macrosomia and fetal birth injury) 6 6 of 40 to 407 weeks, 3024 (14.2%) 41 to 417 weeks and 388 (1.8%) 42 to 44 and maternal complications (cesarean section, postpartum 6 2 weeks of gestation. Adverse perinatal outcomes associated with 40 to 407 hemorrhage, labor dysfunction and obstetric trauma). Although it weeks deliveries were (odds ratio; 95% confidence interval): macrosomia is known that these risks are increased in post-term pregnancies, (1.9; 1.5 to 2.6), acute fetal distress (1.4; 1.2 to 1.7), emergency cesarean what has received less attention is whether and to what extent these delivery (1.4; 1.2 to 1.5) and chorioamnionitis (1.4; 1.2 to 1.6). Adverse risks increase before 42 weeks of gestation. Currently, the American 6 perinatal outcomes associated with 41 to 417 weeks were macrosomia (2.5; College of Obstetricians and Gynecologists (ACOG) recommends 1.8 to 3.3), chorioamnionitis (2; 1.7 to 2.3), emergency cesarean delivery initiation of antenatal surveillance between 41 and 42 weeks of (1.8; 1.6 to 2.1) and acute fetal distress (1.4; 1.1 to 1.7). Adverse perinatal gestation.3 However, some studies have demonstrated an increased outcomes associated with 42 to 44 weeks were macrosomia (7; 4.6 to 10.7), risk of perinatal complications with deliveries as early as 40 weeks. meconium aspiration syndrome (5.6; 2.8 to 11.2), neonatal death (4.8; 1.7 Caughey et al.4,5 reported that at a community hospital, maternal to 13.8), stillbirth (4.3; 1.4 to 13.5), 50 Apgar <4 (4.2; 1.1 to 15.7), and neonatal complications were observed at 40 to 42 weeks of chorioamnionitis (2.8; 2.2 to 3.9), admission to neonatal intensive care unit gestation, suggesting a need for additional study of this cohort. (2.7; 1.5 to 4.8), admission to neonatal intensive care unit or step-down unit In Mexico, there is scant information regarding the incidence (2.4; 1.5 to 3.9), acute fetal distress (1.8; 1.2 to 2.6) and emergency cesarean of and perinatal outcomes associated with pregnancies at or delivery (1.8; 1.3 to 2.4). beyond 40 weeks’ gestation. The aim of this study was to identify Conclusion: An increased risk for perinatal and maternal complications perinatal morbidity and mortality associated with late-term were detected as early as 40 weeks’ gestation. The risks of stillbirth and and post-term pregnancy, as compared with term pregnancies 6 neonatal death were significantly higher in the post-term group than the (39 to 397 weeks’ gestation). control group. Journal of Perinatology (2011) 31, 789–793; doi:10.1038/jp.2011.43; published online 16 June 2011 Methods Population Correspondence: Dr MT Murguı´a-Peniche, Area Director-Infancy, National Center for Child All babies (live birth or dead X400 g) born from April 2006 and Adolescent Health (CeNSIA), Francisco de P. Miranda 177, 1 er piso, Col. Merced Go´mez, to April 2009 at the study hospitals in NEOSANO’s Perinatal 01600 Deleg. A. Obrego´n, Me´xico, D.F., Me´xico. Network in Mexico (five hospitals at Mexico City, three hospitals E-mail: [email protected] Received 9 March 2010; revised 6 March 2011; accepted 15 March 2011; published online at Tlaxcala City and one hospital at Oaxaca City) were included. 16 June 2011 This network gathers social, gynecological, obstetric, baseline Perinatal complications in late-term and post-term pregnancies AM De los Santos-Garate et al 790 maternal medical conditions and neonatal data. Multiple births, this figure was significantly higher (40%) for those mothers who babies with congenital malformations or inaccurate gestational delivered at or beyond at 40 weeks’ gestation. The frequency of poor age were excluded. prenatal care, defined as less than four prenatal visits, was more prevalent among those pregnancies that lasted >40 weeks. The Gestational age assessment most common obstetric complications were chorioamnionitis Gestational age was calculated by dates (when known) or and prolonged rupture of membranes. Of note, 38 to 55% of the 6 7 alternatively by Ballard Score, Capurro Score or prenatal cases were delivered by emergency cesarean section. ultrasound. Table 2 summarizes the frequency of adverse perinatal outcomes by gestational age. In general, obstetric complications Design increased as gestational age advanced beyond 39 to 40 weeks. For each delivery, a trained field worker completed a questionnaire, Preeclampsia and chorioamnionitis was approximately twice as which included pertinent social, gynecological, obstetric, perinatal common in the 42 to 44-week gestational group as compared and baseline maternal medical data. All babies were followed up with the 39 weeks group. until discharge. As expected, the greater the gestational age beyond 39 weeks, We examined the following outcomes: maternal vaginal the higher the frequency of adverse neonatal outcomes, and these bleeding, chorioamnionitis, emergency cesarean delivery, elective were mainly associated with acute fetal distress, macrosomia cesarean delivery, 5 min Apgar score less than 4, acute fetal distress, and death. macrosomia, meconium aspiration syndrome, admission to The association between gestational age and adverse perinatal the neonatal intensive care or step-down unit, stillbirth and outcomes (adjusted analysis) is presented in Table 3. A significant neonatal death. increased risk of perinatal morbidity (chorioamnionitis, emergency cesarean delivery, acute fetal distress and macrosomia) was Statistical Analysis observed as early as 40 weeks compared with 39 weeks’ gestation. The population was divided into three groups: post-term (42 to 44 The same outcomes were also associated with pregnancies at weeks’ gestation), a late-term group of 40 to 406 weeks, and a 7 42 to 44 weeks, but the odds ratios were higher. Post-term second late-term group of 41 to 416 weeks’ gestation. Pregnancies 7 pregnancies also demonstrated additional complications such as at 39 to 396 weeks’ gestation were used for the control group. Risks 7 5 min Apgar score less than 4, meconium aspiration syndrome, (odds ratio; 95% confidence interval) for selected perinatal admission to the neonatal intensive care or step-down unit, outcomes were assessed by several logistic regression models stillbirth and neonatal death. controlled for cofounders: maternal age, <6 years of education, marital status, smoking during pregnancy, history of adverse perinatal outcomes (such as previous preterm birth, stillbirth Discussion and congenital malformations), maternal chronic diseases In this study, the frequency of pregnancies beyond 396 weeks (diabetes mellitus, thyroid disease), nulliparity, gestational 7 was approximately 37%. This represents an important proportion diabetes, preeclampsia, eclampsia, prenatal care and gender. of all deliveries and as such, it is important to analyze adverse SPSS 16.0 for Windows was used for analysis. perinatal outcomes in this population in order to obtain an increased understanding of the problem to be able to improve outcomes. Results Previous reports noted that the best outcomes occurred when the 6 8 There were 23 231 births in the study period; 1956 (8.4%) were length of pregnancy ranges from 37 to 417 weeks of gestation. It is excluded: 1295 (6%) multiple births, 419 (1.8%) for inaccurate widely accepted that infants born before or after this period, have gestational age and 242 (1%) for congenital malformations. The more perinatal complications. However, although controversial, gestational age was calculated by Capurro Score n ¼ 13 703 (64%), there are some studies that have found increased perinatal risk dates n ¼ 7448 (35%), prenatal ultrasound n ¼ 106 (0.5%) and as early as 40 weeks’ gestation.3,9 the New Ballard Score 18 (0.1%). A total of 21 275 infants were In this study population, the rate of adolescent women among 6 analyzed; of these, 4545 (21.3%) were 40 to 407 weeks’ gestation, pregnancies >39 weeks was higher than those of shorter duration 6 3024 (14.2%) 41 to 417 weeks’ gestation and 388 (1.8%) 42 to and the rates were also high in relation to that reported in our 44 weeks’ gestation. country, which is estimated to be 17% of all pregnancies. It would The maternal characteristics of the study population are shown be interesting to see if adolescence is related to prolonged in Table 1.
Load more

Recommended publications
  • Induction of Labor
    36 O B .GYN. NEWS • January 1, 2007 M ASTER C LASS Induction of Labor he timing of parturi- nancies that require induction because of medical com- of labor induction, the timing of labor induction, and the tion remains a conun- plications in the mother. advisability of the various conditions under which in- Tdrum in obstetric Increasingly, however, patients are apt to have labor in- duction can and does occur. medicine in that the majority duced for their own convenience, for personal reasons, This month’s guest professor is Dr. William F. Rayburn, of pregnancies will go to for the convenience of the physician, and sometimes for professor and chairman of the department of ob.gyn. at term and enter labor sponta- all of these reasons. the University of New Mexico, Albuquerque. Dr. Ray- neously, whereas another This increasingly utilized social option ushers in a burn is a maternal and fetal medicine specialist with a na- portion will go post term and whole new perspective on the issue of induction, and the tional reputation in this area. E. ALBERT REECE, often require induction, and question is raised about whether or not the elective in- M.D., PH.D., M.B.A. still others will enter labor duction of labor brings with it added risk and more com- DR. REECE, who specializes in maternal-fetal medicine, is prematurely. plications. Vice President for Medical Affairs, University of Maryland, The concept of labor induction, therefore, has become It is for this reason that we decided to develop a Mas- and the John Z.
    [Show full text]
  • Association Between First Caesarean Delivery and Adverse Outcomes In
    Hu et al. BMC Pregnancy and Childbirth (2018) 18:273 https://doi.org/10.1186/s12884-018-1895-x RESEARCHARTICLE Open Access Association between first caesarean delivery and adverse outcomes in subsequent pregnancy: a retrospective cohort study Hong-Tao Hu1†, Jing-Jing Xu1†, Jing Lin1, Cheng Li1, Yan-Ting Wu2, Jian-Zhong Sheng3, Xin-Mei Liu4,5* and He-Feng Huang2,4,5* Abstract Background: Few studies have explored the association between a previous caesarean section (CS) and adverse perinatal outcomes in a subsequent pregnancy, especially in women who underwent a non-indicated CS in their first delivery. We designed this study to compare the perinatal outcomes of a subsequent pregnancy in women who underwent spontaneous vaginal delivery (SVD) or CS in their first delivery. Methods: This retrospective cohort study included women who underwent singleton deliveries at the International Peace Maternity and Child Health Hospital from January 2013 to December 2016. Data on the perinatal outcomes of all the women were extracted from the medical records. Multivariate logistic regression was conducted to assessed the association between CS in the first delivery and adverse perinatal outcomes in the subsequent pregnancy. Results: CS delivery in the subsequent pregnancy was more likely for women who underwent CS in their first birth than for women with previous SVD (97.3% versus 13.2%). CS in the first birth was also associated with a significantly increased risk of adverse outcomes in the subsequent pregnancy, especially in women who underwent a non- indicated CS. Adverse perinatal outcomes included pregnancy-induced hypertension [adjusted odds ratio (OR), 95% confidence interval (CI): 2.20, 1.59–3.05], gestational diabetes mellitus (1.82, 1.57–2.11), gestational anaemia (1.27, 1.
    [Show full text]
  • Review Article Umbilical Cord Hematoma: a Case Report and Review of the Literature
    Hindawi Obstetrics and Gynecology International Volume 2018, Article ID 2610980, 6 pages https://doi.org/10.1155/2018/2610980 Review Article Umbilical Cord Hematoma: A Case Report and Review of the Literature Gennaro Scutiero,1 Bernardi Giulia,1 Piergiorgio Iannone ,1 Luigi Nappi,2 Danila Morano,1 and Pantaleo Greco1 1Department of Morphology, Surgery and Experimental Medicine, Section of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria S. Anna, University of Ferrara, Via Aldo Moro 8, 44121 Cona, Ferrara, Italy 2Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Viale L. Pinto, 71100 Foggia, Italy Correspondence should be addressed to Piergiorgio Iannone; [email protected] Received 17 December 2017; Accepted 21 February 2018; Published 26 March 2018 Academic Editor: John J. Moore Copyright © 2018 Gennaro Scutiero et al. *is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. To deepen the knowledge in obstetrics on a very rare pregnancy complication: umbilical cord hematoma. Methods.A review of the case reports described in the last ten years in the literature was conducted in order to evaluate epidemiology, predisposing factors, potential outcomes, prenatal diagnosis, and clinical management. Results. Spontaneous umbilical cord hematoma is a rare complication of pregnancy which represents a serious cause of fetal morbidity and mortality. *ere are many risk factors such as morphologic anomalies, infections, vessel wall abnormalities, iatrogenic causes, and traction or torsion of the cord, but the exact etiology is still unknown.
    [Show full text]
  • Maternal and Foetal Mortality in Placenta Praevia"
    J Obs Gyn Brit Emp 1962 V-69 MATERNAL AND FOETAL MORTALITY IN PLACENTA PRAEVIA" BY C. H. G. MACAFEE,C.B.E., D.Sc., F.R.C.S., F.R.C.O.G. Professor of Obstetrics and Gynaecology, The Queen's Universiiy of Belfast W. GORDONMILLAR, F.R.F.P.S., F.R.C.S., M.R.C.O.G. Consultant Obstetrician and Gynaecologist, Royal Injirmary, Perth; formerly Lecturer in Department qf Obstetrics and Gynaecology, The Queen's University of Belfast AND GRAHAMHARLEY, M.D., M.R.C.O.G. Lecturer, Department of Obstetrics and Gynaecology, The Queen's University of Belfast IN the 95 years between 1844-1939 the foetal During the first eight-year period 206 patients mortality from placenta praevia remained at were dealt with and in the second period the between 54 per cent and 60 per cent, while the number was 219. These two figures correspond maternal mortality fell from 30 per cent to 5 so closely that they permit a good statistical per cent. comparison to be made between the two eight- year periods. TABLE I Maternal Foetal Expectant Treatment Author Date Mortality Mortality In recent years the value of this treatment has been recognized and is becoming more 01,'O % SimDson . .. 1844 30 60 widely accepted even though it entails the Berkeley . 1936 7 59 occupation of antenatal beds sometimes for Browne . 1939 5 54 weeks. It is obvious that the nearer the preg- Belfast series . 1945-52 nil 14.9 nancy can be carried to full term the more 1953-60 0.9 11.1 favourable the outlook for the baby.
    [Show full text]
  • 15 Complications of Labor and Birth 279
    Complications of 15 Labor and Birth CHAPTER CHAPTER http://evolve.elsevier.com/Leifer/maternity Objectives augmentation of labor (a˘wg-me˘n-TA¯ -shu˘n, p. •••) Bishop score (p. •••) On completion and mastery of Chapter 15, the student will be able to do cephalopelvic disproportion (CPD) (se˘f-a˘-lo¯ -PE˘L- v i˘c the following: di˘s-pro¯ -PO˘ R-shu˘n, p. •••) 1. Defi ne key terms listed. cesarean birth (se˘-ZA¯ R-e¯-a˘n, p. •••) 2. Discuss four factors associated with preterm labor. chorioamnionitis (ko¯ -re¯-o¯-a˘m-ne¯-o¯ -NI¯-ti˘s, p. •••) 3. Describe two major nursing assessments of a woman dysfunctional labor (p. •••) ˘ ¯ in preterm labor. dystocia (dis-TO-se¯-a˘, p. •••) episiotomy (e˘-pe¯ z-e¯-O˘ T- o¯ -me¯, p. •••) 4. Explain why tocolytic agents are used in preterm labor. external version (p. •••) 5. Interpret the term premature rupture of membranes. fern test (p. •••) 6. Identify two complications of premature rupture of forceps (p. •••) membranes. hydramnios (hi¯-DRA˘ M-ne¯-o˘s, p. •••) 7. Differentiate between hypotonic and hypertonic uterine hypertonic uterine dysfunction (hi¯-pe˘r-TO˘ N-i˘k U¯ -te˘r-i˘n, dysfunction. p. •••) 8. Name and describe the three different types of breech hypotonic uterine dysfunction (hi¯-po¯-TO˘ N-i˘k, p. •••) presentation. induction of labor (p. •••) ¯ 9. List two potential complications of a breech birth. multifetal pregnancy (mu˘l-te¯-FE-ta˘l, p. •••) nitrazine paper test (NI¯-tra˘-ze¯n, p. •••) 10. Explain the term cephalopelvic disproportion (CPD), and oligohydramnios (p. •••) discuss the nursing management of CPD.
    [Show full text]
  • Induction of Labour in Late and Postterm Pregnancies and Its
    Original Article 793 Induction of Labour in Late and Postterm Pregnancies and its Impact on Maternal and Neonatal Outcome Die Geburtseinleitung bei übertragener Schwangerschaft und die Auswirkungen auf mütterliches und kindliches Outcome Authors F. Thangarajah*, P. Scheufen*, V. Kirn, P. Mallmann Affiliation University Hospital of Cologne, Department of Obstetrics and Gynecology, Cologne, Germany Key words Abstract Zusammenfassung l" induction of labour ! ! l" delivery Introduction: This study aimed to determine the Einleitung: Diese Studie untersuchte die Auswir- l" cesarean section effects of induction of labour in late-term preg- kungen der Geburtseinleitung in der Spätschwan- l" materno‑fetal medicine nancies on the mode of delivery, maternal and gerschaft bzw. bei Übertragung auf die Art der Schlüsselwörter neonatal outcome. Entbindung sowie auf das mütterliche und kind- l" Geburtseinleitung Methods: We retrospectively analyzed deliveries liche Outcome. l" Entbindung between 2000 and 2014 at the University Hospi- Methoden: Alle in der Universitätsklinik Köln l" Kaiserschnittentbindung tal of Cologne. Women with a pregnancy aged be- zwischen 2000 und 2014 erfolgten Entbindungen l" Perinatalmedizin tween 41 + 0 to 42 + 6 weeks were included. wurden retrospektiv untersucht. Alle Frauen, die Those who underwent induction of labour were in der 41 + 0 bis 42 + 6 Schwangerschaftswoche compared with women who were expectantly entbanden, wurden in die Studie eingeschlossen. managed. Maternal and neonatal outcomes were Schwangere Frauen, bei denen eine Geburtsein- evaluated. leitung durchgeführt wurde, wurden mit Frauen Results: 856 patients were included into the verglichen, die exspektativ behandelt wurden. study. The rate of cesarean deliveries was signifi- Die mütterlichen und kindlichen Outcomes wur- cantly higher for the induction of labour group den ausgewertet.
    [Show full text]
  • Caesarean Section for Placenta Praevia (Consent Advice No
    Royal College of Obstetricians and Gynaecologists Consent Advice No. 12 December 2010 CAESAREAN SECTION FOR PLACENTA PRAEVIA This is the first edition of this guidance. This paper provides additional advice for clinicians in obtaining consent of a woman to undergo caesarean section in the specific circumstance of current pregnancy with placenta praevia with or without previous caesarean section. It is designed to be used in conjunction with Consent Advice No. 7: Caesarean section.1 The aim of this paper is to highlight the additional and specific consequences of caesarean section performed in the presence of placenta praevia. The information should, where possible, be provided during the antenatal period in the form of an information sheet to allow the woman to understand the situation and to provide ample opportunities for her to ask any questions she may have and to antenatally meet providers of additional services that may become necessary, such as interventional radiologists. Depending on local clinical governance arrangements, an additional consent form may be used with the addition- al risks highlighted, or the additional risks may be incorporated in a specific consent form for the whole procedure. CONSENT FORM 1. Name of proposed procedure or course of treatment Caesarean section for placenta praevia. 2. The proposed procedure Describe the nature of caesarean section and emphasise how a procedure in the presence of placenta praevia varies in comparison with one performed in the presence of a normally sited placenta. Explain the procedure as described in the patient information. 3. Intended benefits The aim of the procedure is to secure the safest route of delivery to avoid the anticipated risks to the mother and/or baby of the heavy bleeding that would occur during labour and attempted vaginal delivery owing to the position of the placenta.
    [Show full text]
  • Chorioamnionitis and Vaginal Examinations in Labor
    Chorioamnionitis and Vaginal Examinations in Labor Unja Kim, RN, Ashley Stowers, RN, Andrea Chaldek, RN, Molly Lockwood, RN, Nyree Van Maarseven, RN, Anna Woertler, RN, and Catherina Madani, PhD, RN Background Specific Aims Findings Chorioamnionitis is an infection of the placental membranes and of To explore current knowledge, attitudes, and practices of healthcare Of nine risk factors for chorioamnionitis described in the the amniotic fluid. Chorioamnionitis usually occurs when providers regarding vaginal exams and chorioamnionitis. case study, less than half of all nurses were able to correctly membranes are ruptured, and results from the migration of identify five or more risk factors. cervicovaginal bacteria into the uterus.1 More than one third of nurses sampled reported being more aggressive with their VE frequency (i.e., they would Chorioamnionitis is one of the most frequent causes of infant illness perform 4 or more VEs in the case study presented). and is associated with 20 to 40% of cases of early onset neonatal Methodology Nurses’ years of experience were found to be negatively sepsis and pneumonia.2 Other complications include: correlated with the number of VEs performed, rsp(76) = Neonatal Maternal -.330, p = 0.004. Nurses with more years of labor and Cerebral white matter damage Postpartum hemorrhage Cross sectional descriptive study looking at 76 registered delivery experience were less likely to perform VEs in the Neurodevelopmental delay Endometritis nurses working in labor and delivery units at 3 San Diego case study scenarios presented Cerebral palsy Sepsis hospitals. Participants completed written surveys assessing Pneumonia demographics, personality type, and attitudes and practices Sepsis when caring for laboring patients – including vaginal exam frequency.
    [Show full text]
  • Management of Prolonged Decelerations ▲
    OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others.
    [Show full text]
  • Management of Subsequent Pregnancy After an Unexplained Stillbirth
    Journal of Perinatology (2010) 30, 305–310 r 2010 Nature Publishing Group All rights reserved. 0743-8346/10 $32 www.nature.com/jp STATE-OF-THE-ART Management of subsequent pregnancy after an unexplained stillbirth SJ Robson1 and LR Leader2 1Department of Obstetrics and Gynaecology, Australian National University, Canberra, Australia and 2School of Women’s and Children’s Health, University of New South Wales, Royal Hospital for Women, Randwick, Australia they face in a subsequent pregnancy, as well as potential Purpose: To review the management of pregnancy after an unexplained management strategies to optimize future pregnancy outcomes.2–4 stillbirth. Unfortunately, as many as one-third of such cases remain Epidemiology: Approximately 1 in 200 pregnancies will end in ‘unexplained’ and unexplained stillbirth is now the commonest stillbirth, of which about one-third will remain unexplained. Unexplained single contributor to perinatal mortality. stillbirth is the largest single contributor to perinatal mortality. There is no evidence that extensive research efforts over the last Subsequent pregnancies do not appear to have an increased risk of two decades have yielded a reduction in the incidence of this 2,5 stillbirth, but are characterized by increased rates of intervention distressing outcome. Virtually all of the published literature is (induction of labor, elective cesarean section) and iatrogenic adverse concerned with population-based strategies for primary prevention outcomes (low birth weight, prematurity, emergency cesarean section and of unexplained stillbirth. However, the commonest situation in post-partum hemorrhage). which clinicians will find themselves is management of women in their next pregnancy after an unexpected unexplained stillbirth. Conclusions: There is no level-one evidence to guide management in Effective care of women in their next pregnancy after an this situation.
    [Show full text]
  • The Effects of Maternal Chorioamnionitis on the Neonate
    Neonatal Nursing Education Brief: The Effects of Maternal Chorioamnionitis on the Neonate https://www.seattlechildrens.org/healthcare- professionals/education/continuing-medical-nursing-education/neonatal- nursing-education-briefs/ Maternal chorioamnionitis is a common condition that can have negative effects on the neonate. The use of broad spectrum antibiotics in labor can reduce the risks, but infants exposed to chorioamnionitis continue to require treatment. The neonatal sepsis risk calculator can guide treatment. NICU, chorioamnionitis, early onset neonatal sepsis, sepsis risk calculator The Effects of Maternal Chorioamnionitis on the Neonate Purpose and Goal: CNEP # 2090 • Understand the effects of chorioamnionitis on the neonate. • Learn about a new approach for treating infants at risk. None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored. Requirements for successful completion: • Successfully complete the post-test • Complete the evaluation form Date • December 2018 – December 2020 Learning Objectives • Describe the pathogenesis of maternal chorioamnionitis. • Describe the outcomes for neonates exposed to chorioamnionitis. • Identify 2 approaches for the treatment of early onset sepsis. Introduction • Chorioamnionitis is a common complication • It affects up to 10% of all pregnancies • It is an infection of the amniotic fluid and placenta • It is characterized by inflammation
    [Show full text]
  • Preterm Delivery and Risk of Breast Cancer
    British Journal of Cancer (1999) 80(3/4), 609–613 © 1999 Cancer Research Campaign Article no. bjoc.1998.0399 Preterm delivery and risk of breast cancer M Melbye, J Wohlfahrt, A-MN Andersen, T Westergaard and PK Andersen Danish Epidemiology Science Centre, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark Summary To explore the risk of breast cancer in relation to the length of a pregnancy we tested whether a preterm delivery carries a higher risk of breast cancer than does a full-term delivery. Based on information from the Civil Registration System, and the National Birth Registry in Denmark, we established a population-based cohort of 474 156 women born since April 1935, with vital status and detailed parity information, including the gestational age of liveborn children and stillbirths. Information on spontaneous and induced abortions was obtained from the National Hospital Discharge Registry and the National Registry of Induced Abortions. Incident cases of breast cancer in the cohort (n = 1363) were identified through linkage with the Danish Cancer Registry. The period at risk started in 1978 and continued until a breast cancer diagnosis, death, emigration, or 31 December, 1992, whichever occurred first. After adjusting for attained age, parity, age at first birth and calendar period, we observed the following relative risks of breast cancer for different lengths of the pregnancy: < 29 gestational weeks = 2.11 (95% confidence interval 1.00–4.45); 29–31 weeks = 2.08 (1.20–3.60); 32–33 weeks = 1.12 (0.62–2.04); 34–35 weeks = 1.08 (0.71–1.66); 36–37 weeks = 1.04 (0.83–1.32); 38–39 weeks = 1.02 (0.89–1.17); 40 weeks = 1 (reference).
    [Show full text]