Short-term outcome in very low birthweight babies has never been closely examined in Papua New Guinea. A cohort of neonates born over a year at Port Moresby General Hospital was followed from birth to death or discharge. Intrauterine growth retardation was an important contributor to low birthweight. Simple, inexpensive care resulted in respectable survival figures. Improving antenatal surveillance will have much more impact in reducing mortality in this group in the future than trying to emulate sophisticated and costly western neonatal care.
Antibiotic Prophylaxis ; Birth Weight ; Cohort Studies ; Exchange Transfusion, Whole Blood ; Female ; Fetal Growth Retardation - complications ; Respiratory Distress Syndrome, Newborn - therapy

Thrombophilia refers to inherited or acquired hemostatic disorders that result in a predisposition to blood clot formation. When combined with the hypercoagulable state that is characteristic of pregnancy, there is an increased risk of severe and recurrent pregnancy complications. Activated protein C resistance caused by factor V Leiden (FVL) mutation is known to be the most common cause of inherited thrombophilia in Caucasian population. FVL mutation has been related to pregnancy complications associated with hypercoagulation, e.g. miscarriage, intrauterine fetal demise, placental abruption, and intrauterine growth retardation. Although the FVL mutation is easily detected using molecular DNA techniques, patients who are heterozygous for this disorder often remain asymptomatic until they develop a concurrent prothrombotic condition. Because there are potentially serious effects of FVL mutation for pregnancy, and because effective treatment strategies exist, early detection and treatment of this condition might be considered.
Abortion, Spontaneous ; Abruptio Placentae ; Activated Protein C Resistance ; DNA ; Factor V ; Female ; Fetal Death ; Fetal Growth Retardation ; Hemostatic Disorders ; Humans ; Pregnancy Complications ; Pregnancy ; Pregnant Women ; Thrombophilia

OBJECTIVES: To investigate the risk factors for necrotizing enterocolitis (NEC) in very preterm infants and establish a nomogram model for predicting the risk of NEC. METHODS: A total of 752 very preterm infants who were hospitalized from January 2015 to December 2021 were enrolled as subjects, among whom 654 were born in 2015-2020 (development set) and 98 were born in 2021 (validation set). According to the presence or absence of NEC, the development set was divided into two groups: NEC (n=77) and non-NEC (n=577). A multivariate logistic regression analysis was used to investigate the independent risk factors for NEC in very preterm infants. R software was used to plot the nomogram model. The nomogram model was then validated by the data of the validation set. The receiver operating characteristic (ROC) curve, the Hosmer-Lemeshow goodness-of-fit test, and the calibration curve were used to evaluate the performance of the nomogram model, and the clinical decision curve was used to assess the clinical practicability of the model. RESULTS: The multivariate logistic regression analysis showed that neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding were independent risk factors for NEC in very preterm infants (P<0.05). The ROC curve of the development set had an area under the curve (AUC) of 0.833 (95%CI: 0.715-0.952), and the ROC curve of the validation set had an AUC of 0.826 (95%CI: 0.797-0.862), suggesting that the nomogram model had a good discriminatory ability. The calibration curve analysis and the Hosmer-Lemeshow goodness-of-fit test showed good accuracy and consistency between the predicted value of the model and the actual value. CONCLUSIONS Neonatal asphyxia, sepsis, shock, hypoalbuminemia, severe anemia, and formula feeding are independent risk factors for NEC in very preterm infant. The nomogram model based on the multivariate logistic regression analysis provides a quantitative, simple, and intuitive tool for early assessment of the development of NEC in very preterm infants in clinical practice.
Asphyxia/complications* ; Child ; Enterocolitis, Necrotizing/etiology* ; Female ; Fetal Growth Retardation ; Humans ; Hypoalbuminemia ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases ; Infant, Premature ; Infant, Premature, Diseases/etiology* ; Nomograms ; Sepsis/complications*

OBJECTIVETo investigate the risks of recurrent preeclampsia and observe the incidence and long-term prognosis of recurrent preeclampsia.

METHODSOne hundred and fifteen women with preeclampsia history admitted in Women's Hospital, Zhejiang University School of Medicine from January 2009 to December 2013 were enrolled in the study. The clinical data were retrospectively analyzed.

RESULTSAmong 115 women with preeclampsia, 82 cases (71.3%)had recurrent preeclampsia. The onset age, the pregnant interval time, regular prenatal check-up, weight gain during pregnancy, body mass index (BMI), hyperlipidemia, fetal growth restriction (FGR), maternal family history were closely associated with recurrent preeclampsia (P<0.05). Logistic regression analysis showed that the pregnant interval time, BMI, FGR were independent risk factors for preeclampsia recurrence. Compared with the preeclampsia in first pregnancy, the mather had earlier onset and termination of pregnancy, higher blood pressure, higher rate of urine protein ≥ 2+ and higher rate of complications in recurrent preeclampsia. The offspring had higher rate of preterm birth, especially the time of birth for 34 weeks or earlier and lower birth weight (P<0.05). The incidence of chronic hypertension in recurrent preeclampsia group was higher than that in no recurrence group (47.5% vs 23.3%, P<0.05); the overweight rate of first pregnant offspring in recurrence group was higher than that in no recurrence group (31.25% vs 6.70%, P<0.05).

CONCLUSIONThe onset age, time interval, regular prenatal check-up, weight gain during pregnancy, BMI, hyperlipidemia, FGR, maternal family history are closely associated with recurrent preeclampsia, and the pregnant interval time, BMI, FGR are independent risk factors for preeclampsia recurrence. Recurrent preeclampsia has more serious clinical outcome and complications, and prevention need to be emphasized.

Body Mass Index ; Female ; Fetal Growth Retardation ; epidemiology ; Humans ; Hyperlipidemias ; epidemiology ; Infant, Newborn ; Pre-Eclampsia ; epidemiology ; Pregnancy ; Pregnancy Complications ; epidemiology ; Recurrence ; Retrospective Studies ; Risk Factors

Preeclampsia and intrauterine growth restriction (IUGR) of the fetus are the two most common pregnancy complications worldwide, affecting 5%-10% of pregnant women. Preeclampsia is associated with significantly increased maternal and fetal morbidity and mortality. Hypoxia-induced uteroplacental dysfunction is now recognized as a key pathological factor in preeclampsia and IUGR. Reduced oxygen supply (hypoxia) disrupts mitochondrial and endoplasmic reticulum (ER) function. Hypoxia has been shown to alter mitochondrial reactive oxygen species (ROS) homeostasis and induce ER stress. Hypoxia during pregnancy is associated with excessive production of ROS in the placenta, leading to oxidative stress. Oxidative stress occurs in a number of human diseases, including high blood pressure during pregnancy. Studies have shown that uterine placental tissue/cells in preeclampsia and IUGR show high levels of oxidative stress, which plays an important role in the pathogenesis of both the complications. This review summarizes the role of hypoxia-induced mitochondrial oxidative stress and ER stress in the pathogenesis of preeclampsia/IUGR and discusses the potential therapeutic strategies targeting oxidative stress to treat both the pregnancy complications.
Pregnancy ; Female ; Humans ; Placenta ; Fetal Growth Retardation/etiology* ; Pre-Eclampsia/pathology* ; Reactive Oxygen Species ; Hypoxia/pathology* ; Pregnancy Complications/pathology* ; Endoplasmic Reticulum Stress

BACKGROUND: Although HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) is a serious medical complications including coagulopathy, hypertension, hepatic and renal failures, and pulmonary edema in pregnant women, the data about HELLP syndrome were rarely reported in the medical journal in Korea. METHODS: Nineteen cases of HELLP syndrome were retrospectively studied out of 16,910 pregnant women from January 1998 to March 2004 at Uijongbu St. Mary's Hospital. We analyzed incidence, clinical symptoms, laboratory findings, maternal and clinical complications and clinical course of HELLP syndrome. RESULTS: The incidence of HELLP syndrome was 0.27% (19/16,910) in total pregnant women and 4.15% (19/458) in women with preeclampsia. All patients had evidence of hemolysis and serum aspartate aminotransferase level >or= 70 IU/L, and platelet counts complications included acute renal failure (n=3), pulmonary edema (n=2), disseminated intravascular coagulopathy (n=2), postpartum bleeding (n=4). There was no maternal death. Fetal complications included placental disruption (n=2), and intrauterine growth retardation (n=5). Fetal death occurred in 2 cases. CONCLUSION: This data suggest that HELLP syndrome is not uncommon in women with preeclampsia and it represents poor maternal and fetal outcomes. Therefore, in order to decrease maternal and fetal morbidities, cooperation between internists and obstetric doctors is very important.
Acute Kidney Injury ; Aspartate Aminotransferases ; Female ; Fetal Death ; Fetal Growth Retardation ; HELLP Syndrome* ; Hemolysis ; Hemorrhage ; Humans ; Hypertension ; Incidence* ; Korea ; Liver ; Maternal Death ; Platelet Count ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnant Women* ; Pulmonary Edema ; Renal Insufficiency ; Retrospective Studies

OBJECTIVE: To evaluate the importance of assessment of fetal cardiac output (CO) for the prediction of complications of pregnancy. METHODS: We evaluated 65 fetuses and all of them had a fetal cardiac scan at 20 to 24 weeks of pregnancy. To measure CO, diameters (d) of the left right ventricle outflow tract were measured just above the valves. Each left CO (LCO) and right CO (RCO) was derived using the following equation: CO = velocity time integral ×π× d²/4 × heart rate. Pregnancy complications included gestational hypertensive disorders, fetal growth restriction (FGR) and preterm birth (PTB) caused from preterm labor or preterm premature rupture of membrane (PPROM). RESULTS: There were 23 cases with one more pregnancy complication (FGR, 9; gestational hypertensive disorders, 8; PTB caused from PTB or PPROM, 12). The LCO was lower in complication group than in normal group (88±53 vs. 117±48 mL/min, P=0.028). The RCO to the LCO ratio (RCO/LCO) was higher in complication group (2.43±1.69 vs. 1.48±0.81, P=0.001). Regression analysis demonstrated that RCO/LCO was a significant predictor of pregnancy complication; Odds ratio was 7.76 (95% CI, 1.15 to 52.21; P=0.029). The area under the receiver-operating characteristic curve for prediction of pregnancy complications from LCO was 0.71. The diagnostic cut-off value of LCO was 80 mL/min. The area under the receiver-operating characteristic curve from RCO/LCO was 0.68 and cut-off value was 1.41. CONCLUSION: This study demonstrated that pregnancy complications can be suspected based on fetal CO assessments at a GA of 20 to 24 weeks.
Cardiac Output* ; Echocardiography ; Female ; Fetal Development ; Fetal Growth Retardation ; Fetus ; Heart Rate ; Heart Ventricles ; Membranes ; Obstetric Labor, Premature ; Odds Ratio ; Pre-Eclampsia ; Pregnancy Complications* ; Pregnancy* ; Premature Birth ; Rupture ; Ultrasonography*

PURPOSE: The purpose of this study was to compare the obstetric and perinatal outcome between two groups with or without meconium staining of amniotic fluid (MSAF) at term birth in one-year consecutive population at our delivery unit. METHODS: Pregnancy complication including nonreassuring fetal heart rate pattern, intrauterine growth retardation, oligohydramnios, hydramnios and preeclampsia between the two groups were retrospectively documented by review of medical record. To evaluate the perinatal outcome, apgar score at 1min and 5min, and umbilical artery blood gas analysis were also analyzed. Student T test and chi square test were used for statistic analysis. RESULTS: The study population consisted of 687 full-term neonates with presence (n=89) and absence (n=598) of MSAF. Gestational age at delivery was significantly higher in the MSAF group (p< 0.001). Although the fetal acidemia (umbilical artery blood pH <7.0) was significantly higher in the MSAF group (3.4% vs 1.0%, p<0.01), the metabolic acidemia (base deficit >12.0 mEq/L) was not increased. The incidence of non reassuring fetal heart rate pattern was also increased in the MSAF group (4.5% vs 1.0%, p=0.03). However there was no significant difference in 1 min and 5 min Apgar score. CONCLUSION: Although MSAF is associated with the risk of non reassuring fetal heart rate pattern and fetal acidemia, the metabolic acidemia and low apgar score at 5minutes was not significantly increased compared with clear amniotic fluid group. Delivery of pregnancy with MSAF should be managed under the careful fetal heart rate monitoring.
Amniotic Fluid ; Apgar Score ; Arteries ; Blood Gas Analysis ; Female ; Fetal Growth Retardation ; Gestational Age ; Heart Rate, Fetal ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant, Newborn ; Meconium ; Medical Records ; Oligohydramnios ; Polyhydramnios ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Retrospective Studies ; Term Birth ; Umbilical Arteries

OBJECTIVETo investigate the effects of pregnancy malnutrition on the occurrence of insulin resistance (IR) in rat offspring during adult stage and to find out the relationship between TNF-alpha and IR; and to find out a reasonable early nutritional intervention measure for the prevention of IR, through giving different diets to offspring.

METHODSAn IUGR model was built by maternal nutrition restriction. 80 newborn IUGR female pups were randomly divided into 4 groups, the mother rats were given the following diet respectively for 3 weeks after delivery, pups were fed by mother milk: (1) The IUGR (intrauterine growth retardation) rat model was used and the animals were divided into: IUGR control group (group S/N) fed with normal diet, (2) IUGR high-caloric diet group (group A), (3) IUGR high-protein and high-caloric diet group (group B) and (4) IUGR high-protein isocaloric diet group (group C). Each group had 20 pups and another 20 normal female pups were fed with normal diet as the normal control group (group C/N). All pups were weaned at the 4th week of age and fed with normal diet till the end of the experiment. At the 12th week (adulthood) and 48th week (senility) of life, body weight and length, the fasting blood glucose, insulin concentration, TNF-alpha of adipose tissue and body weight were measured. Body mass index (BMI), ISI (insulin sensitive index), IRI (insulin resistant index) and HBCI (beta cell insulin excretion index) and their correlation to TNF-alpha were calculated.

RESULTSAt 12th week and 48th week of life, the insulin sensitivity of IUGR model group was significantly lower than group C/N, although there was no significant difference of body weight between these two groups. TNF-alpha was negatively correlated with ISI, positively correlated with IRI and no relation to HBCI. Group A and B was fatter and developed more severe IR. There were no significant differences in ISI, IRI, HBCI and TNF-alpha between group C and group C/N.

CONCLUSIONSIUGR offspring of pregnancy malnutrition mother rats showed IR at the age of 12th week. TNF-alpha was closely related to the occurrence of IR in IUGR pups. IUGR pups fed with high caloric diet or high protein and caloric diet at the early postnatal period amplified the metabolic abnormality. The high protein isocaloric diet is effective early nutritional intervention measure for the prevention of occurrence of IR at adulthood.

Animals ; Animals, Newborn ; growth & development ; Body Weight ; drug effects ; Dietary Proteins ; pharmacology ; Female ; Fetal Growth Retardation ; blood ; etiology ; Insulin Resistance ; physiology ; Malnutrition ; physiopathology ; Pregnancy ; Pregnancy Complications ; Prenatal Exposure Delayed Effects ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; metabolism

Animals ; Caffeine/adverse effects* ; Central Nervous System Stimulants/adverse effects* ; Dose-Response Relationship, Drug ; Female ; Fetal Growth Retardation/chemically induced* ; Immune System Diseases/chemically induced* ; Male ; Organ Size/drug effects* ; Pregnancy ; Pregnancy Complications/immunology* ; Rats ; Spleen/growth & development*