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*

Acute atherosis is unique vascular changes of the placenta associated with poor placentation. It is characterized by subendothelial lipid-filled foam cells, fibrinoid necrosis of the arterial wall, perivascular lymphocytic infiltration, and it is histologically similar to early-stage atherosclerosis. Acute atherosis is rare in normal pregnancies, but is frequently observed in non- transformed spiral arteries in abnormal pregnancies, such as preeclampsia, small for gestational age (SGA), fetal death, spontaneous preterm labor and preterm premature rupture of membranes. In preeclampsia, spiral arteries fail to develop physiologic transformation and retain thick walls and a narrow lumen. Failure of physiologic transformation of spiral arteries is believed to be the main cause of uteroplacental ischemia, which can lead to the production of anti-angiogenic factors and induce endothelial dysfunction and eventually predispose the pregnancy to preeclampsia. Acute atherosis is more frequently observed in the spiral arteries of the decidua of the placenta (parietalis or basalis) than in the decidual or myometrial segments of the placental bed. The presence and deeper location of acute atherosis is associated with poorer pregnancy outcomes, more severe disease, earlier onset of preeclampsia, and a greater frequency of SGA neonates in patients with preeclampsia. Moreover, the idea that the presence of acute atherosis in the placenta may increase the risk of future cardiovascular disease in women with a history of preeclampsia is of growing concern. Therefore, placental examination is crucial for retrospective investigation of pregnancy complications and outcomes, and accurate placental pathology based on universal diagnostic criteria in patients with abnormal pregnancies is essential for clinicopathologic correlation.
Arteries* ; Atherosclerosis ; Cardiovascular Diseases ; Cholesterol ; Decidua ; Female ; Fetal Death ; Foam Cells ; Gestational Age ; Humans ; Infant, Newborn ; Ischemia ; Membranes ; Necrosis ; Obstetric Labor, Premature ; Pathology ; Placenta ; Placentation ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Retrospective Studies ; Rupture

OBJECTIVE: To access the pregnancy tendency and delivery in women aged 40 years and older. METHODS: From January 1999 to June 2001, 7882 deliveries were in Gacheon Medical School. Among them we compared 95 cases of pregnant women aged 40 years and older with 94 cases of those aged under 40 years as a control group. RESULTS: The parity was higher in women aged older than 40 years compared to control group. Number of prenatal special studies was higher in women aged older than 40 years (n=82) compared to control group (n=14). In modes of delivery and indications for c/sec, there were no difference in two groups. There were no difference in prenatal complications between two groups. But, number of cases related to placenta previa, myoma and anemia were increased in women aged older than 40 years. In postpartum complications, uterine atony and hysterectomy, postpartum bleeding and placenta accreta were higher in women aged older than 40 years compared to control group. CONCLUSION: For pregnant women aged 40 years and older, a careful approach and appropriate management will be necessary for good pregnant outcome.
Anemia ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Myoma ; Parity ; Placenta Accreta ; Placenta Previa ; Postpartum Period ; Pregnancy* ; Pregnant Women ; Schools, Medical ; Uterine Inertia

The correct diagnosis and management of patients with uterine inversion will always remain as a challenge to any obstetrician. Two cases of puerperal uterine inversion managed differently are presented. In the first patient, there was delay in the diagnosis of uterine inversion and patient had to undergo hysterectomy. In contrast, there was early recognition of uterine inversion in the second patient prompting immediate manual repositioning.

Human ; Female ; Young Adult ; Adolescent ; Uterine Inversion ; Hysterectomy ; Obstetric Labor Complications

BACKGROUNDUse of an emergency peripartum hysterectomy (EPH) as a lifesaving measure to manage intractable postpartum hemorrhage (PPH) appears to be increasing recently around the world, and the indications for EPH have changed. The object of this study is to identify risk factors associated with EPH.

METHODSWe conducted a case-control study of 21 patients who underwent EPH because of intractable PPH between January 1, 2005 and June 30, 2013, at the International Peace Maternity and Child Health Hospital Shanghai Jiao Tong University, School of Medicine (IPMCH). The parametric t-test, chi-square tests and Logistic regression models were used for analysis to identify the risk factors. The results were considered statistically significant when P < 0.05.

RESULTSThere were 89 178 deliveries during the study period. Twenty-one women had an EPH, with an incidence of 24 per 100 000 deliveries. The loss of blood during postpartum hemorrhage of the EPH group was (5 060.7 ± 3 032.6) ml, and that of the control group was (2 040.8 ± 723.5) ml. There was a significant difference of PHH between the EHP group and the control group (P = 0.001). Independent risk factors for EPH from a logistic regression model were: disseminated intravascular coagulation (DIC) (OR: 9.9, 95% CI 2.8-34, P = 0.003), previous cesarean section (OR: 5.27; 95% CI: 1.48-17.9, P = 0.009), placenta previa (OR: 6.9; 95% CI 1.6-2.9, P = 0.008), the loss of PPH (OR: 1.001; 95% CI 1.001-1.002, P = 0.002), placenta accreta (OR: 68; 95% CI 10-456, P = 0.004), the use of tocolytic agents prenatally (OR: 6.55, 95%CI 1.34-32.1,P = 0.049), and fetal macrosomia (OR: 6.9, 95% CI 1.25-38, P = 0.049).

CONCLUSIONSignificant risk factors of EPH are DIC, placenta previa, PPH, previous cesarean delivery, and placenta accrete, the use of tocolytic agents prenatally, and fetal macrosomia.

Adult ; Case-Control Studies ; Emergencies ; Female ; Fetal Macrosomia ; complications ; Humans ; Hysterectomy ; statistics & numerical data ; Middle Aged ; Obstetric Labor Complications ; epidemiology ; Placenta Accreta ; surgery ; Postpartum Hemorrhage ; surgery ; Pregnancy ; Risk Factors ; Tocolytic Agents ; adverse effects

BACKGROUNDCongenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aimed to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.

METHODSThis retrospective study evaluated the fertility and obstetric outcome of 116 inpatients with uterine malformations with pregnancy in Peking University Third Hospital from June 1998 to June 2009. A total of 270 randomly selected pregnant women with a previously confirmed normally shaped uterus as a control group. Student's t test and analysis of variance (ANOVA) were used to compare means for normally distributed variables. The analysis was carried out using the SPSS.

RESULTSAmong 21 961 deliveries in Peking University Third Hospital, 116 (0.45%) were in women with uterine anomalies. A septate uterus was present in 43 (37.1%) and the uterus didelphys in 28 (24.2%) of the 116 women identified. Bicornuate uterus, arcuate and unicomate uterus were observed in 12 (10.3%), 18 (15.5%) and 15 (12.9%) patients, respectively. Patients with uterine anomalies had significantly higher rates of malpresentation (38.8%), preterm delivery (19.8%), and cesarean section (78.5%) compared with the group of women with a normal uterus. Patients with uterine anomalies had significantly lower mean birth-weight neonates and a significantly higher incidence of small for gestationalage (SGA) neonates; women with uterus didelphys more frequently required infertility treatment than patients with other uterine anomalies (P < 0.001). The rate of malpresentation was significantly higher in patients with septated uterus in comparison with patients with uterus unicorns (P < 0.05).

CONCLUSIONSWomen with congenital uterinemal formation usually have higher incidence of complications during pregnancy and delivery. A septate uterus appears to be associated with poorer obstetric outcomes.

Adult ; Birth Weight ; Cesarean Section ; China ; Female ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infertility, Female ; Obstetric Labor Complications ; physiopathology ; Pregnancy ; Pregnancy Complications ; physiopathology ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Uterine Diseases ; complications ; physiopathology ; Young Adult

OBJECTIVE: To evaluate the efficacy and safety of prostaglandin (PG) E₂ for preterm labor induction and to investigate the predictive factors for the success of vaginal delivery. METHODS: A retrospective cohort study was performed in women (n=155) at 24+0 to 36+6 weeks of gestation who underwent induction of labor using a PGE₂ vaginal pessary (10 mg, Propess) from January 2009 to December 2015. Success rates of vaginal delivery according to gestational age at induction and incidence of intrapartum complications such as tachysystole and nonreassuring fetal heart rate were investigated. Multivariable logistic regression analysis was performed to evaluate the predictive factors for success of labor induction. RESULTS: The vaginal delivery rate was 57% (n=89) and the rate of cesarean delivery after induction was 43% (n=66). According to gestational age, labor induction was successful in 16.7%, 50.0%, and 62.8% of patients at 24 to 31, 32 to 33, and 34 to 36 weeks, showing a stepwise increase (P=0.006). There were 18 cases (11%) of fetal distress, 9 cases (5.8%) of tachysystole, and 6 cases (3.8%) of massive postpartum bleeding (>1,000 mL). After adjusting for confounding factors, multiparity (odds ratio [OR], 8.47; 95% confidence interval [CI], 3.10 to 23.14), younger maternal age (OR, 0.84; 95% CI, 0.75 to 0.94), advanced gestational age at induction (OR, 1.06; 95% CI, 1.02 to 1.09), rupture of membranes (OR, 11.83; 95% CI, 3.55 to 39.40), and the Bishop score change after removal of PGE₂ (OR, 2.19; 95% CI, 1.0 to 4.8) were significant predictors of successful preterm vaginal delivery. CONCLUSION: An understanding of the principal predictive factors of successful preterm labor induction, as well as the safety of PGE₂, will provide useful information when clinicians consult with preterm pregnant women requiring premature delivery.
Cohort Studies ; Dinoprostone ; Female ; Fetal Distress ; Gestational Age ; Heart Rate, Fetal ; Hemorrhage ; Humans ; Incidence ; Labor, Induced ; Logistic Models ; Maternal Age ; Membranes ; Obstetric Labor, Premature ; Parity ; Pessaries ; Postpartum Period ; Pregnancy ; Pregnant Women ; Premature Birth ; Retrospective Studies ; Rupture

OBJECTIVE: Our purpose was to determine whether abnormal triple marker in the second trimester may be associated with adverse pregnancy outcomes. METHODS: Between November 1996 and April 1998, we evaluated 1,158 pregnant women undergoing second trimester triple marker screening tests who delivered at our hospital. The pregnancy outcomes of 48 women with false positive screens were compared with 1,158 screen negative controls. The pregnancy outcomes were obtained from hospital delivery records. RESULTS: Women with abnormal triple marker showed increased risks for low birth weight(p<0.01). But there was no significant differences between study and control groups with respect to preterm labor, pregnancy induced hypertension, oligohydroamnios, premature rupture of membrane, placenta previa, abruptio placenta, fetal death in utero. CONCLUSION: Abnormal triple marker in the second trimester was associated with low birth weight.
Female ; Fetal Death ; Humans ; Hypertension, Pregnancy-Induced ; Infant, Low Birth Weight ; Infant, Newborn ; Mass Screening* ; Membranes ; Obstetric Labor, Premature ; Parturition ; Placenta ; Placenta Previa ; Pregnancy ; Pregnancy Outcome ; Pregnancy Trimester, Second ; Pregnancy, High-Risk* ; Pregnant Women ; Rupture

PURPOSE: The aim of this study was to determine the influence of various factors on preterm labor symptoms (PLS) and preterm birth (PB). METHODS: This prospective cohort study included 193 women in the second stage of pregnancy. Multiple characteristics including body mass index (BMI), smoking, and pregnancy complications were collected through a self-report questionnaire. Pregnancy stress and PLS were each measured with a related scale. Cervical length and birth outcome were evaluated from medical charts. Multiple regression was used to predict PLS and logistic regression was used to predict PB. RESULTS: Multiple regression showed smoking experience, pregnancy complications and pregnancy specific stress were predictors of PLS and accounted for 19.2% of the total variation. Logistic regression showed predictors of PB to be twins (OR=13.68, CI=3.72~50.33, p<.001), shorter cervix (<25mm) (OR=5.63, CI=1.29~24.54, p<.05), BMI >25 (kg/m²) (OR=3.50, CI=1.35~9.04, p<.01) and a previous PB (OR=4.15, CI=1.07~16.03, p<.05). CONCLUSION: The results of this study show that the multiple factors affect stage II pregnant women can result in PLS or PB. And preterm labor may predict PB. These findings highlight differences in predicting variables for pretrm labor and for PB. Future research is needed to develop a screening tool to predict the risk of preterm birth in pregnant women.
Body Mass Index ; Cervical Length Measurement ; Cervix Uteri ; Cohort Studies ; Female ; Humans ; Logistic Models ; Mass Screening ; Obstetric Labor, Premature* ; Parturition ; Pregnancy ; Pregnancy Complications ; Pregnancy Trimester, Second* ; Pregnancy* ; Pregnant Women ; Premature Birth* ; Prospective Studies ; Smoke ; Smoking ; Twins

OBJECTIVES: The purpose of this study was to evaluate the efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor. METHODS: This study was undertaken to assess the clinical efficacy & safety of magnesium sulfate and ritodrine hydrochloride on 120 patients admitted with preterm labor from Jul. 1, 1996 to Dec. 31, 1998. RESULTS: 1. The incidence of preterm labor was showed 6.0~7.7% of total number of delivery. 2. The risk factors of the preterm labor were premature rupture of membrane, severe preeclampsia, previous preterm delivery, twin pregnancy, placenta previa, fetal anomaly, incompetent cervix, placental abruption, and uterine myoma in order, but 28.6% of preterm labor had no apparent risk factors. 3. The days gained in uterus was not statistically different between the magnesium sulfate group and the ritodrine group (p<0.05) but longer in the two groups than the control group. And the delivery time was also not statistically different between the magnesium sulfate group and the ritodrine group (p<0.01) but significantly increased in the two groups than the control group. 4. The rate of complete and incomplete success was similar as 12.5% and 35% (total success rate 47.5%) in the magnesium sulfate group, 7.5% and 45% (total success rate 52.5%) in the ritodrine group but only 2.5% and 27.5% (total success rate 30%) was showed in the control group. 5. The side effects were much more in the ritodrine group than the magnesium sulfate group. The patients requiring second-line therapy were similar in the both groups but the main cause was uncontrolled uterine contraction in the magnesium sulfate group, and intolerable side effects in the ritodrine group. 6. The pulse rate was not statistically different in magnesium sulfate group but markedly increased in ritodrine group (p<0.05). After managements of preterm labor, the serum potassium and ionized calcium level was significantly decreased in the two groups (p<0.05, p<0.01). CONCLUSION: There was not significantly different efficacy and safety of magnesium sulfate and ritodrine hydrochloride in the management of preterm labor.
Abruptio Placentae ; Calcium ; Female ; Heart Rate ; Humans ; Incidence ; Leiomyoma ; Magnesium Sulfate* ; Magnesium* ; Membranes ; Obstetric Labor, Premature* ; Placenta Previa ; Potassium ; Pre-Eclampsia ; Pregnancy ; Pregnancy, Twin ; Risk Factors ; Ritodrine* ; Rupture ; Uterine Cervical Incompetence ; Uterine Contraction ; Uterus