Obstructive sleep apnoea and its association with gestational hypertension.

Hypertension develops in 10% of pregnancies. Snoring, a marker of obstructive sleep apnoea, is a newly identified risk factor for gestational hypertension. Moreover, obstructive sleep apnoea is an independent risk factor for incident hypertension in the non-pregnant population. The aim of the present study was to test the hypothesis that obstructive sleep apnoea is associated with new onset of hypertension among pregnant females. A case-control study was performed involving 17 pregnant females with gestational hypertension and 33 pregnant females without hypertension. Subjects were frequency-matched for gestational age and recruited in a tertiary obstetrical centre. Obstructive sleep apnoea was ascertained by polysomnography and defined by an apnoea/hypopnoea index (AHI) of >or=15 events x h(-1), without requirement for desaturation. The mean+/-sd AHI for normotensive pregnant females was 18.2+/-12.2 events x h(-1) compared with 38.6+/-36.7 events x h(-1) for females with hypertensive pregnancies. The crude odds ratio for the presence of obstructive sleep apnoea given the presence of gestational hypertension was 5.6. The odds ratio was 7.5 (95% confidence interval 3.5-16.2), based on a logistic regression model with adjustment for maternal age, gestational age, pre-pregnancy body mass index, prior pregnancies, and previous live births. In conclusion, gestational hypertension appears to be strongly associated with the presence of obstructive sleep apnoea.

A comparison of pre-discharge survival and morbidity in singleton and twin very low birth weight infants.

The perinatal mortality rate of twins is four to 11 times higher than that of singletons, and twins are widely reported to have more morbidity than singletons, mainly because of a higher preterm birth rate. However, it is not clear that live-born preterm birth rate. However, it is not clear that live-born preterm twins suffer greater morbidity than comparable singletons. In fact, twins have been reported to develop pulmonary maturity earlier than singletons, which might result in decreased morbidity relative to comparable preterm singletons. We conducted this retrospective review of 496 consecutive singleton and 104 twin infants weighing 500-1499 g and born alive at 24-31 weeks' gestation to determine whether pre-discharge survival and morbidity in very low birth weight (VLBW) twin infants were greater than those of comparable singletons. The mean (+/- standard deviation) gestational age of the singletons was 27.5 +/- 2.0 weeks and of the twins 27.6 +/- 2.0 weeks. There were no differences in mean gestational age, gestational age distribution, mean birth weight, birth weight distribution, gender, or maternal race between the two groups. The pre-discharge survival rate for twins (77%) was not significantly different than that of singletons (82%). There were no differences between twins and singletons in the incidences of neonatal respiratory distress syndrome (63 versus 71%), pulmonary interstitial emphysema (14 versus 16%), patent ductus arteriosus (28 versus 29%), necrotizing enterocolitis (3 versus 5%), intraventricular hemorrhage (11 versus 16%), and retinopathy of prematurity (11 versus 18%). The incidence of bronchopulmonary dysplasia was significantly less in twins (27 versus 46%; P = .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Placenta previa is not an independent risk factor for a small for gestational age infant.

Previous studies have presented conflicting evidence on the association between intrauterine growth retardation (IUGR) and placenta previa, with some groups reporting rates of IUGR as high as 16-19%. However, most of these studies failed to include a control population, included patients with other factors known to be associated with IUGR (eg, chronic hypertension, fetal anomalies, pregnancy-induced hypertension, insulin-dependent diabetes mellitus, etc), and/or did not confirm the patient's estimated gestational age. During the study period of January 1, 1980 through June 30, 1990, 54,969 deliveries occurred at the three affiliated hospitals of the Maternal-Fetal Medicine Division of the University of Connecticut Health Center. Review of the delivery records revealed 179 singleton pregnancies with documented placenta previa and without the above exclusion factors. One hundred seventy-one of these 179 study patients were compared with 171 women without placenta previa matched for confirmed gestational age, race, parity, and fetal sex. The incidence of small for gestational age (SGA) infants was 4.1% (seven of 171) in the study group and 5.8% (ten of 171) in the control group. Mean birth weights were 2559 and 2476 g, respectively. Neither difference was statistically significant. These results suggest that the prenatal diagnosis of an SGA fetus in a pregnancy complicated by placenta previa should not simply be attributed to abnormal placental implantation. Furthermore, routine ultrasonic examinations for growth in pregnancies complicated by placenta previa are not indicated.

Successful perinatal management of hydrops fetalis due to hemolytic disease associated with D-- maternal phenotype.

We report the successful management of a case of hemolytic disease and hydrops fetalis secondary to anti Rh 17 antibodies in a woman with the rare D-- phenotype. We discuss the efficacy of intravenous immunoglobulins in treating hemolytic disease of the newborn infant.

Pregnancy outcomes and ultrasonographic diagnosis in patients with histologically-proven placental chorioangioma.

OBJECTIVE: To evaluate pregnancy outcome and ultrasound diagnosis in patients with histologically-confirmed placental chorioangioma. STUDY DESIGN: Placentas with histological diagnosis of chorioangioma were identified and medical charts were reviewed for findings of ultrasound examinations. Pregnancy outcomes were compared with all singleton deliveries without chorioangioma in the same time period. MAIN OUTCOME MEASURES: Primary outcome was Neonatal Intensive Care Unit admission rate. Secondary outcome was ultrasound detection rate of chorioangioma. RESULTS: Among 14,725 singleton deliveries, 23 placentas were diagnosed with chorioangioma (0.16%). The control group included all singleton deliveries without chorioangioma (n = 14702). Neonates in the study group were more likely to be admitted to the Neonatal Intensive Care Unit (OR = 4.45) and to have smaller birth weight (p = 0.006). Only 2 of 7 larger chorioangiomas (≥ 2 cm) with available ultrasound reports were identified by ultrasound (29% detection rate). All cases demonstrated normal fetal growth and wellbeing. CONCLUSION: Chorioangiomas are not always identified by routine prenatal sonography. Even in the absence of ultrasonic abnormalities, neonatal morbidity, as measured by NICU admission rate, is increased.