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INTRODUCTION: The use of different growth charts can lead to confusion in discussions between professionals. There are obstetric charts (of fetal growth) and neonatal charts (of measurements at birth and of postnatal growth). These charts can be descriptive (derived from an unselected population) or prescriptive (derived from of a population at low risk and with optimal conditions for growth). OBJECTIVES: (1) To describe available charts for infants at birth and in the neonatal period and compare them, and (2) to recommend one or more charts for use in neonatology in France. METHODS: Bibliographic research was conducted on MEDLINE and completed by the guidelines of professional societies. RESULTS: Antenatal information about fetal growth restriction or fetuses identified as small-for-gestational-age using Intrauterine charts must be integrated into the identification of newborns at risk, but the use of Intrauterine charts to evaluate birthweight is not recommended to allow consistency with postnatal charts used in neonatal practice. Z-score variations using the updated Fenton postnatal charts are the most appropriate for the assessment of birthweight and postnatal growth for infants born preterm. These charts are sex-specific, include the three measurements (length, weight, and head circumference) and enable longitudinal follow-up of growth up to 50 weeks of corrected age and are linked to the World Health Organization charts at term. The French Audipog charts, although are individualized, accessible online and can be used in maternity units to evaluate birthweight for term infants, but do not allow the follow-up of postnatal growth, while Fenton charts may be used to evaluate birthweight and postnatal growth in the first month for hospitalized term infants. CONCLUSION: The updated Fenton charts are the neonatal charts that best suit the objectives of pediatricians in France for monitoring the growth of preterm newborns. The use of the Audipog charts at term remains an alternative in maternity wards, while Fenton charts can be used for hospitalized term newborns.
Subject(s)
Birth Weight , Growth Charts , Humans , Infant, Newborn , France , Female , Fetal Development , Infant, Small for Gestational Age/growth & development , Infant, Premature/growth & development , Male , Neonatology/standards , Neonatology/methods , Fetal Growth Retardation/diagnosis , Gestational Age , Pregnancy , Body WeightABSTRACT
BACKGROUND: Congenital heart defects are common and occur in approximately 0.9% of births. In France, the registries cover approximately 20% of the population but not the entirety of France; therefore, we aimed to update the incidence data for congenital heart defects in France from 2013 to 2022 using the medico-administrative database PMSI-MCO (French Medical Information System Program in Medicine, Surgery, and Obstetrics). We aimed to compare the frequency of risk factors in a population with congenital heart defects and a reference population. METHODS: From 2013 to 2022, we included children aged < 3 years diagnosed with congenital heart defects according to the International Classification of Diseases, 10th Revision, in the PMSI-MCO database. We compared them with a population without congenital defects on several medical data items (e.g., parity, gemellarity, and mortality rate). Bivariate and multivariate analyses compared children with congenital heart defects and children without congenital malformation. RESULTS: We identified 83,879 children with congenital heart defects in France from 2013 to 2022 in the PMSI-MCO database and 7,739,840 children without such defects, including 7,218,952 without any congenital defects. We observed more deaths (7.49% vs. 0.68%, d = 0.59) and more twinning (8.67% vs. 1.23%, d = 0.35) among children with congenital heart defects. Multivariate analysis revealed an increased risk of congenital heart defects in male individuals (OR [odds ratio] 1.056, 95% CI [confidence interval] [1.039-1.076]) and cases of medically assisted reproduction (OR 1.115, 95% CI [1.045-1.189]) and a reduced risk in the case of multiparity (OR 0.921, 95% CI [0.905-0.938]). CONCLUSIONS: According to the PMSI-MCO database, the incidence of congenital heart defects in France from 2013 to 2022 is 1% of births. Congenital heart defects are more frequent in cases of prematurity, twinning, primiparity, male sex, and maternal age > 40 years.
Subject(s)
Cephalosporins , Heart Defects, Congenital , Pregnancy , Child , Female , Humans , Male , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Incidence , Risk Factors , Information Systems , France/epidemiologyABSTRACT
OBJECTIVE: If a small for gestational age (SGA) foetus needs to be delivered because of severity (<3rd centile) attempting induction of labor theoretically increases the risk of caesarean section and neonatal acidosis, but these risks are poorly understood. This article aims to assess the risk of caesarean section and neonatal acidosis in attempted vaginal birth of a moderately preterm foetus in the setting of severe SGA. METHOD: A single-centre hospital-based observational study conducted over a period of 17 consecutive years in mothers with a single foetus in cephalic presentation with severe SGA (<3rd centile) needing foetal extraction. Neonatal acidosis was considered moderate if pH<7.10 and severe if pH<7.0. The degree of severity of SGA was estimated according to the birth weight ratio. RESULTS: Four hundred and thirty-four foetuses with severe SGA were included during the period, 140 of whom were born after induction (32.3%). In this group, 66.4% of women achieved a vaginal birth (66.4%; 95% CI [58.0-74.2]) and the risk of moderate or severe acidosis was doubled compared with the group of foetuses who had undergone a planned caesarean section (7.9% vs. 3.1%, OR=2.7 [1.1-6.7]). Neither gestational age nor the degree of growth restriction was significantly related to the risk of caesarean section or to the risk of moderate or severe neonatal acidosis. CONCLUSION: In cases of severe SGA before 37weeks' gestation, induction of labour allows vaginal delivery in two-thirds of cases. It is accompanied by a doubling of the risk of moderate or severe neonatal acidosis.
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BACKGROUND: Labor induction of women with a history of uterine scarring is an increasingly frequent situation and one for which there are currently no clear professional recommendations favoring one method over another. The objectives of this study were to determine the success rate of balloon catheter induction in women with a history of caesarean section and to evaluate the main factors associated with vaginal delivery. MATERIALS AND METHODS: This single-center retrospective study was conducted between January 1, 2014, and December 31, 2018, in Lille, France, and included all women with one previous caesarean section who were induced by first-line balloon catheter induction. Multivariate analysis was performed to identify the factors associated with the primary outcome (vaginal delivery). RESULTS: Of the 310 women in the sample, 192 delivered vaginally (62 %). After adjustment, factors associated with successful induction (vaginal delivery) were the number of previous vaginal deliveries (odds ratio [OR] 1.37; 95 % confidence interval [CI] 1.04-1.81), evolution of the Bishop score after balloon removal (OR 1.24; 95 % CI 1.10-1.41), and the initial Bishop score (OR 1.17; 95 % CI 1.00-1.37). Uterine rupture was observed in three women (1 %). CONCLUSION: The vaginal delivery rate after balloon catheter induction in women with a previous caesarean section was 62 %. Prognostic factors for vaginal delivery include previous vaginal delivery, the initial Bishop score, and evolution of the Bishop score after balloon catheter induction.
Subject(s)
Cesarean Section , Vaginal Birth after Cesarean , Pregnancy , Female , Humans , Retrospective Studies , Labor, Induced/methods , CathetersABSTRACT
OBJECTIVE: To assess the association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born preterm. STUDY DESIGN: EPIPAGE 2 is a national, population-based cohort study of children born before 35 weeks of gestation in France in 2011. We included infants born alive between 240/7 and 346/7 weeks after preterm labor or preterm premature rupture of membranes. Clinical chorioamnionitis was defined as maternal fever before labor (>37.8°C) with ≥2 of the following criteria: maternal tachycardia, hyperleukocytosis, uterine contractions, purulent amniotic fluid, or fetal tachycardia. The primary outcome was a composite, including cerebral palsy, coordination disorders, cognitive disorders, sensory disorders, or behavioral disorders. We also analyzed each of these disorders separately as secondary outcomes. We performed a multivariable analysis using logistic regression models. We accounted for the nonindependence of twins and missing data by generalized estimating equation models and multiple imputations, respectively. RESULTS: Among 2927 children alive at 5 years of age, 124 (3%) were born in a context of clinical chorioamnionitis. Overall, 8.2% and 9.6% of children exposed and unexposed, respectively, to clinical chorioamnionitis had moderate-to-severe neurodevelopmental disorders. After multiple imputations and multivariable analysis, clinical chorioamnionitis was not associated with the occurrence of moderate-to-severe neurodevelopmental disorders (aOR, 0.9; 95% CI, 0.5-1.8). CONCLUSIONS: We did not find any association between clinical chorioamnionitis and neurodevelopmental disorders at 5 years of age in children born at <35 weeks of gestation after preterm labor or preterm premature rupture of membrane.
Subject(s)
Chorioamnionitis , Fetal Membranes, Premature Rupture , Premature Birth , Infant, Newborn , Infant , Pregnancy , Child , Female , Humans , Aged, 80 and over , Chorioamnionitis/epidemiology , Cohort Studies , Gestational Age , Tachycardia , Fetal Membranes, Premature Rupture/epidemiologyABSTRACT
OBJECTIVE: To assess which fetal growth charts best describe intrauterine growth in France defined as the ability to classify 10% of fetuses below the 10th percentile (small for gestational age [SGA]) and above the 90th percentile (large for gestational age [LGA]) in the second and third trimesters. METHODS: We analyzed five studies on fetal ultrasound measurements using three French data sources. Two studies used second and third trimester ultrasound data from a nationwide birth cohort in 2011 (the ELFE study, N = 13 197 and N = 7747); one study used third trimester ultrasound data from on a nationwide cross-sectional study (the 2016 French National Perinatal Survey, N = 9940); and the last two studies were from the "Flash study" 2014 which prospectively collected ultrasound data from routine visits in the second and third trimesters (N = 4858 and N = 3522). For each study, we reported the percentage of measurements below the 10th percentile or above the 90th percentile, using French, Hadlock's, WHO and Intergrowth (IG) charts. RESULTS: WHO classified 4.7% and 16.3% of fetuses as having an estimated fetal weight (EFW) <10th and >90th percentiles in the second trimester compared to 3.3% and 34.7% with IG. The percentage of fetuses in the third trimester with an EFW <10th and >90th percentiles, ranged from 9.1% to 9.4% and from 8.0% to 11.1%, respectively, for WHO, and from 3.9% to 4.1% and from 17.3% to 21.6%, respectively, for IG. The WHO and IG charts for head circumference were very similar and performed well. Compared to the WHO charts, the French and Hadlock's charts deviated more frequently from the target percentiles values for EFW and biometric measures. CONCLUSION: It is recommended to use the WHO charts for the assessment of EFW and ultrasound biometric measurements in France (strong recommendation; low quality of evidence).
Subject(s)
Fetal Development , Growth Charts , Ultrasonography, Prenatal , Humans , Female , Pregnancy , France , Infant, Small for Gestational Age , Pregnancy Trimester, Third , Fetal Weight , Fetal Growth Retardation/diagnostic imaging , Fetal Growth Retardation/diagnosis , Cross-Sectional Studies , Gestational Age , Infant, Newborn , Pregnancy Trimester, Second , Fetal Macrosomia , Obstetricians , GynecologistsABSTRACT
BACKGROUND: Although thrombotic thrombocytopenic purpura frequently affects women of childbearing age, there is no clear recommendation for the management of subsequent pregnancies in women with established thrombotic thrombocytopenic purpura. METHODS: This single-center, retrospective, observational study included all women with hereditary thrombotic thrombocytopenic purpura or immune thrombotic thrombocytopenic purpura who had had at least one subsequent pregnancy after thrombotic thrombocytopenic purpura diagnosis between 2003 and 2022. The strategy comprised weekly surveillance of platelet count during pregnancy (and quarterly monitoring of ADAMTS13 activity) for women with immune thrombotic thrombocytopenic purpura, without any routine prophylactic treatment. In case of thrombocytopenia < 150,000/mm3 (with or without hemolysis relapse), women with hereditary thrombotic thrombocytopenic purpura systematically received plasma infusions twice weekly until platelet count normalized. RESULTS: A total of 13 patients were included (7 with hereditary thrombotic thrombocytopenic purpura and 6 with immune thrombotic thrombocytopenic purpura, with 20 planned pregnancies (11 and 9, respectively). All pregnancies resulted in live births, and all mothers survived. There was a marked improvement in pregnancy terms in the hereditary thrombotic thrombocytopenic purpura group compared to index pregnancies (37 [35;39] versus 31 [24;38] weeks, p = 0.037) and birth weights (3265 [3029;3410] versus 2160 [1240;2705] grams, p = 0.016), with need for plasma support mostly starting during the third trimester (5/7 patients, 7/11 pregnancies). A single hereditary thrombotic thrombocytopenic purpura relapse occurred, with rapid resolution after plasma support intensification. There were no relapses in the immune thrombotic thrombocytopenic purpura group, with ADAMTS13 activity systematically above 40% during all monitored pregnancies. CONCLUSION: These real-life data support the feasibility of a preemptive approach to pregnancy monitoring in women with known thrombotic thrombocytopenic purpura who undergo active surveillance within a multidisciplinary network.
Subject(s)
Purpura, Thrombotic Thrombocytopenic , Pregnancy , Humans , Female , Purpura, Thrombotic Thrombocytopenic/diagnosis , Purpura, Thrombotic Thrombocytopenic/therapy , Follow-Up Studies , Platelet Count , Retrospective Studies , Recurrence , Observational Studies as TopicSubject(s)
Hypercalcemia , Pregnancy , Female , Humans , Hypercalcemia/genetics , Vitamin D3 24-Hydroxylase/genetics , Mutation , Calcium , Vitamin DABSTRACT
OBJECTIVE: To compare the neurodevelopmental outcomes of preterm twins at 5½ years by chorionicity of pregnancy. DESIGN: Prospective nationwide population-based EPIPAGE2 (Etude Epidémiologique sur les Petits Âges Gestationnels) cohort study. SETTING: A total of 546 maternity units in France, between March and December 2011. POPULATION: A total of 1126 twins eligible for follow-up at 5½ years. METHODS: The association of chorionicity with outcomes was analysed using multivariate regression models. MAIN OUTCOME MEASURES: Survival at 5½ years with or without neurodevelopmental disabilities (comprising cerebral palsy, visual, hearing, cognitive deficiency, behavioural difficulties or developmental coordination disorders) were described and compared by chorionicity. RESULTS: Among the 1126 twins eligible for follow-up at 5½ years, 926 (82.2%) could be evaluated: 228 monochorionic (MC) and 698 dichorionic (DC). Based on chronicity and gestational age of birth, we found no significant differences for severe neonatal morbidity. The rates of moderate/severe neurobehavioral disabilities were similar in infants from DC pregnancies versus infants from MC pregnancies (OR 1.22, 95% CI 0.65-2.28). By gestational age and without twin-twin transfusion syndrome (TTTS), no difference according to chorionicity was found for all neurodevelopmental outcome measures. CONCLUSIONS: The neurodevelopmental outcomes among preterm twins at 5½ years is similar, irrespective of chorionicity.
Subject(s)
Pregnancy Outcome , Twins, Monozygotic , Infant, Newborn , Infant , Pregnancy , Humans , Female , Cohort Studies , Prospective Studies , Twins, Dizygotic , Gestational Age , Pregnancy, Twin , Retrospective StudiesABSTRACT
AIM: To compare the frequencies and types of congenital heart defects for infants of women without and with pre-gestational diabetes, type 1 and type 2 diabetes (T1DM, T2DM) and to identify risk factors. METHODS: All live births between 2012 and 2020 were screened for maternal diabetes and infant congenital heart defects using the French Medical Information System Program in Medicine, Surgery and Obstetrics database (PMSI-MCO). Incidences of these defects were estimated, and a logistic model evaluated maternal and fetal prognostic risk factors. RESULTS: Overall, 6,038,703 mothers did not have pre-gestational diabetes (no-diabetes), 23,147 had T1DM, and 14,401 had T2DM. The incidence of infant congenital disease was 6.2% for the no-diabetes group, 8.0%, for women with T1DM, and 8.4% for women with T2DM (P < 0.001); for congenital heart defects, incidences were respectively 0.8%, 3.0% and 2.7% (P < 0.001). In comparison with the no-diabetes group, the odds ratios (95%CI) of coronary heart defects were 2.07 (1.91;2.24) (P < 0.001) for women with T1DM and 2.20 (1.99;2.44) (P < 0.001) for women with T2DM, with no difference between T1DM and T2DM (P = 0.336). cesarian section, small and large for gestational age, and prematurity were also associated with an increased risk of congenital heart defects. CONCLUSION: In this study we observed higher incidences of congenital heart defects in infants of women with pre-gestational diabetes compared to women without pre-gestational diabetes, with no difference between women with T1DM or T2DM. These data call for intensifying preconception care and justify systematic cardiac echography in selected fetuses.
Subject(s)
Diabetes Mellitus, Type 1 , Diabetes Mellitus, Type 2 , Diabetes, Gestational , Heart Defects, Congenital , Pregnancy , Female , Humans , Diabetes, Gestational/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 1/complications , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/complications , Risk FactorsABSTRACT
INTRODUCTION: The objective of our study was to compare the effectiveness of induction in cephalic presentations to that of breech presentations as well as the characteristics of the latter and the maternal-fetal morbidity and mortality. MATERIAL AND METHODS: This was a single-center retrospective study carried out at the Lille University Hospital in the Jeanne de Flandre Maternity Hospital including all patients with a breech fetus for whom an induction was indicated beyond 37 weeks of gestation between January 2014 and December 2020. A matching was performed to include 2 cephalic presentations for one breech presentation. The primary outcome was successful induction defined by two things: passage into the active phase (cervical dilatation > 5 cm) and vaginal delivery. RESULTS: 101 inductions of breech presentations were included and matched to 202 cephalic presentations. After adjustment by BISHOP score, there was no significant difference in the caesarean section rate between the two groups (25.7% in cephalic vs 33.7% in breech, OR 0.67 [CI95% 0.38-1.18]) or in the rate of transition to active phase (80.7% in cephalic vs 82.2% in breech, OR 1.26 [CI95% 0.65-2.44]). Post-partum blood loss was not significantly different between the two groups (14.4% in cephalic vs 12.9% in breech, OR 1.22 [CI95% 0.57-2.57]). Moderate neonatal acidosis was more frequent in the breech group (6,4% in cephalic vs 15,8% in breech, OR 3.04 [CI95% 1.38-6.71]). CONCLUSION: Induction of breech births beyond 37 weeks of gestation appeared to be as effective as induction of cephalic presentations. There was no difference in the rate of caesarean section and transition to active labor. Maternal morbidity was not increased.
Subject(s)
Breech Presentation , Version, Fetal , Infant, Newborn , Pregnancy , Humans , Female , Cesarean Section , Retrospective Studies , Delivery, ObstetricABSTRACT
BACKGROUND: To define a threshold of maternal antibodies at risk of severe fetal anemia in patients followed for anti-RH1 alloimmunization (AI). STUDY, DESIGN, AND METHODS: We conducted a retrospective study of patients followed for anti-RH1 AI at the Lille University Hospital. The first group, severe anemia, included patients who received one or more in utero transfusions (IUT) or who were induced before 37 weeks of pregnancy for suspected severe fetal anemia. The second group, absence of severe anemia, corresponded to patients without intervention during pregnancy related to AI. Sensitivities, specificities, and positive and negative predictive values for screening for severe fetal anemia were calculated for the antibody thresholds of 3.5 and 5 IU/ml for the quantification. RESULTS: Between 2000 and 2018, 207 patients were included 135 in the severe anemia group and 72 in the no severe anemia group. No severe anemia was observed for an antibody titer below 16. For an antibody threshold of 3.5 IU/ml, the sensitivity was 98.2%, with 30.2% false positives. All severe anemias were detected in the second trimester; two cases of severe anemia were not detected in the third trimester. For an antibody threshold of 5 IU/ml, the sensitivity was lower at 95.6%, with five cases of severe anemia not detected. CONCLUSION: The antibody threshold of 3.5 IU/ml for the quantification and 16 for the titration allow targeting patients requiring close monitoring by an experienced team in case of anti-RH1 AI.
Subject(s)
Anemia, Hemolytic, Autoimmune , Fetal Diseases , Rh Isoimmunization , Pregnancy , Female , Humans , Retrospective Studies , Prenatal Care , Isoantibodies , Blood Transfusion, IntrauterineABSTRACT
INTRODUCTION: Total alkaline phosphatase (tALP) levels rise physiologically in maternal serum during pregnancy, and excessively so in certain conditions. However, current reference values are dated, nonlinear, and based on small samples. Factors related to variation in tALP remain unexplained. Thus, our goals in this study were to establish a physiological development curve for tALP within low-risk pregnancies and to evaluate the factors influencing tALP values. METHODS: This was a single-center, retrospective, observational study. All patients who delivered a live singleton infant at our center from January 1, 2011 to May 31, 2019, and had a tALP assay during pregnancy, were included regardless of the gestational age at which the assay was conducted. RESULTS: A total of 2415 pregnancies were included. Median tALP decreased during the first trimester, it increased slightly during the second trimester, and then increased sharply during the third trimester. Factors associated with a significant increase in tALP were chronic histiocytic intervillositis, cholestasis, multiple pregnancies, liver disease, preeclampsia, smoking, and low weight for gestational age. Conversely, gestational diabetes was associated with a discrete decrease in tALP. DISCUSSION: Our large sample allowed establishment of tALP reference curves based on gestational age. To interpret these results more thoroughly, factors that influence tALP rates should be further scrutinized.
Subject(s)
Alkaline Phosphatase , Gestational Age , Female , Humans , Pregnancy , Alkaline Phosphatase/blood , Pregnancy Trimester, Second , Retrospective StudiesABSTRACT
INTRODUCTION: The etiology of lower-limb neurological deficit after vaginal delivery remains poorly understood. The objective herein was to identify factors associated with this maternal nerve injury after vaginal delivery. MATERIAL AND METHODS: A single-center, case-control (matching 1:4) study. Cases were women with a lower-limb neurological deficit that appeared immediately after vaginal delivery. Controls were randomly selected women who gave birth vaginally during the same period, without any deficit. Finally, to assess the rates of factors associated with these deficits, we studied them using a randomly selected 5% sample of the population with vaginal deliveries. RESULTS: During the 30-month study period, 31 cases were identified among 10 333 women who gave birth vaginally (0.3%, 95% CI 0.20-0.43); 124 controls were also included. After logistic regression, the presence of a neurological deficit after delivery was associated with second-stage labor duration (per hour odds ratio [OR] 3.67, 95% CI 2.09-6.44; OR per standard deviation increase 2.73, 95% CI 1.75-4.25, p < 0.001) and instrumental delivery (OR = 3.24, 95% CI 1.29-8.14, p = 0.012), with no interaction effect (p = 0.56). Extrapolation of these factors to a 5% sample of the overall population of women with vaginal births showed that the rate of these deficits would be very low for women with second-stage labor lasting up to 90 min without instrumental delivery (0.05%) but increased to 1.52% when these factors were combined (OR 33.1, 95% CI 9.4-116.9). CONCLUSIONS: Following vaginal delivery, the onset of a neurological deficit is principally associated with the duration of second-stage labor and instrumental delivery.
Subject(s)
Delivery, Obstetric , Labor Stage, Second , Female , Humans , Male , Pregnancy , Data Collection , Delivery, Obstetric/adverse effects , Retrospective Studies , Vagina , Case-Control StudiesABSTRACT
AIM: The objective of the present real-life study in France was to assess and compare characteristics and outcomes in a cohort of pregnant women with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM) or conventional blood glucose monitoring (BGM). MATERIAL AND METHODS: We performed an observational study of a cohort of 153 women with T1D: 77 women were using isCGM, and 76 were using BGM. We compared the groups' maternal characteristics and maternal-fetal complications. The level of HbA1c was measured before pregnancy and then four times (after 8-12, 24-28, 30-33, and 35-37 weeks of gestation). RESULTS: The two groups were similar in terms of age, prepregnancy BMI, diabetes duration, and diabetic vascular complications. There were no significant intergroup differences in the obstetric history. The spontaneous abortion rate was lower in the isCGM group than in the blood glucose monitoring group (5.3% vs. 20%, respectively; p = .0129), while the prepregnancy and first-trimester HbA1c levels were similar. There were no significant intergroup differences in the incidence of other maternal-fetal complications. CONCLUSIONS: This observational study demonstrates that isCGM use is associated with lower spontaneous abortion compared with conventional BGM. Large prospective studies are needed to corroborate our findings and fully understand the relationship between glucose data at the time of conception/early pregnancy and foetal outcome.
Subject(s)
Abortion, Spontaneous , Diabetes Mellitus, Type 1 , Female , Humans , Pregnancy , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/diagnosis , Blood Glucose Self-Monitoring , Blood Glucose , Glycated Hemoglobin , Abortion, Spontaneous/diagnosis , Abortion, Spontaneous/etiology , Pregnant Women , Hypoglycemic AgentsABSTRACT
INTRODUCTION: In the most recent recommendations of the International Federation of Gynecology and Obstetrics (FIGO), a chapter was dedicated to the physiological approach and to the description of fetal mechanisms developed to respond to hypoxia. Our objective was to classify the type of hypoxia in the case of metabolic acidemia and to describe the order of appearance of fetal heart rate abnormalities in cases of gradually evolving hypoxia. MATERIAL AND METHODS: 132 neonates born between 2018 and 2020 with acidemia were included. We excluded preterm birth, fetuses with congenital anomaly and twin pregnancies. Intrapartum cardiotocography traces were assigned to one of these four types of labor hypoxia: acute, subacute, gradually evolving and chronic hypoxia. For gradually evolving hypoxia, fetal heart rate abnormalities were described according to the FIGO classification. RESULTS: 36 cardiotocography traces (27.3%) were classified as acute hypoxia, 14 (10.6%) as subacute hypoxia, and 3 (3.2%) as chronic hypoxia; gradually evolving hypoxia occurred in 62 cases (47%). In 77.4% of cases of gradually evolving hypoxia, deceleration was the first anomaly to appear, with loss of variability and bradycardia appearing later. Increased fetal heart rate was observed immediately after late deceleration in 46.8% of cases and was followed by a loss of variability or saltatory rhythm in 37.1% of cases. CONCLUSIONS: In cases of metabolic acidemia at term, the most frequent situation observed was gradually evolving hypoxia, with an initial occurrence of decelerations. The sequence of fetal heart rate modifications was variable.
Subject(s)
Acidosis , Fetal Diseases , Pregnancy , Infant, Newborn , Female , Humans , Retrospective Studies , Cardiotocography , Heart Rate, Fetal/physiology , Acidosis/diagnosis , Hypoxia/diagnosisABSTRACT
OBJECTIVE: In comparison to eutrophic fetuses, intra uterine growth restriction fetuses (IUGR) have a higher risk of perinatal morbi-mortality. There are no guidelines on the labor induction of labor (IOL) method to be performed in IUGR. The main objective was to determine fetal and maternal predictive factors of successful induction in IUGR fetuses from 36 weeks. Study design We conducted a retrospective cohort single-center study including 320 women with a cephalic fetal presentation. Labour was induced after 36 weeks for suspected IUGR between January 2013 and December 2019. RESULTS: Among the 320 patients, 246 were delivered vaginally (76.9 %) and 74 had a cesarean (23.1 %). Prognostic factors for successful IUGR induction were nonscarring uterus (OR 8.41; 95 %CI [2.92-24.21]), absence of preeclampsia (OR 7.14; 95 %CI [2.42-21.03]), multiparity (OR 4.32; 95 %CI [1.83-10.18]), normal fetal heart rate before IOL (OR 2.99; 95 %CI [1.24-7.22]) and BMI < 30 (OR 3.54; 95 %CI [1.62-7.72]). Doppler abnormalities, method and number of line of IOL, cervical evaluation were not significant in our study. CONCLUSION: The prognostic factors for successful IUGR induction are essentially maternal. Thus, a low BMI, multiparity, nonscarring uterus, absence of preeclampsia, and a normal FHR are good prognostic factors in IUGR induction.
Subject(s)
Fetal Growth Retardation , Pre-Eclampsia , Female , Humans , Labor, Induced/methods , Parity , Pregnancy , Prognosis , Retrospective StudiesSubject(s)
Diabetes Mellitus, Type 1 , Hypoglycemia , Blood Glucose , Cross-Over Studies , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Female , Humans , Hypoglycemia/chemically induced , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Insulin Infusion Systems , PregnancyABSTRACT
OBJECTIVE: It is unclear whether glycated haemoglobin (HbA1c) has utility in predicting adverse outcomes in gestational diabetes mellitus (GDM). The aims of the study were to examine the predictive value of HbA1c at GDM diagnosis with adverse pregnancy outcomes. RESEARCH DESIGN AND METHODS: This was a cohort study of 4,383 women with GDM between 2011 and 2018. We assessed the association of HbA1c with pregnancy outcomes using logistic regression models before and after adjustment for predefined risk factors of GDM. We examined these associations considering HbA1c as categorical variables using five pre-specified HbA1c classes: and as a continuous variable. RESULTS: An HbA1c ≥ 5.6% (38 mmol/mol) identified women with at greater risk for macrosomia: odds ratio (OR) [95% confidence interval] = 2.12 [1.29; 3.46] for HbA1c = 5.6-5.9% and 2.06 [1.14; 3.70] for HbA1c > 5.9% versus HbA1c ≤ 4.5% (26 mmol/mol). Similarly, HbA1c ≥ 5.6% (38 mmol/mol) was associated with greater risk for caesarean: 1.64 [1.06; 2.53] for HbA1c = 5.6-5.9% and 1.58 [0.93; 2.7] for HbA1c > 5.9% (41 mmol/mol) versus HbA1c ≤ 4.5% (26 mmol/mol). Using HbA1c ≤ 4.5% (26 mmol/mol) as reference category, HbA1c > 5.9% (41 mmol/mol) increased the OR of preterm delivery to 3.33 [1.27; 8.71]. HbA1c remained significant for Adverse Pregnancy Outcome Composite after adjustment (P < 0.0001). DISCUSSION: Our finding suggests that a single HbA1c reading may be a useful pragmatic tool to identify women at risk. Such identification may be a useful guide for identifying and applying preventative treatment for women at increased risk.