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BACKGROUND: We investigated the potential association between Marfan Syndrome (MFS) and adverse obstetric outcomes using the National Inpatient Sample (NIS) database. METHODS: We utilized the International Classification of Diseases (ICD-10) system to identify relevant codes and extracted data from the NIS database covering the period 2016-2019. Descriptive statistics and χ2 tests were employed to summarize and compare baseline characteristics. Univariate and multivariate regression analyses (adjusted for age, race, hospital region, smoking status, and alcohol misuse) were conducted to evaluate association between MFS and adverse obstetric outcomes. The regression analyses were summarized as Odds Ratios (OR) with 95% confidence intervals (CI). RESULTS: Among the 2,854,149 pregnant individuals, 179 had MFS. Baseline characteristics revealed significant associations between MFS and age, race, and hospital location. Univariate analysis showed MFS individuals had significantly increased risks of amniotic fluid/membrane abnormalities (AFAs, OR=1.64, 95% CI: 1.01-2.68, P=0.045) and postpartum hemorrhage (PPH, OR=3.73, 95% CI: 2.41-5.78, P<0.001). Several obstetric outcomes showed some trends towards increased (multiple gestation, placenta previa, and preterm labor) and decreased (premature rupture of membrane, gestational diabetes, and preeclampsia) obstetric risks with MFS; however, they were not statistically significant. Multivariate analysis showed MFS was significantly associated with increased risks of AFAs (adjusted OR=1.68, 95% CI: 1.03-2.74, P=0.037) and PPH (adjusted OR=3.62, 95% CI: 2.31-5.68, P<0.001). CONCLUSIONS: MFS is associated with increased risks of adverse obstetric outcomes, specifically AFAs and PPH. These results highlight the importance of monitoring these specific pregnancy outcomes in MFS individuals to ensure optimal maternal-fetal health.
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OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal-neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction. STUDY DESIGN: Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. RESULTS: Overall, 14 studies with 15 arms were analyzed (n = 2,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n = 2, unclear risk n = 7, and high risk n = 1), whereas all NCTs had good quality (n = 4). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR = 1.04, 95% CI: 0.95-1.14, p = 0.41) and rate of cesarean delivery (RR = 1.04, 95% CI: 0.93-1.17, p = 0.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission. CONCLUSION: During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal-neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal-neonatal outcomes, and lack of drug-related adverse events. KEY POINTS: · This is the first analysis of cervical osmotic dilators versus PGE2 for cervical ripening during labor.. · There was no difference between both arms regarding the rates of normal vaginal/cesarean deliveries.. · There was no difference between both arms regarding the rates of neonatal adverse events.. · Cervical osmotic dilators had significant lower risk of uterine hyperstimulation compared with PGE2.. · Cervical osmotic dilators may be superior to PGE2 in view of their similar efficacy and better safety..
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BACKGROUND: Anemia in pregnancy has a number of adverse effects. This study aims to estimate anemia prevalence in pregnant women and examine the associations between maternal anemia with maternal characteristics, maternal outcomes during pregnancy and delivery, and neonatal outcomes at a university hospital in Riyadh. MATERIALS AND METHODS: A cross-sectional study was undertaken among 400 women who delivered at the hospital. Data were collected through a data extraction sheet. Multivariate analysis was adopted according to the results of univariate analysis. RESULTS: Overall anemia prevalence was 39% (including 21% moderate anemia and 18% mild anemia); the rest, 61%, were normal. Non-intake of intravenous iron was more common among mothers with mild anemia (65.3%) compared to normal and moderately anemic (p=0.001). Significant differences between groups were found in relation to maternal outcomes such as pregnancy-induced hypertension (p=0.019), antepartum hemorrhage (p=0.001), postpartum hemorrhage (p=0.002), and non-intake of blood transfusion during pregnancy (p=0.012) and emergency cesarean section (p=0.017). Neonatal outcomes, including congenital malformations (p=0.003) and admission to the neonatal intensive care unit (NICU) (p<0.001), were higher in mildly anemic mothers. Statistically significant relationships were found between anemia in pregnancy and postpartum hemorrhage (odds ratio [OR] = 3.61; confidence interval [CI] 1.52-8.58; p=0.004), congenital malformations (OR = 5.09; CI 1.81-14.29; p=0.002), NICU admissions (OR=8.32; CI 2.77-24.96; p=0.001), and low birth weight (LBW; OR=1.833; CI 1.021-3.294; p=0.042). CONCLUSIONS: The study highlights the association of maternal anemia with adverse events in mothers, such as postpartum hemorrhage. Among neonates, congenital malformations, low birth weight, and higher admissions to the NICU have been reported.
