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1.
Acta Obstet Gynecol Scand ; 100(4): 658-665, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33341933

RESUMO

INTRODUCTION: Placental abruption is a serious complication in pregnancy. Its incidence varies across countries, but the information of how placental abruption varies in immigrant populations is limited. The aims of this study were to estimate the incidence of placental abruption in immigrant women compared with non-immigrants by maternal country and region of birth, reason for immigration, and length of residence. MATERIAL AND METHODS: We conducted a nationwide population-based study using data from the Medical Birth Registry of Norway and Statistics Norway (1990-2016). The study sample included 1 558 174 pregnancies, in which immigrant women accounted for 245 887 pregnancies and 1 312 287 pregnancies were to non-immigrants. Crude and adjusted odds ratios with 95% CI for placental abruption in immigrant women compared with non-immigrants were estimated by logistic regression with robust standard error estimations (accounting for within-mother clustering). Adjustment variables included year of birth, maternal age, parity, multiple pregnancies, chronic hypertension, and level of education. RESULTS: The incidence of placental abruption decreased during the study period for both immigrants (from 0.68% to 0.44%) and non-immigrants (from 0.80% to 0.34%). Immigrant women from sub-Saharan Africa had an adjusted odds ratio of 1.35 (95% CI 1.15-1.58) compared with non-immigrants for placental abruption, whereas immigrant women from Ethiopia had an adjusted odds ratio of 2.39 (95% CI 1.67-3.41). We found a small variation in placental abruption incidence by other countries or regions of birth, length of residence, and reason for immigration. CONCLUSIONS: Immigrant women from sub-Saharan Africa, especially Ethiopia, have increased odds for placental abruption when giving birth in Norway. Reason for immigration and length of residence had little impact on the incidence of placental abruption.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Emigrantes e Imigrantes , Adulto , Feminino , Humanos , Incidência , Noruega/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco
4.
Am J Cardiol ; 131: 17-22, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32718545

RESUMO

Complications of pregnancy present an opportunity to identify women at high risk of cardiovascular disease (CVD). Placental abruption is a severe and understudied pregnancy complication, and its relationship with CVD is poorly understood. The California Healthcare Cost and Utilization Project database was used to identify women with hospitalized pregnancies in California between 2005 and 2009, with follow-up through 2011. Pregnancies, exposures, covariates, and outcomes were defined by International Classification of Diseases Ninth Revision codes. Cox proportional-hazards regression was used to examine the association between placental abruption and myocardial infarction (MI), stroke, and heart failure (HF). Multivariate models controlling for age, race, medical co-morbidities, pregnancy complications, psychiatric and substance use disorders, and socioeconomic factors were employed. Among over 1.5 million pregnancies, placental abruption occurred in 14,881 women (1%). Median follow-up time from delivery to event or censoring was 4.87 (interquartile range 3.54 to 5.96) years. In unadjusted models, placental abruption was associated with risk of HF, but not MI or stroke. In fully-adjusted models, placental abruption remained significantly associated with HF (Hazard ratio 1.44; 95% confidence interval 1.09 to 1.90). Among women with placental abruptions, hypertensive disorders of pregnancy and preterm birth respectively modified and mediated the association between placental abruption and HF. In conclusion, placental abruption is a risk factor for HF, particularly in women who also experience hypertensive disorders of pregnancy and preterm birth. Placental abruption is a specific adverse pregnancy outcome associated with risk of HF.


Assuntos
Descolamento Prematuro da Placenta/fisiopatologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Adulto , California , Feminino , Humanos , Gravidez , Resultado da Gravidez , Fatores de Risco
5.
Artigo em Inglês | MEDLINE | ID: mdl-32707683

RESUMO

To evaluate labor and delivery complications and delivery modes between physicians and white-collar workers in Taiwan, this retrospective population-based study used data from Taiwan's National Health Insurance Research Database. We compared 1530 physicians aged 25 to 50 years old who worked and had singleton births between 2007 and 2013 with 3060 white-collar workers matched by age groups, groups of monthly insured payroll-related premiums, previous cesarean delivery, perinatal history anemia, and gestational diabetes mellitus. The logistic regression models were used to assess the labor and delivery complications between the two groups. Multivariate analysis revealed that physicians had a significantly higher risk of placenta previa (odds ratio (OR) 1.35, 95% confidence interval (CI) 1.08-1.69) and other malpresentation (OR 1.86, 95% CI 1.45-2.39) than white-collar workers, whereas they had a significantly lower risk of placental abruption (OR 0.53, 95% CI 0.40-0.71), preterm delivery (OR 0.75, 95% CI 0.61-0.92), and premature rupture of membranes (OR 0.72, 95% CI 0.59-0.88). Increased risks of some adverse labor and delivery complications were observed among physicians, when compared to white-collar workers. These findings suggest that working women should take preventative action to manage occupational risks during pregnancy.


Assuntos
Descolamento Prematuro da Placenta , Trabalho de Parto , Ocupações , Nascimento Prematuro , Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Fatores de Risco , Taiwan , Mulheres Trabalhadoras
6.
J Clin Invest ; 130(9): 4947-4953, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32573498

RESUMO

BACKGROUNDThe effects of the novel coronavirus disease 2019 (COVID-19) in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic COVID-19 complicated by severe preeclampsia and placental abruption.METHODSWe analyzed the placenta for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through molecular and immunohistochemical assays and by and electron microscopy and measured the maternal antibody response in the blood to this infection.RESULTSSARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the materno-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for the vasculopathy typically associated with preeclampsia.CONCLUSIONThis case demonstrates SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with COVID-19.FUNDINGBeatrice Kleinberg Neuwirth Fund and Fast Grant Emergent Ventures funding from the Mercatus Center at George Mason University. The funding bodies did not have roles in the design of the study or data collection, analysis, and interpretation and played no role in writing the manuscript.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Placenta/patologia , Placenta/virologia , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/etiologia , Complicações Infecciosas na Gravidez/virologia , Aborto Terapêutico , Descolamento Prematuro da Placenta/etiologia , Descolamento Prematuro da Placenta/patologia , Descolamento Prematuro da Placenta/virologia , Adulto , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Betacoronavirus/patogenicidade , Infecções por Coronavirus/patologia , Infecções por Coronavirus/virologia , Feminino , Humanos , Microscopia Eletrônica de Transmissão , Pandemias , Filogenia , Pneumonia Viral/patologia , Pneumonia Viral/virologia , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/patologia , Pré-Eclâmpsia/virologia , Gravidez , Complicações Infecciosas na Gravidez/patologia , Segundo Trimestre da Gravidez , RNA Viral/genética , RNA Viral/isolamento & purificação , Carga Viral
7.
PLoS One ; 15(6): e0233641, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525937

RESUMO

OBJECTIVE: To evaluate the effects of changes in risk factors between the first two pregnancies on the occurrence of placental abruption (PA) in the same woman. METHODS: Routinely collected obstetric data from Aberdeen Maternity and Neonatal Databank, the Maltese National Obstetric Information System and the Finnish Medical Birth Register were aggregated. Records of the first two singleton pregnancies from women who had PA in one pregnancy but not the other, were identified from this pooled dataset. A case-crossover study design was used; cases were pregnancies with abruption and matched controls were pregnancies without abruption in the same woman. Conditional logistic regression was used to investigate changes in risk factors for placental abruption in pregnancies with and without abruption. RESULTS: A total of 2,991 women were included in the study. Of these 1,506 (50.4%) had PA in their first pregnancy and 1,485 (49.6%) in a second pregnancy. Pregnancies complicated by preeclampsia {194 (6.5%) versus 115 (3.8%) adj OR 1.69; (95% CI 1.23-2.33)}, antepartum haemorrhage of unknown origin {556 (18.6%) versus 69 (2.3%) adjOR 27.05; 95% CI 16.61-44.03)} and placenta praevia {80 (2.7%) versus 21 (0.7%) (adjOR 3.05; 95% CI 1.74-5.36)} were associated with PA. Compared to 20 to 25 years, maternal age of 35-39 years {365 (12.2) versus 323 (10.8) (adjOR 1.32; 95% CI 1.01-1.73) and single marital status (adjOR 1.36; 95% CI 1.04-1.76) were independently associated with PA. Maternal smoking, BMI and fetal gender were not associated with PA. CONCLUSION: Advanced maternal age, pregnancies complicated with unexplained bleeding in pregnancy, placenta praevia and preeclampsia were independently associated with a higher risk of placental abruption.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Placenta Prévia/epidemiologia , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Adulto , Fatores Etários , Estudos Cross-Over , Feminino , Finlândia/epidemiologia , Humanos , Malta/epidemiologia , Idade Materna , Gravidez , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
8.
Am J Obstet Gynecol ; 223(5): 741.e1-741.e12, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32434001

RESUMO

BACKGROUND: Platelet activation may play a role in the pathophysiology of placenta-mediated obstetrical complications, as evidenced by the efficacy of aspirin in preventing preeclampsia, but published data regarding the relationship between biomarkers for platelet activation and adverse obstetrical outcomes are sparse. In particular, it is unknown whether prepregnancy biomarkers of platelet activation are associated with adverse pregnancy outcomes. OBJECTIVE: This study aimed to determine the following: (1) whether maternal plasma concentrations of platelet factor 4 are associated with risk of placenta-mediated adverse obstetrical outcomes, and (2) whether these associations are modified by low-dose aspirin. STUDY DESIGN: This ancillary study included measurement of platelet factor 4 among 1185 of 1228 women of reproductive age enrolled in the Effects of Aspirin in Gestation and Reproduction trial with available plasma samples, with relevant outcomes assessed among 584 women with pregnancies lasting at least 20 weeks' gestation. We measured platelet factor 4 in plasma samples obtained at the prepregnancy study visit (before randomization to low-dose aspirin or placebo), 12 weeks' gestation, and 28 weeks' gestation. The primary outcome was a composite of hypertensive disorders of pregnancy, placental abruption, and small-for-gestational-age infant. We estimated the relative risks (RRs) and 95% confidence intervals (CIs) for the association between platelet factor 4 and the composite and individual outcomes at each time point using log-binomial regression that was weighted to account for potential selection bias and adjusted for age, body mass index, education, income, and smoking. To evaluate the potential effect modification of aspirin, we stratified the analyses by aspirin treatment assignment. RESULTS: During follow-up, 95 women experienced the composite adverse obstetrical outcome, with 57 cases of hypertensive disorders of pregnancy, 35 of small for gestational age, and 6 of placental abruption. Overall, prepregnancy platelet factor 4 was positively associated with the composite outcome (third tertile vs first tertile; relative risk, 2.36; 95% confidence interval, 1.38-4.03) and with hypertensive disorders of pregnancy (third tertile vs first tertile; relative risk, 2.14; 95% confidence interval, 1.08-4.23). In analyses stratified by treatment group, associations were stronger in the placebo group (third tertile vs first tertile; relative risk, 3.36; 95% confidence interval, 1.42-7.93) than in the aspirin group (third tertile vs first tertile; relative risk, 1.78; 95% confidence interval, 0.90-3.50). CONCLUSION: High concentrations of platelet factor 4 before pregnancy are associated with increased risk of placenta-mediated adverse pregnancy outcomes, particularly for hypertensive disorders of pregnancy. Aspirin may mitigate the increased risk of these outcomes among women with higher plasma concentrations of preconception platelet factor 4, but low-dose aspirin nonresponders may require higher doses of aspirin or alternate therapies to achieve obstetrical risk reduction.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Aspirina/uso terapêutico , Retardo do Crescimento Fetal/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Ativação Plaquetária , Inibidores da Agregação de Plaquetas/uso terapêutico , Fator Plaquetário 4/sangue , Descolamento Prematuro da Placenta/sangue , Adulto , Feminino , Retardo do Crescimento Fetal/sangue , Humanos , Hipertensão Induzida pela Gravidez/sangue , Recém-Nascido Pequeno para a Idade Gestacional , Cuidado Pré-Concepcional , Gravidez , Primeiro Trimestre da Gravidez/sangue , Segundo Trimestre da Gravidez/sangue , Adulto Jovem
9.
BMJ ; 369: m1007, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349968

RESUMO

OBJECTIVE: To explore conditions and outcomes of a first delivery at term that might predict later preterm birth. DESIGN: Population based, prospective register based study. SETTING: Medical Birth Registry of Norway, 1999-2015. PARTICIPANTS: 302 192 women giving birth (live or stillbirth) to a second singleton child between 1999 and 2015. MAIN OUTCOME MEASURES: Main outcome was the relative risk of preterm delivery (<37 gestational weeks) in the birth after a term first birth with pregnancy complications: pre-eclampsia, placental abruption, stillbirth, neonatal death, and small for gestational age. RESULTS: Women with any of the five complications at term showed a substantially increased risk of preterm delivery in the next pregnancy. The absolute risks for preterm delivery in a second pregnancy were 3.1% with none of the five term complications (8202/265 043), 6.1% after term pre-eclampsia (688/11 225), 7.3% after term placental abruption (41/562), 13.1% after term stillbirth (72/551), 10.0% after term neonatal death (22/219), and 6.7% after term small for gestational age (463/6939). The unadjusted relative risk for preterm birth after term pre-eclampsia was 2.0 (95% confidence interval 1.8 to 2.1), after term placental abruption was 2.3 (1.7 to 3.1), after term stillbirth was 4.2 (3.4 to 5.2), after term neonatal death was 3.2 (2.2 to 4.8), and after term small for gestational age was 2.2 (2.0 to 2.4). On average, the risk of preterm birth was increased 2.0-fold (1.9-fold to 2.1-fold) with one term complication in the first pregnancy, and 3.5-fold (2.9-fold to 4.2-fold) with two or more complications. The associations persisted after excluding recurrence of the specific complication in the second pregnancy. These links between term complications and preterm delivery were also seen in the reverse direction: preterm birth in the first pregnancy predicted complications in second pregnancies delivered at term. CONCLUSIONS: Pre-eclampsia, placental abruption, stillbirth, neonatal death, or small for gestational age experienced in a first term pregnancy are associated with a substantially increased risk of subsequent preterm delivery. Term complications seem to share important underlying causes with preterm delivery that persist from pregnancy to pregnancy, perhaps related to a mother's predisposition to disorders of placental function.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Morte Perinatal , Pré-Eclâmpsia/epidemiologia , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Nascimento a Termo , Adulto , Feminino , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Noruega/epidemiologia , Gravidez , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Adulto Jovem
10.
Arch Gynecol Obstet ; 301(5): 1181-1187, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32303889

RESUMO

PURPOSE: To determine whether meconium-stained amniotic fluid (MSAF) encountered in pregnancies complicated by preterm premature rupture of membranes (PPROM) is associated with adverse maternal and perinatal outcome. METHODS: A retrospective cohort study of all singleton pregnancies with PPROM and MSAF who delivered in a tertiary hospital at 24 + 0-36 + 6 weeks of gestation between 2007 and 2017. Women with PPROM-MSAF (study group) were compared to women with PPROM and clear amniotic fluid (control group). Controls were matched to cases according to age, gravidity, parity and gestational age at delivery in a 3:1 ratio. Primary outcome was defined as neonatal intensive care unit admission. Secondary outcomes were neonatal adverse outcomes, chorioamnionitis and placental abruption diagnosed clinically or by placental cultures and histology. RESULTS: Seventy-five women comprised the study group and were matched to 225 women representing the control group. A significantly higher rate of neonatal intensive care unit admissions was noted in the study group compared to controls (61.3% vs. 45.7%, p = 0.03). Multivariate analysis demonstrated that MSAF is an independent risk factor for neonatal intensive care unit admission (adjusted OR = 2.82, 95% CI 1.39-5.75, p = 0.004). MSAF was found to be associated to higher rates of cesarean and operative vaginal deliveries (30.7% vs. 24.4% and 5.3% vs. 2.7%, p = 0.057, respectively) as well as to chorioamnionitis and placental abruption (33.3% vs. 19.3%, p = 0.034 and 16.0% vs. 7.7%, p = 0.021, respectively). CONCLUSION: MSAF is associated with higher frequencies of adverse perinatal outcome when compared to clear amniotic fluid in pregnancies complicated by PPROM.


Assuntos
Líquido Amniótico , Corioamnionite/epidemiologia , Ruptura Prematura de Membranas Fetais , Mecônio , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Estudos de Casos e Controles , Corioamnionite/etiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Mortalidade Perinatal , Gravidez , Complicações Infecciosas na Gravidez , Estudos Retrospectivos , Fatores de Risco
11.
Am J Obstet Gynecol ; 223(4): 525-537, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32199925

RESUMO

OBJECTIVE DATA: Chronic hypertension is associated with adverse perinatal outcomes, although the optimal treatment is unclear. The aim of this network metaanalysis was to simultaneously compare the efficacy and safety of antihypertensive agents in pregnant women with chronic hypertension. STUDY: Medline, Scopus, CENTRAL, Web of Science, Clinicaltrials.gov, and Google Scholar databases were searched systematically from inception to December 15, 2019. Both randomized controlled trials and cohort studies were held eligible if they reported the effects of antihypertensive agents on perinatal outcomes among women with chronic hypertension. STUDY APPRAISAL AND SYNTHESIS METHODS: The primary outcomes were preeclampsia and small-for-gestational-age risk. A frequentist network metaanalytic random-effects model was fitted. The main analysis was based on randomized controlled trials. The credibility of evidence was assessed by taking into account within-study bias, across-studies bias, indirectness, imprecision, heterogeneity, and incoherence. RESULTS: Twenty-two studies (14 randomized controlled trials and 8 cohorts) were included, comprising 4464 women. Pooling of randomized controlled trials indicated that no agent significantly affected the incidence of preeclampsia. Atenolol was associated with significantly higher risk of small-for-gestational age compared with placebo (odds ratio, 26.00; 95% confidence interval, 2.61-259.29) and is ranked as the worst treatment (P-score=.98). The incidence of severe hypertension was significantly lower when nifedipine (odds ratio, 0.27; 95% confidence interval, 0.14-0.55), methyldopa (odds ratio, 0.31; 95% confidence interval, 0.17-0.56), ketanserin (odds ratio, 0.29; 95% confidence interval, 0.09-0.90), and pindolol (odds ratio, 0.17; 95% confidence interval, 0.05-0.55) were administered compared with no drug intake. The highest probability scores were calculated for furosemide (P-score=.86), amlodipine (P-score=.82), and placebo (P-score=.82). The use of nifedipine and methyldopa were associated with significantly lower placental abruption rates (odds ratio, 0.29 [95% confidence interval, 0.15-0.58] and 0.23 [95% confidence interval, 0.11-0.46], respectively). No significant differences were estimated for cesarean delivery, perinatal death, preterm birth, and gestational age at delivery. CONCLUSION: Atenolol was associated with a significantly increased risk for small-for-gestational-age infants. The incidence of severe hypertension was significantly lower when nifedipine and methyldopa were administered, although preeclampsia risk was similar among antihypertensive agents. Future large-scale trials should provide guidance about the choice of antihypertensive treatment and the goal blood pressure during pregnancy.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Anti-Hipertensivos/uso terapêutico , Retardo do Crescimento Fetal/epidemiologia , Hipertensão/tratamento farmacológico , Pré-Eclâmpsia/epidemiologia , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Anlodipino/uso terapêutico , Atenolol/uso terapêutico , Cesárea/estatística & dados numéricos , Doença Crônica , Feminino , Furosemida/uso terapêutico , Idade Gestacional , Humanos , Hipertensão/fisiopatologia , Incidência , Recém-Nascido Pequeno para a Idade Gestacional , Ketanserina/uso terapêutico , Metildopa/uso terapêutico , Metanálise em Rede , Nifedipino/uso terapêutico , Morte Perinatal , Pindolol/uso terapêutico , Gravidez , Nascimento Prematuro/epidemiologia , Índice de Gravidade de Doença
12.
Radiol Clin North Am ; 58(2): 381-399, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044013

RESUMO

Placenta is a vital organ that connects the maternal and fetal circulations, allowing exchange of nutrients and gases between the two. In addition to the fetus, placenta is a key component to evaluate during any imaging performed during pregnancy. The most common disease processes involving the placenta include placenta accreta spectrum disorders and placental masses. Several systemic processes such as infection and fetal hydrops can too affect the placenta; however, their imaging features are nonspecific such as placental thickening, heterogeneity, and calcifications. Ultrasound is the first line of imaging during pregnancy, and MR imaging is reserved for problem solving, when there is need for higher anatomic resolution.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Placenta Acreta/diagnóstico por imagem , Placenta Prévia/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Placenta/diagnóstico por imagem , Gravidez
13.
Obstet Gynecol Clin North Am ; 47(1): 183-196, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008668

RESUMO

Because of the critical role that placental structure and function plays during pregnancy, abnormal placental structure and function is closely related to stillbirth: when an infant dies before birth. However, understanding the role of the placental and specific lesions is incomplete, in part because of the variation in definitions of lesions and in classifying causes of stillbirths. Nevertheless, placental abnormalities are seen more frequently in stillbirths than live births, with placental abruption, chorioamnionitis, and maternal vascular malperfusion most commonly reported. Critically, some placental lesions affect the management of subsequent pregnancies. Histopathological examination of the placenta is recommended following stillbirth.


Assuntos
Descolamento Prematuro da Placenta/diagnóstico , Morte Fetal/etiologia , Placenta/patologia , Complicações na Gravidez , Natimorto , Feminino , Idade Gestacional , Humanos , Gravidez
14.
Am J Obstet Gynecol ; 223(2): 226.e1-226.e19, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32109461

RESUMO

BACKGROUND: The use of assisted reproductive technology is increasing worldwide and conception after assisted reproduction currently comprises 3%-6% of birth cohorts in the Nordic countries. The risk of placenta-mediated pregnancy complications is greater after assisted reproductive technology compared with spontaneously conceived pregnancies. Whether the excess risk of placenta-mediated pregnancy complications in pregnancies following assisted reproduction has changed over time, is unknown. OBJECTIVES: To investigate whether time trends in risk of pregnancy complications (hypertensive disorders in pregnancy, placental abruption and placenta previa) differ for pregnancies after assisted reproductive technology compared with spontaneously conceived pregnancies during 3 decades of assisted reproduction treatment in the Nordic countries. STUDY DESIGN: In a population-based cohort study, with data from national health registries in Denmark (1994-2014), Finland (1990-2014), Norway (1988-2015) and Sweden (1988-2015), we included 6,830,578 pregnancies resulting in delivery. Among these, 146,998 (2.2%) were pregnancies after assisted reproduction (125,708 singleton pregnancies, 20,668 twin pregnancies and 622 of higher order plurality) and 6,683,132 (97.8%) pregnancies were conceived spontaneously (6,595,185 singleton pregnancies, 87,106 twin pregnancies and 1,289 of higher order plurality). We used logistic regression with post-estimation to estimate absolute risks and risk differences for each complication. We repeated analyses for singleton and twin pregnancies, separately. In subsamples with available information, we also adjusted for maternal body mass index, smoking during pregnancy, previous cesarean delivery, culture duration, and cryopreservation. RESULTS: The risk of each placental complication was consistently greater in pregnancies following assisted reproductive technology compared with spontaneously conceived pregnancies across the study period, except for hypertensive disorders in twin pregnancies, where risks were similar. Risk of hypertensive disorders increased over time in twin pregnancies for both conception methods, but more strongly for pregnancies following assisted reproductive technology (risk difference, 1.73 percentage points per 5 years; 95% confidence interval, 1.35-2.11) than for spontaneously conceived twins (risk difference, 0.75 percentage points; 95% confidence interval, 0.61-0.89). No clear time trends were found for hypertensive disorders in singleton pregnancies. Risk of placental abruption decreased over time in all groups. Risk differences were -0.16 percentage points (95% confidence interval, -0.19 to -0.12) and -0.06 percentage points (95% confidence interval, -0.06 to -0.05) for pregnancies after assisted reproduction and spontaneously conceived pregnancies, respectively, for singletons and multiple pregnancies combined. Over time, the risk of placenta previa increased in pregnancies after assisted reproduction among both singletons (risk difference, 0.21 percentage points; 95% confidence interval, 0.14-0.27) and twins (risk difference, 0.30 percentage points; 95% confidence interval, 0.16-0.43), but remained stable in spontaneously conceived pregnancies. When adjusting for culture duration, the temporal increase in placenta previa became weaker in all groups of assisted reproductive technology pregnancies, whereas adjustment for cryopreservation moderately attenuated trends in assisted reproductive technology twin pregnancies. CONCLUSIONS: The risk of placenta-mediated pregnancy complications following assisted reproductive technology remains higher compared to spontaneously conceived pregnancies, despite declining rates of multiple pregnancies. For hypertensive disorders in pregnancy and placental abruption, pregnancies after assisted reproduction follow the same time trends as the background population, whereas for placenta previa, risk has increased over time in pregnancies after assisted reproductive technology.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Diabetes Gestacional/epidemiologia , Placenta Prévia/epidemiologia , Complicações na Gravidez/epidemiologia , Técnicas de Reprodução Assistida/efeitos adversos , Descolamento Prematuro da Placenta/etiologia , Adulto , Fatores Etários , Diabetes Gestacional/etiologia , Feminino , Humanos , Incidência , Placenta Prévia/etiologia , Gravidez , Complicações na Gravidez/etiologia , Sistema de Registros , Risco , Países Escandinavos e Nórdicos , Adulto Jovem
16.
J Perinatol ; 40(4): 633-639, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32051541

RESUMO

OBJECTIVE: To study the association between perinatal sentinel events (PSE) and brain MRI/neurodevelopmental outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH). DESIGN: This is a retrospective single-center study. Data collection included perinatal history, brain MRI, and neurodevelopmental outcome. RESULTS: Out of the 182 neonates, 53 (29%) neonates had PSE and 129 (71%) neonates did not have PSE. Neonates with PSE had more normal MRIs (76%) compared with neonates without PSE (55%), p = 0.01. PSE was associated with favorable motor (p = 0.02), language outcome (p = 0.03), and trend to better cognitive scores (p = 0.13). In PSE, favorable motor outcome persisted (OR for impairment 0.15 (0.003-0.84), p = 0.03) after adjusting for the degree of encephalopathy and brain MRI injury. Injury on brain MRI despite TH after PSE was associated with unfavorable neurodevelopmental outcome (p < 0.001). CONCLUSION: Neonates with HIE receiving TH after PSE had less severe injury on brain MRI after rewarming, and improved motor and language outcomes at 18-36 months.


Assuntos
Encéfalo/patologia , Hipotermia Induzida , Hipóxia-Isquemia Encefálica/terapia , Transtornos do Neurodesenvolvimento/prevenção & controle , Descolamento Prematuro da Placenta , Encéfalo/diagnóstico por imagem , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/patologia , Lactente , Recém-Nascido , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Transtornos do Neurodesenvolvimento/diagnóstico , Transtornos do Neurodesenvolvimento/etiologia , Testes Neuropsicológicos , Complicações do Trabalho de Parto , Gravidez , Estudos Retrospectivos , Distocia do Ombro
17.
BMC Pregnancy Childbirth ; 20(1): 14, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906889

RESUMO

BACKGROUND: Major obstetric haemorrhage is a leading cause of maternal mortality and accounts for one-third of maternal deaths in of Africa. This study aimed to assess the population-based incidence, causes, management and outcomes of major obstetric haemorrhage and risk factors associated with poor maternal outcome. METHODS: Women with major obstetric haemorrhage who met the WHO maternal near-miss criteria or died in the Metro East region, Cape Town, South Africa, were evaluated from November 2014-November 2015. Major obstetric haemorrhage was defined as haemorrhage in pregnancies of at least 20 weeks' gestation or occurring up to 42 days after birth, and leading to hysterectomy, hypovolaemic shock or blood transfusion of ≥5 units of Packed Red Blood Cells. A logistic regression model was used to analyse associations with poor outcome, defined as major obstetric haemorrhage leading to massive transfusion of ≥8 units of packed red blood cells, hysterectomy or death. RESULTS: The incidence of major obstetric haemorrhage was 3/1000 births, and the incidence of massive transfusion was 4/10.000 births in the Metro East region (32.862 births occurred during the studied time period). Leading causes of haemorrhage were placental abruption 45/119 (37.8%), complications of caesarean section 29/119 (24.4%) and uterine atony 13/119 (10.9%). Therapeutic oxytocin was administered in 98/119 (82.4%) women and hysterectomy performed in 33/119 (27.7%). The median numbers of packed red blood cells and units of Fresh Frozen Plasma transfused were 6 (interquartile range 4-7) and 3 (interquartile range 2-4), ratio 1.7:1. Caesarean section was independently associated with poor maternal outcome: adjusted OR 4.01 [95% CI 1.58, 10.14]. CONCLUSIONS: Assessment of major obstetric haemorrhage using the Maternal Near Miss approach revealed that placental abruption and complications of caesarean section were the major causes of major obstetric haemorrhage. Caesarean section was associated with poor outcome.


Assuntos
Saúde Materna , Near Miss , Hemorragia Pós-Parto/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Descolamento Prematuro da Placenta/epidemiologia , Adulto , Transfusão de Sangue , Cesárea/efeitos adversos , Estudos de Coortes , Feminino , Humanos , Histerectomia , Incidência , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Gravidez , Resultado da Gravidez , Fatores de Risco , África do Sul/epidemiologia , Inércia Uterina/epidemiologia
18.
Am J Pathol ; 190(2): 388-399, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31955792

RESUMO

Preterm premature rupture of membranes (PPROM) and thrombin generation by decidual cell-expressed tissue factor often accompany abruptions. Underlying mechanisms remain unclear. We hypothesized that thrombin-induced colony-stimulating factor-2 (CSF-2) in decidual cells triggers paracrine signaling via its receptor (CSF2R) in trophoblasts, promoting fetal membrane weakening and abruption-associated PPROM. Decidua basalis sections from term (n = 10), idiopathic preterm birth (PTB; n = 8), and abruption-complicated pregnancies (n = 8) were immunostained for CSF-2. Real-time quantitative PCR measured CSF2 and CSF2R mRNA levels. Term decidual cell (TDC) monolayers were treated with 10-8 mol/L estradiol ± 10-7 mol/L medroxyprogesterone acetate (MPA) ± 1 IU/mL thrombin pretreatment for 4 hours, washed, and then incubated in control medium with estradiol ± MPA. TDC-derived conditioned media supernatant effects on fetal membrane weakening were analyzed. Immunostaining localized CSF-2 primarily to decidual cell cytoplasm and cytotrophoblast cell membranes. CSF-2 immunoreactivity was higher in abruption-complicated or idiopathic PTB specimens versus normal term specimens (P < 0.001). CSF2 mRNA was higher in TDCs versus cytotrophoblasts (P < 0.05), whereas CSF2R mRNA was 1.3 × 104-fold higher in cytotrophoblasts versus TDCs (P < 0.001). Thrombin enhanced CSF-2 secretion in TDC cultures fourfold (P < 0.05); MPA reduced this effect. Thrombin-pretreated TDC-derived conditioned media supernatant weakened fetal membranes (P < 0.05), which MPA inhibited. TDC-derived CSF-2, acting via trophoblast-expressed CSFR2, contributes to thrombin-induced fetal membrane weakening, eliciting abruption-related PPROM and PTB.


Assuntos
Descolamento Prematuro da Placenta/fisiopatologia , Decídua/patologia , Membranas Extraembrionárias/patologia , Ruptura Prematura de Membranas Fetais/patologia , Fator Estimulador de Colônias de Granulócitos e Macrófagos/metabolismo , Nascimento Prematuro/etiologia , Trombina/farmacologia , Decídua/efeitos dos fármacos , Decídua/metabolismo , Membranas Extraembrionárias/metabolismo , Feminino , Ruptura Prematura de Membranas Fetais/etiologia , Ruptura Prematura de Membranas Fetais/metabolismo , Fator Estimulador de Colônias de Granulócitos e Macrófagos/genética , Humanos , Gravidez , Nascimento Prematuro/metabolismo , Nascimento Prematuro/patologia , Transdução de Sinais , Trofoblastos/efeitos dos fármacos , Trofoblastos/metabolismo , Trofoblastos/patologia
19.
Medicina (Kaunas) ; 56(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31952287

RESUMO

BACKGROUND: To evaluate maternal and neonatal outcomes of assisted reproductive technology (ART). MATERIALS AND METHODS: Pregnant women registered from 2015 through 2017 (n = 6994) at five perinatal centers that managed high-risk pregnancies in Mie, Japan, retrospectively. Rates of preterm birth (<37 gestational weeks), early onset preeclampsia (<34 gestational weeks), late onset preeclampsia (≥34 gestational weeks), low-lying placenta, placenta previa, placenta accreta, placental abruption, atonic bleeding, uterine rupture, and amniotic fluid embolism after ART were evaluated. ART was defined as in vitro fertilization and micro-fertilization. Fisher's exact test, Mann-Whitney's U test, and logistic regression analysis were used to analyze the data. RESULTS: Rates of obstetrical complications including low-lying placenta, placenta previa, placenta accreta, and atonic bleeding were increased with ART compared to those with the control. Particularly, ART was associated with a significantly increased rate of placenta accreta (adjusted odds ratio: 7.35, 95% confidence interval (CI): 3.20-16.6) and significantly decreased rate of placental abruption (adjusted odds ratio: 0.24, 95% CI: 0.07-0.61). CONCLUSIONS: This study showed that ART may reduce placental abruption and increase placenta previa. There is a possibility that the placenta attaches deeper in the myometrium because of ART.


Assuntos
Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Técnicas de Reprodução Assistida/efeitos adversos , Descolamento Prematuro da Placenta/epidemiologia , Descolamento Prematuro da Placenta/etiologia , Adulto , Feminino , Humanos , Recém-Nascido , Japão/epidemiologia , Modelos Logísticos , Razão de Chances , Placenta Prévia/epidemiologia , Placenta Prévia/etiologia , Pré-Eclâmpsia/epidemiologia , Pré-Eclâmpsia/etiologia , Gravidez , Complicações na Gravidez/etiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-31936225

RESUMO

Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a higher incidence of caesarean section. A significant correlation with pregnancy-induced hypertension and preeclampsia was found in the presence of adenomyosis. No difference in fetal outcome was found. One case of hemoperitoneum during pregnancy was observed. Pregnancy in women with endometriosis carries a higher risk of obstetric complications, such as miscarriage, threatened miscarriage, preterm labor, preterm birth, and a higher caesarean section rate. Endometriosis does not seem to influence fetal well-being.


Assuntos
Endometriose/complicações , Complicações na Gravidez/etiologia , Aborto Espontâneo/etiologia , Descolamento Prematuro da Placenta/etiologia , Adulto , Cesárea/estatística & dados numéricos , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Recém-Nascido , Trabalho de Parto Prematuro/etiologia , Gravidez , Resultado da Gravidez , Nascimento Prematuro/etiologia , Estudos Prospectivos
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