Polyhydramnios is usually diagnosed with an amniotic fluid index (AFI) ≥ 24.0 cm or a maximum vertical pocket (MVP) ≥ 8.0 cm [1]. However, which methodology—AFI versus MVP—has a stronger association with adverse perinatal outcomes is uncertain. Our aim was to undertake a systematic review of the literature of studies comparing AFI, MVP or AFI&MVP for polyhydramnios related to adverse perinatal outcomes. We conducted a systematic review of the literature. Medline, Cochrane Library, EMBASE, Pubmed Central, Scopus and ClinicalTrial.gov were electronically searched from their inception to April 2025. Multiple combinations of (MeSH) terms and word variants (‘amniotic fluid index’, ‘AFI’, ‘deepest vertical pocket’, ‘DVP’, ‘maximum vertical pocket’, ‘MVP’, ‘polyhydramnios’, ‘hydramnios’) were used. No restrictions for geographic location or temporal limit were applied. Evaluation of each included study followed the Newcastle Ottawa Scale for cohort studies [2]. Disagreements were resolved by discussion until a consensus was reached. As we originally planned to do a systematic review and meta-analysis, the review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration No. CRD420251040958). Studies were included if they evaluated adverse perinatal outcomes by either AFI, MVP or AFI and MVP for the diagnosis of polyhydramnios. Electronic search, inclusion criteria and risk of bias assessment were independently assessed by two reviewers (AP and VB). Data from each eligible study were extracted without modification of original data onto custom-made data collection forms. The primary outcome was perinatal mortality, as defined by the included studies [3] (sum of stillbirths and neonatal deaths). Secondary outcomes were large for gestational age (LGA) or macrosomia (estimate of fetal weight ≥ 90th percentile or absolute weight ≥ 4000 g, respectively), fetal growth restriction (FGR, estimate of fetal weight < 10th percentile or as defined by included studies), IUFD, neonatal intensive care unit (NICU) admission and neonatal death. Out of 133 studies screened, there were no RCTs comparing the outcomes using MVP, AFI or both. Five non-RCT studies were assessed for eligibility for a total of 5319 patients [3-7] (Figure 1). However, only one retrospective study reported neonatal outcomes [7] (Table 1) and could be included in the analysis, and it was judged as low quality. In this study, polyhydramnios was identified by an AFI ≥ 24 cm or an MVP ≥ 8 cm on at least one ultrasound ≥ 20 weeks [7]. Those diagnosed with polyhydramnios by both methods had an increased risk of perinatal mortality (aRR = 5.94, 95% CI 3.07–11.50), including IUFD (aRR = 5.58, 95% CI 2.81–11.09) and neonatal death (aRR = 13.07, 95% CI 1.72–99.60), compared to those with normal amniotic fluid (Table 1). Only MVP and AFI were associated with increased risks of FGR, IUFD, NICU admission, neonatal and perinatal death (Table 1). Although polyhydramnios is frequently found in clinical practice, there is limited prospective, high-quality data concerning the best ultrasonographic methodology associated with adverse perinatal outcomes. Only Kraus et al. [7] compare AFI, MVP or both in terms of adverse perinatal outcomes, finding that polyhydramnios diagnosed by both methods is associated with an increased risk of perinatal mortality (Table 1). This is interestingly in contrast with the literature regarding oligohydramnios. A recent meta-analysis included 6 RCTs for a total of 4278 patients in the setting of oligohydramnios [4] showed that the use of MVP was associated with significantly lower rates of non-reassuring fetal heart tracing, Caesarean Delivery for non-reassuring fetal heart testing, and induction of labour, but without any worsening of adverse pregnancy outcomes [4]. To our knowledge, there are no ongoing RCTs on polyhydramnios diagnosis in terms of adverse perinatal outcomes. There is an urgent need for RCTs comparing different ultrasonographic methodologies for the diagnosis of polyhydramnios in terms of adverse perinatal outcomes, leading to an evidence-based management of polyhydramnios in everyday clinical practice. All authors fulfil the criteria of authorship. The authors have nothing to report. Transparency: The lead author (the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned have been explained. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.
694 Impact of neonatal birth weight on adverse perinatal outcomes in cesarean deliveries in nulliparous women
694 Impact of neonatal birth weight on adverse perinatal outcomes in cesarean deliveries in nulliparous women
Abstracts of the 34th World Congress on Ultrasound in Obstetrics and Gynecology, 15-18 September 2024, Budapest, Hungary.
This study aimed to evaluate the performance of sonographic biometric and Doppler parameters assessed at a routine third trimester scan, in combination with maternal characteristics, in predicting small-for-gestational-age (SGA) neonates and adverse perinatal outcomes. This was a cohort study of low-risk singleton pregnancies undergoing routine ultrasound between 35+0 and 37+6 weeks. Demographic characteristics, estimated fetal weight (EFW) and abdominal circumference (AC) centiles, and Doppler indices, including the Pulsatility Index (PI) of the Umbilical Artery (UA), Middle Cerebral Artery (MCA), and Uterine Artery (UtA) were evaluated. The Cerebroplacental ratio (CPR) was calculated, all indices were converted into Multiples of the Median (MoM). Multivariable logistic regression analysis was performed. Receiver-operating curves (ROC) were created to determine factors predictive of an SGA neonate with birthweights <3rd, 5th, and 10th centile and composite adverse perinatal outcomes (CAPO), which was comprised of intrauterine death, neonatal death, and neonatal intensive care unit admission. A total of 14,161 pregnancies were included. EFW centile (adjusted odds ratio (aOR) 0.91 (95% CI, 0.9-0.92), p < 0.001) (aOR 0.9 (95% CI, 0.89-0.91), p < 0.001), UA PI (aOR 4.6 (95% CI, 2.2-9.6), p < 0.001) (aOR 2.5 (95% CI, 1.1-6.1), p < 0.04), MCA PI (aOR 0.37 (95% CI, 0.2-0.7), p = 0.002) (aOR 0.26 (95% CI, 0.12-0.59), p = 0.001), CPR (aOR 0.23 (95% CI, 0.13-0.42), p < 0.001) (aOR 0.25 (95% CI, 0.12-0.53), p < 0.001), and UtA PI (aOR 2.5 (95% CI, 1.68-3.83), p < 0.001) (aOR 2.2 (95% CI, 1.31-3.6), p = 0.003) were independent predictors of SGA <5th and SGA <3rd or SGA with CAPO, respectively. The combination of EFW, CPR, and UtA PI was associated with an Area under the curve (AUC) of 0.93 (95% CI 0.92-0.94), p < 0.001 for both outcomes. In an unselected population, the UA PI, MCA PI, CPR, and UtA PI are independent predictors of SGA and adverse perinatal outcomes. The combination of these parameters can reliably predict SGA and adverse perinatal outcomes with a high degree of accuracy.
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1Maternal and Fetal Outcomes in Idiopathic Oligohydramnios vs. Normal Amniotic Fluid Index After 34 Weeks: A Case-Control Study in Eastern India.
Oligohydramnios, traditionally associated with adverse perinatal outcomes, often prompt early delivery via caesarean section, even in otherwise uncomplicated pregnancies. However, emerging research suggests that isolated oligohydramnios may not significantly impact neonatal outcomes, warranting re-evaluation of current management strategies. This study aimed to assess maternal and fetal outcomes in patients with idiopathic oligohydramnios diagnosed between 34-40 weeks of gestation, compared to low-risk pregnancies with normal amniotic fluid volume. A prospective case-control study was conducted in a tertiary care hospital in Eastern India over a period of one year. The study enrolled 100 pregnant women divided into cases: women with idiopathic oligohydramnios (amniotic fluid index [AFI] ≤5 without any identifiable maternal, fetal, or placental cause) and controls: gestational age-matched women with normal AFI (5-25 cm). Maternal characteristics, labor course, mode of delivery, and neonatal outcomes were analyzed. Statistical analysis was performed using SPSS, with p<0.05 considered significant. The rate of labor induction was significantly higher in cases compared to controls (50% vs. 20%, p=0.001). Meconium-stained liquor (44%) and non-reactive cardiotocography (NRCTG) (60%) were more common in the oligohydramnios group. Caesarean section rates were markedly higher among cases (78% vs. 32%, p<0.001), primarily due to fetal distress (71.8%). Newborns of cases had a higher incidence of small-for-gestational-age (SGA) status (56%). APGAR scores <7 at 1 and 5 minutes were more frequent in cases, with significantly higher neonatal intensive care unit (NICU) admissions (60% vs. 16%, p<0.001). Isolated oligohydramnios is associated with increased obstetric interventions, higher caesarean rates, and adverse neonatal outcomes, including SGA and higher NICU admissions, despite reassuring antenatal fetal surveillance. These findings suggest the need for individualized care and close fetal monitoring rather than automatic early delivery in isolated oligohydramnios cases.
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12Adverse Perinatal Outcomes of True Knot of the Umbilical Cord: A Case Series and Review of Literature
A true knot of the umbilical cord (TKUC) is an actual knot formed in pregnancy. It is seen in approximately 0.3%-1.2% of all pregnancies. True knots are of significance as they can cause a wide spectrum of adverse perinatal outcomes like small for gestational age (SGA) fetus, low appearance, pulse, grimace, activity, and respiration (Apgar) score at birth, fetal hypoxia, and even fetal demise.Here, we report a case series of three patients with TKUC and the varied adverse perinatal outcomes associated with them. A low-risk primigravida at term gestation had a suspicious non-stress test (NST). Repeat NST after maternal resuscitation became pathological. Emergency cesarean delivery was performed in view of pathological NST persisting despite intrauterine resuscitation. A healthy male baby weighing 2920 g was delivered, and the umbilical cord had a true knot.A multigravida at 33 + 3 weeks of gestation was referred with fetal growth restriction (FGR). Color Doppler examination showed absent end-diastolic flow (AEDF) in the umbilical artery (UA). Cesarean delivery was performed in view of FGR stage two with AEDF in the UA at 34 weeks of gestation as per the Barcelona criteria. A male baby weighing 1505 g was delivered. The umbilical cord had a true tight knot. The baby had an Apgar score of 7 at one minute after birth but was shifted to the neonatal intensive care unit (NICU) in view of low birth weight and prematurity. The baby slowly gained weight and was discharged from NICU after 15 days in stable condition.A multigravida at 32 weeks of gestation was referred with intrauterine fetal demise. Ultrasonography confirmed the presence of a single intrauterine dead fetus corresponding to 30 + 4 weeks of gestation with an estimated fetal weight (EFW) of 1633 g, amniotic fluid index (AFI) equal to nine, and presence of Spalding’s sign. Induction of labor was done, and she expelled a dead macerated male fetus weighing 1825 g. The infantogram was normal. A true umbilical cord knot was found.The umbilical cord is the source of fetal blood supply; therefore, any cord abnormality can have a significant impact on the fetal outcome. There are various factors that can predispose to TKUC, such as polyhydramnios, increased cord length, monoamniotic twins, male baby, grand multiparity, small fetus, and amniocentesis. TKUC can lead to various adverse outcomes in pregnancy and labor like SGA fetus, low Apgar score at birth, fetal hypoxia, and fetal demise. TKUC increases the risk of fetal demise by as much as four times.With the development of advanced techniques such as three-dimensional/four-dimensional color Doppler ultrasounds, TKUC can be diagnosed antenatally in the form of a four-leaf-clover, a “hanging-noose sign,” or by an unusual multicolor pattern in the cord. The prenatal detection rate of TKUC is only 12%. It mostly remains undetected unless visualized incidentally. Although TKUC is not rare and can have serious outcomes, the importance of its antenatal diagnosis has not been determined. It should be suspected in patients with risk factors, and emphasis should be placed on its antenatal diagnosis on ultrasonography to avoid obstetric disasters in otherwise low-risk females. Though there is no specific management of these cases, a good clinical outcome can be achieved if TKUC is diagnosed antenatally and monitored closely until fetal maturity is attained.
Read more9Predictive Value of Middle Cerebral Artery to Umbilical Artery Pulsatility Index Ratio for Neonatal Outcomes in Hypertensive Disorders of Pregnancy.
Background:Hypertension may lead to notifying adverse perinatal events that should be diagnosed and managed precisely. This study aims to investigate the values of cerebroplacental ration for the prediction of adverse perinatal events in hypertensive disorders of pregnancy.Materials and Methods:The current descriptive-comparative study has been conducted on 100 singleton pregnant women with the diagnosis of preeclampsia or pregnancy-induced hypertension. The Cerebroplacental ratio (CPR) was measured for the included population and divided into normal and abnormal ranges of >1 and ≤1. The adverse perinatal outcomes, including abnormal 5 min APGAR, low birth weight, perinatal death, neonatal intensive care unit (NICU) admission, academia, seizure, emergency cesarean delivery, and Tchirikov index as the general manifestation of adverse perinatal outcomes were compared between the groups. The specificity, sensitivity, positive predictive value, negative predictive value (NPV), and accuracy were measured for the adverse perinatal outcomes.Results:The two groups were remarkably different in terms of 5 min APGAR, low birth weight, cesarean section delivery, and Tchirikov index (P < 0.05). The specificity of CPR for prediction of small-for-gestational age, poor APGAR, requirement of assisted respiration, academia, Tchirikov score and NICU admission was 93.1%, 93.1%, 67.1%, 91.8%, 71.2%, and 63%, and its sensitivity was 26%, 14.8%, 51.8%, 14.8%, 51.8%, and 37%, respectively.Conclusion:CPR seems to be an appropriate means for the prediction of adverse perinatal outcomes with diversity in the prediction values of different determinants of adverse perinatal outcomes; however, in general, it had sensitivity, specificity, PP, NPV, and accuracy of 51.8%, 71.2%, 40%, 80%, and 66%, respectively.
Read more101Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population-based study in Alberta, Canada, 2005-11.
We assessed the prevalence and pregnancy outcomes of pre-existing diabetes mellitus (pre-DM) and gestational diabetes mellitus (GDM) in Alberta, Canada, 2005-11. 327 198 singleton and 5552 twin pregnancies resulting in live births or stillbirths were included. The odds ratios of adverse outcomes were evaluated comparing pre-DM with no diabetes and GDM with no diabetes, controlling for maternal characteristics. Diabetes complicated 6.3% of pregnancies, with 88% being GDM. In singleton pregnancies, pre-DM and GDM were associated with increased risks of pre-eclampsia (adjusted odds ratio [aOR] = 3.38 and 1.83, respectively), cesarean delivery (aOR 2.53, 1.55), spontaneous preterm (aOR 4.20, 1.71), and labor-induced preterm (aOR 3.82, 2.00) in the mother, and macrosomia (aOR 2.11, 1.30), shoulder dystocia (aOR 1.54, 1.32), congenital anomalies (aOR 1.61, 1.20), and neonatal intensive care unit (NICU) admissions (aOR 3.81, 1.60) in the infants. In addition, pre-DM was associated with an increased likelihood of stillbirth (aOR 3.73) and neonatal death (aOR 2.00) compared with non-diabetic pregnancies. In twin pregnancies, pre-DM was associated with increased risks of spontaneous (aOR 3.54) and labor-induced (aOR 3.57) preterm births, large for gestational age (LGA) infants (aOR 3.73), congenital anomalies (aOR 3.05) and NICU admissions (aOR 2.91); GDM was associated with an increased risk of pre-eclampsia (aOR 1.54), cesarean delivery (aOR 1.57), and LGA infants (aOR 1.63). Pre-existing diabetes confers higher risks than GDM. Diabetes is associated with adverse outcomes in singleton and twin pregnancies, and the increased risks are generally similar or less in twins, probably due to their higher "baseline" risks and closer clinical monitoring.
Read more10Assessment of ultrasound and Doppler parameters in the third trimester of pregnancy as predictors of adverse perinatal outcome in unselected pregnancies.
The aim of the study was to investigate ultrasound and Doppler parameters in the third trimester of pregnancy as possible predictors of adverse perinatal outcome in unselected pregnancies. We performed a retrospective cross-sectional study including unselected pregnant women be-tween 27 and 36 + 6 weeks of gestation. The following ultrasound and Doppler parameters were assessed: estimated fetal weight (EFW) [g], EFW percentile, placental maturity grade (Grannum classification), single vertical deepest pocket (SVDP) of amniotic fluid [cm], amniotic fluid index (AFI) [cm], mean uterine artery (UtA) pulsatility index (PI), umbilical artery (UA) PI, middle cerebral artery (MCA) PI, MCA peak systolic velocity (PSV) [cm/s], and cerebroplacental ratio (CPR). Adverse perinatal outcome was defined as Apgar score of < 7 at 1 min, birth weight of < 2500 g at delivery, and gestational age of < 37 weeks at delivery. The unpaired t test was used to compare the groups. AFI (p = 0.01), mean UtA PI (p = 0.04) and mean UA PI (p = 0.03) were significantly different with regard to the Apgar score at 1 min. EFW, EFW percentile, SVDP of amniotic fluid, AFI, mean UtA PI, UA PI, and MCA PI were significantly different (p < 0.001) in terms of birth weight. Placental maturity grade (p = 0.02), SVDP of the amniotic fluid (p < 0.001), AFI (p < 0.001), mean UtA PI (p < 0.001), UA PI (p = 0.001), and MCA PI (p < 0.001) were significantly different as far as gestational age at delivery is concerned. Ultrasound and Doppler parameters may predict adverse perinatal outcomes in unselected pregnancies in the third trimester of pregnancy.
Read more17Polyhydramnios and adverse perinatal outcome – what is the actual cutoff?
Objective: The purpose of this study was to evaluate the association between amniotic fluid index (AFI) and adverse perinatal outcome, and whether a critical cutoff can be defined.Methods: A retrospective cohort study was conducted. Included were patients who were admitted to the ultrasound unit of the tertiary medical center between the years 1988 and 2010. Parturients were classified into five groups according to their AFI: <20 (n = 9974; comparison group), 20–23 (n = 2771), 24–27 (n = 1315), 28–31 (n = 494) and 32 + (n = 260). Pregnancy and the perinatal outcomes were compared between the groups. Statistical analysis included the chi-square tests for trends, and multivariable models to control for confounders (with AFI as a dummy variable).Results: A significant linear association was found between AFI and adverse perinatal outcomes including hypertensive disorders, diabetes mellitus, preterm labor, macrosomia, placental abruption and low birth weight. Furthermore, using multivariable logistic regression models, controlling for confounders such as maternal and gestational age, hypertension, diabetes mellitus, etc., the significant association between all four subgroups of AFI > 20 and adverse perinatal outcomes remained.Conclusion: A significant linear association exists between AFI > 20 and perinatal complications such as perinatal mortality, low Apgar scores and preterm labor. Hence, the critical cutoff for polyhydramnios should be re-evaluated.
Read moreLate-Onset Severe Fetal Growth Restriction and Isolated Severely Small Abdominal Circumference: Do Neonatal Outcomes Differ? [ID: 1377666
INTRODUCTION: Updated guidelines from the Society for Maternal-Fetal Medicine (SMFM) define severe fetal growth restriction (sFGR), or an estimated fetal weight (EFW) less than 3rd percentile, as a distinct entity due to higher perinatal morbidity in this group. Whether an isolated abdominal circumference (AC) less than 3rd percentile similarly portends adverse outcomes remains unclear. METHODS: This is a single-institution, retrospective cohort study of singleton gestations with late-onset FGR and normal Doppler studies from 2012 to 2022. Pregnancies affected by AC less than 3rd percentile (but EFW≥3rd percentile) and EFW less than 3rd percentile were compared using univariable analysis and multivariable logistic regression. The primary outcome was neonatal intensive care unit (NICU) admission. RESULTS: Among eligible participants, 78 (63%) had an isolated AC less than 3rd percentile and 45 (37%) had sFGR. Neonates prenatally diagnosed with sFGR were more likely to be admitted to the NICU than those with isolated AC less than 3rd percentile (68.9% versus 23.1%, P<.001). After adjusting for gestational age, birth weight, race, maternal age, and medical comorbidities, sFGR was still associated with an increased odds of NICU admission (adjusted odds ratio 4.9, 95% CI 1.37–17.48, P=.014). Rates of cesarean delivery (46.7% versus 26.9%; P=.03), small for gestational age (86.7% versus 67.9%, P=.02), and 5-minute Apgar score less than 7 (6.7% versus 0.0%, P=.02) were also higher in the sFGR group. There were no significant differences in NICU length of stay or perinatal death between groups. CONCLUSION: Adverse neonatal outcomes were more prevalent in pregnancies affected by sFGR compared with isolated AC less than 3rd percentile, providing support for the updated SMFM guidelines.
Read moreMaternal hypoglycemia after 75gm. oral glucose tolerance test: Is it bad for the fetus and mother?
Background: While extensive research has focused on gestational diabetes mellitus, less is understood about maternal hypoglycemia following a 75g oral glucose tolerance test (OGTT). This study investigates the potential impacts of maternal hypoglycemia on both maternal and fetal outcomes. Aim and objective: To study whether maternal hypoglycemia after 75gm OGTT is associated with adverse fetal and obstetric outcomes and to study incidence of reactive hypoglycemia after 75gm OGTT. Materials and Methods: A retrospective case-control study involving 2553 antenatal women at 40 weeks was conducted over twelve months. Participants underwent a 75g OGTT (twice, first as soon as pregnancy was confirmed and second after 24 weeks of gestation) and were categorized into two groups: Normal OGTT (90-140 mg/dL) and Reactive Hypoglycemia (<70 mg/dL). Outcomes measured included rates of preterm delivery, small for gestational age (SGA) babies, cesarean sections (LSCS), large for gestational age (LGA) and neonatal intensive care unit (NICU) admissions. Results: Out of 2553 participants, 55 women experienced reactive hypoglycemia. There was a significantly higher incidence of preterm deliveries (<37 weeks) and SGA infants in the hypoglycemia group compared to the control (p<0.001 and p = 0.002, respectively). Additionally, the reactive hypoglycemia group exhibited a higher frequency of cesarean deliveries (p<0.001) and NICU admissions (p<0.001).There was a higher incidence of LGA babies in hypoglycemia group (p=0.001). Three cases were large for gestational age, and two cases were converted to GDM. APGAR scores at 1 minute also significantly differed, with more cases scoring below 6 compared to controls (p = 0.0091). Conclusions: Maternal reactive hypoglycemia after a 75g OGTT is associated with adverse pregnancy outcomes, including increased risks of preterm birth, SGA babies, higher cesarean rates, LGA babies and NICU admissions. These findings underscore the importance of careful monitoring and managing glucose levels during pregnancy to improve maternal and neonatal health outcomes.
Read moreEvaluation of the Relationship Between the Thymic-Thoracic Ratio and Perinatal Adverse Outcomes in Fetuses with Congenital Heart Defects: An Observational Study at a Tertiary Care Center.
The aim of this study was to evaluate the thymic-thoracic ratio (TTR) in fetuses with congenital heart defects (CHD) and to investigate the association between TTR and adverse perinatal outcomes. This prospective study was conducted at a tertiary care center. A total of 85 participants were enrolled, including 42 fetuses with CHD and 43 healthy controls between 18 and 37 gestational weeks. The TTR was calculated for each case. First, outcomes were compared between the CHD and control groups; subsequently, CHD cases were analyzed in subgroups. Receiver operating characteristic (ROC) analysis was performed to assess the relationship between TTR and perinatal outcomes in the CHD group. TTR was significantly lower in the fetal CHD group compared with controls (p < .001). In the conotruncal CHD subgroup, TTR values were also significantly lower (p < .001). In the Spearman correlation analysis performed for neonatal intensive care unit (NICU) admission between the study and control groups, TTR showed a negative correlation with NICU admission (r = -0.331, p = .002). ROC analysis indicated that the optimal TTR cut-off value for predicting NICU admission was 0.41, with 72% sensitivity and 62% specificity (AUC = 0.729; p < .001). TTR was lower in fetuses with CHD. A decreasing TTR was associated with an increased rate of adverse perinatal outcomes. Assessment of TTR in fetuses with CHD may be a useful tool for predicting adverse perinatal outcomes.
Read more2Amniotic-umbilical-to-cerebral ratio, a Doppler index for estimating adverse perinatal outcomes in fetal growth restriction.
To evaluate amniotic fluid volume with Doppler parameters and its association with composite adverse perinatal outcomes (CAPOs) in fetal growth restriction (FGR). This study was conducted prospectively in a tertiary referral center between 2023 and 2024 on pregnant women diagnosed with early- and late-onset FGR. Fetal ultrasonographic measurements, including deepest vertical pocket (DVP) for amniotic fluid, and Doppler parameters including uterine artery (UtA) systolic/diastolic (S/D) and pulsatility index (PI), middle cerebral artery (MCA) S/D and PI, and umbilical artery (UA) S/D and PI, were conducted following fetal biometry. The cerebroplacental ratio (CPR), cerebral ratio, cerebro-placental-uterine ratio (CPUR), and amniotic-umbilical-to-cerebral ratio (AUCR) were all calculated. Pregnant women diagnosed with FGR were planned to give birth after 37 weeks' gestation, unless a pregnancy complication requiring earlier delivery occurred. We assessed perinatal outcomes subsequent to delivery, with CAPOs defined as the presence of at least one adverse outcome: 5th minute APGAR score <7, respiratory distress syndrome (RDS), umbilical cord blood pH <7.2, and neonatal intensive care unit (NICU) admission. The study included 132 participants, divided into early- (n = 32) and late-onset FGR (n = 100) groups. AUCR was significantly lower in fetuses with late-onset FGR who experienced CAPOs. Multivariate analysis showed gestational age at birth and birth weight were significant predictors of CAPOs in early-onset FGR, while gestational age, birth weight, and AUCR were significant predictors in late-onset FGR. CPR, UCR, and CPUR did not show significance in predicting CAPOs in both early- and late-onset FGR on multivariate analysis. AUCR is a potential reliable marker for predicting adverse perinatal outcomes in late-onset FGR.
Read more44Prediction by maternal risk factors of neonatal intensive care admissions: Evaluation of >59,000 women in national managed care programs
Prediction by maternal risk factors of neonatal intensive care admissions: Evaluation of >59,000 women in national managed care programs
Read morePredicting Perinatal Outcomes With an Obstructive Sleep Apnea Screening Tool [13N
INTRODUCTION: The objective was to determine if a screening tool for obstructive sleep apnea (OSA) can be used to predict adverse perinatal outcomes. METHODS: Prospective observational study of patients receiving prenatal care (June 1 2013-May 31 2014) at a tertiary care center clinic. Patients were universally screened for OSA with the STOP questionnaire, a concise tool with four questions related to snoring, tiredness during daytime, observed apnea, and high blood pressure. It has been validated in surgery patients. Positive and negative screens and several confounding variables were included in a backwards logistic regression model to predict the following adverse perinatal outcomes: cesarean delivery, preeclampsia, preterm delivery (PTD) (<37 weeks), low birth weight (LBW) (<2500 g), Intra Uterine Growth Restriction, and Neonatal Intensive Care Unit (NICU) admission. RESULTS: Of the 680 patients who received prenatal care, 442 (65%) had singleton births and were included in analysis. Patient body mass indexes ranged from 12.8-61.4 with mean of 29.7. This study population had high tobacco (241; 54.5%) and illicit drug use (155; 35.1%). Positive STOP screens (64;14.5%) were associated with two outcomes: PTD and NICU admission. For PTD, history of pre-term labor was the strongest predictor, followed by STOP and nulliparity with odds ratios (OR) of 4.2 (95% CI 2.0-8.8; p < 0.001), 2.8 (95% CI 1.4-5.8; p=0.004), and 2.3 (95% CI 1.2-4.4; p=0.013). For NICU admission, a positive STOP was the only significant predictor with 2.5 OR (95% CI 1.1-5.7; p=0.036). CONCLUSION: The STOP screening questionnaire may be useful in predicting PTD and NICU admission.
Read more5Increased length of active labor is associated with adverse perinatal outcomes among nulliparous women undergoing labor induction
Objective Evaluate the association between current recommendations for active labor duration in nulliparous women undergoing labor induction and adverse perinatal outcomes. Study design Retrospective cohort study from 2012 to 2015. Subjects were nulliparous, 18–44 years, cephalic, singleton ≥37 weeks undergoing labor induction who reached active labor. We created three subgroups, defined by active labor duration from 6 to 10cm as < the median, median-95th percentile, and >95th percentile based on contemporary labor curves. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, blood loss (EBL), 5-minute Apgar score < 7, and neonatal intensive care unit (NICU) admission using logistic regression. Results Among 356 women, 34.8% had an active labor duration < median, 43.3% were between the median-95th percentile, and 21.9% were >95th percentile. The risk of cesarean delivery increased with longer active labor duration; 1.8-fold (95%CI = 1.1–3.1) and 4.0-fold (95%CI = 2.5–6.5) for women whose active labors were between the median-95th percentile and >95th percentile, respectively. Chorioamnionitis increased by 3.9-fold (95%CI = 1.2–13.2) in the >95th percentile subgroup. Active labor length was not associated with EBL, Apgar scores, or NICU admission. Conclusions Cesarean delivery and chorioamnionitis increased significantly as induced active labor duration exceeded the median. This study provides a better understanding regarding the risks of longer active labor as defined by contemporary labor curves.
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