Biomedical subjects

M Hallak

Publications and source records attributed to M Hallak.

At least 19 recordsLinked to original sources

PubMed2003

Placental abruption in term pregnancies: clinical significance and obstetric risk factors.

OBJECTIVE: To determine the incidence, obstetric risk factors and pregnancy outcome of placental abruption at term. METHODS: A comparison of all singleton term deliveries (> or = 37 weeks' gestation) complicated with placental abruption to singleton term deliveries without placental abruption. Multivariate analysis was performed to investigate independent risk factors for placental abruption. RESULTS: Placental abruption complicated 0.3% of all term deliveries (n = 72,995). A multiple logistic regression model with backward elimination found the following factors to be independently associated with the occurrence of placental abruption in term pregnancies: pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), non-vertex presentation, hydramnios and advanced maternal age. Perinatal mortality was significantly higher in pregnancies complicated with placental abruption (OR = 30.0, 95% CI 19.7-45.6; p < 0.001). In order to assess whether the increased risk for perinatal mortality was due to the placental abruption or to its significant association with other risk factors, a multivariate analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR = 50.5, 95% CI 32.2-79.1), cord prolapse, small for gestational age and congenital malformations were found to be independent risk factors for perinatal mortality. CONCLUSION: Abruption of the placenta at term was found to be significantly associated with PIH, non-vertex presentation, IUGR, hydramnios and advanced maternal age. Owing to the independent association found between placental abruption and perinatal mortality, these conditions should be carefully evaluated in order to reduce the occurrence of placental abruption.

Abruptio Placentae↗

PubMed2002

Risk factors for arrest of descent during the second stage of labor.

OBJECTIVE: To define obstetrical risk factors for arrest of descent during the second stage of labor and to determine perinatal outcome. STUDY DESIGN: All singleton, vertex, term deliveries with an unscarred uterus, between the years 1988 and 1999 were included. Univariable and multivariable analysis were performed to investigate independent risk factors associated with arrest of descent during the second stage of labor and the perinatal outcome. RESULTS: The study included 93266 deliveries, of these 1545 (1.7%) were complicated with arrest of descent during the second stage of labor. Using a multivariable analysis, the following obstetric risk factors were found to be significantly associated with arrest of descent: nulliparity (OR=7.8, 95% CI=6.9-8.7; P<0.001), birth weight >4 kg (OR=2.3, 95% CI=1.9-2.8; P<0.001), epidural analgesia (OR=1.8, 95% CI=1.6-2.0; P<0.001), hydramnios (OR=1.6, 95% CI=1.3-2.0; P<0.001), hypertensive disorders (OR=1.5, 95% CI=1.3-1.8; P<0.001), gestational diabetes A1 and A2 (OR=1.5, 95% CI=1.2-1.8; P<0.001), male gender (OR=1.4, 95% CI=1.2-1.5; P<0.001), premature rupture of membranes (PROM, OR=1.3, 95% CI=1.04-1.6; P=0.021), and induction of labor (OR=1.2, 95% CI=1.02-1.4; P=0.030). Deliveries complicated by arrest of descent resulted in cesarean section in 20.6%, vacuum extraction in 74.0%, and forceps delivery in 5.4%. Newborns delivered after arrest of descent during the second stage of labor had significantly higher rates of low Apgar scores (<7) at 1 and 5 min, as compared to the controls (12.7 vs. 2.1%, P<0.001; and 0.9 vs. 0.2%, P<0.001, respectively). Nevertheless, no significant differences were noted between the groups regarding perinatal mortality (0.38 vs. 0.44%; P=0.759). CONCLUSIONS: Major risk factors for arrest of descent during the second stage of labor were nulliparity, fetal macrosomia, epidural analgesia, hydramnios, hypertensive disorders and gestational diabetes mellitus. These risk factors should be carefully evaluated during pregnancy in order to actively manage high-risk pregnancies.

Analgesia, Epidural↗

PubMed2002

Incidence, obstetric risk factors and pregnancy outcome of preterm placental abruption: a retrospective analysis.

OBJECTIVE: To determine obstetric risk factors for the occurrence of preterm placental abruption and to investigate its subsequent perinatal outcome. STUDY DESIGN: A retrospective comparison of all singleton preterm deliveries complicated with placental abruption, between the years 1990-1998, to all singleton preterm deliveries without placental abruption, in the Soroka University Medical Center. RESULTS: Placental abruption complicated 300 (5.1%) of all preterm deliveries (n = 5934). A backstep multivariable analysis found the following factors to be independently correlated with the occurrence of preterm placental abruption: grandmultiparity (more than five deliveries), early gestational age, severe pregnancy-induced hypertension, previous second-trimester bleeding and non-vertex presentation. These pregnancies had a significantly lower rate of preterm premature rupture of membranes than preterm pregnancies without placental abruption. Pregnancies complicated with preterm placental abruption had significantly higher rates of cord prolapse, non-reassuring fetal heart rate patterns, congenital malformations, Cesarean deliveries, perinatal mortality, Apgar scores lower than 7 at 5 min, postpartum anemia and delayed discharge from the hospital than did preterm deliveries without placental abruption. In order to assess whether the increased risk for perinatal mortality was due to the placental abruption, or due to its significant association with other risk factors, a multivariable analysis was constructed with perinatal mortality as the outcome variable. Placental abruption (OR 3.0, 95% CI 2.1-4.1) as well as cord prolapse, previous perinatal death, low birth weight and congenital malformations were found to be independent risk factors for perinatal mortality. CONCLUSION: Preterm placental abruption is an unpredictable severe complication associated with significant perinatal morbidity and mortality. Factors found to be independently associated with placental abruption were grandmultiparity, severe pregnancy-induced hypertension, malpresentation, earlier gestational age and a history of second-trimester vaginal bleeding.

Abruptio Placentae↗

PubMed2002

Post-term pregnancy: should induction of labor be considered before 42 weeks?

OBJECTIVE: To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor. STUDY DESIGN: A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves. RESULTS: The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section. CONCLUSIONS: The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.

Amniotic Fluid↗

PubMed2002

The effect of meconium on perinatal outcome: a prospective analysis.

OBJECTIVE: To evaluate the effect of meconium-stained amniotic fluid (AF) on perinatal outcome. METHODS: A prospective observational study was performed, comparing perinatal outcome of parturients with thick and thin meconium-stained AF to those with clear AF. RESULTS: The rate of meconium-stained AF was 18.1% (106/586). Of those, 78 (13.3%) patients had thin and 28 (4.8%) had thick meconium-stained AF. The rate of oligohydramnios was significantly higher among pregnancies complicated with thick meconium-stained AF (OR 7.2, 95% Cl 2.1-24.1; p = 0.002). A significant linear association, using the Mantel-Haenszel test for linearity, was found between the thickness of the meconium and abnormal fetal heart rate patterns during the first and second stages of labor, low Apgar scores at 1 min and the risk for Cesarean section. A statistically significantly higher risk for neonatal intensive care unit admission was observed among patients with thick meconium as compared to those with clear AF (OR 11.4, 95% CI 2.0-59.3; p = 0.006), even after adjustment for oligohydramnios and abnormal fetal heart rate patterns. CONCLUSIONS: Thick, and not thin, meconium-stained AF, was associated with an increased risk for perinatal complications during labor and delivery. Therefore, thick meconium-stained AF should be considered a marker for possible fetal compromise, and lead to careful evaluation of fetal well-being.

Adult↗

PubMed2002

Obstetric risk factors for failure to progress in the first versus the second stage of labor.

OBJECTIVE: To compare obstetric risk factors for failure of labor to progress in the first versus the second stage. STUDY DESIGN: A comparison was performed of all singleton, vertex and term deliveries with an unscarred uterus, complicated with non-progressive labor during the first and the second stages. Deliveries occurred between the years 1988 and 1999 in a tertiary university medical center. RESULTS: Patients with non-progressive labor in the first stage (n = 1197) were significantly older, of higher birth order, and were more likely to have complications such as gestational diabetes, hypertensive disorders, premature rupture of membranes, meconium-stained amniotic fluid, hydramnios and oligohydramnios (p < 0.001 for all variables) as compared to patients with non-progressive labor in the second stage (n = 1545). In addition, pregnancies complicated with non-progressive labor in the first stage had a significantly higher rate of fetal macrosomia as compared to patients with non-progressive labor in the second stage (11.6% vs. 8.8%; p < 0.001). CONCLUSIONS: Higher rates of fetal macrosomia and high-risk pregnancies were noted among pregnancies complicated with non-progressive labor during the first vs. the second stage. The significant increase in Cesarean deliveries during the first stage of labor among high-risk pregnancies might reflect exaggerated concern of caregivers. This concern may influence an overall conservative attitude leading to the seemingly simpler mode of direct intervention by Cesarean delivery.

Adolescent↗

PubMed2002

Ripening of the uterine cervix in a post-cesarean parturient: prostaglandin E2 versus Foley catheter.

OBJECTIVE: To compare the success and complication rates of prostaglandin E2 tablets (PGE2) and a Foley catheter for the ripening of the uterine cervix in post-Cesarean section parturients. STUDY DESIGN: The study population in this retrospective cohort study consisted of parturients in their second pregnancy who had undergone Cesarean section in their previous delivery and who underwent ripening of the uterine cervix by using PGE2 (n = 55) or Foley catheter (n = 161) in the current pregnancy. The control group consisted of 1432 post-Cesarean section parturients without induction of labor. We compared the rates of placental abruption, non-reassuring fetal heart rate patterns, intrapartum fetal deaths (IPFD), uterine rupture, Apgar scores, labor dystocia, severe birth canal lacerations, vacuum deliveries and repeated Cesarean section rates in the three groups by using ANOVA, chi2 analysis and Fisher's exact test when appropriate. RESULTS: A significant increase in the rates of labor dystocia during the first stage (30.4% vs. 11.6%, p < 0.01) and repeated Cesarean deliveries (49.1% vs. 35.2%, p < 0.01) were observed in women in whom the Foley catheter was used as compared to controls, respectively. No such changes were demonstrated in the PGE2 group as compared to the controls. No significant differences were found between the PGE2 group and Foley catheter group as compared to the controls in rates of placental abruption, IPFD, uterine rupture, fetal distress, birth canal lacerations, vacuum deliveries and Apgar scores. CONCLUSIONS: PGE2 was found to be superior to the Foley catheter for ripening of the uterine cervix in a post-Cesarean parturient, as demonstrated by a lower repeated Cesarean delivery rate.

Adult↗

PubMed2002

Changes in the expression of cytoskeletal proteins in the CNS of transferrin transgenic mice.

Apotransferrin injected intracranially into young rats has been shown in our laboratories to induce an early differentiation of oligodendroglial cells and an increased deposition of myelin. The expression of some myelin-specific proteins such as myelin basic protein (MBP) and 2',3'-cyclic nucleotide 3'-phosphodiesterase (CNPase) and of their mRNAs were significantly increased in these animals. Also, in the cytoskeleton obtained from isolated myelin, it was found that several microtubule associated proteins (MAPs), particularly the stable tubule only peptide (STOP) and MAP 1B, as well as actin and tubulin were markedly increased. In the present paper, we compare the changes in expression of brain and myelin cytoskeletal proteins in a newly generated transferrin transgenic mouse (Tg), overexpressing the human transferrin gene, with the results obtained in aTf-injected rats. In the myelin cytoskeletal fraction of Tg mice there was a significant increase in the expression of MBP, tubulin, tau and STOP, similarly to what was previously found in the aTf-injected rats. Immunohistochemical studies showed that a variance with what occurs in the aTf-injected model, in which the above mentioned changes were limited to the corpus callosum, in the Tg mice the changes in expression of cytoskeletal proteins were observed in the various anatomical areas studied such as cerebral cortex, brain stem and cerebellum. There was also an increased expression of neurofilaments in the Tg animals, in contrast with results obtained in aTf-injected rats, suggesting that in the Tg mice, the continuous overexpression of Tf might also induce some neuronal changes. Changes in tau, total and acetylated tubulin and MAP 1B were observed in both neurons and OLGc. The increase in STOP was more significant in OLGc while the changes in MAP2 were exclusively found in neurons.

Animals↗

PubMed2001

Activation of HTLV-I long terminal repeat by stress-inducing agents and protection of HTLV-I-infected T-cells from apoptosis by the viral tax protein.

HTLV-I is etiologically implicated with tropical spastic paraparesis/HTLV-I associated myelopathy, adult T-cell leukemia and certain other diseases. However, after infection the virus enters into a dormant state, whereas the characteristics of the HTLV-I related diseases indicate that their genesis requires activation of the dormant virus by a Tax-independent mechanism. In the present study we demonstrate that a variety of stress-inducing agents (TPA, cisplatin, etoposide, taxol, and 3-methylcholanthrene) are capable of Tax-independent activation of HTLV-I LTR and that this activation is detected mainly in cells that are undergoing through the apoptotic process. Furthermore, it is demonstrated that both apoptosis induction and HTLV-I LTR activation are inhibited by Bcl-2 and by PKC, indicating that these two processes are mechanistically cross-linked. In addition, using an HTLV-I producing human T-cell line which permanently express the negatively transdominant tax mutant, Delta58tax, under the Tet-Off control system, we prove that the virally encoded Tax protein protects the host cells from apoptosis. Together, these data suggest that activation of the dormant virus in the carriers' infected T-cells by certain stress-inducing conditions and protecting these cells from the consequent apoptotic death by the viral Tax protein emerging after this activation, might be the basis for switching the virus from latency to a pathogenic phase.

Antineoplastic Agents↗

PubMed2001

Clinical significance of fetal heart rate tracings during the second stage of labor.

OBJECTIVE: To examine the significance of abnormal fetal heart rate (FHR) patterns during the second stage of labor in terms of pregnancy outcome. METHODS: A prospective observational study comparing women who had abnormal FHR patterns during the second stage of labor with women who demonstrated normal FHR patterns. RESULTS: Abnormal second-stage FHR patterns were found in 420 tracings (75%), whereas 140 tracings (25%) were normal. In a multivariable analysis, nulliparity (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5, 4.2), cord problems (OR 1.8; 95% CI 1.03, 3.3), and male sex (OR 1.5; 95% CI 1.01, 2.2) were independent factors affecting the occurrence of abnormal second-stage FHR patterns. Patients with abnormal tracings had significantly higher rates of operative delivery compared with patients with normal tracings. The newborns from the case group had significantly higher percentages of Apgar scores lower than 7 at 1 minute, arterial pH lower than 7.2, and base deficit of 12 mmol/L or higher, and six were admitted to the intensive care unit (ICU). A multiple logistic regression model found second-stage late decelerations, bradycardia less than 70 beats per minute, and the presence of abnormal FHR patterns during the first stage of labor to be independently associated with fetal acidosis (determined by pH less than 7.2 and base deficit greater than 12 mmol/L). CONCLUSION: Late decelerations, bradycardia less than 70 beats per minute, and abnormal FHR patterns during the first stage of labor might jeopardize fetal well-being, and expedited delivery should be considered.

Adult↗

PubMed2001

Multiple courses of antenatal steroids: risks and benefits.

OBJECTIVE: To review the existing literature regarding the effect of multiple courses of antenatal corticosteroids in reducing the occurrence of complications arising because of lung immaturity. DATA SOURCES: A systematic review of the English-language literature was conducted using a computerized database. We searched the English-language human and animal literature in MEDLINE and PubMed (National Library of Medicine, Bethesda, MD), as well as abstracts from recent meetings of the Society for Gynecologic Investigation and the Society for Maternal-Fetal Medicine. The search terms used were antenatal steroids, prenatal steroids, and respiratory distress syndrome. STUDY SELECTION: We screened 2472 abstracts and found 280 relevant articles, which we independently reviewed. Only prospective well-designed animal studies were included. In humans, no well-designed randomized controlled trials (RCTs) were identified. Data that specifically addressed the issue of beneficial and adverse outcome of multiple courses of antenatal corticosteroids were included. TABULATION, INTEGRATION, AND RESULTS: Twelve studies and three abstracts concerning animal models were included. These suggest multiple adverse consequences including decrease in birth and lung weights and brain growth restriction. In humans, 14 publications and five abstracts, mostly in the form of retrospective studies, although methodologically lacking, were included. Possible beneficial effects include lower rates of respiratory distress syndrome and a decrease in oxygen use, whereas adverse outcomes embody reduction in birth head circumference, birth weights, and increased neonatal and maternal infection rates. CONCLUSION: To date, there are no well-designed RCTs in humans that support the advantages of multiple courses over a single course of antenatal corticosteroids. An increasing body of evidence raises the concern of adverse consequences from the use of repeated courses. While awaiting results from RCTs in progress, we recommend that a single course of antenatal corticosteroids be given to all women at risk for preterm birth at 24-34 weeks' gestation.

Animals↗

PubMed2001

The effects of intrapartum magnesium sulfate therapy on fetal serum interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha at delivery: a randomized, placebo-controlled trial.

OBJECTIVE: Elevated levels of inflammatory cytokines in the fetus have been linked to neurologic morbidities in preterm neonates. Magnesium sulfate is currently being studied in clinical trials as a potential fetal neuroprotective agent. The purpose of this study was to determine whether intrapartum magnesium sulfate therapy has an effect on the umbilical venous concentrations of interleukin-1beta, interleukin-6, and tumor necrosis factor-alpha at delivery. STUDY DESIGN: Women with singleton gestations >32 weeks with no clinical indications for magnesium sulfate therapy (preeclampsia or tocolysis) and either clinical chorioamnionitis or prolonged rupture of membranes were recruited for the study. Consenting patients were randomly assigned, in a double-blinded fashion, to receive either magnesium sulfate (6-g load then 2 g/hr) or matched volumes of lactated Ringer's solution until delivery. Fetal blood specimens were obtained by aspiration of the umbilical vein after cord clamping but before placental separation. Umbilical cytokine levels were measured with a sensitive and specific immunoassay. RESULTS: Twenty-two patients were randomly assigned to groups and received either magnesium sulfate (n = 11) or placebo (n = 11). There were no differences in the demographic or clinical characteristics between groups. The umbilical venous ionized magnesium concentration was significantly higher in the magnesium sulfate group (2.32 +/- 0.27 mg/dL vs 1.23 +/- 0.15 mg/dL; P <.001). There were no statistically significant differences between groups with respect to umbilical levels of interleukin-1beta (1.5 pg/mL [1.5-58] vs 1.5 pg/mL [1.5-10]; P =.5); interleukin-6 (8.5 pg/mL [1-1000] vs 11.2 pg/mL [1-113]; P =.9); or tumor necrosis factor-alpha (16 pg/mL [7.6-20.3] vs 16.6 pg/mL [8.3-22.2]; P =.5). CONCLUSION: In this pilot study the intrapartum administration of magnesium sulfate does not appear to affect the concentration of inflammatory cytokines in fetal blood at delivery.

Adult↗

PubMed2001

Abnormal fetal heart rate tracing patterns during the first stage of labor: effect on perinatal outcome.

OBJECTIVE: The purpose of this study was to evaluate perinatal outcomes of infants who had pathologic fetal heart rate tracings during the first stage of labor, in comparison with pregnancies with normal tracings. STUDY DESIGN: The perinatal outcomes of 301 infants born at 37 to 42 weeks of gestation with pathologic fetal heart rate patterns during the first stage of labor were compared with 300 infants with normal fetal heart rate tracing patterns. The data were collected prospectively. Tracings were interpreted with the use of the National Institute of Child Health and Human Development fetal heart rate monitor guidelines. RESULTS: Hydramnios (odds ratio, 7.68; 95% CI, 1.75%-33.63%), oligohydramnios (odds ratio, 2.74; 95% CI, 1.01%-7.39%), and the presence of meconium-stained amniotic fluid (odds ratio, 1.91; 95% CI, 1.03%-3.3%) were independent factors that were associated with pathologic fetal heart rate monitoring during the first stage of labor in a multivariable analysis. The occurrences of umbilical arterial pH of <7.20, a 1-minute Apgar score of <7, a base deficit of 12 mmol/L or higher, and operative deliveries were significantly higher in the study group as compared with subjects with normal fetal heart rate monitoring. Late decelerations and severe variable decelerations (<70 bpm) during the first stage of labor were independent risk factors (odds ratio, 17.5; 95% CI, 1.61%-185.7% and odds ratio, 3.9; 95% CI, 1.36%-11.7%, respectively) that were associated with fetal acidosis (determined by both pH of <7.2 and a base deficit of 12 mmol/L or higher) in a multiple logistic model, controlled for hydramnios, oligohydramnios, meconium-stained amniotic fluid, augmentation by oxytocin, nulliparity, duration of first stage of labor, and birth weight. CONCLUSION: The operative delivery rate was higher among patients with abnormal first-stage fetal heart rate patterns. Late decelerations and severe variable decelerations were significant factors associated with fetal acidosis.

Apgar Score↗

PubMed2001

Lack of prenatal care in two different societies living in the same region and sharing the same medical facilities.

We set out to examine pregnancy outcome of women who utilised prenatal care facilities and those who did not, within two different ethnic groups living in the same region and sharing basically the same medical facilities. The study population consisted of all singleton deliveries occurring between the years 1990-97 (n = 78 955). The analysis was based on a comparison of births to Jewish and Bedouin women who did not have prenatal care (defined as less than three visits at any prenatal care facility during the pregnancy) and those who had prenatal care (at least three visits at any prenatal care facility). Lack of prenatal care was found in 0.98% of the Jewish mothers and in 20.95% of the Bedouin women. Bedouin women receiving prenatal care had significantly higher rates of perinatal mortality (OR = 1.8, 95% CI 1.6-2.2; P < 0.001) and newborns weighing less than 2500 g (OR = 1.2, 95% CI 1.2-1.3; P < 0.001) compared to their Jewish counterparts. However, in the comparison of women lacking prenatal care, no statistically significant differences were found between the groups with regard to those variables. In spite of the overwhelming cultural and socioeconomic differences between these societies, lack of prenatal care crossed social borders and a similar poor pregnancy outcome was found to be common in the two groups. Attempts should be made in order to remove barriers to prenatal care and to increase adequate utilisation of prenatal care in all societies in general and in ethnic minorities in particular.

Journal Article↗

PubMed2001

Evidence for abnormal middle cerebral artery values in patients with idiopathic hydramnios.

OBJECTIVE: Idiopathic hydramnios is an independent risk factor for perinatal morbidity and mortality, although the precise mechanism is unknown. Hydramnios may alter oxygen delivery to the human fetus. The middle cerebral artery (MCA) pulsatility index (PI) is a sensitive parameter for detection of blood flow redistribution or centralization. The aim of this study was to determine whether idiopathic hydramnios is associated with changes in the PI of the MCA and the umbilical artery (UA). DESIGN: The PI of the MCA and UA were determined prospectively in 113 consecutive pregnant women with singleton pregnancies and idiopathic hydramnios (study group) and in 113 matched control patients with normal amniotic fluid (AF) volume (control group). The control group was matched for maternal age, gravidity, parity and gestational age at examination. Hydramnios was defined as an AF index above 24 cm. Patients with fetal structural or chromosomal anomalies and with diabetes mellitus were excluded. A PI below the 5th centile for the MCA was considered abnormal. RESULTS: The rate of abnormal MCA PI was significantly higher in the study group than in the control group (30.9% (35/113) vs. 5.3% (6/113), respectively, OR 8.0; p < 0.0001; 95% CI 3.3-22.1). A significant inverse correlation was found between MCA PI and increasing AF index among patients with hydramnios (p = 0.008, r = 0.46). In contrast, there were no significant differences between the UA PI (0.93 (0.57-2.06) vs. 1.0 (0.49-1.48), (p = 0.20)) and MCA/UA (1.86 (0.77-2.01) vs. 2.15 (0.86-4.11), (p = 0.14)) in both groups. CONCLUSIONS: Our observations provide evidence of cerebral blood flow redistribution in fetuses with idiopathic hydramnios.

Adult↗

PubMed2001

Placenta previa: obstetric risk factors and pregnancy outcome.

OBJECTIVE: To determine the incidence, obstetric risk factors and perinatal outcome of placenta previa. STUDY DESIGN: All singleton deliveries at our institution between 1990 and 1998 complicated with placenta previa were compared with those without placenta previa. RESULTS: Placenta previa complicated 0.38% (n = 298) of all singleton deliveries (n = 78 524). A back-step multiple logistic regression model found the following factors to be independently correlated with the occurrence of placenta previa: maternal age above 40 years (OR 3.1, 95% CI 2.0-4.9), infertility treatments (OR 3.1, 95% CI 1.8-5.6), a previous Cesarean section (OR 1.8, 95% CI 1.4-2.4), a history of habitual abortions (OR 1.3, 95% CI 1.3-2.7) and Jewish ethnicity (OR 1.3, 95% CI 1.1-1.8). Pregnancies complicated with placenta previa had significantly higher rates of second-trimester bleeding (OR 156.0, 95% CI 87.2-277.5), pathological presentations (OR 7.6, 95% CI 5.7-10.1), abruptio placentae (OR 13.1, 95% CI 8.2-20.7), congenital malformations (OR 2.6, 95% CI 1.5-4.2), perinatal mortality (OR 2.6, 95% CI 1.1-5.6), Cesarean delivery (OR 57.4, 95% CI 40.7-81.4), Apgar scores at 5 min lower than 7 (OR 4.4, 95% CI 2.3-8.3), placenta accreta (OR 3.6, 95% CI 1.1-9.9) postpartum hemorrhage (OR 3.8, 95% CI 1.2-10.5), postpartum anemia (OR 5.5, 95% CI 4.4-6.9) and delayed maternal and infant discharge from the hospital (OR 10.9, 95% CI 7.3-16.1) as compared to pregnancies without placenta previa. In a multivariable analysis investigating risk factors for perinatal mortality, the following were found to be independent significant factors: congenital malformations, placental abruption, pathological presentations and preterm delivery. In contrast, placenta previa and Cesarean section were found to be protective factors against the occurrence of perinatal mortality while controlling for confounders. CONCLUSION: Although an abnormal implantation per se was not an independent risk factor for perinatal mortality, placenta previa should be considered as a marker for possible obstetric complications. Hence, the detection of placenta previa should encourage a careful evaluation with timely delivery in order to reduce the associated maternal and perinatal complications.

Abortion, Habitual↗

PubMed2001

Oxytocin use in grand-multiparous patients: safety and complications.

OBJECTIVE: To determine whether the use of oxytocin for the augmentation of labor in grandmultiparous women increases the risk of peripartum complications. STUDY DESIGN: During the years 1989-97, 11 075 grand-multiparous women delivered at our institution. In 424 grand-multiparous women, intravenous oxytocin was used for augmentation of labor. The control group consisted of the other 10 651 grand-multiparous women. All women were monitored for fetal heart rate and uterine contractions. We compared the rates of maternal and perinatal complications in these two groups by using chi(2) analysis and Fisher's exact test when appropriate. RESULTS: No significant differences were found between the oxytocin and the control groups in the rates of placental abruption, intrapartum fetal death, postpartum hemorrhage, uterine rupture, fetal distress, meconium-stained amniotic fluid, an Apgar score of less than 7 at 5 min, Cesarean section, retained placenta and vaginal and cervical lacerations. In contrast, a significant increase in the rate of vacuum deliveries was observed in patients given oxytocin as compared to controls (3.5% vs. 1.4%, respectively; p = 0.001). CONCLUSIONS: The use of oxytocin in the grand-multiparous parturient was a safe procedure with no significant increase in peripartum complications. However, a higher rate of vacuum deliveries was found.

Adult↗

PubMed2001

Teenage pregnancy: risk factors for adverse perinatal outcome.

OBJECTIVES: To assess the perinatal outcome of teenage pregnancy in a large cohort and to determine risk factors for low birth weight (LBW) in teenage pregnancy. STUDY DESIGN: All singleton first deliveries to mothers of age 16-24 years between 1990 and 1997 were included. The deliveries were subdivided into three maternal age groups (16-17 and 18-19 compared to 20-24 years) and parameters of perinatal outcomes were compared. To adjust for potential confounding effects on the association between young maternal age and birth weight, logistic regression analysis was performed for LBW with maternal ethnicity, pregnancy-induced hypertension, lack of prenatal care and malformations of the newborn. RESULTS: Among a total of 11 496 patients, 600 (5.2%) were 16-17 years old, 2097 (18.2%) were 18-19 years old and the remaining 8799 (76.6%) were 20-24 years old. Bedouin ethnicity and lack of prenatal care were common in the youngest mothers. Rates of preterm delivery were 14.2%, 9.8% and 8.8% in the three age groups, respectively (p < 0.05). Rates of malformations, small for gestational age, LBW and very LBW were also significantly higher in the youngest mothers. Rates of pregnancy-induced hypertension, operative delivery and Cesarean delivery were not significantly different among the three age groups. A multivariate analysis on LBW was performed to assess the unique contribution of young maternal age, adjusted for potential confounders. Adjusted ORs for LBW were 1.25 (95% CI 1.00-1.56) for maternal age < 18 years, 1.80 (95% CI 1.54-2.03) for Bedouin ethnicity, 2.57 (95% CI 2.14-3.07) for pregnancy-induced hypertension, 1.55 (95% CI 1.30-1.84) for lack of prenatal care and 4.09 (95% CI 3.2-5.2) for malformations. CONCLUSIONS: Teenage pregnancy was found to be associated with adverse outcome such as LBW, preterm delivery, small for gestational age and malformations. The risk for LBW was affected mainly by demographic factors (maternal ethnicity, lack of prenatal care) and medical factors (pregnancy-induced hypertension, malformations).

Adolescent↗