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Medicina
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Maternal and Perinatal Outcomes in High and Low Risk Pregnancies
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Maternal and Perinatal Outcomes in High and Low Risk Pregnancies

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 26795

Special Issue Editors

Dr. Ioannis Tsakiridis

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Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: high-risk pregnancy; maternal–fetal medicine
Special Issues, Collections and Topics in MDPI journals
Dr. Themistoklis Dagklis

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: fetal medicine; obstetric medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prenatal care constitutes a major public health issue, both in high and medium/low income countries. Preterm birth, congenital anomalies, hypertensive disorders in pregnancy, fetal growth restriction and postpartum hemorrhage are the most severe complications in pregnancy. As science advances and experience is accumulating, new therapies are emerging and new algorithms are proposed to clasify pregnancies based of the risk of developing complications. At the same time, populations in high-income countries include more and more women that are older, with higher BMI and pre-existing morbidities.

The aim of this special issue was to present recent evidence on the perinatal outcomes in populations considered low risk or high risk. This includes populations with preexisting morbidities, i.e. obesity, diabetes mellitus, metabolic syndrome, congenital heart disease, autoimmune disease, but also advanced maternal age, history of preterm birth or stilbirth.

Studies reporting perinatal outcomes of interest, preterm birth, macrosomia, small for gestational age neonates are of particular interest.

Furthermore, reviews or meta-analyses of studies addressing less common conditions or outcomes help developing new strategies for the antenatal surveillance of these cases.

Dr. Ioannis Tsakiridis
Dr. Themistoklis Dagklis
Guest Editors

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Keywords

  • high-risk pregnancy
  • obstetric medicine
  • pregnancy complications
  • perinatal commorbidities

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Published Papers (7 papers)

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10 pages, 611 KiB  
Article
Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies
by Raquel Martin-Alonso, Valeria Rolle, Ranjit Akolekar, Catalina de Paco Matallana, Irene Fernández-Buhigas, Maria Isabel Sánchez-Camps, Tara Giacchino, Miguel Rodríguez-Fernández, Jose Eliseo Blanco-Carnero, Belén Santacruz and María M. Gil
Medicina 2023, 59(9), 1670; https://doi.org/10.3390/medicina59091670 - 15 Sep 2023
Cited by 1 | Viewed by 1921
Abstract
Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for [...] Read more.
Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40–42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
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23 pages, 3337 KiB  
Article
Retrospective Study of First Trimester Metrorrhagia: Pregnancy Follow-Up and Relationship with the Appearance of Gestational Complications
by Laura Baños Cándenas, Daniel Abehsera Davó, Lucía Castaño Frías and Ernesto González Mesa
Medicina 2023, 59(8), 1370; https://doi.org/10.3390/medicina59081370 - 27 Jul 2023
Cited by 1 | Viewed by 2151
Abstract
Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that [...] Read more.
Background and Objectives: The purpose of this study was to describe and evaluate the bleeding that occurs during the first weeks of gestation and its implications throughout pregnancy. Secondarily, we assessed the associated complications in order to identify potential risk factors that could be used to select women at higher risk of adverse outcomes that could benefit from an early diagnosis and improved monitoring. Materials and Methods: We made a selection of all the women who consulted in the Emergency Department of the Hospital QuirónSalud in Malaga on 2015 presenting with first trimester metrorrhagia. We refer to first trimester metrorrhagia as that which occurs until week 12 + 6. Once these pregnant women were identified, we studied several variables not related to the gestation and some others associated with it and its natural course. Results: The average age of the patients assessed was 34.1. Associated gestational complications were metrorrhagia in the second trimester (6.3%), threatened preterm labor (7.4%), preeclampsia (2.5%), gestational diabetes (7.4%), late abortion (1.2%), and early postpartum hemorrhage (1.8%). We sought associations to assess possible risk factors, establishing an increased maternal age as an aggravating factor for the development of complications. We also studied gestational complications, finding a higher prevalence of them in older women, such as prematurity (33.11 vs. 34.48 years), gestational diabetes (33.11 vs. 36.06 years), and preeclampsia (33.25 vs. 35 years). Conclusions: Maternal age is a risk factor for first-trimester spontaneous miscarriage and for the development of complications of pregnancy. It is crucial to perform a correct screening of different pathologies throughout the pregnancy to anticipate potential complications. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
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9 pages, 287 KiB  
Article
Incidence and Risk Factors for Postpartum Hemorrhage: A Case-Control Study in a Tertiary Hospital in Greece
by Kyriaki Mitta, Ioannis Tsakiridis, Themistoklis Dagklis, Riola Grigoriadou, Apostolos Mamopoulos, Apostolos Athanasiadis and Ioannis Kalogiannidis
Medicina 2023, 59(6), 1151; https://doi.org/10.3390/medicina59061151 - 15 Jun 2023
Cited by 5 | Viewed by 5696
Abstract
Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the [...] Read more.
Background and Objectives: Postpartum hemorrhage (PPH) is an obstetrical emergency and although the mortality rate from PPH has decreased, it is still considered a challenge in obstetrics. This study aimed to estimate the rate of primary PPH, as well as to investigate the potential risk factors and management options. Material and methods: This was a retrospective case-control study of all cases with PPH (blood loss > 500 mL, irrespective of the mode of delivery) managed in the Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece, from 2015 to 2021. The ratio of cases to controls was estimated to be 1:1. The chi-squared test was used to examine if there was any relationship between several variables and PPH, while subgroup multivariate logistic regression analyses of certain causes of PPH were also conducted. Results: During the study period, from a total of 8545 births, 219 (2.5%) pregnancies were complicated with PPH. A maternal age > 35 years (OR: 2.172; 95% CI: 1.206–3.912; p = 0.010), preterm delivery (<37 weeks) (OR: 5.090; 95% CI: 2.869–9.030; p < 0.001) and parity (OR: 1.701; 95% CI: 1.164–2.487; p = 0.006) were identified as risk factors for PPH. Uterine atony was the main cause of PPH in 54.8% of the women, followed by placental retention in 30.5% of the sample. Regarding management, 57.9% (n = 127) of the women received uterotonic medication, while in 7.3% (n = 16), a cesarean hysterectomy was performed to control PPH. Preterm delivery (OR: 2.162; 95% CI: 1.138–4.106; p = 0.019) and delivery via a cesarean section (OR: 4.279; 95% CI: 1.921–9.531; p < 0.001) were associated with a higher need for multiple treatment modalities. Prematurity (OR: 8.695; 95% CI: 2.324–32.527; p = 0.001) was identified as an independent predictor for an obstetric hysterectomy. From the retrospective analysis of the births complicated by PPH, no maternal death was identified. Conclusions: Most of the cases complicated with PPH were managed with uterotonic medication. An advanced maternal age, prematurity and multiparity had a significant impact on the occurrence of PPH. More research is needed on the risk factors of PPH, while the establishment of validated predictive models would be of value. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
7 pages, 1106 KiB  
Article
rSO2 Measurement Using NIRS for Lower-Limb Blood Flow Monitoring and Estimation of Safe Balloon Occlusion/Deflation Time in Patients with PAS Who Underwent PBOA during CS
by Hiroyuki Tokue, Azusa Tokue and Yoshito Tsushima
Medicina 2023, 59(6), 1146; https://doi.org/10.3390/medicina59061146 - 14 Jun 2023
Cited by 2 | Viewed by 3147
Abstract
We examined the utility of regional oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) for monitoring lower-limb blood flow and estimate the safe balloon occlusion/deflation time in patients with PAS who underwent prophylactic balloon occlusion of the abdominal artery (PBOA) during cesarean section [...] Read more.
We examined the utility of regional oxygen saturation (rSO2) measurement using near-infrared spectroscopy (NIRS) for monitoring lower-limb blood flow and estimate the safe balloon occlusion/deflation time in patients with PAS who underwent prophylactic balloon occlusion of the abdominal artery (PBOA) during cesarean section (CS). During CS, the NIRS probes were positioned on either of the anterior tibial muscles. rSO2 was measured continuously during balloon occlusion/deflation. A cycle consisted of inflating the aortic balloon for 30 min and deflating it for 5 min. The rSO2 before/during balloon occlusion and after 5 min of balloon deflation were evaluated. Sixty-two lower limbs (fifteen women and data from 31 sessions of balloon inflation/deflation) were evaluated. rSO2 during balloon occlusion was significantly lower than rSO2 before balloon occlusion (57.9% ± 9.6% vs. 80.3% ± 6.0%; p < 0.01). There were no significant differences between rSO2 before balloon occlusion and rSO2 after 5 min of balloon deflation (80.3% ± 6.0% vs. 78.7% ± 6.6%; p = 0.07). Postoperatively, the lower limbs showed no ischemic symptoms. NIRS can assess lower-limb rSO2 during PBOA for PAS in real time to determine ischemia severity, duration, and recovery capacity. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
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11 pages, 324 KiB  
Article
Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges
by Anna Kornete, Ludmila Volozonoka, Maksims Zolovs, Adele Rota, Inga Kempa, Linda Gailite, Dace Rezeberga and Anna Miskova
Medicina 2023, 59(4), 653; https://doi.org/10.3390/medicina59040653 - 26 Mar 2023
Cited by 3 | Viewed by 4508
Abstract
Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The [...] Read more.
Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The preventive modalities that have been tested include progesterone supplementation and cervical cerclage and pessaries. The study aimed to assess the management strategies and outcomes in a group of patients with a short cervix during pregnancy or cervical insufficiency. Materials and Methods: Seventy patients from the Riga Maternity Hospital in Riga, Latvia, were included in the prospective longitudinal cohort study between 2017 and 2021. Patients were treated with progesterone, cerclage, and/or pessaries. The signs of intra-amniotic infection/inflammation were assessed, and antibacterial therapy was given when the signs were positive. Results: The rates of PTB were 43.6% (n = 17), 45.5% (n = 5), 61.1% (n = 11), and 50.0% (n = 1) in progesterone only, cerclage, pessary, and cerclage plus pesssary groups, respectively. The progesterone therapy was associated with a reduced preterm birth risk (x2(1) = 6.937, p = 0.008)), whereas positive signs of intra-amniotic infection/inflammation significantly predicted the risk of preterm birth (p = 0.005, OR = 3.82, 95% [CI 1.31–11.11]). Conclusions: A short cervix and bulging membranes, both indicators of intra-amniotic infection/inflammation, are the key risk factors in preterm birth risk predictions. Progesterone supplementation should remain at the forefront of preterm birth prevention. Among patients with a short cervix and especially complex anamnesis, the preterm rates remain high. The successful management of patients with cervical shortening lies between the consensus-based approach for screening, follow-up, and treatment on the one side and personalising medical therapy on the other. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
9 pages, 638 KiB  
Article
Investigation of The Effects of Oxytocin Administration Timing on Postpartum Hemorrhage during Cesarean Section
by Soner Gök and Mehmet Babür Kaleli
Medicina 2023, 59(2), 222; https://doi.org/10.3390/medicina59020222 - 24 Jan 2023
Cited by 2 | Viewed by 6471
Abstract
Background and Objectives: To determine and compare the effects of the timing of oxytocin administration (routinely used for intraoperative uterotonic purposes in cesarean section (CS) deliveries in our clinic) on the severity of postpartum hemorrhage following CS. Materials and Methods: All [...] Read more.
Background and Objectives: To determine and compare the effects of the timing of oxytocin administration (routinely used for intraoperative uterotonic purposes in cesarean section (CS) deliveries in our clinic) on the severity of postpartum hemorrhage following CS. Materials and Methods: All study participants (n = 216) had previous cesarean deliveries, were 38–40 weeks pregnant, and had CS planned under elective conditions. The cases were randomly divided into two groups: one group (n = 108) receiving oxytocin administration before the removal of the placenta (AOBRP) and another group (n = 108) receiving oxytocin administration after the removal of the placenta (AOARP). In all cases, the placenta was removed using the manual traction method. The standard dose of oxytocin is administered as an intravenous (IV) push of 3 international units (IU); simultaneously, 10 IU of oxytocin is added to 1000 cc isotonic fluid and given as an IV infusion at a rate of 250 cc/h. All methods and procedures applied to both groups were identical, except for the timing of administration of the standard oxytocin dose. Age, body mass index (BMI), parity, gestational week, preoperative hemoglobin (HB) and hematocrit (HTC), postoperative 6th and 24th hour HB-HTC, intraoperative hemorrhage, additional uterotonic need during cesarean section, postoperative hemorrhage (number of pads), need for blood transfusion during or after cesarean section, cesarean section time, and postpartum newborn baby weight were evaluated. Results: Age (year), BMI (kg/m2), parity, gestational week, surgical time, and newborn weight (g) did not differ between the groups (p > 0.05). The AOBRP group had significantly higher postoperative 6th hour HB and HTC and postoperative 24th hour HB and HTC values (p < 0.05). The intraoperative hemorrhage level was higher in the AOARP group (p = 0.000). Conclusions: The administration of oxytocin before placenta removal did not change the volume of bleeding in the postoperative period but significantly reduced the volume of bleeding in the intraoperative period. Therefore, in the postoperative period, the HB and HTC values of the AOBRP group were higher than those of the AOARP group. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
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13 pages, 3913 KiB  
Case Report
Foetal Intrapartum Compromise at Term: Could COVID-19 Infection Be Involved? A Case Report
by Adrian-Ioan Toma, Bashar Haj Hamoud, Caliopia Gavril-Parfene, Mihaela Farcaş, Romina-Marina Sima and Liana Ples
Medicina 2023, 59(3), 552; https://doi.org/10.3390/medicina59030552 - 11 Mar 2023
Viewed by 1949
Abstract
The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports have been published, mainly focussing on complications and in utero transmission with neonatal consequences. Although the effects of other viruses on foetuses are well known, the impact of maternal [...] Read more.
The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports have been published, mainly focussing on complications and in utero transmission with neonatal consequences. Although the effects of other viruses on foetuses are well known, the impact of maternal COVID-19 during pregnancy is not completely understood. We report a case of acute foetal intrapartum hypoxia without other risk factors than maternal COVID-19 disease 2 weeks previous to birth at term. Placental histological changes suggested that the viral infection could have been the culprit for the unfavourable outcome during labour. The neonate was promptly delivered by Caesarean section. Neonatal intensive care was started, including therapeutic hypothermia. The procedure was successful, the evolution of the neonate was favourable, and she was discharged after 10 days. Follow-up at 2 months of life indicated a normal neurological development but a drop in head growth. The case raises the idea that pregnancies with even mild COVID-19 symptoms may represent the cause of neonate compromise in a low-risk pregnancy. An important follow-up in the neonatal period and infancy is required to identify and treat any subsequent conditions. Further long-term studies are necessary to identify a cause–effect relationship between COVID-19 pregnancies and the whole spectrum of neonatal and infant consequences. Full article
(This article belongs to the Special Issue Maternal and Perinatal Outcomes in High and Low Risk Pregnancies)
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