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Background: Aerobic vaginitis (AV) is a newly defined clinical entity that is distinct from candidiasis, trichomoniasis and bacterial vaginosis (BV). Because of the poor recognition of AV, this condition can lead to treatment failures and is associated with severe complications, such as pelvic inflammatory disease, infertility, preterm birth and foetal infections. Objective: This review describes the diagnosis and treatment of AV and the relationship between AV and pregnancy. Results: The characteristics of AV include severely depressed levels of lactobacilli, increased levels of aerobic bacteria and an inflamed vagina. The diagnosis is made by microscopy on wet mounts of fresh vaginal fluid, and some distinct clinical features are recognized. Vaginal suppositories that contain kanamycin or clindamycin have shown curative effects in nonpregnant women. Additionally, the application of topical probiotics can restore the vaginal flora and reduce the recurrence of AV. Clindamycin vaginal suppositories and probiotics may be a better choice for gravida with AV than metronidazole. AV requires prompt attention, and the early diagnosis and treatment of AV during pregnancy significantly improves perinatal outcomes. Conclusion: Further research is needed to define the pathogenesis, diagnostic criteria and standard treatment guidelines for AV. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate maternal-fetal outcomes in women of advanced maternal age (AMA; >35 years old) and women of physiological maternal age as controls ( C; <35 years old). Methods: Single-center, retrospective case-control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ test and Fisher exact test (when required). A p value < 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %. Results: We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination ( p = 0.022; OR = 1.59), iterative cesarean section ( p = 0.026; OR = 2.33), SA ( p = 0.001; OR = 12.82), preterm delivery ( p = 0.001; OR = 69.84), congenital malformations ( p = 0.036; OR = 3.94). In C there was a greater number of nulliparous ( p = 0.009; OR = 0.52) and vaginal deliveries ( p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies ( p = 0.862; OR = 0.97), first cesarean section ( p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes. Conclusion: AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the influence of gestational diabetes mellitus (GDM) on maternal and neonatal outcomes in twin pregnancies. Methods: A retrospective population-based study was conducted, comparing maternal and neonatal outcome in women carrying twins with and without GDM. Deliveries occurred in a tertiary medical center between the years 1988 and 2010. Multivariable analysis was used to control for confounders. Results: The study population included 4,428 twin pregnancies, of these 341 (7.7 %) were complicated with GDM. Twin pregnancies complicated with GDM had higher rates of fertility treatment, chronic hypertension, preeclampsia and cesarean deliveries (CD). Nevertheless, using a multivariable analysis, with CD as the outcome variable, controlling for confounders such as maternal age, fertility treatments and hypertensive disorders, GDM in twins was not found to be an independent risk factor for CD (adjusted OR = 1.8, 95 % CI 0.9−1.4; P = 0.18). Rates of low 5 min Apgar scores (<7) and perinatal mortality were lower among twins with GDM (2.9 % vs. 5.3 %, OR = 0.5, 95 % CI 0.3−0.8 0; P = 0.005 and 2.3 % vs. 4.4 %, OR = 0.5, 95 % CI 0.3-0.8; P = 0.005, respectively). Conclusion: In our population, GDM in twin pregnancies was not associated with increased rates of adverse perinatal outcomes. In addition, GDM was not found to be an independent risk factor for CD in twin pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between the amniotic fluid MMP-9 and zinc levels during 16-19th gestational weeks and perinatal outcomes. Method: One hundred and seventeen singleton pregnancies that underwent genetic amniocentesis from January 2005 through November 2009 were evaluated. Subjects were divided into two main groups: a control group (group 1) ( n: 74), and an adverse obstetric outcomes group (group 2) ( n: 43). Group 2 consisted of the following: preterm birth group, gestational hypertension and preeclampsia group, gestational diabetes group, fetal growth restriction group, macrosomia group, and pregnancy loss group. MMP-9 and zinc (Zn) values in the amniocentesis materials sampled between the 16th and 19th gestational weeks were analyzed retrospectively in terms of perinatal outcomes. Any significant difference among the groups was assessed by unpaired samples t test and the Mann-Whitney U test. Statistical significance was defined as p < 0.05. Results: A comparison among groups showed no significant difference in terms of Zn results between the group 1 and 2 ( p = 0.879). MMP-9 levels were significantly lower in both the preterm birth group ( p = 0.043) and group 1 ( p = 0.015). Conclusion: We found that the amniotic fluid MMP-9 levels of patients who delivered preterm were significantly lower between the 16th and 19th gestational weeks. [ABSTRACT FROM AUTHOR]

Purpose: Genital ureaplasmas are considered opportunistic pathogens of human genitourinary tract involved in adverse pregnancy sequelae and infertility. While association of Ureaplasma urealyticum with urogenital tract infections is well established, the role of Ureaplasma parvum in these infections is still insufficient. In the study, we compared how often cervicovaginal colonization with U. parvum is associated with the presence of these microorganisms in the upper genitourinary tract of fertile and infertile women. Methods: We used PCR assay to determine the prevalence of U. parvum and U. urealyticum in pairs of specimens, i.e., vaginal swabs and Douglas' pouch fluid samples from consecutive 40 women with no symptoms of genital tract infection. Results: In total, 19 (47.5 %) of the 40 samples were positive for ureaplasmas. U. parvum was simultaneously detected in pairs of samples in five (55.5 %) of the nine (47.4 %) women positive in PCR assay. As many as 5 (18.5 %) of the 27 infertile women and 1 (7.7 %) of the 13 fertile women showed infection of the upper genital tract with U. parvum. Conclusion: The results of the study demonstrated that colonization of the lower genital tract with U. parvum can produce asymptomatic infection of the upper reproductive system in women. These findings also imply that U. parvum may be present in the upper genital tract at the time of conception and might be involved in adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the pregnancy outcome between pregnancies affected and not affected by thalassemia trait. Methods: A retrospective case-control cohort study was conducted on singleton pregnant women who attended antenatal care and delivered at Songklanagarind Hospital. All of the participating thalassemia trait pregnant women were diagnosed based on hemoglobin typing and/or DNA analysis. A ratio of around 1-1 was used to compare their pregnancy outcomes with normal pregnant women. Results: Seven hundred thirty-nine thalassemia trait and 799 normal pregnant women were included in the study. All of the women were Thai nationals living in the Southern Region of Thailand and nearly all of them had spontaneously conceived. Maternal complication rates of gestational diabetes, preterm birth, antepartum bleeding, postpartum bleeding, shoulder dystocia and puerperal morbidity, and the rates of neonatal complications: macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR), stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were not significantly different between the two groups. The rate of pre-eclampsia, however, was significantly different, with RRs of 1.73 (CI 1.01-3.00). Conclusion: The thalassemia trait condition did not affect the risk of gestational diabetes, postpartum hemorrhage, stillbirth, preterm birth and puerperal morbidity. However, pre-eclampsia should be warranted especially among nulliparous and high-BMI pregnant women. [ABSTRACT FROM AUTHOR]

Purpose: Trauma during pregnancy is among leading causes of non-pregnancy-related maternal death (MD). This study describes risk factors for MD from trauma during pregnancy in a large urban population. Methods: We queried an urban Level One Trauma Center registry for the medical records of pregnant women suffering trauma from 1990 to 2007. Associations were examined between maternal demographics, injury mode details, injury characteristics, and risk of maternal death upon arrival to the emergency room. Results: Overall, 351 patients were identified. Most traumas was caused by motor vehicle collision (71.8 %), accounting for 78.9 % of MD, followed by gun shot wound (10.3 %), stabbing (8.5 %), falls (4.3 %), and assaults (4 %). Abdominal and head injuries were more frequent in cases of MD compared with patients admitted to the hospital (33.3 vs. 25.1 % abdominal, 55.6 vs. 29.4 % head; p < 0.001). A greater proportion of MDs were characterized by lack of restraint use (66.7 %) compared to women admitted to the hospital (47.7 %) and women discharged after observation (43.1 %); p = 0.014. ER deaths had more negative base excess scores than women who were admitted or discharged (−14 vs. −3 vs. −2; p < 0.001), lower blood pH values (6.96 vs. 7.40 vs. 7.44; p < 0.001), greater Injury Severity Scores (ISS) (44.4 vs. 11.49 vs. 2.66; p < 0.001), and lower Revised Trauma Scores (RTS) (0.5 vs. 7.49 vs. 7.83; p < 0.001). Conclusions: Lack of restraint use in the pregnant population is associated with increased MD. Although not validated in the pregnant population, the ISS and RTS were associated with maternal mortality outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Female genital mutilation (FGM) is still performed in the world. Women who underwent FGM have marked psychological, gynecological and obstetric consequences. This article contributes to the spread of knowledge about obstetric and neonatal outcomes in women with FGM I and II. Methods: Our observational study compared the obstetric outcomes of 85 women with FGM I and II (case group) and 95 women without it (control group). We evaluated age, need of oxytocin during labor, duration of the expulsion phase, need of episiotomy, weight of the newborn, Apgar score at birth, resuscitation of the newborn, stillbirth. We observed the rate of cesarean sections and their main indications. We compared the rate of cesarean sections among the cases and the controls. Results: Controls were younger than women who underwent FGM. Intravenous oxytocin injection was higher in cases. The expulsion phase was longer in women with FGM than in the controls. FGM is related to a higher risk of episiotomy. Apgar score 9/10 was more frequently assigned to babies from mothers without FGM. There were more resuscitated babies and more stillbirth in the group of cases. Ten percent of all women underwent cesarean section. FGM is related to a higher incidence of cesarean section. Conclusion: FGM is associated with a higher risk of gynecological and obstetrical consequences, acting on women's health and also on the economy of resource limited countries. Because of migration, health professionals could interface with women who underwent FGM and have to know their related complications. [ABSTRACT FROM AUTHOR]

Objectives: To determine the obstetrical complications and perinatal outcomes of patients with recurrent episodes of preterm contractions (PTC) that eventually delivered at term compared to those who delivered preterm. Methods: A retrospective study evaluating pregnancy complications and adverse perinatal outcomes of patients with recurrent episodes of PTC (three or more) was conducted. A comparison was made between those who delivered preterm to those who eventually delivered at term. Results: Deliveries occurred between the years 1989 and 2009. During the study period, there were 1,897 singleton deliveries at term and 393 preterm singleton deliveries of patients who were previously hospitalized with PTCs. Patients who delivered at term were significantly more likely to be in their first pregnancy and to be primiparous. Patients in the study group were less likely to have had fertility treatments, a history of miscarriage, a higher incidence of one previous hospitalization but lower rates of multiple hospitalizations for PTC. Patients who delivered at term had a significantly lower rate of severe preeclampsia as well as cesarean delivery and a shorter hospital stay than those who delivered preterm. At term, an increased incidence of small for gestational age (SGA) neonates was noted compared to patients who delivered prematurely (10.07 vs. 5.6 %; P = 0.005). Conclusion: Patients with symptoms of preterm labor may require further surveillance, not only because of their risk to progress to preterm delivery, but also because they are at an increased risk for delivering an SGA neonate at term. [ABSTRACT FROM AUTHOR]

Purpose: This was to determine the sero-prevalence of hepatitis C viral (HCV) antibodies in pregnant women attending the first antenatal clinic and assess the epidemiologic correlates of women anti-HCV positive. Methods: This was a prospective observational study which used in vitro diagnostic test kits to detect anti-HCV antibodies. Women attending their first antenatal clinic were recruited at the antenatal clinic of Irrua Specialist Teaching Hospital, Edo State, Nigeria. Seropositive women had liver enzymes assessed, and screening for hepatitis B surface antigen and Human Immuno-deficiency Virus (HIV) was done. Results: Eight out of 205 women were anti-HCV positive. The prevalence of hepatitis C infection was 3.9 %. The mean age of the women was 28.9 ± 2.1 years. Most (50 %) anti-HCV positive women had tertiary level education. Though health workers made up 3.5 % of the participants, they constituted 25 % women with anti-HCV antibody. Awareness of HCV infection had no impact on the rate of infection. Multiple sexual partners ( P = 0.71), blood transfusion (0.64) and female circumcision ( P = 1.00) were not significant risks of infection. 2 (1 %) women had hepatitis B co-infection and 1 (12.5 %) woman had both HCV antibody and HIV co-infection. Conclusion: Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended. [ABSTRACT FROM AUTHOR]

Objective: Obesity is one of global health problems and maternal obesity may be associated with increase in risk of pregnancy complications and neonatal death. The purpose of this study was to evaluate the effect of maternal pre-pregnancy body mass index (BMI) on neonate Apgar score at minute 5. Methods: In a retrospective cohort study, Apgar score at minute 5 of all singleton term babies of nulliparous women whom were delivered in Shahid Sadoughi Hospital, Yazd, Iran, from 2007 to 2009 were evaluated. Body mass index (BMI: weight in kg/height in m) of the mothers were calculated and BMI less than 18.5, 18.5-24.9, 25-29.9 and more than 30 were considered underweight, normal, overweight and obesity, respectively. Neonatal Apgar score of 3-7 and less than three was considered as low and very low Apgar score, respectively. Results: Eighty-eight (2.8 %) women were underweight, 1,401 (44.9 %) normal weight, 1,389 (44.5 %) overweight and 242 (7.8 %) were obese. 477 (15.3 %) and 31(0.7 %) neonates had low and very low Apgar score, respectively at minute 5. Logistic regression analysis showed maternal overweight [in odd ratio of 3.7, 95 % CI 2.4-4.6] and obesity [in odd ratio of 13.4, 95 % CI 9.7-14.1] were risk factors of neonatal low Apgar score, but they had not any statistically significant effect on neonatal very low Apgar score. Conclusion: Maternal pre-pregnancy overweight should be more concerned to prevent complication of low Apgar score in their newborns. [ABSTRACT FROM AUTHOR]

Objective: To determine maternal fetal medicine (MFM) referral trends in a Medicaid population over time. Study design: Sixteen clinical guidelines and 23 clinical conditions were identified where co-management/consultation with MFM specialist is recommended. Linked Medicaid claims and birth certificate data for 2001-2006 were used to identify pregnancies with these conditions and whether they received co-management/consultation from a MFM specialist. Results: Between 2001 and 2006, there were 108,703 pregnancies with delivery of 110,890 neonates. Forty-five percent had one or more of the conditions identified for co-management/consultation. Overall pregnancies receiving MFM contact remained unchanged at 22.2 % in 2001 and 22.1 % in 2006. However, face to face contacts decreased from 14.6 % (2001) to 8.7 % (2006) while telemedicine consults increased from 7.6 % (2001) to 13.3 % (2006). Health departments were most likely and family practitioners least likely to refer to MFM ( p < 0.001). Pregnancy complications leading to MFM referrals include cardiac complications, renal disease, systemic disorders, PPROM, suspected fetal abnormalities, and cervical insufficiency. Conclusion: Referral of high-risk pregnancies to MFMs varies with the level of expertise at the primary prenatal site. Increased contact between MFMs and local providers increased MFM referrals. [ABSTRACT FROM AUTHOR]

Objectives: To characterize risk factors and perinatal outcome following cephalopelvic disproportion (CPD). Methods: A retrospective population-based study comparing all singleton deliveries of women with and without CPD, between 1988 and 2010, was conducted. A multiple logistic regression model was used to control for confounders. Results: Out of 242,520 patients, 0.3% ( n = 673) were diagnosed with CPD. Using a multivariable analysis, the following obstetric risk factors were significantly associated with CPD: fetal macrosomia (birth weight above 4 kg, OR = 3.3, 95% CI 2.7-4.1, P < 0.001), infertility treatment (OR = 2.6, 95% CI 1.8-3.8, P < 0.001), previous caesarean delivery (OR = 2.2, 95% CI 1.9-2.7, P < 0.001), maternal obesity (OR = 2.1, 95% 1.3-3.4, P < 0.001), and polyhydramnios (OR = 1.7, 95% CI 1.3-2.3, P < 0.001). Deliveries complicated by CPD resulted in Caesarean delivery in 99%, and were more likely to have laceration of the cervix (1.2 vs. 0.3%, P < 0.001), rupture of uterus (0.4 vs. 0.1%, P < 0.001), intrapartum mortality (0.6 vs. 0.1% in control, P < 0.001), and low 1-min Apgar scores (<7; 27.2 vs. 6.5%, P < 0.001). Conclusions: In our population, independent risk factors for CPD include fetal macrosomia, infertility treatment, previous caesarean delivery, maternal obesity and polyhydramnion. These pregnancies had higher rates of adverse perinatal outcomes and accordingly high index of suspicion should be pursued when commencing trial of labor of such pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To investigate risk factors and pregnancy outcome of patients with placenta previa. Methods: A population-based study comparing all singleton pregnancies of women with and without placenta previa was conducted. Stratified analysis using multiple logistic regression models was performed to control for confounders. Results: During the study period, there were 185,476 deliveries, of which, 0.42% were complicated with placenta previa. Using a multivariable analysis with backward elimination, the following risk factors were independently associated with placenta previa: infertility treatments (OR 1.97; 95% CI 1.45-2.66; P < 0.001), prior cesarean delivery (CD; OR 1.76; 95% CI 1.48-2.09; P < 0.001) and advanced maternal age (OR 1.08; 95% CI 1.07-1.09; P < 0.001). Placenta previa was significantly associated with adverse outcomes such as peripartum hysterectomy (5.3 vs. 0.04%; P < 0.001), previous episode of second trimester bleeding (3.9 vs. 0.05%; P < 0.001), blood transfusion (21.9 vs. 1.2%; P < 0.001), maternal sepsis (0.4 vs. 0.02%; P < 0.001), vasa previa (0.5 vs. 0.1%; P < 0.001), malpresentation (19.8 vs. 5.4%; P < 0.001), postpartum hemorrhage (1.4 vs. 0.5%; P = 0.001) and placenta accreta (3.0 vs. 1.3%; P < 0.001). Placenta previa was significantly associated with adverse perinatal outcomes such as higher rates of perinatal mortality (6.6 vs. 1.3%; P < 0.001), an Apgar score <7 after 1 and 5 min (25.3 vs. 5.9%; P < 0.001, and 7.1 vs. 2.6%, P < 0.001, respectively), congenital malformations (11.5 vs. 5.1%; P < 0.001) and intrauterine growth restriction (3.6 vs. 2.1%; P = 0.003). Using another multivariable logistic regression model, with perinatal mortality as the outcome variable, controlling for confounders, such as preterm birth, maternal age, etc., placenta previa was not found as an independent risk factor for perinatal mortality (weighted OR 1.018; 95% CI 0.74-1.40; P = 0.910). Conclusions: Infertility treatments, prior cesarean section, and advanced maternal age are independent risk factors for placenta previa. An increase in the incidence of these risk factors probably contributes to a rise in the number of pregnancies complicated with placenta previa and its association with adverse maternal and perinatal outcomes. Careful surveillance of these risk factors is recommended with timely delivery in order to reduce the associated complications. [ABSTRACT FROM AUTHOR]

We describe a patient with a known diagnosis of Takayasu’s arteritis who presented late in the third trimester. She was delivered by caesarean section and her postpartum course was complicated by aortic dissection. This report is the first to describe peripartum aortic dissection in a patient with known Takayasu’s arteritis. Takayasu’s arteritis should be regarded as a risk factor for aortic dissection. It is important to treat systemic hypertension in Takayasu’s arteritis patients and suspect the diagnosis of aortic dissection in any pregnant patient complaining of chest pain as dissection is a leading cause of maternal mortality in the developed world. [ABSTRACT FROM AUTHOR]

Complete hydatiforme mole with coexisting live fetus (CMCF) is a rare entity. Management for this rare twin pregnancy still remains undetermined. We report the delivery of a healthy baby coexisting with complete mole as twins. There was no other complication during or after the pregnancy. A 30-year-old multiparous woman was first time assessed in the antenatal outpatient department of our hospital at 17 weeks gestation for normal pregnancy control. Ultrasound examination showed a 17 week and 5 days viable fetus with normal anatomy and placenta. There was a second multicystic placenta located at the posterior wall of the uterus next to the normal placenta. Hydatiforme mole was suspected. The couple was informed about the possible complications but they were not willing to consider pregnancy termination or to have any invasive procedure for diagnosis. A cesarean section was performed at 33 weeks gestation due to premature rupture of membranes and initiation of labor with the fetus presenting as breech. After the delivery of a live healthy female 1,950 g baby, as well as the normal placenta, a second vesicular placenta was delivered. Histopathologic examination confirmed the diagnosis of complete mole. Today most of the twin pregnancies with complete mole are identified in the first or second trimester. In this case, the parents who choose continuation of pregnancy, are counseled about the increased risk of complications like preeclampsia, fetal loss, persistent gestational trophoblastic disease. Close surveillance of the woman with CMCF is mandatory during and after the pregnancy. [ABSTRACT FROM AUTHOR]

An increasing proportion of women in the US and other countries delay initiation of childbearing until their thirties. Little is known about their subsequent pregnancies, particularly with regard to pregnancy spacing. To determine interpregnancy interval (IPI) patterns, factors associated with IPI among women delaying initiation of childbearing until their thirties, and ascertain if delay in initiation of childbearing is associated with increased likelihood for short interpregnancy interval of less than 6 months. A retrospective cohort study was performed using the Missouri maternal linked file for 1978–1997, inclusive. Analysis was limited to mothers aged 20–50 years at first pregnancy, having a first and second pregnancy during the study period; the sample size included 242,559 mother–infant pairs. Analysis strategies included stratified analysis, and multivariable logistic regression. Interpregnancy interval was main outcome variable, and was grouped in seven categories: 0–5, 6–11, 12–17, 18–23, 24–59, 60–119, ≥120 months. The mean interpregnancy interval was significantly shorter for women delaying start of childbearing (≥30 years) compared to 20–29 year olds. Observed intervals are 31 (±24) months for mothers aged 20–29 years, 25 (±17) months for mothers aged 30–34 years, 21 (± 14) for 35–39 year olds, and 19 (±16) for 40–50 year olds ( P < 0.0001). A significant trend for shorter intervals was noted as maternal age at first pregnancy increased ( P < 0.0001). Factors associated with interpregnancy interval for women delaying initiation of childbearing included adverse outcome in preceding pregnancy, and low educational status. Mothers aged 35 and above at first pregnancy had increased odds for a second pregnancy following short IPI <6 months; (35–39 years OR = 1.26 95% CI 1.11–1.44; 40–50 OR = 1.91 95% CI 1.13–3.24). Mothers aged 30–34 years have lower odds for short IPI (OR = 0.93 95% CI 0.87–0.99). First time mothers aged 35 and above have higher odds of having a second pregnancy shortly after their first pregnancy. Given the increasing number of first time mothers aged 35 and above, these findings are of relevance for preconception counseling for this unique population of women. [ABSTRACT FROM AUTHOR]