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To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data.MethodsLiterature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946-2018), PubMed Central (1900-2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies.ResultsFifty-three cases were collected. The average maternal age was 316years ; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation.Conclusions p id=Par4 The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

Perinatal mortality has been decreasing in Europe thanks to a reduction in neonatal mortality. The causes of fetal mortality remain poorly studied. The objective was to determine the late fetal mortality rate in Spain in 2015 and the associated factors. A cross-sectional study was performed using data regarding births in 2015 in Spain extracted from the National Institute of Statistics. Single births at 28 or more weeks of pregnancy were included. The sample comprised 340,371 births. Sociodemographic, obstetrical and neonatal variables were analyzed using univariate and multivariate logistic regression (MLR), with the fetal mortality from 28 weeks of pregnancy as the dependent variable. The total number of late fetal deaths was 884 (2.6 × 1000). The MLR model showed that the following factors were associated with late fetal mortality: birth before 37 weeks of pregnancy (OR 13.1); weight of the newborn

Objective To evaluate the risk of intrauterine fetal death (IUFD) in low-risk pregnancies at and beyond term under conditions of fetal monitoring practiced in Baden-Wuerttemberg/Germany (BW). Methods We performed a retrospective analysis of 472,843 low-risk singleton pregnancies in BW, using data from the local National Medical Birth registry. The setting of fetal monitoring was uniform during the analyzed time period (2004–2009). We calculated the IUFD rate per 1,000 ongoing pregnancies for each gestational week and compared our results to other published studies using the same calculation scheme. Results Our study demonstrates a markedly lower risk of IUFD between 37+0/7 and 42+6/7 weeks of pregnancy when compared with data from Scotland, England, and Sweden collected between 1985 and 1996. When our data were compared to a recently published study from California reporting on deliveries between 1997 and 2006, the risk for IUFD was only significantly lower from 41 weeks onward. The distribution of weekly delivery rates shows a trend to earlier deliveries in weeks 37+0/7 to 39+6/7 for the actual cohorts from California and BW. Conclusion In our study, the risk for IUFD in pregnancies going beyond term is remarkably lower than found in studies published about other countries. Our results do not support current guidelines which recommend a routine induction of labor in low risk pregnancies at 41+0/7 weeks of pregnancy.

Perinatal outcomes were compared before and after changes in the treatment policy to improve the management for preterm PROM (pPROM). This is a retrospective analysis of 99 cases of pPROM diagnosed between 27 and 34 weeks of gestation, which were managed according to the following two different protocols. Group A (47 cases): tocolytic therapy was continued to prevent preterm delivery until clinical chorioamnionitis (CAM) was diagnosed between January 2000 and June 2004. Group B (52 cases): labor was induced or cesarean section performed when oligohydramnios was diagnosed and/or elevation elastase (EL) of amnion was detected by amniocentesis between July 2004 and July 2009. The outcomes of the cases in each group were compared with regard to the extension of pregnancy period, reasons for delivery, perinatal complications, stage of pathological CAM and funisitis (FUN), neonatal serum IgM concentration, mortality, and morbidity. The incidences of pathological CAM and FUN were significantly lower in Group B than in Group A. The concentration of neonatal serum IgM was also significantly lower in Group B than in Group A. The addition of oligohydramnios and elevation EL of amnion as indicative factors of intrauterine infection might lead to a reduction in the severity of fetal infection in cases of pPROM.

We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), fetal weight, and Apgar scores. The association of these factors with perinatal mortality was determined. Statistical analyses were performed using the Chi-square (χ (2)) test with Yates' correction, the Student's t test, logarithmic transformation, and the logistic regression method.Ninety-two (60.52%) patients had mild preeclampsia, 46 (22.2%) had eclampsia, and 14 (15.2%) had severe preeclampsia. The fetal mortality rate was higher in eclamptic and severe preeclamptic patients (P = 0.029). No correlation was found between maternal age, laboratory values (platelet count, ALT, AST, and LDH), or systolic and diastolic blood pressure and fetal morbidity. According to the logistic regression model, fetuses with prematurity, low birth weight, and low Apgar scores (Apgar score 1 ≤ 3 and Apgar score 5 ≤ 5) were found to be at significant risk for perinatal mortality (P0.001). The odds ratios (95% CI) were 3.0 (2-5), 3.42 (1.82-6.41), 0.62 (0.44-0.86) and 4.66 (2.04-10.63), respectively.Maternal laboratory and clinical parameters were not associated with fetal mortality. Fetal prematurity, low birth weight, and low Apgar scores were significantly associated with fetal mortality. The HELLP syndrome and severe preeclampsia may be life threatening to the mother; therefore, the accepted treatment is expeditious delivery. Our study indicates that prevention of prematurity must be the main priority for the fetus in pregnancies complicated by the HELLP syndrome. This can be efficaciously achieved using glucocorticoid therapy for lung maturity and ensuring that delivery is at an experienced hospital with a multidisciplinary approach including a neonatal intensive care unit.

To characterize neonatal morbidity and mortality rates in extreme preterm deliveries (between 23 and 27 weeks’ gestation) with and without PPROM, and to evaluate the association between PPROM and chorioamnionitis. A retrospective population-based study was conducted on preterm singleton pregnancies delivered between 23 and 27 weeks’ gestation from 1988 to 2007. Immediate neonatal morbidity and mortality rates in pregnancies complicated by PPROM were compared to pregnancies with intact membranes. A multivariate analysis was conducted in order to determine the independent association between PPROM and chorioamnionitis. Out of 1,437 preterm deliveries, 236 (16.4%) were complicated with PPROM. There were more neonates with low 1 min (61.0 vs. 42.5%; P = 0.001) and low 5 min (30.1 vs. 23.8%; P = 0.042) Apgar scores (of less than 7) in pregnancies complicated by PPROM than in the comparison group. There were more cases of chorioamnionitis in the PPROM group born at 23–24 weeks’ gestation (33.8 vs. 17.0%; P

The objective was to assess fetal, antenatal, and pregnancy determinants of unexplained antepartum fetal death. This is a hospital-based cohort study of 34,394 births weighing 500 g or more from January 1995 to December 2002. Unexplained fetal deaths were defined as fetal deaths occurring before labor, without evidence of significant fetal, maternal or placental pathology. Ninety-eight unexplained antepartum fetal deaths accounted for 27.2% of 360 total fetal deaths. Two-thirds of these deaths occurred after 36 weeks’ gestation. The following factors are independently associated with unexplained fetal deaths: primiparity (OR 1.74; 95% CI 1.21, 2.86); parity of five or more (OR 1.19; 95% CI 1.26, 3.26); low socioeconomic status (OR 1.22; 95% CI 1.14, 2.86); maternal age 40 years or more (OR 3.62; 95% CI 1.22, 4.52); maternal age of 18 years or less (OR 1.79; 95% CI 0.82, 2.89); maternal prepregnancy weight greater than 70 kg (OR 2.20; 95% CI 1.85, 3.68); fewer than three antenatal visits in women whose fetuses died at 31 weeks or more (OR 1.11; 95% CI 1.08, 2.48); birth weight ratio (defined as ratio of birth weight to mean birth weight for gestational age) between 0.85 and 0.94 (OR 1.77; 95% CI 1.28, 4.18) or over 1.45 (OR 2.92; 95% CI 1.75, 3.21); trimester of first antenatal visit. Previous fetal death, previous abortion, cigarette smoking, fetal sex, low maternal weight, fetal-to-placenta weight, and post date pregnancy were not significantly associated with unexplained fetal deaths. Several factors were identified that are associated with an increased risk of unexplained fetal deaths.

To determine the time trends and risk factors for intrapartum fetal death (IPFD).A case-control study comparing pregnancies with and without IPFD between the years 1988 and 2008 was conducted. A multiple logistic regression model was used to determine the risk factors for IPFD.During the study period, 204,102 singleton births were analyzed; of these, 110 IPFD cases occurred. The following independent risk factors were identified: Bedouin ethnicity (OR = 1.85, 95% CI 1.22-2.8), malpresentations (OR = 2.76, 95% CI 1.71-4.47), gestational age (OR = 0.72, 95% CI 0.69-0.76), polyhydramnios (OR = 3.49, 95% CI 1.94-6.26), meconium-stained amniotic fluid (OR = 3.18, 95% CI 2.01-5.05), umbilical cord prolapse (OR = 6.64, 95% CI 2.79-15.78), placental abruption (OR = 3.24, 95% CI 1.73-6.04), uterine rupture (OR = 38.59, 95% CI 10.58-140.71) and congenital malformations (OR = 2.41, 95% CI 1.47-3.97). A gradual decline over the years in the rate of IPFD was noted in the Bedouin population. No significant association was noted in the prevalence of IPFD during the weekends as compared to the week days (OR = 0.85; 95% CI 0.54-1.32; P = 0.475).Independent risk factors for IPFD are preterm birth, malpresentation, polyhydramnios, meconium-stained amniotic fluid, umbilical cord prolapse, placental abruption, uterine rupture, congenital malformations and Bedouin ethnicity. Weekends do not pose additional risk for the occurrence of IPFD.

To perform a district hospital-based maternal death review aimed at assessing the benefits and limits of an integrated and comprehensive project for reproductive health in Oyam district, northern Uganda. From April 01, 2009 to March 31, 2010, all cases of maternal death occurring in the hospital were prospectively recorded using a specific questionnaire. A clinical review of these maternal deaths was systematically done. The hospital is located in a rural area and it offers the possibility to perform cesarean sections, obstetrics ultrasounds, and blood transfusions. No emergency room and pathological services are available. Seventeen cases were recorded. Thirteen (76%) were classified as direct obstetrics deaths (post-partum hemorrhagia in five cases, unsafe abortion in five cases, eclampsia in two cases and ante-partum hemorrhagia for placenta previa in one case). The remaining cases (n = 4, 24%) were indirect obstetrics deaths (meningitis HIV-related in two cases, cardiopathy in one case and cerebral malaria in one case). An important negligence of the health staff of the health centers was evident in three cases. The availability of an emergency room service was estimated to potentially prevent death in six cases. Three main targets for future interventions were identified: improving the quality of assistance in the health centers, implementing an emergency room service in the hospital and counteract unsafe abortion.

Uterine rupture during pregnancy is a rare occurrence that frequently results in high incidence of maternal and fetal morbidity and mortality. To study the incidence, risk factors, maternal and fetal outcome of uterine rupture. A retrospective study. A retrospective study was carried out in the Department of Obstetrics and Gynecology in a tertiary health care center. The cases of uterine rupture whether booked or unbooked that were received and managed in the hospital over a period of 5 years from January 2002 to December 2006, were included in the study. The total number of uterine rupture cases was 57 out of 33,394 deliveries. The incidence of uterine rupture was 0.17%. Majority of the patients belonged to age group 30–34 years and were multiparas. Most of the cases were due to obstructed and neglected labor (52.63%), 35.08% due to scar rupture and 8.77% were due to uterine trauma. The bladder injuries were found in 8.77%. Repair of the uterine rent was possible in 70.18% (40/57) cases. Hysterectomy was done in 29.82% cases. Stillbirths were observed in 94.74% of women with uterine rupture. There was no maternal mortality. The leading cause of uterine rupture was found to be neglected and obstructed labor due to mismanagement by local untrained birth attendants. Timely recognition and referral to higher centers can reduce the maternal and fetal morbidity and mortality due to uterine rupture.

To describe the experiences in diagnostic amniocentesis in twin pregnancies. The computerized database and medical records of pregnant women attending Maternal Fetal Medicine Unit of the hospital for diagnostic amniocentesis at 16–20 weeks gestation between January 1992 and December 2006 were retrospectively reviewed. During 15 years of experience, 7,890 amniocenteses at 16–20 weeks gestation were performed for prenatal diagnosis, including 174 procedures in 87 twin pregnancies. The mean gestational age at the time of amniocentesis was 17.13 ± 3.35 weeks. Preterm birth rate defined as the delivery before 36 gestational weeks was 36.24%. The total fetal loss rate was 5.17%, however, the procedure related fetal loss within 2 weeks after the procedure was 1.15%. Based on our limited data and previous studies, we can counsel patients undergoing twin amniocentesis at mid-trimester that the fetal loss rate may be slightly higher than that of singleton amniocentesis.