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Objectives: Preterm premature rupture of membranes (PPROM) is a major contributor to overall preterm birth (PTB) rates. A short interpregnancy interval (IPI) is a well-known risk factor for PTB. It is unknown if a short IPI specifically affects the risk of developing PPROM in a subsequent pregnancy. We sought to determine the association between IPI and the risk of PPROM in a subsequent pregnancy.Methods: A retrospective cohort study using the Missouri birth certificate database of singleton births from 2003 to 2013 was conducted. A short IPI (delivery of the prior pregnancy to conception of the index pregnancy) was defined as ≤6 months. IPI >6 months was categorized into two groups: IPI 7-23 months and IPI ≥24 months. PPROM was defined as premature rupture of membranes between 160 and 366 weeks. Multivariable logistic regression was conducted to determine the association between IPI and PPROM while controlling for maternal age, race, body mass index (BMI), education level, use of social services (Medicaid insurance, food stamps, or participation in the WIC [Women, Infants, and Children] program), tobacco use, and history of PTB. Secondary outcome included the gestational age at delivery, categorized into five subgroups (≤240, 241-280, 281-320, 321-340, and 341-366 weeks).Results: 474,957 subjects with singleton gestations had data available to calculate the IPI. Of these, 1.4% (n = 6797) experienced PPROM. IPI ≤6 months was significantly associated with an increased risk of developing PPROM compared with patients with IPI ≥24 months (odds ratio (OR) 1.80, 95% CI 1.70-1.90, p < .001). A higher proportion of women with IPI ≤6 months delivered between 281 and 320 weeks compared to the other two IPI groups (27.0 versus 15.0 and 16.4%, p < .001). Individual maternal factors associated with an increased risk of PPROM included advanced maternal age, African American race, BMI <18.5 kg/m2, BMI ≥30 kg/m2, use of social services, tobacco use, and a prior PTB.Conclusion: Our data demonstrate that an IPI of ≤6 months is significantly associated with an increased risk of developing PPROM in the subsequent pregnancy. Of greater clinical relevance is that these women were more likely to deliver between 281 and 320 weeks as compared with women with a longer IPI. Novel to this study is the establishment of a specific link between a short IPI and PPROM with subsequent early delivery. Several maternal demographic factors known to be associated with PTB risk were also found to be associated with an increased risk of PPROM. Further studies are necessary to elucidate plausible biologic mechanisms ultimately leading to the development and implementation of preventive and therapeutic strategies for this high-risk cohort. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate the effect of maternal obesity on fetal size in first- and second-trimester pregnancies and to determine duration of pregnancy as estimated by a variety of methods.Methods: Between 2006 and 2011, a cohort study included (n = 9055) singleton pregnancies that resulted in live birth at Holbaek Hospital in Denmark. This study recorded first- and second-trimester fetal measurements and maternal anthropometry. Characteristics considered included mother's age, parity, height, body mass index (BMI), smoking habits, and sex of child. The correlation between BMI and duration of pregnancy was analyzed by time-to-event analysis and accounted for medical intervention by censoring while correlation of BMI on fetal size was evaluated by multiple regression analysis.Results: Adjusting for maternal and fetal characteristics, BMI was associated with prolonged pregnancy duration (0.20-0.22 d per kg/m2 (standard error (SE) 0.02)) when using ultrasound and 0.26 d per kg/m2 (SE: 0.03) when using last menstrual period. With increasing BMI, fetal biometries in first and second trimester were significantly smaller than expected (0.08 mm per kg/m2 when measured by crown rump length (SE 0.02)).Conclusions: Maternal BMI is correlated to smaller fetal size in early pregnancy and prolongs duration of pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome.Materials and Methods: Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery.Results: Four thousand five hundred and four women were included in the final analysis - 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0-3.28 for TSH 2.5-4.0 mIU/L and OR 2.33, 95% CI 1.11-4.42 for those with TSH > 4 4.0 mIU/L).Conclusions: Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome - low birth weight and placental abruption - although this needs to be further explored. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between small for gestational age (SGA) and inadequate gestational weight gain (GWG) in obese women (compared with Institute of Medicine [IOM] guidelines) stratified by obesity classes.Methods: We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis. MEDLINE and EMBASE were searched through Ovid from 28 May 2009 to 1 December 2015. Quality was assessed using a modified Newcastle-Ottawa scale.Results: 480 citations were screened and 13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14-1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22-1.54); Class II (OR 1.38; 95% CI 1.24-1.54); Class III (OR 1.25; 95% CI 1.14-1.36).Conclusions: From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for mediolateral episiotomy, and evaluate the risk of obstetrical anal sphincter injury (OASI) among women with an episiotomy.Methods: A retrospective cohort study of all singletons vaginal deliveries at term between 2007 and 2014. Spontaneous and operative vaginal deliveries were compared separately, as well as nulliparous and multiparous women.Results: Overall, 41,347 women were included in the spontaneous vaginal delivery group: 12,585 (30.4%) nulliparous and 28,762 (69.6%) multiparous women. Risk factors for episiotomy (nulliparous) were maternal age (aOR 0.98), gestational age (GA, aOR 1.07), regional analgesia (RA, aOR 1.18), labor induction (aOR 1.17), meconium (aOR 1.37) and birth weight (BW, aOR 1.04). Episiotomy was associated with PPH (aOR 1.49). Among multiparous, risk factors were maternal age (aOR 1.04), previous vaginal delivery (aOR 0.38), GA (aOR 1.06), RA (aOR 1.22), meconium (aOR 1.22) and BW (aOR 1.05). Episiotomy was associated with 3rd degree perineal tear (aOR 2.26, 95% CI 1.03-4.97). Only birth weight (nulliparous) and previous vaginal deliveries (multiparous) were contributors for episiotomy in the OVD group.Conclusion: Several risk factors for mediolateral episiotomy exist. Episiotomy does not protect nulliparous women, and may be associated with an increased risk for multiparous, for OASI. Therefore, the practice of routine episiotomy should be abandoned, and the practice of selective episiotomy reconsidered. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for mediolateral episiotomy, and evaluate the risk of obstetrical anal sphincter injury (OASI) among women with an episiotomy.Methods: A retrospective cohort study of all singletons vaginal deliveries at term between 2007 and 2014. Spontaneous and operative vaginal deliveries were compared separately, as well as nulliparous and multiparous women.Results: Overall, 41,347 women were included in the spontaneous vaginal delivery group: 12,585 (30.4%) nulliparous and 28,762 (69.6%) multiparous women. Risk factors for episiotomy (nulliparous) were maternal age (aOR 0.98), gestational age (GA, aOR 1.07), regional analgesia (RA, aOR 1.18), labor induction (aOR 1.17), meconium (aOR 1.37) and birth weight (BW, aOR 1.04). Episiotomy was associated with PPH (aOR 1.49). Among multiparous, risk factors were maternal age (aOR 1.04), previous vaginal delivery (aOR 0.38), GA (aOR 1.06), RA (aOR 1.22), meconium (aOR 1.22) and BW (aOR 1.05). Episiotomy was associated with 3rd degree perineal tear (aOR 2.26, 95% CI 1.03-4.97). Only birth weight (nulliparous) and previous vaginal deliveries (multiparous) were contributors for episiotomy in the OVD group.Conclusion: Several risk factors for mediolateral episiotomy exist. Episiotomy does not protect nulliparous women, and may be associated with an increased risk for multiparous, for OASI. Therefore, the practice of routine episiotomy should be abandoned, and the practice of selective episiotomy reconsidered. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of antioxidant administration on the oxidative parameters in both blood and placental tissue and its relation to fetal outcome in women with GDM. Patients and methods: Two-hundred pregnant women with gestational diabetes mellitus (GDM) were randomized into 2 groups, Group1 received 1 gram L-ascorbic acid per day and Group2 received placebo. Results: The use of antioxidants significantly lower the needed insulin dose for blood sugar control (25.6 ± 20.3 versus 40.5 ± 23.7, respectively). In placental tissue homogenates, glutathione (GSH) was 49.6 ± 5.9 versus 62.34 ± 4.99, malondialdahyde (MDA) was 165.7 ± 9.2 versus 264.15 ± 12, superoxide dismutase (SOD) was 0.3 ± 0.3 versus 0.054 ± 0.16 while catalase (CAT) was 14.06 ± 2.4 versus 15.52 ± 3.97 and glutathione peroxidase (GPx) was 14 ± 4.1 versus 26.3 ± 4.26 in antioxidant group compared to the control group (p < 0.001). In maternal blood, GSH was 1.5 ± 0.3 versus 0.74 ± 0.088, CAT was 380.7 ± 11 versus 325.44 ± 21.8, GPx was 52.3 ± 8.7 versus 75.82 ± 6.84 and SOD was 188 ± 15.3 versus 98.56 ± 11.05 in antioxidant group compared to control group (p< 0.001). In neonatal blood, the level of MDA and SOD showed a statistically significant difference between antioxidants and control groups (4 ± 0.7 versus 6.6 7 ±0.66 and1 8 8 ± 15.3 versus 98.5 ± 11.05, respectively) (p < 0.001). The neonatal blood sugar after 1 and 2 hours of delivery was more stable in antioxidant group (56.7 ± 10.9 versus 39.7 ± 11.1 and 58.5 ± 10.8 versus 41.7 ± 13.1, respectively) (p<0.05). The neonates NICU admission was lower in antioxidant group (5 versus 11) (p<0.05). Conclusion: The use of antioxidants markedly reverses the oxidative stresses in women with GDM with marked improvement on neonatal outcome. [ABSTRACT FROM PUBLISHER]

Objective: The length of the third stage of labor is an important risk factor for postpartum hemorrhage (PPH). Current practice recommends manual placenta removal, if not delivered spontaneously, within 30 min. The review reexamines the evidence to determine the optimal length of the third stage of labor. Methods: A MEDLINE search that associated the length of the third stage of labor with the risk of PPH was undertaken. Results: A retrospective cohort study revealed the risk of a PPH became significant at 10 min (odds ratio = 2.1, 95% confidence interval: 1.6–2.6), and had doubled by 20 min (odds ratio = 4.3, 95% confidence interval: 3.3–5.5). A receiver operator curve determined the optimal length of the third stage of labor to prevent PPH was 18 min. A follow up randomized controlled trial showed that hemodynamic compromise secondary to a PPH can be reduced with manual placenta removal at 10 compared to 15 min (6.4 versus 19.2%,p = 0.001). Conclusion: The time interval of 15 min may be a more appropriate time interval to recommend placental removal to prevent PPH. [ABSTRACT FROM PUBLISHER]

Objectives: The aim of this study was to evaluate the evidence for Helicobacter pylori, Chlamydiae pneumoniae and trachomatis to act as a probable etiology for preeclampsia (PE), together with estimating the prevalence of such infections in pregnant women with PE.Methods: We performed a prospective study in Mansoura University Hospitals, Egypt, for detecting H. pylori infection by estimating H. pylori IgG and IgM, in addition to detection of Chlamydiae infections by PCR in 90 pregnant women with PE and 90 normotensive pregnant women of the same age and body mass index who were studied as control.Results: The prevalence of H. pylori infection in preeclamptic pregnant women was 54.4% with a statistically significant association to PE. The prevalence of C. pneumonia was 27.8% whereas that of C. trachomatis was 4.44%. The infected preeclamptic cases showed high levels of leucocytes besides elevated C-reactive protein concentrations.Conclusion: Helicobacter pylori was found to act as a cofactor in the development of PE. Occurrence of C. trachomatis was low in pregnant women in our community; however, it showed that it may act as a cofactor in PE, whereas C. pneumoniae was attributed to have no role in PE pathogenesis until supported by further studies. [ABSTRACT FROM AUTHOR]

Objective: To analyze perinatal outcomes in singleton pregnancies with a single umbilical artery (SUA) as an isolated finding with no other underlying disorders.Methods: This retrospective observational study compared a group of pregnancies with SUA (n = 127) and a group with a normal 3-vessel umbilical cord (n = 27 752). The study variables comprised maternal and obstetric characteristics and perinatal outcomes.Results: The frequency of SUA was 0.45%. Pregnancies with SUA ended more frequently with cesarean delivery, and had a higher risk that the indication for cesarean delivery was non-reassuring fetal heart rate (NRFHR). Neonates in the SUA group had a lower weight for gestational age, and a higher risk of low umbilical cord blood pH.Conclusion: Obstetricians should monitor fetal growth closely in pregnancies with SUA, and be alert to NRFHR during labor and delivery. [ABSTRACT FROM AUTHOR]

Objective: To assess the fetal outcomes of pregnancies of systemic lupus erythrematosus (SLE) patients in northern Israel. Methods: A retrospective cohort study was conducted. The association between demographic characteristics, disease-related variables and adverse pregnancy outcome was assessed. Results: Data were collected regarding 59 pregnancies of 35 SLE patients; 77.1% were Jewish patients and 22.8% Arab. None of the patients suffered from a major organ flare during pregnancy. There was no difference in the frequency of the different lupus manifestations across the two ethnic groups. The mean birth week of all pregnancies followed was 31.8 weeks. An adverse pregnancy outcome had occurred in 35.6% of the pregnancies. Intrauterine growth restriction was observed in 13.5% of the pregnancies. Antiphospholipid antibodies (APLA) positivity, past major organ involvement and a younger age at conception were associated with an adverse pregnancy outcome; however, ethnicity was not associated. Discussion: The pregnancy outcomes of our cohort are similar to those previously published, worse than the general population. Ethnicity did not affect the fetal outcome. [ABSTRACT FROM AUTHOR]

Objective: We sought to determine subsequent pregnancy outcomes in a cohort of women with a history of unexplained recurrent miscarriage (RM) who were not receiving medical treatment. Study design: This was a prospective cohort study, of women with a history of three unexplained consecutive first trimester losses, who were recruited and followed in their subsequent pregnancy. Control patients were healthy pregnant patients with no previous adverse perinatal outcome. Results: A total of 42 patients with a history of unexplained RM were recruited to the study. About nine (21.4%) experienced a further first trimester miscarriage, one case of ectopic and one case of partial molar pregnancy. About 74% (23/31) of the RM cohort had a vaginal delivery. There was one case of severe pre-eclampsia. The RM group delivered at a mean gestational age of 38 + 2 weeks and with a mean birthweight of 3.23 kg. None of the neonates were under the 10th centile for gestational age. Overall, there was no significant difference in pregnancy outcomes between the two cohorts. Conclusion: Our study confirms the reassuring prognosis for achieving a live birth in the unexplained RM population with a very low incidence of adverse events with the majority delivering appropriately grown fetuses at term. [ABSTRACT FROM AUTHOR]

There are four major blood groups in human based on the presence of A and B antigens. ABO gene encodes A and B antigens on the surface of red blood cells and there are reported relations between this blood phenotype and pregnancy outcomes in the women. In this study, medical records of 792 healthy pregnant women were investigated and their age and blood test results including blood group with fasting blood sugar, hemoglobin, hematocrit, urea, creatinine and red blood cell counts were analyzed in statistical package for the social sciences. The RBC count in AB blood type was significantly higher than A and O blood group, also FBS level in the people with AB blood group was meaningfully higher than A group. But the mean of HGB and HCT were not significantly different between groups. The serum urea in the AB group was higher than the three other groups and also it was significantly higher in B compared to O and A blood groups. The serum creatinine in the AB group was higher than the three other groups too. Also it was significantly higher in the B group compared to A blood groups. These results indicate that the ABO blood group may have association with some of the risk factors of the unfavorable outcomes of pregnancy and it may be one of the prognostic tools, also it addresses more extensive studies. [ABSTRACT FROM AUTHOR]

Objectives: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey. Methods: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers' age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels. Results: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97 ± 3.27 ng/ml and 4.29 ± 2.44 ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels ( r: 0.735, p < 0.05). Ninety-five mothers had serum 25(OH)D3 below 20 ng/ml and all cord blood serum 25(OH)D3 levels were below 20 ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71 ± 1.88 and 5.2 ± 3.4 ng/ml, respectively, with a significant difference between them ( p < 0.05). Conclusion: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas. [ABSTRACT FROM AUTHOR]

Objective: To measure the incidence and outcomes of pregnancies in renal transplant (RT) patients and to identify risk factors of adverse pregnancy outcomes. Methods: We conducted a population-based retrospective cohort study using the United States Nationwide Inpatient Sample from 2003-2010. The incidence of pregnancies in women with RT was measured and logistic regression analysis was used to estimate the adjusted effect of RT on maternal and fetal outcomes. Results: We identified 375 deliveries in patients with a RT among 7 094 300 births for an overall incidence of 5.3 cases per 100 000 births over 8 years. Maternal complications, including preeclampsia OR = 9.87 (7.76, 12.55) and blood transfusion OR = 2.29 (1.69, 3.12) were more common in women with RT as compared to in women without. RT pregnancies were also complicated by an increased risk of preterm birth OR = 4.65 (3.72, 5.81), intrauterine fetal death OR = 3.67 (1.89, 7.15) and fetal congenital anomalies OR = 5.28 (2.81, 9.90). Among women with RT and pre-existing hypertension, the risk of intrauterine growth restriction (IUGR) was considerably increased from 4.3% to 21.8%, OR = 3.79 (1.67, 8.62). Conclusion: Pregnancies in RT patients are associated with an increased risk of maternal and fetal morbidities. Among women with RT, pre-existing hypertension strongly increases the risk of IUGR. [ABSTRACT FROM AUTHOR]