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The outcome of pregnancy was studied on a comparative basis. 150 Nigerian women who were underweight at the 14th week of pregnancy were compared with a group of 150 women of average weight who had been matched with the case group on the basis of age, height, parity and social class. Antenatal complications and labor complications/incidence of operative delivery among the 2 groups are tabulated. The incidence of underweight birth weights in the 2 groups is graphed. Prematurity was twice as prevalent among the underweight women as in the control group. 4 of the underweight and none of the control group suffered from hyperemesis gravidarum. The incidence of anemia, hypertension and preeclampsia did not differ in the 2 groups. The incidence of fetal distress was more common at delivery among the underweight mothers. There was also a comparatively higher incidence of Caesarian Section in the underweight group, most necessitated by fetal distress. Forceps deliveries were nearly 3 times more common among the underweight women. Delivery also lasted longer in this group. Babies of underweight mothers tended to weigh less than the babies born to the normal weight mothers.
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PMID:Outcome of pregnancy in the underweight Nigerian. 54 6

A case-control study on preterm delivery was conducted in Jianan and Jianhan District, Wuhan City in 1988. 130 singleton preterm infants were included with 260 term infants as control. The results showed that the risk factors in prematurity were edema-proteinuria-hypertension syndrome (OR 1.8), maternal diseases in pregnancy (OR 1.6), hyperemesis gravidarum (OR 5.1), vaginal bleeding during pregnancy (OR 2.4), premature rupture of membranes (OR 3.6), low weight gain and low average weight gain per week during pregnancy, psychosocial stress during pregnancy, inadequate prenatal care, maternal stature less than 158 cm (OR 1.7), menarche before age 12 (OR 4.3), multi-gravida (OR 2.1), previous induced abortion (OR 2.1) and passive cigarette smoking during pregnancy. The author suggests that early treatment of complications of pregnancy and forcing prenatal care should be emphasized in order to reduce the incidence of preterm births.
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PMID:[Preterm delivery and its risk factors]. 150 73

Acute renal failure is a most challenging clinical problem when it occurs in pregnancy. It requires an understanding of the normal physiology of the kidney in pregnancy and the natural history of different underlying renal diseases when pregnancy occurs. Because patients with chronic renal disease may present with worsening proteinuria, hypertension, and renal function, these disorders must be excluded from those conditions that cause acute deterioration of renal failure in otherwise normal women during pregnancy. As in all patients who develop acute renal failure, prerenal and obstructive causes must be excluded. Particularly important causes of prerenal azotemia in pregnancy include hyperemesis gravidarum and uterine hemorrhage, especially if it is unsuspected as in abruptio placentae. Infectious causes of acute renal failure in the pregnant woman include acute pyelonephritis and septic abortion. The clinical presentation of both these conditions should be apparent, and appropriate diagnosis and treatment can then be promptly instituted. Renal cortical necrosis is another cause of renal failure that occurs more frequently in pregnancy, and it must be differentiated from the many causes of acute tubular necrosis that may be associated with pregnancy. Those conditions that cause renal failure unique to pregnancy must always be considered when renal function deteriorates in the last trimester or the postpartum period. Severe preeclampsia, acute fatty liver of pregnancy, and idiopathic postpartum acute renal failure may all present similar complications, but the approach to each of these clinical disorders must be individualized. By understanding the causes of renal functional deterioration in pregnancy, a logical differential diagnosis can be established, allowing appropriate therapeutic decisions to preserve both maternal and fetal well-being.
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PMID:Acute renal failure in pregnancy. 305 11

The objective is to assess the impact of workload on pregnancy among women physicians in public hospitals in Israel. A self-administered, cross-sectional study of pregnancies among women physicians in public hospitals was conducted. An 82-item questionnaire was mailed to women physicians in the three largest university hospitals in Israel. The questionnaire assessed demographic data, pregnancy course, perceived stress, and complications during pregnancy. Response rate was 52% (207/400). The complication rates were compared with rates in the Jewish population and expressed as mean +/- SD. Mean number of pregnancies during residency was 1.3 +/- 1.2. Mean age at the first delivery was 27 +/- 3.2 years. There was a significant difference in the rates of stillbirth (32/1000 births versus 3.7/1000, p < 0.001) and premature delivery (12.4% versus 7.6%, p = 0.0014) between women physicians and the general population. There was no significant difference in the proportion of spontaneous abortions (12.7%), pregnancy induced hypertension (3.2%), hyperemesis gravidarum (3.2%), and diabetes (1%). Seven percent of women physicians changed their specialty due to pregnancy while in residency. Our results suggest that working long hours in a stressful occupation in a hospital environment has an adverse effect on pregnancy course and is associated with increased rates of stillbirth and premature delivery.
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PMID:Pregnancy during residency--an Israeli survey of women physicians. 1033 56

In a five year retrospective study (between January 1990 and December 1994), there were 86 twin births out of 5,953 deliveries at University of Maiduguri Teaching Hospital giving a twin delivery incidence of 14.4/1000 birth. Only 82 case notes were available for this study. Dizygotic twins accounted for 80.5% of the cases while monozygotic twins represented 19.5% in the series. Increasing maternal age during the reproductive age and positive family history of multiple pregnancy were associated with increase twinning rate. The main complications encountered during pregnancy were hyperemesis gravidarum, pregnancy-induced hypertension and preterm labour. The frequency of preterm labour in this study was significantly higher than the observed among the singleton pregnancies within the period of study (P < 0.005). The perinatal mortality rate 85.4/1000 births was similarly significantly higher than that observed among the singleton deliveries (P < 0.005). Compared to singleton pregnancies there was a higher rate of caesarean section intervention (P < 0.005). The commonest mode of presentation and sex distribution were vertex-vertex and male-female respectively. The vertex-vertex presentation accounted for 48.8% of all the presentations while the male-female ratio was 1.2.
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PMID:Twin births at University of Maiduguri Teaching Hospital: incidence, pregnancy complications and outcome. 1222 62

BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases covering the period 1980-2008. RESULTS Clinically relevant associations of adverse outcome in the subsequent pregnancy with an odds ratio (OR) > 2.0 after complications in a previous pregnancy are the risk of perinatal death after a single previous miscarriage, the risk of very preterm delivery (VPTD) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing pregnancy with an OR > 2.0 after complications in the index pregnancy are the risk of LBW and very low birthweight (VLBW) after a threatened miscarriage, the risk of pregnancy-induced hypertension, pre-eclampsia, placental abruption, preterm delivery (PTD), small for gestational age and low 5-min Apgar score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small uncontrolled studies. Larger population-based controlled studies are needed to confirm these findings. Nevertheless, identification of these risks will improve obstetric care.
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PMID:Predicting adverse obstetric outcome after early pregnancy events and complications: a review. 1927 Mar 17

Twin pregnancy is a high-risk pregnancy as it is associated with significant increase in the perinatal mortality and morbidity and maternal mortality and morbidity. This study was carried out to determine the maternal complications related with twin pregnancy. This was a cross-sectional observational study among all women with twin pregnancy, both booked (patients who had at least three visits to antenatal care were considered as booked) and unbooked, admitted in Institute of Post Graduate Medicine and Research, Dhaka now Bangabandhu Sheikh Mujib Medical University. Out of 3675 deliveries 53(1.4%) patients had twin pregnancy during a period of two years beginning from September 1996 to August 1998. Out of 53 patients, 34(64.2%) were multipara and 19(35.8%) were primipara. Most of the patients were between 22-29(67.9%) years group. The duration of gestations was 32-36 weeks for 17(32.1%) patients, 37-40 weeks for 30(56.6%) patients. Maternal complications were noticed as anaemia in 19(35.8%) patients, hypertension in 12(22.6%) patients, post-partum haemorrhage (PPH) in 10(18.9%) patients, hyperemesis gravidarum in 4(7.5%), polyhydramnios in 3(5.7%) patients, ante-partum haemorrhage (APH) in 3(5.7%) patients, premature rupture of membranes (PROM) in 2(3.8%) patients, gestational diabetes in 3(5.7%) patients, urinary tract infection (UTI) in 2(3.8%) patients, complications of operative delivery in 2(3.8%) patients. There was no maternal death in our study. Twin Pregnancy is a high-risk pregnancy associated with significant increase in maternal mortality and morbidity. With aggressive management of complications such as preterm labour, foetal distress, hypertension, APH, PPH, premature rupture of membranes etc morbidity and mortality can be improved.
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PMID:Maternal complications in twin pregnancies. 2124 Jan 68

Acute kidney injury (AKI) is costly and is associated with increased mortality and morbidity. An understanding of the renal physiologic changes that occur during pregnancy is essential for proper evaluation, diagnosis, and management of AKI. As in the general population, AKI can occur from prerenal, intrinsic, and post-renal causes. Major causes of pre-renal azotemia include hyperemesis gravidarum and uterine hemorrhage in the setting of placental abruption. Intrinsic etiologies include infections from acute pyelonephritis and septic abortion, bilateral cortical necrosis, and acute tubular necrosis. Particular attention should be paid to specific conditions that lead to AKI during the second and third trimesters, such as preeclampsia, HELLP syndrome, acute fatty liver of pregnancy, and TTP-HUS. For each of these disorders, delivery of the fetus is the recommended therapeutic option, with additional therapies indicated for each specific disease entity. An understanding of the various etiologies of AKI in the pregnant patient is key to the appropriate clinical management, prevention of adverse maternal outcomes, and safe delivery of the fetus. In pregnant women with pre-existing kidney disease, the degree of renal dysfunction is the major determining factor of pregnancy outcomes, which may further be complicated by a prior history of hypertension.
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PMID:Acute kidney injury in the pregnant patient. 2316 15

Nausea and vomiting are symptoms frequently seen in normal pregnancy. We report a patient with gastric carcinoma who presented with severe hyperemesis gravidarum that led to extreme volume depletion, hypertension, proteinuria, and acute renal failure. A 35-year-old woman (para 2-1-0-1) with a prenatal course significant for persistent nausea, vomiting, and poor weight gain presented at 36 weeks' gestation with elevated blood pressure (157/114 mm Hg), proteinuria (4+), hypochloremic metabolic alkalosis, and severe intravascular volume contraction. A presumptive diagnosis of severe preeclampsia was made, the patient was given intravenous MgSO4, and cesarean delivery was accomplished uneventfully. When significant emesis persisted in the postoperative period, esophagogastroduodenoscopy revealed an antral/prepyloric mass with a biopsy-proven poorly differentiated adenocarcinoma. To our knowledge, this is the first report of a case of hyperemesis gravidarum with gastric cancer masquerading as preeclampsia.
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PMID:A Case of Hyperemesis Gravidarum due to Gastric Cancer Masquerading as Preeclampsia. 2370 89

Kidney disease and pregnancy may exist in two general settings: acute kidney injury that develops during pregnancy, and chronic kidney disease that predates conception. In the first trimester of pregnancy, acute kidney injury is most often the result of hyperemesis gravidarum, ectopic pregnancy, or miscarriage. In the second and third trimesters, the common causes of acute kidney injury are severe preeclampsia, hemolysis-elevated liver enzymes-low platelets syndrome, acute fatty liver of pregnancy, and thrombotic microangiopathies, which may pose diagnostic challenges to the clinician. Cortical necrosis and obstructive uropathy are other conditions that may lead to acute kidney injury in these trimesters. Early recognition of these disorders is essential to timely treatment that can improve both maternal and fetal outcomes. In women with preexisting kidney disease, pregnancy-related outcomes depend upon the degree of renal impairment, the amount of proteinuria, and the severity of hypertension. Neonatal and maternal outcomes in pregnancies among renal transplant patients are generally good if the mother has normal baseline allograft function. Common renally active drugs and immunosuppressant medications must be prescribed, with special considerations in pregnant patients.
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PMID:Kidney disease in pregnancy: (Women's Health Series). 2400 58


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