Maternal Group B Streptococcus Infection, Neonatal Outcome and the Role of Preventive Strategies

To determine the newborn infection rate with group B streptococcus infection (GBS) before and after American Academy of Pediatrics Protocol (AAP) implementation in Croatia, antenatal risk factors, neonatal outcome and necessity for introducing national policy for intrapartum chemoprophylaxis. To evaluate the role of intrapartum chemoprophylaxis in preterm labor at <37 weeks of gestation, premature rupture of membranes at <37 weeks of gestation, fever during labor, ruptures of membranes >18 hours before delivery and previous delivery of a sibling with GBS disease. A total of 784 neonates admitted to the Neonatal Intensive Care Unit, from 1 January 2005 to 31 December 2005. 60 (10/1000 live born) developed early-onset infection (EOGBS). The dominant presentation for EOGBS was sepsis (65%), pneumonia (32.2%) and meningitis (3%). Mean gestational age was 34.5 (±5.3) weeks. There were 2 neonatal deaths (3%) in EOGBS, both preterm. EOGBS disease was associated with following risk factors: rupture of the membranes >12 hours (49.3%), chorioamnionitis (11.9%), status post cerclage (10.4%), diabetes mellitus (4.5%), delivery out of hospital (3%), uroinfection (1.5%). After AAP implementation the incidence of GBS infection decreased from 15/1000 to 10/1000 of live born infants. The mortality from EOGBS dropped from 5% to 3 %. The incidence of GBS infection in our study was considerably higher than in all current reports. Reasons for that can be inadequate perinatal screen in some parts of the country and no established policy for intrapartum antibiotic treatment of women with risk factors. Our results documented that intrapartum chemo-prophylaxis for GBS infection significantly reduces perinatal mortality due to neonatal infection and sepsis

Maternal and Fetal Outcome in Elective versus Emergency Caesarean Section in a Developing Country

As the other major European countries, Croatia has also seen a marked increase in the rate of caesarean sections. The aim of this study was to determine the most common reasons for caesarean section, to compare emergency and elective caesarean section in regard to intraoperative and postoperative complications in both mother and child, and to assess the decision-to-delivery interval (DDI) in our clinic in comparison to current recommendations. Analyzing the results of our research we can say that the new-borns in the group with the elective caesarean section had considerably better Apgar index score in the first minute (p=0.00056) and in the fifth minute (p=0.054) than the children born in the group with emergency caesarean section. Children from the group with elective caesarean section had also less frequent asphyxia (p=0.02315) and considerably less frequent resuscitation (p=0.0143) than the children from the group with emergency caesarean sections. Only 39.73% of the emergency caesarean sections were performed within the »golden standard« period of 30 minutes. Regarding the data from the literature our results are similar with the ones from developed countries and 30 minute current standard seem to be not achievable

The Role of Antibiotic Prophylaxis in Preterm Premature Rupture of Membranes

Preterm premature rupture of membranes (PPROM) occurs in 3 percent of all pregnancies and is responsible for, or associated with, approximately one-third of preterm births causing significant perinatal morbidity and fetal death. Preterm infants are very vulnerable to respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), other neurological sequelae, infection and necrotizing enterocolitis (NEC). Chorioamnionitis based on clinical criteria occurs in approximately 3-30% of all PPROM pregnancies. The aim of this study was to analyze the role of antibiotic prophylaxis in delivery delay on neonatal outcome (body weight, Apgar scores, pulmonary complications, neurological complications - abnormal cerebral ultrasound scan prior to hospital discharge, perinatal infections) and to determine the possibility of an optimal antibiotic regimen. Therefore we retrospectively analyzed last 5 years of data from patients treated in our center and provided a coherent overview of the clinical course and outcome of patients with PPROM treated with prophylactic antibiotics and antenatal corticosteroids. There were 324 preterm newborns which fulfilled the inclusion criteria for our study; 190 in Study group (received empiric i.v. antibiotics) and 134 in Control group (without antibiotic). We found significant difference in gestational age (p<0.0001), birth weight (p<0.0001), Apgar scores (p<0.0001) maternal C-reactive protein level (p<0.0001) and latency period (5.54days vs. 11.33days, p=0.001) between the groups. Histologic chorioamnionitis was significantly more frequent in s Study group (14.2% vs. 36.3%, p<0.0001). We found significant difference in neonatal outcome according the different antibiotic treatment. Antenatal antibiotics and corticosteroid therapies have clear benefits and should be offered to all women without contraindications

Effect of severe gestational thrombocytopenia to perinatal outcome

Thrombocytopenia is a common hematologic abnormality during pregnancy. It may be a diagnostic and management problem, and has many causes, some of them specific to pregnancy. We considered all singleton deliveries after 24 weeks of gestation between 2007 and 2012 in our third level centre. Women with a platelet count <100 × 109/L, but who did not suffer from the aforementioned diseases, were considered to have incidental thrombocytopenia. The aim of this study is to investigate the incidences of moderate and severe gestational thrombocytopenia, to determine if the severity of maternal gestational thrombocytopenia affect perinatal outcome and to define if the severity of maternal gestational thrombocytopenia implicates the appearance of neonatal thrombocytopenia

Nucleated Red Blood Cells Count as First Prognostic Marker for Adverse Neonatal Outcome in Severe Preeclamptic Pregnancies

The purpose of this study was to determine acceptability of the nucleated red blood cells counts (NRBC) as early prognostic parameter for adverse outcome in preterm neonates born from pregnancies complicated with severe preeclampsia. We analysed 77 premature newborns who were born from pregnancies with severe preeclampsia during eight years (2004–2011) in our tertiary center. Women with other pregnancy complications were excluded from the study, as well as newborns with malformations and chromosomal anomalies. Newborns were compared according to the count of nucleated red blood cells (NRBC) on the first day of life. Cut off of NRBC was determined at 40 per 100 white blood cells. We analyzed and compared birth weight, gestational age, Apgar scores in 1st and 5th minute, hypoglycemia in first day of life, need for respiratory support, neonatal infection and brain ultrasound findings at the day of discharge between the groups of newborns. We found significantly lower birth weight, gestational age and Apgar scores in case group (NRBC> 40) and significantly higher rate of infections, need for respiratory support, abnormal brain ultrasound findings, morbidity rate and adverse neonatal outcome compared to control newborns group. Increased count of nucleated red blood cells (NRBC) in preterm newborns born from pregnancies with severe preeclampsia seems to be the first significant marker for detecting adverse neonatal outcome

Pregnancy outcomes in women with Fontan circulation

The Fontan operation is a life-saving procedure performed on pediatric patients diagnosed with univentricular heart disease. The Fontan circulation is established by redirecting blood flow directly to the pulmonary circulation without passing through a ventricle. As more women with Fontan circulation reach adulthood and become pregnant, it is important to recognize obstetrical risks and provide optimal care for this rare condition

Fetal-maternal complications and their association with gestational thrombocytopenia

Objectives: Thrombocytopenia is defined as a platelet count of &lt; 150 × 109/L. It is a common hematologic abnormality during pregnancy. Evaluation and treatment of gestational thrombocytopenia can be both, expensive and invasive, and may result in an adverse outcome. The aim of our study was to investigate the incidence of perinatal complications in pregnancies complicated with gestational thrombocytopenia and to determine if the severity of maternal gestational thrombocytopenia implicates unfavorable perinatal outcome. Material and methods: Over a period of three years, we identified 50 patients with gestational thrombocytopenia: 38 with platelet count between 50–100 × 109/L — classified as moderate thrombocytopenia, and 12 with platelet count of &lt; 50 × 109/L — classified as severe thrombocytopenia. Fifty women with normal platelet count constituted the control group. Maternal complications and neonatal outcomes were compared. Results: Neonatal thrombocytopenia occurred more often in pregnancies complicated with gestational thrombocytopenia (p = 0.041). Thrombocytopenia in previous pregnancy seems to be an important predicting factor for disease severity in the current pregnancy (p = 0.01). Conclusions: Gestational thrombocytopenia, even if severe, is not associated with adverse maternal or neonatal outcome. Moderate neonatal thrombocytopenia is more common in pregnancies complicated with severe gestational thrombocytopenia. The incidence of severe gestational thrombocytopenia is higher in patients with thrombocytopenia in previous pregnancy

Procalcitonin vs C-reactive protein in early detection of intrauterine infection in premature rupture of membranes and neonatal infections

At any time during pregnancy intrauterine infection is an important risk factor for neonatal sepsis and is a frequent cause of mortality and morbidity in newborn infants. The aim of this study was to consider the patterns of procalcitonin (PCT) response in normal pregnancy and in pregnancies complicated with a premature rupture of the membranes, to compare the results of PCT with those of C-reactive protein (CRP) and to assess their diagnostic accuracy both to mothers and neonates. 120 mothers with singleton pregnancies were enrolled in this study. 60 pregnancies were complicated with a premature rupture of membranes, and 60 were control pregnancies. We analyzed PCT and CRP values, clinical chorioamnionitis, neonatal infection and other neonatal outcomes in both groups. We found significantly higher maternal serum concentrations of PCT and CRP in the Study group. Regarding our results, both markers are predictive for chorioamnionitis and neonatal infections, with almost similar significance

Does assisted reproductive technology increase adverse perinatal outcome in preterm twins ? A hospital based comparative study at a single tertiary center in Croatia

Objective: The aim of this study is to investigate the association of assisted reproductive technology (ART) as an independent risk factor for obstetric complications and perinatal outcome in preterm twin pregnancies in 5 years period at a single tertiary center. Methods: We collected the data (from maternal and neonatal medical records) from 88 preterm twin pregnancies conceived after ART and 147 preterm twin pregnancies conceived naturally in a 5-year period. Results: Pregnancy complications in ART mainly included preterm premature rupture of membranes, gestational hypertension and gestational diabetes. More than 85% of ART twins were born by caesarean section, significantly higher than non-ART twins (p = 0.005). Neonatal complications in both groups mainly included low Apgar score in 1st minute, perinatal infections, respiratory distress syndrome (RDS) and hyperbilirubinemia and the incidences of these complications were comparable between the groups. According to Weinberg’s differential rule, there were 32 monozygotic ART twins and 119 monozygotic non-ART twins. This represents a monozygotic twin rate of 4.7% for ART births and 0.6% for non-ART births. Conclusion: Our results indicated that ART procedures were not associated with adverse perinatal outcome and that ART is not associated with increased obstetric complications in preterm twins followed and born in a single tertiary center