Can a Difference in Gestational Age According to Biparietal Diameter and Abdominal Circumference Predict Intrapartum Placental Abruption?

This study aimed to investigate whether a difference in gestational age according to biparietal diameter (BPD) and abdominal circumference (AC) could be a clinically useful predictor of placental abruption during the intrapartum period. This retrospective cohort study was based on singletons who were delivered after 32 + 0 weeks between July 2015 and July 2020. We only included cases with at least two antepartum sonographies available within 4 weeks of delivery (n = 2790). We divided the study population into two groups according to the presence or absence of placental abruption and compared the clinical variables. The incidence of placental abruption was 2.0% (56/2790) and was associated with an older maternal age, a higher rate of preeclampsia, and being small for the gestational age. A difference of >2 weeks in gestational age according to BPD and AC occurred at a higher rate in the placental abruption group compared to the no abruption group (>2 weeks, 21.4% (12/56) vs. 7.5% (205/2734), p < 0.001; >3 weeks, 12.5% (7/56) vs. 2.0% (56/2734), p < 0.001). Logistic regression analysis revealed that the differences of >2 weeks and >3 weeks were both independent risk factors for placental abruption (odds ratio (OR) (95% confidence interval), 2.289 (1.140–4.600) and 3.918 (1.517–9.771), respectively) after adjusting for maternal age, preeclampsia, and small for gestational age births. We identified that a difference in gestational age of >2 weeks between BPD and AC could be an independent predictor of placental abruption

Do the Causes of Spontaneous Preterm Delivery Affect Placental Inflammatory Pathology and Neonatal Outcomes?

Objective: To investigate the severity of histologic chorioamnionitis /funisitis according to the indication for preterm delivery and their corresponding neonatal outcomes. Method: This study included 411 singleton women who delivered between 21+0 and 31+6 week of gestation due to preterm labor (PTL, n = 165), preterm premature rupture of membranes (PPROM, n = 202), or incompetent internal os of the cervix (IIOC, n = 44). The primary outcome measure was the rate of severe histological chorioamnionitis/funisitis. Secondary outcome measure was neonatal outcomes including neonatal and infant death, and neonatal composite morbidity. Results: The PPROM group demonstrated a higher rate of severe histological chorioamnionitis/funisitis compared to the PTL group (severe histological chorioamnionitis; PPROM, 66.3% vs. PTL, 49.1%, p = 0.001, severe funisitis; PPROM, 44.1% vs. PTL, 23.6%, p < 0.001) and this remained significant after multivariable analysis (severe histologic chorioamnionitis, OR 2.367, 95% CI 1.517–3.693; severe funisitis, OR 2.668, 95% CI 1.684–4.226). For neonatal outcomes only, a higher rate of patent ductus arteriosus was observed in the IIOC group compared to the PTL and PPROM groups (IIOC, 77.3% vs. PTL, 54.0% vs. PPROM, 54.0%, p = 0.043) and this remained significant after multivariable analysis. Conclusion: Indication of spontaneous preterm delivery might affect the placental inflammatory pathology and neonatal morbidity

Short- and long-term neonatal outcomes according to differential exposure to antenatal corticosteroid therapy in preterm births prior to 24 weeks of gestation.

AIM:To assess the effects of differential exposure to antenatal corticosteroid (ACS) on short- and long-term outcomes of infants born before 24 weeks of gestation. METHODS:This is a retrospective cohort study of 147 infants delivered by 116 women at 21-23 weeks of gestation between January 2001 and December 2016 at a tertiary referral hospital in Seoul, Korea. Eligible subjects were categorized into the following three groups according to ACS exposure: non-user (n = 53), partial-course (n = 44), and complete-course (n = 50). Univariable and multivariable analyses were used to compare neonatal mortality, neonatal morbidities including intraventricular hemorrhage (IVH), and neurodevelopmental impairment including cerebral palsy among the three groups. RESULTS:Neonatal mortality rate was significantly lower in the ACS-user groups (non-user, 52.8%; partial-course, 27.3%; complete-course, 28.0%; P = 0.01), but complete-course of ACS therapy had no advantages over partial-course. A lower incidence of IVH was observed in the complete-course group (non-users, 54.8%; partial-course, 48.6%; complete-course, 20.5%; P = 0.003). Multiple logistic regression analysis showed that ACS therapy, either partial- or complete-course, was associated with a lower rate of neonatal mortality (adjusted odds ratio (aOR) 0.375; 95% confidence interval (CI) 0.141-0.996 in partial-course; aOR 0.173; 95% CI 0.052-0.574) in complete-course). IVH (aOR 0.191; 95% CI 0.071-0.516) was less likely to occur in the complete-course group than in the non-user group. Neurodevelopmental impairment of survivors at 18-22 month after birth was not significantly different among the three groups. CONCLUSION:ACS therapy in preterm births at 21-23 weeks of gestation was associated with significantly reduced rates of neonatal mortality and IVH, especially with complete administration