Preeclampsia and risk of developing bronchopulmonary dysplasia in very preterm neonates

Objective: Bronchopulmonary dysplasia (BPD) is a severe common complication of preterm birth with considerable short and long-term consequences. As more evidence is emerging that dysregulation of angiogenesis is implicated in the pathogenesis of preeclampsia as well as in fetal lung development, we assessed if preeclampsia is associated with development of BPD in very preterm neonates. Study design: A retrospective cohort study of 308 infants born between 24+0 and 31+6 weeks of gestation in 2011 and 2012. We performed association analysis with univariable and multivariable logistic regression, adjusting for confounders. Models were additionally adjusted for intermediates, to show how an association can be disguised by over adjusting. Main outcome measure: BPD was diagnosed at 36+0 weeks postmenstrual age and defined as the need for oxygen (FiO2 > 0.21) for at least 12 h per day, for more than 28 days before or at 36+0 weeks postmenstrual age, and classified as mild, moderate or severe. Results: After applying our exclusion criteria, we report our primary outcome on 247 mother-neonate pairs. Fifty-nine neonates developed BPD (23.9%) which was moderate to severe in 27 of them (10.9%). Preeclampsia was associated with BPD, adjusted odds ratio, 95% confidence interval: 4.22 (1.63, 10.91). However, after adjusting for additional intermediates no statistical significance remained, adjusted odds ratio, 95% confidence interval: 1.87 (0.49, 7.24). Conclusion: This study shows that early-onset preeclampsia is associated with development of BPD in the very preterm neonate. Part of this association is mediated by fetal growth restriction and mode of delivery

Fetal complications after placement of an intrauterine pressure catheter: a report of two cases and review of the literature

BACKGROUND: Uterine contractions during labor can be monitored by external tocodynamometry or by the use of an intrauterine pressure catheter (IUPC). Since an IUPC measures the frequency of contractions as well as their strength and duration, it is thought to be more accurate than external tocodynamometry. However, limited evidence on this subject suggests that IUPC may not improve maternal or perinatal outcomes. Moreover, the use of IUPC may cause fetal complications. CASES: We describe the placement of an IUPC during induction of labor with oxytocin in two cases, one presenting with a singleton pregnancy and the other a twin pregnancy. After introduction of the IUPC, both cases were complicated by blood loss and signs of fetal distress on cardiotocography. An emergency cesarean section was performed in both cases. In the first case, extramembranous placement of the IUPC was observed, whereas in the second case, the IUPC had lacerated an arteriovenous anastomosis in the membranes, resulting in perinatal death. CONCLUSION: Placement of an intrauterine pressure catheter instead of external tocodynamometry has a small risk for serious fetal complication

Neonatal outcome following elective cesarean section beyond 37 weeks of gestation : a 7-year retrospective analysis of a national registry

Objective: We sought to evaluate number and timing of elective cesarean sections at term and to assess perinatal outcome associated with this timing. Study Design: We conducted a recent retrospective cohort study including all elective cesarean sections of singleton pregnancies at term (n = 20,973) with neonatal follow-up. Primary outcome was defined as a composite of neonatal mortality and morbidity. Results: More than half of the neonates were born at <39 weeks of gestation, and they were at significantly higher risk for the composite primary outcome than neonates born thereafter. The absolute risks were 20.6% and 12.5% for birth at <38 and 39 weeks, respectively, as compared to 9.5% for neonates born ≥39 weeks. The corresponding adjusted odds ratios (95% confidence interval) were 2.4 (2.1-2.8) and 1.4 (1.2-1.5), respectively. Conclusion: More than 50% of the elective cesarean sections are applied at <39 weeks, thus jeopardizing neonatal outcome

Timing van electieve keizersneden à terme; trends in Nederland

OBJECTIVE: To analyse if from 2000-2010 the rate of elective caesarean sections (CS) before 39 0/7 weeks of gestation declined when compared with all elective CS, and to evaluate the possible associated factors. DESIGN: Retrospective cohort study. METHOD: Using data from The Netherlands Perinatal Registry, all term elective CS (n = 59,653) from 2000-2010 were selected. Trends in patient characteristics and in performing an elective CS before 39 0/7 weeks were analysed using regression analysis, and differences between hospitals using the χ2 test. Using multiple logistic regression analysis it was analysed which factors were associated with performing an elective CS before 39 0/7 weeks. RESULTS: The percentage of elective CS before 39 0/7 weeks decreased from 56% in 2000 to 43% in 2010 (p < 0.0001). In peripheral hospitals an elective SC was performed more often before 39+0 weeks than in academic hospitals; 53% in peripheral teaching hospitals, 57% in peripheral non-teaching hospitals, and 46% in academic hospitals. Adjusted odds ratios and 95% confidence intervals were 1.38 (1.30-1.47) in peripheral teaching hospitals, and 1.55 (1.46-1.65) in peripheral non-teaching hospitals. In hospitals where the number of deliveries per year was situated in the lower quartile, elective CS before 39 0/7 weeks was carried out more often than in hospitals where deliveries per year were in the upper quartile, 60% versus 52% (p < 0.0001). CONCLUSION: In the period 2000-2009 the timing of elective CS improved marginally. In 2010 the trend began to decline, even though 43% of elective caesarean sections were still carried out before 39 0/7 weeks. This results in a higher risk of neonatal morbidity and health problems in long-term.Freke A. Wilmink, Chantal W.P.M. Hukkelhoven, Joris A.M. van der Post, Eric A.P. Steegers, Ben Willem J. Mol, Dimitri N.M. Papatsoni

Neonatal outcome following elective cesarean section of twin pregnancies beyond 35 weeks of gestation

Objective: We sought to assess neonatal morbidity and mortality of elective cesarean section (CS) of uncomplicated twin pregnancies per week of gestation >35+0. Study Design: We performed a retrospective cohort study in our nationwide database including all elective CS of twin pregnancies. Two main composite outcome measures were defined, ie, severe adverse neonatal outcome and mild neonatal morbidity. Results: We report on 2228 neonates. More than 17% were born <37+0 weeks of gestation. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for severe adverse neonatal outcome at 35 +0-6, 36+0-6, and 37+0-6 weeks were, OR, 9.4; 95% CI, 3.2-27.6; OR, 1.7; 95% CI, 0.5-5.3; and OR, 0.7; 95% CI, 0.2-2.0, respectively; and for mild neonatal morbidity, OR, 4.7; 95% CI, 2.6-8.7; OR, 4.9; 95% CI, 3.1-7.9; and 1.4; 95% CI, 0.9-2.1, respectively, compared to neonates born <38+0 weeks of gestation. Conclusion: In uncomplicated twin pregnancies elective CS can best be performed between 37 +0 and 39+6 weeks of gestation

Neonatal outcome following elective cesarean section of twin pregnancies beyond 35 weeks of gestation

OBJECTIVE: We sought to assess neonatal morbidity and mortality of elective cesarean section (CS) of uncomplicated twin pregnancies per week of gestation > 35(+0). STUDY DESIGN: We performed a retrospective cohort study in our nationwide database including all elective CS of twin pregnancies. Two main composite outcome measures were defined, ie, severe adverse neonatal outcome and mild neonatal morbidity. RESULTS: We report on 2228 neonates. More than 17% were born = 38(+0) weeks of gestation. CONCLUSION: In uncomplicated twin pregnancies elective CS can best be performed between 37(+0) and 39(+6) weeks of gestatio