Asunto(s)
Síndrome de Down , Reacción Leucemoide , Mielopoyesis/fisiología , Ultrasonografía Prenatal , Adulto , Síndrome de Down/sangre , Síndrome de Down/diagnóstico por imagen , Síndrome de Down/genética , Femenino , Sangre Fetal/citología , Factor de Transcripción GATA1/genética , Hepatomegalia/diagnóstico por imagen , Humanos , Recién Nacido , Reacción Leucemoide/sangre , Reacción Leucemoide/diagnóstico por imagen , Reacción Leucemoide/genética , Embarazo , Resultado del Embarazo , Pronóstico , Esplenomegalia/diagnóstico por imagenRESUMEN
Criss-cross heart is a rare congenital cardiac anomaly characterized by crossing of the inflow streams of the two ventricles, due to an apparent twisting of the heart about its long axis and when the axes of the openings of the atrioventricular (AV) valves are not parallel. If unrecognized, this leads to incorrect sequential segmental analysis. We report three cases of double-inlet ventricle with a criss-cross spatial relationship of the AV valves detected on prenatal ultrasound examination at 19-23 weeks' gestation. The sequential diagnosis was confirmed at postmortem examination in two cases and by neonatal echocardiography in the other. Antenatal diagnosis of criss-cross effect of the AV valves is feasible, allowing correct fetal diagnosis and appropriate counseling for this rare form of congenital cardiac disease.
Asunto(s)
Corazón con Ventrículos Entrecruzados/diagnóstico por imagen , Ecocardiografía/métodos , Ultrasonografía Prenatal/métodos , Aborto Terapéutico , Adulto , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , EmbarazoAsunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/transmisión , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo , Receptores CCR5/genética , Europa (Continente) , Femenino , Genotipo , Infecciones por VIH/genética , Humanos , Lactante , Recién Nacido , Embarazo , Eliminación de SecuenciaRESUMEN
OBJECTIVE: To evaluate the adequacy of cytology in detecting cervical intraepithelial neoplasia (CIN) among human immunodeficiency virus (HIV)-seropositive women compared to controls. METHODS: A cross-sectional study was carried out evaluating 241 HIV-seropositive women and 991 controls (404 HIV seronegative and 587 of unknown HIV status) at risk for CIN attending a vaginitis clinic. All patients had a Pap smear and a standard colposcopic examination of the lower genital tract. Cervical biopsies were taken as indicated by colposcopy. Cytology and histology slides were read by a cytopathologist blinded to patients' serostatus. False-negative cytologic cases were reviewed by three independent cytopathologists to estimate sampling and screening error rates. Sensitivity, specificity, and false-negative rate of cytologic smears were compared between HIV seropositives and controls. We estimated the sampling and screening error rates among cases with false-negative cytology. RESULTS: Among seropositives, the sensitivity, specificity, and the false-negative smear rate for CIN were 73.4% (47/64), 97.1% (134/138), and 26.6% (17/64), respectively. The corresponding figures in controls were 83.8% (83/99), 99.04% (825/833), and 16.2% (16/99), respectively, and did not differ significantly from those of seropositives. The negative predictive value of cytology was lower among seropositives (134/151) than in controls (825/841, chi2 = 34.8, P < .001). The agreement between cytologic readings and combined colposcopy and histology was stronger among controls (kappa = 0.789, 95% CI 0.723 to 0.856) than among seropositives (kappa = 0. 593, 95% CI 0.475 to 0.712). Three independent cytopathologists were unable to detect atypical cells in 52.9% (9/17) of false-negative smears taken from seropositive women as opposed to 37.5% (6/16) of controls. CONCLUSIONS: The sensitivity, specificity, and false negative rate of screening cytology for CIN among HIV seropositive women are comparable with those in the general population. Since almost 50% of false-negative results could be attributed to sampling errors, more frequent cytological screening may prove to be beneficial to this high-risk group.
Asunto(s)
Seropositividad para VIH/complicaciones , Tamizaje Masivo/normas , Displasia del Cuello del Útero/prevención & control , Neoplasias del Cuello Uterino/prevención & control , Adulto , Colposcopía , Estudios Transversales , Femenino , Humanos , Tamizaje Masivo/métodos , Prueba de Papanicolaou , Sensibilidad y Especificidad , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal , Displasia del Cuello del Útero/diagnósticoRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the frequency and natural history of cervical intraepithelial neoplasia (CIN) during pregnancy in past or current intravenous drug users infected with human immunodeficiency virus type 1 (HIV-1). STUDY DESIGN: We prospectively evaluated 48 pregnant HIV-1 seropositive patients and 38 HIV seronegative controls. All the subjects were current or past intravenous drug users. Follow-up visits were carried out each trimester of pregnancy and 8-12 weeks post-partum with Papanicolau smears, colposcopic examinations and, when necessary, colposcopically directed cervical biopsies. RESULTS: Thirteen of 48 HIV-seropositive women (27.1%) and three of 38 HIV-seronegative controls (7.9%) (P = 0.027 by Fisher exact test) had biopsy-proven CIN at the beginning of pregnancy. High-grade CIN was detected in 10 cases (20.8%) and in two (5.3%) controls (P = 0.058 by Fisher exact test). None of the cervical squamous intraepithelial lesions progressed throughout pregnancy, in both cases and controls. Post-partum cold-knife cervical conization was performed on seven patients with CIN III and examination of the cone biopsy specimens demonstrated persistence of CIN III. CONCLUSIONS: HIV-infected intravenous drug users are at high risk of CIN during pregnancy, thus requiring adequate screening programs. Our preliminary data suggest that the progression rate of CIN during gestation is low in this high-risk group.
Asunto(s)
Seropositividad para VIH/complicaciones , Complicaciones del Embarazo , Abuso de Sustancias por Vía Intravenosa , Displasia del Cuello del Útero/complicaciones , Neoplasias del Cuello Uterino/complicaciones , Adulto , Femenino , VIH-1 , Humanos , Hibridación in Situ , Embarazo , Estudios Prospectivos , Neoplasias del Cuello Uterino/patología , Frotis Vaginal , Displasia del Cuello del Útero/patologíaRESUMEN
BACKGROUND: The relationship between physical activity at work and risk of fetal growth restriction is controversial. For the most part, previous studies investigated the effect of work activity on birthweight alone. We evaluated the impact of type of occupation and physical effort at work on the risk of ultrasonographically confirmed fetal growth retardation among nulliparous women. METHODS: We compared the characteristics of work and the intensity of occupational fatigue (work posture, weekly working hours, physical effort at work) in 349 patients with ultrasonographically confirmed fetal growth retardation and 698 control pregnancies with appropriate fetal growth. Physical demands at work were evaluated by interview at birth. Logistic regression analysis was used to evaluate the association of employment status, type of occupation, and intensity of occupational fatigue with the risk of fetal growth retardation, correcting for potential confounders (maternal age, pre-pregnancy body mass index, mean weight gain in pregnancy, education, partner's social status, smoking in pregnancy, alcohol use, illicit drug use, time of stopping work, and hypertension). RESULTS: After adjusting for confounding, the risk of fetal growth retardation was similar between unemployed and formally employed women at the beginning of pregnancy (OR = 1.26; 95% confidence interval = 0.86 - 1.83). However, manual workers were at slightly higher risk of IUGR than not formally employed women (OR = 1.81; 95% CI = 1.15 - 2.85). Among formally employed women, standing or walking at work, and working > or = 30 hours a week were not significantly associated with IUGR. Finally, the risk of IUGR was significantly higher (OR = 2.46; 95% CI = 1.36 - 4.21) among women reporting moderate-to-heavy as compared to light physical effort at work. CONCLUSION: Formal employment at the beginning of pregnancy is not associated with an increased risk of IUGR. However, moderate-to-heavy physical effort at work seems to increase the risk of sonographically confirmed fetal growth retardation.
Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico por imagen , Esfuerzo Físico , Trabajo , Femenino , Retardo del Crecimiento Fetal/etiología , Humanos , Modelos Logísticos , Embarazo , Factores de Riesgo , UltrasonografíaRESUMEN
The purpose of this study was to estimate the proportion of ultrasonically diagnosed fetal growth retardation that may be attributable to potentially remediable factors (for example, cigarette smoking, alcohol use, and drug addition). We computed multivariate odds ratios for fetal growth retardation associated with cigarette smoking and alcohol and illicit drug consumption in 350 singleton pregnancies complicated by fetal growth retardation and 700 controls. The odds ratio of fetal growth retardation among women who smoked throughout pregnancy was 2.61 (95% confidence interval, 1.38 to 4.93) compared to women who claimed to have stopped smoking by the 18th week of gestation. The summary attributable risk of fetal growth retardation associated with behavioral variables measured during the first trimester and thereafter ranged from 18 to 21%. By implication, the maximum proportion of fetal growth retardation that could theoretically be prevented by eliminating these risk factors accounts for about 1% of all births. However, allowance for the limited modifiability of preventable factors and the consistent overlap between them would probably reduce such estimate to less than 1%. We conclude that only interventions to reduce the prevalence of strong risk factors (for example, preeclampsia, sociodemographic variables) may have a substantial effect on the incidence of impaired fetal growth and subsequent infant morbidity.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Retardo del Crecimiento Fetal/etiología , Complicaciones del Embarazo , Fumar/efectos adversos , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios de Casos y Controles , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/epidemiología , Humanos , Oportunidad Relativa , Embarazo , Complicaciones del Embarazo/epidemiología , Prevalencia , Factores de Riesgo , Fumar/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Ultrasonografía Prenatal , Aumento de PesoRESUMEN
OBJECTIVE: The purpose of the study was to evaluate the sociodemographic and clinical variables modifying the smoking-related risk of low birth weight (< 2500 g). METHOD: This case-control study included a population of 967 singleton low birth weight deliveries and 967 selected controls. Unconditional logistic regression analysis was used to test statistical significance of the interactions between smoking in pregnancy and other risk factors for low birth weight. RESULTS: Increasing maternal age and parity potentiate the smoking-related risk of a low birth weight infant. The effect of maternal smoking on the risk of low birth weight was significantly increased in patients with a history of previous spontaneous abortion (excess risk 2.30, 95% C.I. 1.24-4.27) and in patients of high compared with patients of intermediate or low social class (excess risk 1.97, 95% C.I. 1.1-3.57). Smokers with less than two prenatal visits per trimester were at significantly greater risk of delivering a low birth weight infant (excess risk 2.36, 95% C.I. 1.14-4.87) than their counterparts with more frequent prenatal visits. Among clinical variables, the effect of maternal smoking on the risk of low birth weight was significantly increased in women with a history of first trimester hemorrhage during the current pregnancy (excess risk 2.67, 95% C.I. 1.30-5.49). CONCLUSIONS: The smoking-related risk of low birth weight is very high in some subgroups of women. Identification of these subgroups could be important for prenatal counseling.
Asunto(s)
Recién Nacido de Bajo Peso , Fumar/efectos adversos , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Edad Materna , Oportunidad Relativa , Paridad , Embarazo , Atención Prenatal , Factores de Riesgo , Factores SocioeconómicosRESUMEN
The objective of this study was to evaluate the effect of maternal smoking during pregnancy on the risk of intracranial hemorrhage in preterm infants (born at 24 to 33 weeks of gestation). We conducted a case-control study of 96 preterm infants with intracranial hemorrhage and 96 gestational age-matched control subjects with negative cranial ultrasonographic findings. In conditional multiple logistic regression models, heavy maternal smoking ( > 10 cigarettes per day) during the latter half of pregnancy was associated with an increased risk of mild (grade I or II) intracranial hemorrhage (odds ratio = 5.96, 95% confidence interval 1.72 to 20.76; p = 0.005). After adjustment for the confounding effect of birth weight and respiratory distress syndrome, the risk of any intracranial hemorrhage (grade I to IV) was three times higher (adjusted odds ratio = 3.63, 95% confidence interval 1.37 to 9.63; p = 0.009) in infants of heavy smokers ( > 10 cigarettes per day) than in control subjects. The results of this study indicate that cigarette smoking during the latter half of pregnancy increases the risk of intracranial hemorrhage in preterm infants. The deleterious effect of smoking was greater for mild hemorrhages (grade I or II) and was confined to infants of heavy smokers.
Asunto(s)
Hemorragia Cerebral/epidemiología , Complicaciones del Embarazo/epidemiología , Fumar/efectos adversos , Estudios de Casos y Controles , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/etiología , Ventrículos Cerebrales , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Embarazo , Complicaciones del Embarazo/etiología , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Estudios Prospectivos , Factores de Riesgo , Fumar/epidemiología , Estadística como Asunto , UltrasonografíaRESUMEN
The relation of maternal blood group to pre-eclampsia has not been adequately studied in previous research. To investigate this relation, we conducted a case-control study of primigravidae. Data on 204 consecutive severely pre-eclamptic patients delivered pre-term and 744 controls were analysed using multivariate methods. After adjustment for the confounding effects of maternal age, social class, origin, education, pre-pregnancy weight and body mass index, and weight gain in pregnancy, we found an increased risk of pre-eclampsia for mothers with blood type AB (adjusted odds ratio = 3.07; 95% confidence interval 1.48-6.36). With respect to blood group O, A, B and Rh type, no statistically significant correlation with severe pre-eclampsia was found. Although these results should be considered with caution, they support the hypothesis of a linkage mechanism involving blood group in the inheritance of susceptibility to pre-eclampsia.
Asunto(s)
Antígenos de Grupos Sanguíneos , Preeclampsia/epidemiología , Adulto , Distribución por Edad , Estudios de Casos y Controles , Intervalos de Confianza , Femenino , Humanos , Modelos Logísticos , Análisis Multivariante , Preeclampsia/sangre , Preeclampsia/fisiopatología , Embarazo , Estudios Prospectivos , Factores de Riesgo , Factores SocioeconómicosRESUMEN
This prospective observational study was designed to evaluate the magnitude of the corticosteroid-related reduction in the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage and neonatal death according to different etiologic subgroups of preterm delivery. Of 380 patients delivered before 35 weeks' gestation, 155 received a complete course of dexamethasone or betamethasone to promote fetal lung maturation. In logistic models, the steroid-related reduction of RDS was greater among patients with intact membranes as opposed to patients with premature rupture of membranes (excess risk = 0.31; 95% confidence interval (C.I.) = 0.13-0.73; P = 0.007) and in patients with spontaneous preterm labor as compared with other etiologic groups (excess risk = 0.33; 95% C.I. = 0.11-0.98, P = 0.04). On the other hand, the steroid-related reduction of severe (grade III-IV) intraventricular hemorrhage was more marked in growth retarded as opposed to well-grown fetuses (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04), and in planned as compared with spontaneous preterm deliveries (excess risk = 0.15; 95% C.I. = 0.03-0.96, P = 0.04). Results show that the greatest benefit from antenatal steroids appears to be in preterm deliveries with intact membranes and in planned preterm deliveries.
Asunto(s)
Corticoesteroides/uso terapéutico , Enfermedades del Prematuro/prevención & control , Trabajo de Parto Prematuro/complicaciones , Corticoesteroides/farmacología , Adulto , Betametasona/farmacología , Betametasona/uso terapéutico , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Hemorragia Cerebral/prevención & control , Dexametasona/farmacología , Dexametasona/uso terapéutico , Femenino , Retardo del Crecimiento Fetal/tratamiento farmacológico , Humanos , Mortalidad Infantil , Recién Nacido , Enfermedades del Prematuro/epidemiología , Enfermedades del Prematuro/etiología , Pulmón/efectos de los fármacos , Masculino , Modelos Teóricos , Preeclampsia/tratamiento farmacológico , Embarazo , Resultado del Embarazo/epidemiología , Estudios Prospectivos , Síndrome de Dificultad Respiratoria del Recién Nacido/epidemiología , Síndrome de Dificultad Respiratoria del Recién Nacido/etiología , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Factores de RiesgoRESUMEN
OBJECTIVES: This study was designed to evaluate the effect of antenatal risk factors on the occurrence of germinal matrix hemorrhage or intraventricular hemorrhage in preterm infants. STUDY DESIGN: Antenatal factors were evaluated in 302 infants delivered between 24 and 33 completed weeks gestation. Ultrasonographic screening of intracranial hemorrhage was carried out in all the infants. The association between risk factors and neonatal intracranial hemorrhage was evaluated with both univariate and multivariate models. RESULTS: In stepwise logistic regression analysis, birthweight was a better predictor of neonatal germinal matrix hemorrhage than gestational age. Conversely, gestational age better predicted intraventricular hemorrhage than did birthweight. Risk factors for neonatal germinal matrix hemorrhage and intraventricular hemorrhage were dissimilar. A history of heavy (> 10 cigarettes/day) maternal smoking on admission increased the risk of germinal matrix hemorrhage three-fold (odds ratio = 3.35; 95% C.I. 1.24-9.07). Antenatal corticosteroid use reduced the risk of intraventricular hemorrhage by 76% (odds ratio = 0.24; 95% C.I. 0.09-0.61). Among patients with spontaneous preterm delivery or premature rupture of fetal membranes, the presence of labor was a significant effect modifier of the gestational-age associated risk of germinal matrix hemorrhage-intraventricular hemorrhage. CONCLUSIONS: Risk factors for neonatal germinal matrix hemorrhage are different from those for intraventricular hemorrhage. Most antenatal factors, especially those affecting fetal maturity, could influence the progression rather than the onset of intracranial hemorrhage.
Asunto(s)
Hemorragia Cerebral/etiología , Enfermedades del Prematuro/etiología , Efectos Tardíos de la Exposición Prenatal , Adulto , Peso al Nacer , Femenino , Rotura Prematura de Membranas Fetales , Edad Gestacional , Frecuencia Cardíaca Fetal , Humanos , Recién Nacido , Embarazo , Análisis de Regresión , Factores de Riesgo , Fumar/efectos adversos , TocólisisRESUMEN
We evaluated the rates of short-term neonatal complications, neonatal brain damage or mortality in a group of 96 singleton pregnancies complicated by hypertension and electively delivered before 36 weeks gestation. The neonatal outcome of these pregnancies was compared with that of a matched control group of 192 uneventful pregnancies delivered because of spontaneous preterm labor or premature rupture of membranes. Although the rates of acidosis, apneoic crises, bradycardia and ventilatory support were higher among cases than controls, the risk of intraventricular hemorrhage, severe brain damage (grade III-IV intraventricular hemorrhage or periventricular leucomalacia) or neonatal mortality were comparable between the two groups. Neonatal complications were more frequent among infants born to mothers with severe hypertension or severe proteinuria. In conclusion, this study has shown that short term neonatal complications after elective preterm delivery in hypertensive pregnancies are increased in comparison with low risk controls. However, these complications, which were well managed in our intensive care nursery, did not affected neonatal mortality or severe brain damage.
Asunto(s)
Hipertensión/complicaciones , Enfermedades del Prematuro/etiología , Trabajo de Parto Prematuro/complicaciones , Complicaciones Cardiovasculares del Embarazo , Acidosis/epidemiología , Acidosis/etiología , Adulto , Apnea/epidemiología , Apnea/etiología , Bradicardia/epidemiología , Bradicardia/etiología , Estudios de Casos y Controles , Hemorragia Cerebral/epidemiología , Hemorragia Cerebral/etiología , Femenino , Retardo del Crecimiento Fetal/complicaciones , Retardo del Crecimiento Fetal/etiología , Humanos , Incidencia , Mortalidad Infantil , Recién Nacido , Enfermedades del Prematuro/epidemiología , Análisis Multivariante , Preeclampsia/complicaciones , Preeclampsia/etiología , Embarazo , Resultado del Embarazo , Pronóstico , Estudios Prospectivos , Proteinuria/complicaciones , Proteinuria/etiologíaRESUMEN
OBJECTIVE: Our purpose was to evaluate the interactions between fetal gender and recognized risk factors of fetal growth retardation. STUDY DESIGN: A case-control study of 530 singleton pregnancies complicated by fetal growth retardation and 782 control pregnancies with appropriately grown fetuses was conducted. Interactions were evaluated by logistic regression analysis. RESULTS: In logistic regression analysis fetal growth retardation was more frequent in female than male fetuses (odds ratio 1.39, 95% confidence interval 1.06 to 1.82). In female fetuses hypertension-related fetal growth retardation was three times more common than in males. On the other hand, a low (< 50 kg) maternal prepregnancy weight and a low (< 18) body mass index (kg/m2) were significant risk factors for fetal growth retardation in male fetuses only. Although maternal smoking in pregnancy was a significant risk factor for growth retardation in both male and female fetuses, its effect was significantly stronger in male fetuses. CONCLUSION: Fetal gender can affect the magnitude of the classic risk factors for fetal growth retardation.
Asunto(s)
Retardo del Crecimiento Fetal/epidemiología , Estudios de Casos y Controles , Femenino , Humanos , Hipertensión , Masculino , Embarazo , Complicaciones Cardiovasculares del Embarazo , Análisis de Regresión , Factores de Riesgo , Factores SexualesRESUMEN
We sought to evaluate the effect of vertical transmission of human immunodeficiency virus type 1 (HIV-1) on birthweight and length of gestation. For this purpose we used maternal and pregnancy data of 559 HIV-1-seropositive pregnant women delivered at 13 Italian centers from 1985 to 1991. The mother-to-child transmission rate of HIV infection was 18.2% (84/461). After adjustment for potential confounders with multiple linear regression analysis, there were no differences in birthweight, gestational age, and proportion of expected birthweight (observed birthweight/expected birthweight) between infected and uninfected children. Intravenous drug abuse during current pregnancy was the factor which correlated best with a reduction in birthweight (mean reduction, 214.4 g; 95% confidence interval (CI), 61.7-367.1), length of gestation (mean reduction, 9.3 days; 95% CI, 3.9-14.7) and proportion of expected birthweight (mean reduction, 12.1%; 95% CI, 4.7-19.5%). In our population, HIV-1 infection of the fetus has little effect on length of gestation and birthweight.
Asunto(s)
Peso al Nacer , Edad Gestacional , Infecciones por VIH/transmisión , VIH-1 , Transmisión Vertical de Enfermedad Infecciosa , Complicaciones Infecciosas del Embarazo , Adulto , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Abuso de Sustancias por Vía IntravenosaRESUMEN
BACKGROUND: To evaluate the impact of the expectant management of hypertensive disorders of pregnancy on infant neurodevelopmental outcome. METHODS: The two-year neurodevelopmental outcome of infants delivered prematurely because of complications of maternal hypertension after expectant management was compared with that of infants of uncomplicated age-matched pregnancies delivered after spontaneous preterm labor or premature rupture of membranes. RESULTS: The rate of cerebral palsy was similar between the two groups. Conditional logistic regression analysis of the matched sets showed an increased risk of minor neurodevelopmental impairment among infants delivered after severe hypertension (odds ratio (OR) = 4.0, 95% confidence interval (CI) 1.34-12.1) or preeclampsia (OR = 4.0, 95% CI = 1.61-10.2). Fetal growth retardation was not associated with increasing infant neurodevelopmental morbidity. CONCLUSIONS: Infants delivered prematurely because of preeclampsia or severe hypertension are at increased risk of later minor neurodevelopmental problems.
Asunto(s)
Parálisis Cerebral/etiología , Hipertensión/epidemiología , Enfermedades del Sistema Nervioso/congénito , Complicaciones Cardiovasculares del Embarazo/epidemiología , Resultado del Embarazo , Parálisis Cerebral/epidemiología , Desarrollo Embrionario y Fetal , Femenino , Retardo del Crecimiento Fetal/epidemiología , Retardo del Crecimiento Fetal/etiología , Rotura Prematura de Membranas Fetales/etiología , Humanos , Hipertensión/complicaciones , Recién Nacido de Bajo Peso , Recién Nacido , Enfermedades del Sistema Nervioso/epidemiología , Trabajo de Parto Prematuro , Preeclampsia , Embarazo , Análisis de RegresiónRESUMEN
The relationship between maternal risk factors and severity of fetal growth deficit was evaluated in a population of 613 small for gestational age (SGA) infants and 784 appropriately grown controls. The severity of growth deficit among SGA infants was expressed as 'fetal growth ratio' (observed/expected birthweight, where expected birthweight is the mean birthweight of the Italian population for a given gestational age). In multivariate models, preeclampsia was the only maternal high-risk factor positively correlated with a more severe growth deficit among SGA infants. Chronic cardiac or renal maternal diseases and female fetal sex were associated with mild forms of SGA, thus showing an inverse relationship with severity of growth deficit. Finally, the association between maternal smoking in pregnancy, low (< 0.2 kg/week) maternal weight gain, low (< 50 kg) pre-pregnancy weight, severe (Hb, < 8 g/dl) maternal anaemia, low education (< 6th grade), history of a previous low birthweight infant or recurrent spontaneous abortion, nulliparity and SGA was homogeneous across the severity strata of fetal growth deficit.
Asunto(s)
Retardo del Crecimiento Fetal/etiología , Recién Nacido Pequeño para la Edad Gestacional , Anemia/complicaciones , Escolaridad , Femenino , Edad Gestacional , Cardiopatías/complicaciones , Humanos , Recién Nacido , Italia , Enfermedades Renales/complicaciones , Preeclampsia/complicaciones , Embarazo , Complicaciones del Embarazo , Factores de Riesgo , Fumar/efectos adversos , Aumento de PesoRESUMEN
The short term neonatal morbidity and 2-year neurodevelopmental outcome were evaluated in 40 low birthweight (< 2500 g) liveborn infants delivered after abruptio placentae and in 80 control infants of similar gestational age. Apgar scores at 1' and 5' were lower in infants born to mothers with severe abruption. The prevalence of intraventricular hemorrhage (Grades I-IV) was 17.5% (7/40) in the cases and 5% (4/80) in the controls (P = 0.035). Cystic periventricular leukomalacia was diagnosed in two cases (5%) and in none of the controls (P = 0.1). At 2-year follow-up, among surviving infants, cerebral palsy (spastic diplegia, hemiplegia or tetraplegia with or without mental retardation) was diagnosed in 11.1% (4/36) of the cases and in none of the 76 controls (P = 0.011). After adjustment by logistic regression analysis for the effect of confounders (gestational age, birthweight, social class and duration of mother's education) the odds ratio of a poor outcome defined as neonatal death or cerebral palsy was 4.4 (95% confidence interval, 1.2-17.0) in index cases as a whole and 8.0 (95% confidence interval, 1.5 to 43.0) in the subgroup of infants born after severe abruption. Mild abruption did not affect the 2-year infant outcome in both univariate and multivariate analysis.
Asunto(s)
Desprendimiento Prematuro de la Placenta/fisiopatología , Recién Nacido de Bajo Peso/fisiología , Sistema Nervioso/crecimiento & desarrollo , Desprendimiento Prematuro de la Placenta/complicaciones , Adulto , Puntaje de Apgar , Hemorragia Cerebral/etiología , Parálisis Cerebral/epidemiología , Parálisis Cerebral/etiología , Femenino , Edad Gestacional , Frecuencia Cardíaca Fetal , Humanos , Mortalidad Infantil , Recién Nacido , EmbarazoRESUMEN
The effects of birth order, presentation and method of delivery on neonatal mortality and neurodevelopmental outcome in nondiscordant low birthweight ( < 2500 g) twin gestations were evaluated. Sixty-four sets of twins were included in the study; 29 sets were in vertex/vertex presentation (Group I), 25 sets in vertex/breech (Group II) and in 10 pregnancies the first twin was nonvertex (Group III). The rate of favorable neonatal outcome (survival and normal neurodevelopmental outcome after a 2-year follow-up) was lower in pregnancies in which at least one twin was in nonvertex presentation (50/70 vs. 52/58 P = 0.02). However, after adjustment by multiple logistic regression analysis for the effects of gestational age, birthweight, birth order and educational level of the mother, this difference was not statistically significant (odds ratio = 0.6; 95% confidence interval 0.44 to 5.9; P = 0.5). In pregnancies in which at least one of the twins was in nonvertex presentation, delivery by cesarean section did not affect the rate of favorable neonatal outcome (odds ratio = 1.8; 95% confidence interval 0.48 to 12.9; P = 0.8). The results of this study suggest that in low birthweight twin gestations, method of delivery in relation to fetal presentation has little or no effect on neonatal mortality and subsequent neonatal neurodevelopmental outcome.