morphine and Fetal-Macrosomia

Samples of meconium and first stools were taken prospectively over the first 3 days of life from healthy, term neonates from uncomplicated deliveries (control group) and from neonates that were hypertrophic, premature, delivered through a Cesarian section or born to diabetic mothers. The variability and diagnostic value of determining alpha-1-antitrypsin (AAT), albumin and total protein in these samples was analyzed. Both the level and dynamics of AAT in the first three days of life differed between the study and control groups. No correlation was found between the AAT and albumin concentrations in the studied material. An increase in total protein content over control values was found in the same neonates that showed elevated AAT concentration in meconium and stools. The concomitant determination of AAT, albumin and total protein in stool makes it possible to discriminate between these groups of neonates with a 91.7% accuracy.

Topics: Albumins; alpha 1-Antitrypsin; Biomarkers; Cesarean Section; Feces; Female; Fetal Macrosomia; Humans; Infant, Newborn; Infant, Premature; Meconium; Pregnancy; Prospective Studies; Proteins

The frequency of complications and fetal macrosomia occurring in 243 patients with excellent dates indicating that their pregnancy was prolonged beyond 40 weeks (280 days) was analyzed and compared with that from a control group of 250 normal patients whose pregnancy ended spontaneously between 38 and 40 weeks of gestation. Complications (intrapartum fetal distress, traumatic deliveries, meconium aspiration, postmaturity syndrome) were significantly more frequent in patients in the study group (25.1%) than in the controls (5.6%). Similarly, fetal macrosomia occurred significantly more often in the study patients (29.6%) than in the controls (10.4%). To study the efficacy of antepartum surveillance in predicting these abnormal events, the postterm patients were randomized between two plans of management: 126 were followed with weekly nonstress testing (NST), and 117 with NST plus weekly ultrasound evaluation of fetal size, amniotic fluid volume, and placental grade. Contraction stress testing (CST) was used if the NST was nonreactive. Electronic monitoring had positive and negative predictive values of 42.8 and 87.7%, respectively, whereas ultrasound-plus-electronic monitoring had values of 50 and 65.3%, respectively. These results indicate that the increased incidence of complications in pregnancy prolonged beyond 40 weeks cannot be adequately predicted with antepartum electronic monitoring and ultrasound evaluation of fetal size, placental grade, and amniotic fluid volume.

Topics: Adult; Female; Fetal Distress; Fetal Macrosomia; Fetal Monitoring; Humans; Meconium; Pneumonia, Aspiration; Pregnancy; Pregnancy, Prolonged; Probability; Prospective Studies; Random Allocation; Ultrasonography

Topics: Female; Fetal Diseases; Fetal Macrosomia; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Peritonitis; Pregnancy

Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices.. The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates.. We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models.. Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital.. This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.

Topics: Abruptio Placentae; Adult; Amniotic Fluid; Chorioamnionitis; Cross-Sectional Studies; Female; Fetal Macrosomia; Hospitalization; Humans; Infant, Newborn; Infant, Small for Gestational Age; Intensive Care Units, Neonatal; Labor, Induced; Male; Meconium; Obstetrics; Parity; Pregnancy; Quality Indicators, Health Care; Quality of Health Care; Retrospective Studies; Risk Factors; Term Birth; Young Adult

Obesity is critically important to maternal and fetal health during the perinatal period. We have detected an increasing prevalence of maternal obesity in recent years and investigated its complications during pregnancy.. A total of 931 pregnant females were investigated between March 2012 and March 2013. The patients were divided into four groups: body mass index (BMI) < 18.5 kg/m(2) was underweight, 18.5-24.9 kg/m(2) was normal weight, 25-29.9 kg/m(2) was overweight and ≥30 kg/m(2) was obese. The effects of obesity on fetal and maternal outcomes were investigated.. Significant increases in pregnancy-induced hypertension, gestational diabetes mellitus, cesarean delivery, premature rupture of membranes, shoulder dystocia, meconium-stained amniotic fluid, abnormal heart rate pattern and postpartum infection rates were found in the obese group during the perinatal period. Adverse maternal effects in obese cases were significantly more frequent than those in normal-weight cases. Preterm birth, perinatal mortality, low APGAR scores, newborn intensive care unit requirement, hypoglycemia and macrosomia rates were significantly higher in obese cases than those in non-obese cases. However, low birth weight infant rate was higher in the low BMI cases than that in the other BMI categories (p < 0.01).. We conclude that obesity is an important factor associated with pregnancy complications and the increase in maternal-fetal morbidity and mortality.

Topics: Adult; Apgar Score; Body Mass Index; Cesarean Section; Diabetes, Gestational; Dystocia; Female; Fetal Macrosomia; Fetal Membranes, Premature Rupture; Heart Rate; Humans; Hypertension, Pregnancy-Induced; Hypoglycemia; Infant, Newborn; Intensive Care, Neonatal; Meconium; Obesity; Overweight; Perinatal Mortality; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Puerperal Infection; Shoulder

Immigrants have higher risks for some adverse obstetric outcomes. Furthermore, refugees are reported to be the most vulnerable group. This study compared obstetric outcomes between immigrant women originating from conflict-zone countries and ethnic Norwegians who gave birth in a low-risk setting.. This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period of women from Somalia (n = 278), Iraq (n = 166), Afghanistan (n = 71), and Kosovo (n = 67) and ethnic Norwegians (n = 6826) at Baerum Hospital from 2006-2010. Background characteristics and obstetric outcomes of each immigrant group were compared with ethnic Norwegians with respect to proportions and risks calculated by logistic regression models.. In total, 7408 women and their births were analyzed. Women from Somalia were most at risk for adverse obstetric outcomes. Compared with ethnic Norwegians, they had increased odds ratios (OR) for emergency cesarean section (OR 1.81, CI 1.17-2.80), postterm birth (OR 1.93, CI 1.29-2.90), meconium-stained liquor (OR 2.39, CI 1.76-3.25), and having a small-for-gestational-age infant (OR 3.97, CI 2.73-5.77). They had a reduced OR for having epidural analgesia (OR 0.40, CI 0.28-0.56) and a large-for-gestational-age infant (OR 0.32, CI 0.16-0.64). Women from Iraq and Afghanistan had increased risk of having a small-for-gestational-age infant with OR of 2.21 (CI 1.36-3.60) and 2.77 (CI 1.42-5.39), respectively. Iraqi women also had reduced odds ratio of having a large-for-gestational-age infant (OR 0.35, CI 0.15-0.83). Women from Kosovo did not differ from ethnic Norwegians in any of the outcomes we tested.. Even in our low-risk maternity ward, women originating from Somalia were at the greatest risk for adverse obstetric outcomes in the compared groups. We could not find the same risk among the other immigrant women, also originating from conflict-zone countries. Several factors may influence these findings, and this study suggests that immigrant women from Somalia need more targeted care during pregnancy and childbirth.

Topics: Adolescent; Adult; Afghanistan; Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Cohort Studies; Emergencies; Emigrants and Immigrants; Female; Fetal Macrosomia; Hospitals; Humans; Infant, Newborn; Infant, Small for Gestational Age; Iraq; Kosovo; Logistic Models; Meconium; Norway; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies; Risk; Somalia; Warfare; Young Adult

Obesity is a public health problem and is increasing in all populations, including pregnant women. It influences maternal and neonatal outcomes; however, data are scarce in developing countries. We aimed to compare perinatal results between obese and non-obese pregnant women in a low-risk maternity.. Transversal study of 1,779 40-week-pregnancies from 2005 to 2009 that completed a standard questionnaire with sociodemographic, obstetrical and neonatal variables and performed an ultrasound with amniotic fluid index (AFI) measurement and foetal vitality (FBP, non-stress test). They were analysed about their association with obesity on pregnancy.. When compared with non-obese women, the group of obese patients had higher systolic (118.1 vs 109.2 mmHg; p < 0.01) and diastolic (76.6 vs 70.4 mmHg; p < 0.01) pressure levels, AFI (12.52 vs. 9.61 cm; p = 0.02), presence of meconium on labour (20.52 vs. 14.67%; p = 0.02), birthweight (3602 vs. 3437 g; p < 0.01) and caesarean section (39.74 vs. 29.98%, p < 0.01).. Labour induction before 40 weeks in the antenatal period associated with foetal weight estimation should be considered as a recommendation for decreasing high percentages of caesarean delivery found in obese women.

Topics: Adult; Amniotic Fluid; Birth Weight; Blood Pressure; Body Mass Index; Brazil; Cesarean Section; Female; Fetal Macrosomia; Humans; Infant, Newborn; Labor, Induced; Meconium; Obesity; Pregnancy; Surveys and Questionnaires; Ultrasonography; Young Adult

The purpose of this study was to determine whether, when, and how rates of short-term neonatal complications increase beyond 37 weeks of gestation.. A retrospective cohort study was conducted of all low-risk, term, cephalic, and singleton births that were delivered at the University of California, San Francisco, between 1976 and 2001. Primary outcomes included neonatal umbilical artery pH, umbilical artery base excess, the presence of meconium, macrosomia, 5-minute Apgar scores, and admission to the intensive care nursery. Multivariate analyses were performed that controlled for maternal ethnicity, weight, age, socioeconomic status, and obstetric history.. Among the 32,679 women who were delivered at > or =37 completed weeks of gestation, the rates of umbilical artery pH <7.0, umbilical artery base excess less than -12 increased beyond 40 weeks of gestation, and the presence of meconium increased beyond 39 weeks of gestation (chi-squared test; P < .001). These outcomes continued to increase in each subsequent week, and these findings persisted when they were controlled for potential confounders in multivariate models.. We found that the rates of immediate neonatal morbidity increase with increasing gestational age. Accurate determination of these rates is important in the determination of gestational age at which the risk of continuing the pregnancy outweighs the risk of induction of labor.

Topics: Adult; Apgar Score; California; Cohort Studies; Female; Fetal Blood; Fetal Macrosomia; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Medical Records; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Prolonged; Retrospective Studies; Socioeconomic Factors

To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor.. A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves.. The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section.. The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Macrosomia; Gestational Age; Humans; Labor, Induced; Meconium; Multivariate Analysis; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Retrospective Studies; Risk Assessment

This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome.. This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression.. Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes.. Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.

Topics: Apgar Score; Birth Weight; Body Weight; Cesarean Section; Female; Fetal Heart; Fetal Macrosomia; Heart Rate; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Resuscitation