Abstract Objective To determine the perinatal risk factors of long-term neurologic impairment for preterm infants. Methods A case-control study was conducted with 60 neurologically impaired and 60 ...healthy children, all born prematurely. Results There was no relation between neurologic impairment and maternal pregnancy complications or prenatal steroid administration, bacteriologic content of cervical smear, fetal presentation, fetal heart rate, or mode of delivery. Cerebral palsy was associated with early neurologic signs, perinatal asphyxia, neonatal septicemia, abnormal brain ultrasound findings, prolonged interval between rupture of membranes and delivery, and multiple placental lesions. Children with minimal cerebral dysfunction were more frequently first born. Multiple placental lesions, neonatal septicemia, abnormal brain ultrasound findings, and perinatal asphyxia were independently correlated with long-term neurologic impairment. Conclusion Perinatal infection, perinatal asphyxia, and abnormal brain ultrasound findings seem to be risk factors for cerebral palsy whereas primigravidity seems to be correlated with minimal cerebral dysfunction.
Abstract Objective To determine the incidence of fetal brain injury by fetal brain magnetic resonance imaging (MRI) in pregnancies complicated with preterm labor (PL), preterm premature rupture of ...the membranes (PPROM), and intrauterine growth restriction (IUGR), and to compare fetal brain MRI with prenatal surveillance methods, and with immediate and long-term neurodevelopmental outcome. Methods Between February 2007 and January 2009, high-risk pregnancies were analyzed by MRI at 1.5 Tesla after 24 weeks of gestation at the Clinical Hospital Center Zagreb, Croatia. Long-term outcome was defined as neurodevelopmental outcome at 24 months. Results Among 70 pregnancies analyzed, 40.0% had abnormal fetal brain MRI. The highest incidence occurred in the PL group. There was no correlation between abnormal MRI and fetal surveillance methods (ultrasound, Doppler blood flow analysis, cardiotocography, biophysical profile) or immediate neonatal outcome (1-minute Apgar score, umbilical cord pH). Via MRI, fetal brain injury would have been diagnosed for 45.7% of fetuses with a long-term neurodevelopmental handicap. Binary logistic regression showed that, as compared with other surveillance methods, fetal brain MRI was the best predictor of long-term neurodevelopmental disability. Conclusion PL, IUGR, and PPROM were associated with an early intrauterine CNS insult that was not accurately detected by existing prenatal testing options.
Objective. To investigate whether maternal serum interleukin-6 (IL-6), interleukin-1β (IL-1β) and high sensitive C-reactive protein (CRP) could be used as markers of tocolysis failure and adverse ...neonatal outcome in pregnancies with preterm labor (PL).
Methods. Forty-seven maternal blood samples taken because of PL at admission and delivery were analyzed. Control samples were taken from 20 gravidas with normal pregnancies. Differences in interleukins and CRP levels with or without chorioamnionitis, connatal infection or periventricular leukomalacia (PVL) were analyzed. Cut-off values were estimated for prediction of tocolysis failure and adverse neonatal outcome.
Results. All three parameters were significantly higher in patients delivering prematurely than in patients delivering at term. All three parameters were significantly higher with than without histologic chorioamnionitis (p < 0.001), with than without connatal infection (p < 0.01), with than without PVL (p < 0.01 for IL-6 and IL-1β, p < 0.05 for CRP), and in pregnancies with preterm premature rupture of membranes (PPROM) delivered within 48 hours compared to those more prolonged (p < 0.01). Choosing 50.9 pg mL of IL-6 and a CRP of 19.7 as cut-offs in maternal blood admission concentrations for neonatal PVL, resulted in sensitivity of 81% and specificity of 91% and sensitivity of 91% and specificity of 81%, respectively. At respective maternal blood admission cut-off levels of 27.8 pg mL of IL-6 and 8.9 of CRP, both parameters were effective predictors of connatal infection.
Conclusions. Maternal blood IL-6 and CRP could become useful in predicting tocolysis failure and intrauterine treat for the fetus.
Objective: Examination and comparison of the natural histories of triplet versus quadruplet and quintuplet gestations.
Study design: A retrospective study of sixty-four multifetal pregnancies ...(fifty-two sets of triplets, nine sets of quadruplets and three sets of quintuplets) cared for during past 12 years in our department. Quintuplets and quadruplets were compared with triplet pregnancies according to gestational age, birthweight, pregnancy complications and perinatal outcome. Student’s
t-test, Fisher exact test and
χ
2 test were used for statistical analysis, considering
P value of <0.05 as statistically significant.
Results: Although mean gestational age at delivery between triplets and higher order gestations was not significantly different, birthweight of quadruplets and quintuplets was significantly lower. Pregnancy complications, including intrauterine growth retardation, were equally distributed between the groups. Early neonatal and perinatal mortality were significantly higher in quadruplets and quintuplets than in triplets. Surprisingly, survival of growth retarded fetuses was better than survival of their eutrophic counterparts. The spontaneous loss rate was 11.5% for entire triplet gestation and 16.7% for quadru- and quintuplet pregnancies.
Conclusions: As the spontaneous loss rate of triplets and higher order pregnancies observed in our study is quite similar to pregnancy loss rate caused by multifetal pregnancy reduction, conservative management of multifetal pregnancies in specialised tertiary centers seems to be a prudent solution.
Povezanost autoimunih bolesti i neuspjeha trudnoća poznata je godinama. Povišena perinatalna smrtnost i smrtnost kao i pogoršanje bolesti kod majki u korelaciji je s regulacijom bolesti prije ...trudnoće, poremetnjama tijekom trudnoće, posebice s nakalemljenom gestozom i bubrežnom insuficijencijom i postojanjem ili odsutnošću antifosfolipidnih protutijela. Postojanje antifosfolipidnih protutijela danas se sve češće povezuje s habitualnim gubitkom trudnoća, neovisno o postojanju ili odsutnosti drugih komplikacija kolagenoze. Najpogubnije je postojanje antikardiolipinskih protutijela i lupus antikoagulanta, dok je značenje ostalih autoprotutijela koja se mogu susresti u bolesnica s kolagenozama ili antifosfolipidnim sindromom danas smatra manje istraženo. U radu se raspravlja o tijeku trudnoće poremećene kolagenozom i mogućnostima liječenja.
Long-term neurodevelopmental outcome of triplets SKRABLIN, Snjezana; KUVACIC, Ivan; SIMUNIC, Velimir ...
European journal of obstetrics & gynecology and reproductive biology,
05/2007, Letnik:
132, Številka:
1
Journal Article
Recenzirano
Abstract Objective To analyze the incidence of neurodevelopmental disabilities in triplets and to find out possible connection between the outcome and perinatal events. Design Retrospective cohort ...study of 94 triplets and their outcome at 24–144 months of age correlated with gestational age, birth weight, pregnancy complications, early neonatal period, neonatal cranial ultrasound, period of birth (1985–1995, 1996–2000) and type of antenatal care. Results Sixty-two triplets are healthy, 15 suffer cerebral palsy (CP) and 17 minimal cerebral dysfunction (MCD). Adverse outcome correlates significantly with prematurity, low birth weight and maternal age. In multivariate analysis, both cerebral palsy and minor disabilities correlate significantly with early neonatal complications, neonatal cranial ultrasound with later CP ( p < 0.01), and MCD with preterm rupture of membranes ( p = 0.047). Children conceived spontaneously do worse than those born after assisted reproduction ( p = 0.004), those born in the time period 1996–2000 do better than those born before ( p = 0.021). Seventy-seven percent (77%) of newborns delivered in the time period 1996–2000 and after level 1 antenatal care was introduced, compared with 54% being delivered in the time period before 1996 and with less meticulous types of antenatal care, remain healthy ( p = 0.015). Conclusion Triplets are still at high risk for long-term neurodevelopmental complications. Stringent perinatal care might appear important determinant of their long-term outcome.
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