Is hysteroscopic metroplasty using the incision method for septate uterus a risk factor for adverse obstetric outcomes?

2019 ◽  
Vol 45 (3) ◽  
pp. 634-639 ◽  
Author(s):  
Shuichi Ono ◽  
Yoshimitsu Kuwabara ◽  
Shigeru Matsuda ◽  
Mirei Yonezawa ◽  
Kenichiro Watanabe ◽  
...  
Keyword(s):  
Risk Factor ◽  
Obstetric Outcomes ◽  
Septate Uterus

scholarly journals Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marta Claramonte Nieto ◽  
Eva Meler Barrabes ◽  
Sandra Garcia Martínez ◽  
Mireia Gutiérrez Prat ◽  
Bernat Serra Zantop
Keyword(s):  
Risk Factor ◽  
Gestational Diabetes ◽  
Maternal Age ◽  
Placenta Previa ◽  
Significant Risk ◽  
Advanced Maternal Age ◽  
Obstetric Outcomes ◽  
Chronic Hypertension ◽  
Mediterranean Population ◽  
Confounding Factors

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

P-746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
O Abuzeid ◽  
C Heiselman ◽  
A Fuchs ◽  
J La Chance ◽  
K Herrera ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Surgical Correction ◽  
Obstetric Outcomes ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Septate Uterus ◽  
Significant Difference ◽  
Singleton Birth ◽  
History Of

Abstract Study question The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus. Summary answer The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os. What is known already Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os. Study design, size, duration This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 -2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment. Participants/materials, setting, methods This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups. Main results and the role of chance There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P=0.002) and history of RPL (P=0.017) in the study group. There was significant lower incidence of tubal factors infertility (P=0.005) and endometriosis (P=0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P=0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P=0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P=0.000), and delivery by CS (69.6% vs 41.2%; P=0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P=0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively. Limitations, reasons for caution A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed. Wider implications of the findings Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri. Trial registration number Not Applicable

scholarly journals Impact of the Length of Interpregnancy Interval on Obstetric Outcomes

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
S S T Mohammed ◽  
S A Ashoush ◽  
K H Sweedan ◽  
R R Ali
Keyword(s):  
Risk Factor ◽  
Pregnancy Outcomes ◽  
Perinatal Death ◽  
Perinatal Outcomes ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
Fetal Survival ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Abstract Background Inter-pregnancy interval (IPI) is defined as the period between the last delivery and conception of the current pregnancy. Both short and long intervals between pregnancies have been associated with an increased risk of variable adverse outcomes, such as preterm birth, low birth weight (LBW), small size for gestational age, and perinatal death. Aim of the Work To assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Patients and Methods This study was held in Ain Shams University Maternity Hospital on 1719 patients ranging between the ages of 18-35 years. They were divided into three groups according to the length of their IPI [444 patients in group p1 (6-18 months), 847 patients in group p2 (18-48) and 428 patients in group p3 (&gt; 48 months)]. The aim of this study was to assess the impact of IPI as a risk factor for adverse pregnancy and perinatal outcomes. Results The incidence of LBW among patients with IPI 6-18 months was 11.5%, 12.5% among those with IPI 18-48 months and 16.8% among those with IPI &gt; 48 months. It was also found that the rate of short IPI decreases with age, being more common among the younger age, lower parity groups. The incidence of gestational DM increased with longer IPI. Parity, previous miscarriages, cesarean sections and preterm labor were all significantly associated with the length of IPI. Conclusion This study confirms that both shorter and longer IPIs are associated with increased risks of adverse pregnancy outcomes. This study provides critical information relevant for improving pregnancy outcomes and fetal survival.

scholarly journals CASE REPORT ON FINDING OF ABNORMAL PRESENTATION OF FETUS IN A PARTIAL SEPTATE UTERUS DURING CESAREAN SECTION WITH PARTIAL PLACENTAL SEPTAL IMPLANTATION

2021 ◽  
Vol 9 (04) ◽  
pp. 243-245
Author(s):  
Komal Vijaywargiya ◽  
◽  
Suneeta Bhatnagar ◽  
Aayushi Ruia ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Cesarean Section ◽  
Successful Outcome ◽  
Obstetric Outcomes ◽  
Reproductive Outcome ◽  
Term Pregnancy ◽  
Septate Uterus ◽  
Uterine Anomalies ◽  
Uterine Anomaly ◽  
Uterine Septum

Congenital uterine anomalies are seen 1-3% of women, usually asymptomatic and therefore unrecognized until desire of childbearing.[1] Uterine septum is the most frequent (35-48%) structural uterine anomaly and associated with the poorest reproductive outcome. Even if association of septum with infertility is not certain, it is well recognized that it worsens obstetric outcomes with high abortion (44%) and preterm delivery rate (22%).[1] In this case report, we aim to present a term pregnancy with successful outcome with placental implantation on uterine septum.

scholarly journals Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes

2021 ◽  
Vol 18 (24) ◽  
pp. 13117
Author(s):  
María De la Calle ◽  
Jose L. Bartha ◽  
Laura García ◽  
Marcos J. Cuerva ◽  
David Ramiro-Cortijo
Keyword(s):  
Risk Factor ◽  
Retrospective Cohort ◽  
Maternal Age ◽  
Independent Risk Factor ◽  
Adverse Outcomes ◽  
Obstetric Outcomes ◽  
P Value ◽  
Labor Complications ◽  
Twin Pregnancies ◽  
Over 40 Years

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

P–746 Obstetric outcomes of singleton birth after hysteroscopic division of septate uterus

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
O Abuzeid ◽  
C Heiselman ◽  
A Fuchs ◽  
J L Chance ◽  
K Herrera ◽  
...  
Keyword(s):  
Lower Incidence ◽  
Surgical Correction ◽  
Obstetric Outcomes ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Septate Uterus ◽  
Significant Difference ◽  
Singleton Birth ◽  
History Of

Abstract Study question The aim of this study is to determine the obstetric outcomes in patients with a singleton birth after hysteroscopic division of septate uterus. Summary answer The data suggest excellent obstetric outcomes for singleton gestation after hysteroscopic division of a septate uterus reaching either the internal or the external cervical os. What is known already Septate uterus is a rare Müllerian anomaly with major impact on reproductive outcomes, particularly with a septum over 10mm. Controversy still exists over the need for surgical correction of the septum due to conflicting data on outcomes, particularly in women with histories of good obstetric outcomes and incidental septum findings. Placental location in relation to the septum may account for such conflicting reports. Most data on reproductive outcomes after hysteroscopic surgical correction combine both septate and subseptate uteri. There is limited published data on obstetric outcomes after hysteroscopic surgical correction of septate uteri, especially septate uteri reaching the external os. Study design, size, duration This retrospective cohort study included 107 patients with infertility and/or recurrent pregnancy loss (RPL) who received treatment between 2002 –2019. The study group included 24 patients with a singleton birth after hysteroscopic correction of septate uterus (Class Va; ASRM classification) that was diagnosed on trans-vaginal 3D ultrasound. The control group included 83 patients with a singleton birth who had normal endometrial cavity on hysteroscopy during the same period of time, before starting treatment. Participants/materials, setting, methods This study was conducted at an infertility clinic affiliated with a teaching hospital. In the study group the septum reached the internal or the external cervical os in 14 and 10 patients respectively. After hysteroscopic correction, all patients were offered various infertility treatments depending on the underlying etiology. The inclusion criterion in this study was to have a singleton birth after hysteroscopy. Demographic and clinical data and obstetric outcomes were compared between the two groups. Main results and the role of chance There was no significant difference in mean age, infertility duration, infertility type and incidence of male infertility or ovulatory disorders between the two groups. There was a significantly higher BMI (0.048), and a higher incidence of history of miscarriage (P = 0.002) and history of RPL (P = 0.017) in the study group. There was significant lower incidence of tubal factors infertility (P = 0.005) and endometriosis (P = 0.03) in the study group, therefore there was higher incidence of spontaneous conception (70.8% vs 19.3%; P = 0.000) and lower incidence of conception with IVF-ET (20.8% vs 66.3%; P = 0.000) in the study group compared to the control group respectively. There was significantly higher incidence of prophylactic cervical cerclage (17.4% vs 0%; P = 0.000), and delivery by CS (69.6% vs 41.2%; P = 0.019) and lower incidence of vaginal delivery (30.4% vs 58.8%; P = 0.019), in the study group compared to the control group. There was no significant difference in gestational age in weeks (38.3 + 1.8 vs 38.6 + 2.0), newborn birth weight in grams (3173.9 + 630.0 vs 3202.1 + 555.6), incidence of premature birth (12.5% vs 12.2%), or other obstetric complications (25% vs 17.6%) between the study and the control groups respectively. For premature births, mean gestational age was 34.3 + 0.47 and 34.6 + 1.2 weeks in the study and control groups respectively. Limitations, reasons for caution A retrospective study has its own inherent bias. Furthermore, the small sample size is explained by the fact that a septate uterus is a rare anomaly leading to difficulties finding cases and organizing a prospective study to achieve a larger sample size. A multicenter prospective study is needed. Wider implications of the findings: Regardless of whether the septum reached the internal or external os, there were excellent obstetric outcomes in singleton gestations after hysteroscopic correction of septate uteri. There was no increased risk with septate uteri involving the cervix. Hysteroscopic surgical correction should be the treatment of choice for patients with septate uteri. Trial registration number Not applicable

Clinical aspects of reactive oxygen and nitrogen species

2004 ◽  
Vol 71 ◽  
pp. 121-133 ◽  
Author(s):  
Ascan Warnholtz ◽  
Maria Wendt ◽  
Michael August ◽  
Thomas Münzel
Keyword(s):  
Oxidative Stress ◽  
Reactive Oxygen Species ◽  
Risk Factor ◽  
Endothelial Dysfunction ◽  
Vascular Tissue ◽  
Rapid Development ◽  
Reactive Oxygen ◽  
Clinical Aspects ◽  
No Production ◽  
Oxygen Species

Endothelial dysfunction in the setting of cardiovascular risk factors, such as hypercholesterolaemia, hypertension, diabetes mellitus and chronic smoking, as well as in the setting of heart failure, has been shown to be at least partly dependent on the production of reactive oxygen species in endothelial and/or smooth muscle cells and the adventitia, and the subsequent decrease in vascular bioavailability of NO. Superoxide-producing enzymes involved in increased oxidative stress within vascular tissue include NAD(P)H-oxidase, xanthine oxidase and endothelial nitric oxide synthase in an uncoupled state. Recent studies indicate that endothelial dysfunction of peripheral and coronary resistance and conductance vessels represents a strong and independent risk factor for future cardiovascular events. Ways to reduce endothelial dysfunction include risk-factor modification and treatment with substances that have been shown to reduce oxidative stress and, simultaneously, to stimulate endothelial NO production, such as inhibitors of angiotensin-converting enzyme or the statins. In contrast, in conditions where increased production of reactive oxygen species, such as superoxide, in vascular tissue is established, treatment with NO, e.g. via administration of nitroglycerin, results in a rapid development of endothelial dysfunction, which may worsen the prognosis in patients with established coronary artery disease.

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