scholarly journals Anti-Phosphatidylserine/Prothrombin Antibodies Are Associated with Adverse Pregnancy Outcomes

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Polona Žigon ◽  
Katja Perdan Pirkmajer ◽  
Matija Tomšič ◽  
Tanja Kveder ◽  
Borut Božič ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Premature Birth ◽  
Lupus Anticoagulant ◽  
Premature Delivery ◽  
Normal Fetus ◽  
Glycoprotein I ◽  
History Of ◽  
Adverse Pregnancy ◽  
Normal Neonate

Objective. To determine the prevalence and clinical association of anti-phosphatidylserine/prothrombin antibodies (aPS/PT) in patients with a history of pregnancy complications relevant to antiphospholipid syndrome (APS).Materials and Methods. Two hundred and eleven patients with a history of (a) three or more consecutive miscarriages before 10th week of gestation (WG) (n=64), (b) death of a morphologically normal fetus beyond 10th WG (n=72), (c) premature birth of a morphologically normal neonate before 34th WG due to eclampsia, preeclamsia and placental insufficiency (n=33), and (d) less than three unexplained consecutive miscarriages before 10th WG (n=42). Subjects sera were analyzed for lupus anticoagulant (LA), anti-cardiolipin (aCL), anti-β2-glycoprotein I (anti-β2GPI), and aPS/PT antibodies.Results. 41/169 (24.3%) of patients were positive for at least one measured aPL. The highest prevalence was found for aPS/PT and aCL (13.0% and 12.4%, resp.) followed by LA (7.7%) and anti-β2GPI (7.1%). 11/169 with APS-related obstetric manifestations had only aPS/PT. 17.8% of patients were positive for LA or aCL and/or anti-β2GPI; however when adding the aPS/PT results, an additional 7% of patients could be evaluated for APS.Conclusion. aPS/PT are associated with recurrent early or late abortions and with premature delivery irrespective of other aPL.

Annexin A5 Resistance Is Associated with Thrombotic Risk in Patients with the Lupus Anticoagulant: The Vienna Lupus Anticoagulant and Thrombosis Study (LATS)

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3555-3555
Author(s):  
Florian Posch ◽  
Johanna Gebhart ◽  
Wu Xiao-Xuan ◽  
Silvia Koder ◽  
Cihan Ay ◽  
...  
Keyword(s):  
Pregnancy Complications ◽  
Lupus Anticoagulant ◽  
Pregnancy Complication ◽  
Mean Difference ◽  
Annexin A5 ◽  
Glycoprotein I ◽  
Spearman's Rho ◽  
Spearman’S Rho ◽  
History Of ◽  
Thrombotic Complications

Abstract INTRODUCTION: Antiphospholipid (aPL) antibody mediated interference with the anticoagulant effect of annexin A5 (A5) - designated "annexin A5 resistance" (A5R) - has been implicated in adverse clinical outcomes. In this study, we ask whether A5R is associated with anamnestic thrombotic complications and adverse pregnancy outcomes in patients with the lupus anticoagulant (LA). PATIENTS & METHODS: We conducted a cross-sectional study including 143 patients (median age: 40.5 years, interquartile range (IQR): 31.8-60.0; female: n=119) who tested persistently positive for LA according to ISTH criteria (Miyakis et al. J Thromb Haemost 2006; 4: 295). Thrombotic complications were defined as a composite of arterial and/or venous thromboembolic events. Pregnancy complications were defined according to the modified Sapporo criteria. Out of the 143 patients, 94 (65.7%) had a history of a thrombembolic event (arterial: n=21, venous: n=80, both: n=7). Ninety-three women had at least one pregnancy, and 40 (43.0%) out of these women had at least one pregnancy complication as defined by the above mentioned criteria. It is important to mention that on average, these pregnancy complications had occurred more than ten years before study inclusion. A5R assays were done using phospholipid that was first exposed to patient plasmas as previously described; A5R results were expressed as the ratio of coagulation times with and without annexin A5. In a subsample (n=109), a blinded external validation using two separate measurements of the A5R was performed. RESULTS: In blinded analysis, the concordance between the two A5R measurements was very high (Liu's concordance correlation coefficient=0.83, average difference=12.2 units (95% limits of agreement from Bland-Altman analysis: -37.0 - 61.3). The A5R was inversely correlated with levels of antibodies against cardiolipin (Spearman's rho for IgG and IgM: -0.65 and -0.24, respectively), and against beta2-glycoprotein I (Spearman's rho for IgG and IgM: -0.57 and -0.28). The median A5R level was 205 units (IQR: 205-250, range: 130-336). Patients with a prior history of a thrombotic complications had significantly lower median levels of A5R (193.1 vs. 238.7 units, mean difference: 26.7 units (95% CI: 11.0-42.4), p=0.001). This difference was independent of both IgG and IgM isotype antibody levels against cardiolipin and beta2-glycoprotein I (adjusted mean difference: 20.7 units (95% CI: 6.4-35.0), p=0.005), and of whether patients were on anticoagulation or not (adjusted mean difference: 24.8 units (95% CI: 4.3 - 45.2), p=0.018). In the 95 women with at least one pregnancy, average A5R were lower in women with (n=40) compared to those without (n=53) at least one pregnancy complication (median: 200.9 vs. 231.9 units), however, this difference was not statistically significant (t-test p=0.255). CONCLUSION: A5R is associated with a history of thromboembolic complications in LA positive patients, suggesting that the ex vivo measurement of the A5R may reflect a prothrombotic phenotype in this patient population. Interestingly, we found no clear association between the A5R and anamnestic pregnancy complications was observed, however, the generalizability of this finding is hampered by the long time interval between anamnestic pregnancy complications and inclusion in this study. Disclosures No relevant conflicts of interest to declare.

scholarly journals Adverse Pregnancy Outcomes of Patients with History of First-Trimester Recurrent Spontaneous Abortion

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Jing Yang ◽  
Yan Wang ◽  
Xiao-ye Wang ◽  
Yan-yu Zhao ◽  
Jing Wang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cesarean Section ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
First Trimester ◽  
Recurrent Spontaneous Abortion ◽  
Study Group ◽  
History Of ◽  
Adverse Pregnancy

Although a history of first-trimester recurrent spontaneous abortion (FRSA) is regarded as a risk factor in antenatal care, the characteristic of subsequent pregnancy outcome is not clearly elucidated. Here, a retrospective analysis was performed on the clinical data of 492 singleton pregnant women. 164 of them with the history of FRSA were enrolled in study group, compared to 328 deliveries without the history of FRSA. For maternal outcomes, patients in the study group delivered earlier with mean gestational age and the incidences of cesarean section and postpartum hemorrhage were higher compared to the control group. For placental outcomes, the incidence of placenta-mediated pregnancy complications (PMPC) in the study group increased in terms of late-onset preeclampsia, oligohydramnios, early-onset fetal growth restriction, and second-trimester abortion. Patients in the study group were more likely to suffer from placenta accreta, placenta increta, and placenta percreta. For perinatal outcomes, the proportion of birth defects of newborns in the study group was greater. At last, logistic regression analyses showed that the history of FRSA was an independent risk factor for cesarean section and pregnancy complications. In conclusion, women with the history of FRSA are often exposed to an elevated incidence of maternal-placental-perinatal adverse pregnancy outcomes.

The Association Between Antiphospholipid Antibodies and Adverse Pregnancy Outcomes: A Metaanalysis.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1819-1819
Author(s):  
Karim Abou-Nassar ◽  
Marc Carrier ◽  
Marc Rodger
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Antiphospholipid Antibodies ◽  
Lupus Anticoagulant ◽  
Placental Abruption ◽  
Fetal Loss ◽  
Anticardiolipin Antibodies ◽  
Adverse Pregnancy Outcomes ◽  
Clinical Criteria ◽  
Adverse Pregnancy

Abstract BACKGROUND: The Sapporo criteria for the diagnosis of the antiphospholipid syndrome (APS) are based on the presence of antiphospholipid antibodies (APLA) and clinical criteria. Although pre-eclampsia, intra-uterine growth restriction (IUGR), late fetal loss and placental abruption, collectively termed “placenta mediated complications”, are recognized as clinical criteria for the APS, their association with APLA remains controversial. OBJECTIVE: This review was conducted to evaluate the association between APLA (anticardiolipin antibodies, lupus anticoagulant, anti B2 glycoprotein 1 antibodies) and placenta mediated complications in untreated women without autoimmune diseases. METHODS: We performed a systematic review of published case-control, cohort and cross sectional studies using MEDLINE (1975 to October week 2 2007), EMBASE 16 (1980 to 2007 week 42) and all EBM Reviews (3rd quarter of 2007). For eligible studies, the rates of adverse pregnancy outcomes were compared between patients with and without specific APLA. Pooled odds ratios with 95% CI were generated using random-effects models. RESULTS: Our search strategy identified 1204 potentially relevant studies. Twenty five were included in the final analysis. Results are outlined in table 1. CONCLUSION: The association between various APLA and pregnancy complications is for the most part weak and inconsistent. There is currently insufficient data to support a significant link between anti-B2 glycoprotein 1 antibodies and pregnancy morbidity. Caution should be used when establishing a diagnosis of APS based on the presence of any APLA, particularly anti-B2 glycoprotein 1 antibodies, in the setting of late pregnancy complications. Table 1 Association Between APLA and Adverse Pregnancy Outcomes Pre-eclampsia OR (95%CI) # studies / participants IUGR OR (95%CI) # studies / participants Placental abruption OR (95%CI) # studies / participants Late fetal loss OR (95%CI) # studies / participants LA: Lupus anticoagulant; aCL: Anticardiolipin antibodies; Anti-B2 GP1 antibodies: Anti-B2 glycoprotein 1 antibodies italic characters indicate statistically significant associations LA 2.88 (1.42, 5.87)
 11 / 6085 3.51 (1.38, 8.93)
 4 / 3232 0.78 (0.13, 4.80)
 2 / 226 3.56 (0.12, 106.05)
 3 / 3870 aCL (IgG/IgM) 1.71 (1.09, 2.70)
 21 / 9722 2.31 (0.74, 7.17)
 6 / 5753 1.35 (0.45, 4.02)
 4 / 1274 3.86 (1.14, 13.07)
 7 / 5963 aCL IgG 1.65 (0.84, 3.22)
 15 / 3627 6.16 (2.50, 15.18)
 2 / 1006 1.87 (0.21, 16.83)
 2 / 500 10.06 (0.88, 114.96)
 2 / 1006 aCL IgM 1.36 (0.93, 1.97)
 13 / 5397 0.75 (0.19, 2.93)
 2 / 3002 0.96 (0.24, 3.85)
 2 / 500 1.37 (0.42, 4.46)
 3 / 3212 anti- B2GP1 (IgG/IgM) 2.97 (0.47, 18.69)
 4 / 2225 20.03 (4.59, 87.43)
 1 / 1108 2.64 (0.14, 50.63)
 1 / 510 6.74 (0.24, 191.23)
 3 / 1828 anti- B2GP1 IgG 0.87 (0.38, 2.01)
 2 / 607 N/A
 0 / 0 N/A
 0 / 0 0.52 (0.02, 11.02)
 1 / 212 anti- B2GP1 IgM 0.37 (0.16, 0.85)
 1 / 400 N/A
 0 / 0 N/A
 0 / 0 1.32 (0.24, 7.42)
 1 / 210

scholarly journals Fetal growth restriction as the initial finding of preeclampsia is a clinical predictor of maternal and neonatal prognoses: a single-center retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masaya Takahashi ◽  
Shintaro Makino ◽  
Kyoko Oguma ◽  
Haruka Imai ◽  
Ai Takamizu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Fetal Growth Restriction ◽  
Premature Birth ◽  
Adverse Pregnancy Outcomes ◽  
Growth Restriction ◽  
Hypertensive Disorder ◽  
Adverse Pregnancy

Abstract Background Preeclampsia (PE) is a hypertensive disorder specific to pregnancy that can cause severe maternal-neonatal complications. The International Society for the Study of Hypertension in Pregnancy revised the PE criteria in 2018; a PE diagnosis can be established in the absence of proteinuria when organ or uteroplacental dysfunction occurs. The initial findings of PE (IFsPE) at the first diagnosis can vary considerably across patients. However, the impacts of different IFsPE on patient prognoses have not been reported. Thus, we investigate the predictors of pregnancy complications and adverse pregnancy outcomes based on IFsPE according to the new criteria. Methods This retrospective study included 3729 women who delivered at our hospital between 2015 and 2019. All women were reclassified based on the new PE criteria and divided into three groups based on the IFsPE: Classification 1 (C-1), proteinuria (classical criteria); Classification 2 (C-2), damage to other maternal organs; and Classification 3 (C-3), uteroplacental dysfunction. Pregnancy complications and adverse pregnancy outcomes were assessed and compared among the three groups. Results In total, 104 women with PE were included. Of those, 42 (40.4%), 28 (26.9%), and 34 (32.7%) were assigned to C-1, C-2, and C-3 groups, respectively. No significant differences in maternal characteristics were detected among the three groups, except for gestational age at PE diagnosis (C-1, 35.5 ± 3.0 weeks; C-2, 35.2 ± 3.6 weeks; C-3, 31.6 ± 4.6 weeks, p <  0.01). The rates of premature birth at < 37 weeks of gestation, fetal growth restriction (FGR), and neonatal acidosis were significantly higher in the C-3 group compared to the C-1 and C-2 groups. Additionally, the composite adverse pregnancy outcomes of the C-3 group compared with C-1 and C-2 represented a significantly higher number of patients. Conclusions PE patients with uteroplacental dysfunction as IFsPE had the most unfavorable prognoses for premature birth, FGR, acidosis, and composite adverse pregnancy outcomes.

scholarly journals High risk of adverse pregnancy outcomes in women with a persistent lupus anticoagulant

2019 ◽  
Vol 3 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Johanna Gebhart ◽  
Florian Posch ◽  
Silvia Koder ◽  
Peter Quehenberger ◽  
Thomas Perkmann ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Lupus Anticoagulant ◽  
Adverse Pregnancy Outcomes ◽  
Antiphospholipid Antibody ◽  
Childbearing Age ◽  
Elevated Liver Enzymes ◽  
Increased Risk ◽  
Adverse Pregnancy

Abstract Lupus anticoagulant (LA) has been associated with pregnancy complications and pregnancy loss. Identification of predictive factors could aid in deciding on therapeutic management. To identify risk factors for adverse pregnancy outcomes in high-risk women with persistently positive LA, we prospectively followed 82 women of childbearing age, of whom 23 had 40 pregnancies within the Vienna Lupus Anticoagulant and Thrombosis Study. Pregnancy complications occurred in 28/40 (70%) pregnancies, including 22 (55%) spontaneous abortions (&lt;10th week of gestation [WOG]: n = 12, 10th to 24th WOG: n = 10) and 6 deliveries &lt;34th WOG (15%, 3 due to severe preeclampsia/HELLP [hemolysis, elevated liver enzymes, and a low platelet count] syndrome, 3 due to placental insufficiency). One abortion was followed by catastrophic antiphospholipid syndrome. Neither a history of pregnancy complications nor of thrombosis, or prepregnancy antiphospholipid antibody levels were associated with adverse pregnancy outcomes. In logistic regression analysis, higher age was associated with a lower risk of adverse pregnancy outcome (per 5 years’ increase: odds ratio [OR] = 0.41, 95% confidence interval [CI]: 0.19-0.87), a high Rosner index (index of circulating anticoagulant) predicted an increased risk (OR = 4.51, 95% CI: 1.08-18.93). Live birth rate was 15/28 (54%) in women on the combination of low-molecular-weight heparin and low-dose aspirin and 3/12 (25%) in those with no treatment or a single agent. We conclude that the risk of severe, even life-threatening pregnancy complications and adverse pregnancy outcomes is very high in women with persistent LA. A high Rosner index indicates an increased risk. Improved treatment options for women with persistently positive LA are urgently needed.

scholarly journals A102 ADVERSE PREGNANCY-RELATED OUTCOMES IN WOMEN WITH INFLAMMATORY BOWEL DISEASE

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 77-79
Author(s):  
Y Hanna ◽  
P Tandon ◽  
V W Huang
Keyword(s):  
Inflammatory Bowel Disease ◽  
Disease Activity ◽  
Bowel Disease ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Categorical Variables ◽  
History Of ◽  
Inflammatory Bowel ◽  
Adverse Pregnancy ◽  
Aspirin Prophylaxis

Abstract Background Women with active inflammatory bowel disease (IBD) are at increased risk of adverse pregnancy outcomes such as preeclampsia. Though aspirin prophylaxis is prescribed in the general population (prior to 16 weeks’ gestation) for those at high-risk of preeclampsia, its use in patients with IBD has not been established. Aims To determine the frequency of and risk factors for adverse pregnancy outcomes in women with IBD, and to evaluate the risk for preeclampsia and the use of aspirin for primary prevention. Methods All pregnant women with IBD (Crohns disease (CD), ulcerative colitis (UC) and IBD-unclassified (IBDU)) seen at Mount Sinai Hospital from 2016–2020 were retrospectively identified. Demographics, reproductive history, and IBD characteristics including therapy and activity during pregnancy were recorded. Adverse pregnancy outcomes were also identified. Active disease during pregnancy was defined as a fecal calprotectin &gt; 250 ug/g and/or using clinical disease activity scores. Categorical variables were compared using the Chi-square (x2) test and continuous variables using the Mann-Whitney test. A two-sided p-value less than 0.05 was considered statistically significant. Results 127 patients (66 with CD, 60 with UC, 1 with IBDU) were included with a median age of 32 years at conception. The majority were Caucasian (70.9%), married (82.7%), completed post-secondary education (69.3%), had no prior or current smoking (78.7%) or alcohol use history (67.7%), and had no other comorbidities (81.9%). 50.4% of women had a prior pregnancy. 3 had a history of preeclampsia and 15/127 were prescribed aspirin prophylaxis. 73.2% of women were in clinical remission at conception. Compared to women with CD, women with UC were more likely to have infants with low birth weight (LBW) (p=0.031), small for gestational age (SGA) (p=0.002) and had higher rates of active IBD during pregnancy (p=0.005). 13 women with IBD developed preeclampsia (6 with UC and 7 with CD). IBD type (p=0.844) and disease activity (p=0.308) were not associated with preeclampsia. Married women (p=0.001) while those who had a preconception consultation (50/127) (p=0.009) had lower rates of preeclampsia while those with a prior history of preeclampsia had higher rates (p=0.002). Among women who developed preeclampsia, pregnancy outcomes were comparable to those who did not. Women on aspirin prophylaxis (5/13) had a higher rate of preeclampsia (p=0.012), although they were also more likely to have a history of preeclampsia (p=0.002). Aspirin use was not associated with subsequent disease activity in pregnancy (p=0.830). Conclusions Women receiving aspirin prophylaxis had higher rates of preeclampsia, likely owing to a higher baseline risk. Preeclampsia prevention with aspirin prophylaxis does not appear to result in disease flares but larger studies are needed to confirm this finding. Funding Agencies None

Pregnancy outcomes of women with and without a history of anorexia nervosa

2012 ◽  
Vol 42 (12) ◽  
pp. 2651-2660 ◽  
Author(s):  
J. M. Eagles ◽  
A. J. Lee ◽  
E. Amalraj Raja ◽  
H. R. Millar ◽  
S. Bhattacharya
Keyword(s):  
Anorexia Nervosa ◽  
Pregnancy Outcomes ◽  
Intrauterine Growth Restriction ◽  
Maternal Body Mass Index ◽  
Intrauterine Growth ◽  
North East ◽  
Increased Risk ◽  
History Of ◽  
Obstetric Services ◽  
Adverse Pregnancy

BackgroundWhen women have a history of anorexia nervosa (AN), the advice given about becoming pregnant, and about the management of pregnancies, has usually been cautious. This study compared the pregnancy outcomes of women with and without a history of AN.MethodWomen with a confirmed diagnosis of AN who had presented to psychiatric services in North East Scotland from 1965 to 2007 were identified. Those women with a pregnancy recorded in the Aberdeen Maternal and Neonatal Databank (AMND) were each matched by age, parity and year of delivery of their first baby with five women with no history of AN. Maternal and foetal outcomes were compared between these two groups of women. Comparisons were also made between the mothers with a history of AN and all other women in the AMND.ResultsA total of 134 women with a history of AN delivered 230 babies and the 670 matched women delivered 1144 babies. Mothers with AN delivered lighter babies but this difference did not persist after adjusting for maternal body mass index (BMI) in early pregnancy. Standardized birthweight (SBW) scores suggested that the AN mothers were more likely to produce babies with intrauterine growth restriction (IUGR) [relative risk (RR) 1.54, 95% confidence interval (CI) 1.11–2.13]. AN mothers were more likely to experience antepartum haemorrhage (RR 1.70, 95% CI 1.09–2.65).ConclusionsMothers with a history of AN are at increased risk of adverse pregnancy outcomes. The magnitude of these risks is relatively small and should be appraised holistically by psychiatric and obstetric services.

Neonatal outcome in pregnant patients with antiphospholipid syndrome

2015 ◽  
Vol 43 (6) ◽  
Author(s):  
Katarina Jeremic ◽  
Aleksandar Stefanovic ◽  
Jelena Dotlic ◽  
Jelena Stojnic ◽  
Sasa Kadija ◽  
...  
Keyword(s):  
Risk Factors ◽  
Respiratory Distress Syndrome ◽  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Distress Syndrome ◽  
Adverse Pregnancy Outcome ◽  
Perinatal Asphyxia ◽  
Premature Delivery ◽  
Control Group ◽  
Adverse Pregnancy

AbstractThe study aim was to evaluate pregnancy outcomes in patients with antiphospholipid syndrome (APS) and to determine which clinical parameters present risk factors for adverse pregnancy outcomes in these patients.The study included 55 patients with APS treated at the Clinic for Ob/Gyn, Clinical Center of Serbia, from 2006 to 2012. The control group consisted of 55 healthy pregnant women. Data regarding previous pregnancies and conception method were registered. Immunological and laboratory tests were performed. Pregnancy outcomes, including miscarriage, intrauterine fetal death, hypertensive disorders, diabetes mellitus, phlebothrombosis, fetal growth restriction, premature delivery, delivery method, perinatal asphyxia, respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis were followed.The premature delivery rate in APS patients was 31.8%, and pregnancy loss was 18.2%. Significantly more patients with APS had thrombocytopenia, pregnancy losses, intrauterine growth restriction, and perinatal asphyxia compared with the control group. More miscarriages, preterm delivery, lower birth weight, preeclampsia, and IgM anticardiolipin antibody levels significantly correlated with adverse pregnancy outcomes. Although rare, respiratory distress syndrome can also worsen neonatal health status. According to ROC analysis, previous miscarriages correctly explained 66.3% of adverse pregnancy outcome cases. We generated four equations of adverse pregnancy outcome risk factors.The most important prognostic factor for pregnancy outcome in APS patients is the number of previous miscarriages. Using appropriate current therapeutic protocol can enable live birth of a healthy newborn in most cases.

Role of biometric characteristics of the uterine junctional zone in fertility outcomes in patients with adenomyosis

2021 ◽  
Vol 70 (3) ◽  
pp. 41-50
Author(s):  
Ekaterina K. Orekhova ◽  
Olga A. Zhandarova ◽  
Igor Yu. Kogan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Resonance Imaging ◽  
Junctional Zone ◽  
History Of ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

BACKGROUND: The uterine junctional zone is the inner part of the myometrium. Dysfunction of the zone may underlie the pathogenesis of adenomyosis and its clinical manifestations, while biometric characteristics of the zone are currently considered as promising early diagnostic criteria for this disease. Adenomyosis has traditionally been associated with parity and intrauterine interventions, primarily in older patients. However, modern imaging tools often allow diagnosing the disease in young patients with infertility and an unburdened gynecological history. It is assumed that the detection of changes in the structure and function of the uterine junctional zone in adenomyosis can be the basis for predicting fertility outcomes and complications of pregnancy, as well as for the development of promising therapeutic strategies at the pregravid stage. AIM: The aim of this study was to assess the influence of biometric characteristics of the uterine junctional zone on pregnancy outcomes, depending on the parity and intrauterine interventions in patients with adenomyosis. MATERIALS AND METHODS: This prospective study included 102 patients aged 2239 years old with ultrasound features of adenomyosis who were going to conceive. The patients were divided into two groups: Group 1 (n = 58) consisted of nulliparous patients with no history of previous intrauterine interventions, and Group 2 (n = 44) comprised multipara women with a history of labor and / or intrauterine interventions. Using magnetic resonance imaging, we evaluated minimal, average and maximal junctional zone thicknesses, junctional zone deferential and a ratio of junctional zone thickness to myometrium thickness. Thresholds of biometric characteristics of the uterine junctional zone for adverse pregnancy outcomes were estimated. RESULTS: The frequencies of pregnancy and retrochorial hematoma in patients of Groups 1 and 2 in the first trimester of pregnancy did not differ significantly and amounted to 43.1% and 38.6%, 13.8% and 22.7%, respectively, p 0.05. Adverse pregnancy outcomes were diagnosed in 63.8% of patients in Group 1 and in 68.2% of patients in Group 2, p 0.05. In Group 1, the frequency of retrochorial hematoma depended on the initial junctional zone deferential, as well as on the initial average and maximal junctional zone thicknesses, junctional zone deferentials and ratios of junctional zone thickness to myometrium thickness, which, with an adverse pregnancy outcome, were 1.72.5 times higher than those in patients with a favorable outcome, p 0.05. In Group 2, adverse pregnancy outcomes were recorded with significantly higher values of average and maximal junctional zone thicknesses and junctional zone deferential. ROC curves were constructed using data of logistic regression analysis based on biometric characteristics of the uterine junctional zone to predict spontaneous abortion and infertility in patients with adenomyosis. CONCLUSIONS: Fertility outcomes in patients with adenomyosis depend on a complex of biometric characteristics of the uterine junctional zone as determined by magnetic resonance imaging.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

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