INTRODUCTION: The main goal of placenta accreta spectrum (PAS) screening is to enable delivery in an expert center in the presence of an experienced team at an appropriate time. Our study aimed to identify independent risk factors for emergency deliveries within the IS-PAS 2.0 database cohort and establish a multivariate predictive model. MATERIAL AND METHODS: A retrospective analysis of prospectively collected PAS cases from the IS-PAS database between January 2020 and June 2022 by 23 international expert centers was performed. All PAS cases (singleton and multiple pregnancies) managed according to local protocols were included. Individuals with emergent delivery were identified and compared to those with scheduled delivery. A multivariate analysis was conducted to identify the possible risk factors for emergency delivery and was used to establish a predictive model. Maternal outcomes were compared. RESULTS: Overall, 315 women were included in the study. Of these, 182 participants (89 with emergent and 93 with scheduled delivery) were included in the final analysis after exclusion of those with unsuspected PAS antenatally or who lacked information about the urgency of delivery. Gestational age at delivery was higher in the scheduled group (34.7 vs. 32.9, p < 0.001). Antenatal bleeding (OR 2.9, p = 0.02) and a placenta located over a uterine scar (OR 0.38, p = 0.001) were the independent predictive factors for emergent delivery (AUC 0.68). Ultrasound (US) markers: loss of clear zone (p = 0.001), placental lacunae (p = 0.01), placental bulge (p = 0.02), and presence of bridging vessels (p = 0.02) were more frequently documented in the scheduled group. None of these markers improved the predictive values of the model. Higher PAS grades were identified in the scheduled group (p = 0.01). There were no significant differences in maternal outcomes. CONCLUSIONS: Antenatal bleeding and the placental location away from the uterine scar remained the most significant predictors for emergent delivery among patients with PAS, even when combining more predictive risk factors, including US markers. Based on these results, patients who bleed antenatally may benefit from transfer to an expert center, as we found no differences in maternal outcomes between groups delivered in expert centers. Earlier-scheduled delivery is not supported due to the low predictive value of our model.
- MeSH
- císařský řez * statistika a číselné údaje MeSH
- dospělí MeSH
- lidé MeSH
- náhlé příhody MeSH
- placenta accreta * diagnóza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- vedení porodu * statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Cieľ: Cieľom tejto práce je analýza faktorov, ktoré môžu ovplyvniť spôsob vedenia pôrodu u žien s viacplodovou graviditou. Súbor a metodika: Retrospektívna analýza vybraných parametrov u žien s viacplodovou graviditou, ktoré porodili na II. Gynekologicko-pôrodníckej klinike Lekárskej fakulty Univerzity Karlovy (LF UK) a Univerzitnej Nemoncice (UN) Bratislava v rokoch 2010–2022. Výsledky: Za obdobie 2010–2022 na II. Gynekologicko-pôrodníckej klinike LF UK a UN Bratislava bolo 1,13 % pôrodov viacplodovej gravidity. Po spracovaní štatistických údajov sa štatisticky významne javila primiparita ako riziko akútneho cisárskeho rezu, multipary mali vyššiu pravdepodobnosť porodiť vaginálne. Od roku 2017 mal na klinike počet cisárskych rezov klesajúci trend. Ženy s akútnym cisárskym rezom mali priemerne nižšie pH oboch plodov oproti vaginálnemu pôrodu, avšak výskyt asfyktických plodov nebol štatisticky významne rozdielny. Nezistili sme žiadny rizikový faktor zvyšujúci pravdepodobnosť akútneho cisárskeho rezu na plod B u gemín. Záver: Viacplodová gravidita má vyššiu morbiditu nielen pre ženu ale aj pre plody. Výskyt viacplodovej gravidity je ovplyvnený asistovanou reprodukciou. Spôsob vedenia pôrodu závisí na rôznych faktoroch ako chorionicita, poloha plodov a anamnéza predošlého cisárskeho rezu.
Objective: This paper aims to analyze the factors that can influence the method of childbirth in women with multiple pregnancies. Materials and methods: Retrospective analysis of selected parameters in women with multiple pregnancies who gave birth at the 2nd Clinic of Gynecology and Obstetrics of the Faculty of Medicine (FM), Comenius University (CU) and University Hospital (UH) Bratislava in the years 2010–2022. Results: Between 2010 and 2022, at the 2nd Clinic of Gynecology and Obstetrics of the FM CU and UH in Bratislava, 1.13% of births were multiple pregnancies. After statistical data processing, primiparity appeared statistically significant as a risk of acute caesarean section (C-section); multiparous women had a higher probability to give birth vaginally. Since 2017, the clinic has had a decreasing trend in the number of caesarean sections. Women with an acute caesarean section, in turn had on average a lower pH of both fetuses compared to vaginal delivery. However, the incidence of asphyxia in fetuses was not statistically significantly different. We found no risk factor increasing the likelihood of acute caesarean section for fetus B in twins. Conclusion: Multiple pregnancy has a higher morbidity not only for the woman but also for the fetuses. The incidence of multiple pregnancies is influenced by assisted reproduction. Delivery method depends on various factors such as chorionicity, fetal presentation, and history of a previous caesarean section.
- MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- lidé MeSH
- naléhání plodu MeSH
- rizikové faktory MeSH
- těhotenství mnohočetné * statistika a číselné údaje MeSH
- těhotenství s dvojčaty statistika a číselné údaje MeSH
- těhotenství MeSH
- vedení porodu metody statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
OBJECTIVES: To evaluate the effect of transient fetal bradycardia and other heart rate changes during and after external cephalic version (ECV) on perinatal outcomes. To determine factors associated with a higher risk of occurrence of transient fetal bradycardia during and after ECV. STUDY DESIGN: Prospective study in 286 women after the 36th week of gestation with a fetus in breech presentation who have undergone an ECV attempt. The study analyses the incidence of transient fetal bradycardia during and immediately after ECV, the time interval to complete adjustment of fetal bradycardia, the factors associated with the occurrence of transient fetal bradycardia, cardiotocography (CTG) changes after ECV and perinatal outcomes. All the data were statistically analyzed. RESULTS: The ECV was successful in 51 % (146/286). Transient fetal bradycardia occurred during and after ECV in 81 cases (28.3 %). A successful version was a factor significantly associated with fetal bradycardia (54; 37.0 % versus 27; 19.3 %; p < 0.01). Clinically significant hypotension of the mother was accompanied by transient fetal bradycardia in 12 cases (4.2 %). After the successful ECV there was no significant difference in the percentage of vaginal deliveries between subgroups with and without transient fetal bradycardia (85.2 % versus 83.7 %; p = 1.00). Nor in occurrence of acute fetal distress during labor (18.5 % versus 15.6 %; p = 0.65). In cases of a successful ECV transient CTG changes after ECV had no effect on the incidence of acute fetal distress during labor (23.5 % versus 15.7 %; p = 0.49). CONCLUSIONS: Transient fetal bradycardia and other heart rate changes during and immediately after ECV was not associated with a higher incidence of acute fetal distress during labor and did not affect perinatal outcomes. Higher occurrence of transient bradycardia after ECV was associated only with successful ECV. Transient hypotension of the mother as one of the causes of transient fetal bradycardia during ECV should be considered.
- MeSH
- bradykardie embryologie etiologie patofyziologie MeSH
- distres plodu epidemiologie etiologie MeSH
- dospělí MeSH
- gestační stáří MeSH
- hypotenze epidemiologie etiologie MeSH
- kardiovaskulární komplikace v těhotenství epidemiologie etiologie MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- obrat plodu škodlivé účinky MeSH
- prospektivní studie MeSH
- srdeční frekvence plodu fyziologie MeSH
- těhotenství MeSH
- vedení porodu statistika a číselné údaje MeSH
- výsledek těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- spokojenost pacientů statistika a číselné údaje MeSH
- vedení porodu * metody statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Česká republika MeSH
OBJECTIVE: To evaluate the determinants of vaginal delivery and safety in women undergoing cervical ripening with a synthetic osmotic dilator (Dilapan-S) prior to induction of labor. METHODS: We conducted a secondary analysis of an international multicenter prospective observational study of Dilapan-S for cervical ripening in pregnancies greater than 32 weeks. Data were obtained in a standardized fashion and entered into a centralized electronic data capture system. The association between Bishop score and vaginal delivery was further evaluated with a multivariate receiver-operating characteristic (ROC) curve analysis. A Wilcoxon rank test and multivariable logistic regression were used for statistical analysis (significance: P < .05). RESULTS: Between May 2015 and July 2016, 444 pregnant women were included. Three hundred ten (70 %) delivered vaginally. Compared to patients who underwent cesarean delivery, those who delivered vaginally were more likely to have a history of prior vaginal delivery. Vaginal delivery rates were significantly correlated with Bishop scores of pre and post Dilapan-S and difference. After adjusting for age, BMI, number of dilators, cervical ripening time, and gestational age, both prior vaginal delivery and post-Dilapan-S Bishop scores were strong predictors of vaginal delivery (estimate coefficient: 0.1275 ± 0.03 P = .0002; 0.049 ± 0.01 P = .0001; respectively). Aggregate ROC accounting for these variables further supported these findings (AUC = 0.734). The lower confidence interval limit of vaginal delivery rates was above 50 % when post-Dilapan-S Bishop scores were ≥ 5. Cox regression analyses demonstrated that the duration of labor was significant shorter in women that had vaginal delivery. CONCLUSION: Bishop scores after cervical ripening with Dilapan-S are good predictors of vaginal delivery. Bishop scores < 5 post Dilapan-S may warrant further cervical ripening. Further level 1 trials are needed to compare osmotic dilators to other ripening methods.
- MeSH
- časové faktory MeSH
- císařský řez statistika a číselné údaje MeSH
- dospělí MeSH
- gestační stáří MeSH
- indukovaný porod metody MeSH
- lidé MeSH
- mladý dospělý MeSH
- polymery terapeutické užití MeSH
- proporcionální rizikové modely MeSH
- těhotenství MeSH
- vedení porodu statistika a číselné údaje MeSH
- zrání děložního hrdla * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Cieľ štúdie: Porovnanie perinatálnej mortality v Slovenskej republike (SR) v rokoch 2007–2009 a v rokoch 2010–2012. Typ štúdie: Epidemiologická perinatologická celoštátna. Názov a sídlo pracoviska: I. gynekologicko-pôrodnícka klinika LF UK a UNB, Bratislava. Metodika: Analýza prospektívneho zberu vybraných ukazovateľov pôrodníckej starostlivosti v rokoch 2007–2009 a v rokoch 2010–2012. Výsledky: V roku 2007 mala SR 63 pôrodníc, 51 146 pôrodov a narodilo sa 51 650 živých novorodencov. V období rokov 2010–2012 v SR klesol počet pôrodníc z 57 na 55, počet pôrodov z 55 362 na 54 996 a počet živonarodených z 55 901 na 55 643. Frekvencia predčasných pôrodov v rokoch 2010–2012 v porovnaní s rokmi 2007–2009 stúpla zo 7,4 % na 7,7 % a frekvencia viacplodovej tehotnosti z 1,4 % na 1,5 %. Perinatálna mortalita klesala zo 6,2 ‰ v roku 2007 na 5,1 ‰ v roku 2012. Na perinatálnej mortalite v rokoch 2007–2012 sa podieľala mŕtvorodenosť 64 %, nízka pôrodná hmotnosť 65 % a závažné vrodené vývojové chyby 19 %. Transport novorodencov in utero s veľmi nízkou hmotnosťou do perinatologických centier sa v rokoch 2007–2012 znížil zo 64 % na 56 % a novorodencov s extrémne nízkou hmotnosťou zo 75 % na 70 %. Záver: V roku 2012 slovenská perinatológia dosiahla historicky najlepší výsledok perinatálnej mortality, 5,1 ‰. SR však potrebuje zlepšiť centralizáciu vysokorizikových gravidít, transport plodov s veľmi nízkou pôrodnou hmotnosťou „in utero“, prenatálnu diagnostiku vrodených vývojových chýb a materiálno-technické vybavenie pôrodníc a novorodeneckých jednotiek intenzívnej starostlivosti.
Objective: Comparison of perinatal mortality in Slovak Republic in the years 2007–2009 and in the years 2010–2012. Design: Epidemiological perinatal nation-wide. Setting: 1st Department of Gynaecology and Obstetrics School of Medicine, Comenius University and University Hospital, Bratislava, Slovak Republic. Methods: The analysis of selected perinatal data prospectively collected in the years 2007–2009 and in the years 2010–2012. Results: In the year 2007 there were 63 maternity hospitals, 51,146 deliveries and that of live births 51,650 in Slovak Republic. In the years 2010–2012 decreased the number of maternity hospitals, total number of deliveries and that of live births from 57 to 55, from 55,362 to 54,996 and from 55,901 to 55,643 respectively. Preterm deliveries rate increased from 7.4 to 7.7% and multiple pregnancies rate from 1.4% to 1.5% in the years 2010–2012 compared to years 2007–2009. Perinatal mortality rate decreased from 6.2 in the year 2007 to 5.1 per 1,000 still and live births in the year 2012. During the years 2007–2012 stillbirth participate in perinatal mortality 64%, low birth weight 65% and severe congenital anomalies 19%. Transport in utero to perinatal centres decreased in the years 2007–2012. It was from 64% to 56% for infants with very low birth weight and from 75% to 70% for infants with extremely low birth weight. Conclusion: In the year 2012 Slovak perinatology reach the best result in perinatal mortality rate 5.1‰ (0.51%). Centralisation of high-risk pregnancies, transport in utero very low birth weight infants, prenatal detection of severe congenital abnormalities and obstetric and neonatal intensive care units equipment need still to be improved in Slovak Republic.
- MeSH
- epidemiologické studie MeSH
- jednotky intenzivní péče o novorozence statistika a číselné údaje MeSH
- lidé MeSH
- novorozenec s nízkou porodní hmotností MeSH
- novorozenec s velmi nízkou porodní hmotností MeSH
- novorozenec MeSH
- perinatální mortalita * MeSH
- porodnice statistika a číselné údaje MeSH
- předčasný porod epidemiologie MeSH
- vedení porodu statistika a číselné údaje MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Slovenská republika MeSH
OBJECTIVE: To investigate whether self-rated health (SRH) in pregnancy can predict childbirth complications, adverse birth outcomes, and maternal health problems up to 3 years after delivery. METHODS: A retrospective analysis was performed of data obtained in a prospective longitudinal population-based birth cohort study. Pregnant women resident in the Brno or Znojmo regions in the Czech Republic were included if they were expected to deliver between March 1991 and June 1992. SRH data were collected between 1991 and 1995 via pen-and-paper questionnaires administered in mid-pregnancy, and at 6 months, 18 months, and 3 years after delivery. Medical records were reviewed for pregnancy complications, childbirth complications, and birth outcomes. Multivariate regression analysis was performed. RESULTS: Overall, 4811 women were included. Better SRH in pregnancy predicted fewer childbirth complications (b=-0.03; P=0.036); lower odds of cesarean delivery (odds ratio 0.81; P=0.003); and fewer maternal health problems at 6 months (b=-0.32; P<0.001), 18 months (b=-0.28; P<0.001), and 3 years after delivery (b=-0.30; P<0.001). The effects of SRH were independent of diagnosed complications and self-reported health problems in pregnancy. CONCLUSION: SRH in pregnancy has predictive value for subsequent health outcomes, and might be an additional tool for assessment of pregnant women's health.
- MeSH
- dospělí MeSH
- komplikace porodu epidemiologie MeSH
- komplikace těhotenství epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- multivariační analýza MeSH
- odds ratio MeSH
- prediktivní hodnota testů MeSH
- regresní analýza MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- těhotenství MeSH
- vedení porodu statistika a číselné údaje MeSH
- výsledek těhotenství epidemiologie MeSH
- zdraví matek * MeSH
- zpráva o sobě * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- dospělí MeSH
- druhý trimestr těhotenství krev MeSH
- kohortové studie MeSH
- komplikace těhotenství epidemiologie krev MeSH
- lidé MeSH
- novorozenec MeSH
- porodní hmotnost MeSH
- pozorovací studie jako téma MeSH
- těhotenství krev MeSH
- tělesná hmotnost MeSH
- thyroxin krev MeSH
- vedení porodu statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- těhotenství krev MeSH
- ženské pohlaví MeSH
- Publikační typ
- souhrny MeSH
