Obstetric complications in pregnancies with life-limiting malformations

Quaresima, Paola; Homfray, Tessa; Greco, Elena

doi:10.1097/gco.0000000000000583

Cited by 12 publications

(7 citation statements)

References 88 publications

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“…Nonetheless, 81.1% of the babies (30/37) had appropriate weight for gestational age and only 8.1% were small for gestational age. There were 51.3% preterm, in agreement with works that show a clear association omphalocele/prematurity in the presence of multiple congenital anomalies with premature birth being the obstetric complication most associated with conditions that threaten life, such as Edwards Syndrome [ 8 , 19 ]. In the same period, in Rio de Janeiro City, the overall rate of prematurity was 10.9% [ 13 ].…”

Section: Discussionsupporting

confidence: 88%

Omphalocele: clinical and epidemiological profile of patients born in a tertiary care center in Rio de Janeiro

Pereira

Vieira

Leite

et al. 2023

BMC Pregnancy Childbirth

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Background The objective of this paper is to describe the clinical and epidemiological profile and the early outcomes of patients with omphalocele born in a fetal medicine, pediatric surgery, and genetics reference hospital in Rio de Janeiro - Brazil. To determine its prevalence, describe the presence of genetic syndromes, and congenital malformations, emphasizing the characteristics of congenital heart diseases and their most common types. Methods Using Latin-American Collaborative Study of Congenital Malformations (ECLAMC) database and records review, a retrospective cross-sectional study was performed, including all patients born with omphalocele between January 1st, 2016, and December 31st, 2019. Results During the period of the study, our unity registered 4,260 births, 4,064 were live births and 196 stillbirths. There were 737 diagnoses of any congenital malformation, among them 38 cases of omphalocele, 27 were live born, but one was excluded for missing data. 62.2% were male, 62.2% of the women were multiparous and 51.3% of the babies were preterm. There was an associated malformation in 89.1% of the cases. Heart disease was the most common (45.9%) of which tetralogy of Fallot was the most frequent (23.5%). Mortality rate was 61.5%. Conclusions Our data showed a good correspondence with the existing literature. Most patients with omphalocele had other malformations, especially congenital heart disease. No pregnancy was interrupted. The presence of concurrent defects showed a huge impact on prognosis, since, even if most survived birth, few remained alive and received hospital discharge. Based on these data, fetal medicine and neonatal teams must be able to adjust parents counseling about fetal and neonatal risks, especially when other congenital diseases are present.

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Section: Discussionsupporting

confidence: 88%

Omphalocele: clinical and epidemiological profile of patients born in a tertiary care center in Rio de Janeiro

Pereira

Vieira

Leite

et al. 2023

BMC Pregnancy Childbirth

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“…A study of 27 hemivertebra cases [ 9 ] concluded that a prenatal diagnosis of isolated hemivertebra improves the outcome, these cases presenting a good prognosis, but if associated with other anomalies, the survival rate reduces to 50% and zero if accompanied by oligohydramnios. Prenatal diagnosis should rule out life-limiting spinal abnormalities that may be associated with antenatal and intrapartum complications [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

First-Trimester Diagnosis of Supernumerary Hemivertebra

et al. 2022

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Hemivertebra is a common cause of congenital scoliosis and results from a lack of formation of one-half of the vertebral body. This condition is very rare and can present as solitary or as a syndrome component: i.e., the split notochord syndrome, which often implies vertebral defects, from a bifid vertebra to hemivertebrae, or fused vertebrae. We describe a case of supernumerary lateral hemivertebra detected prenatally at 12 weeks of gestation and the ultrasonography specifics that lead to early and accurate diagnosis, monitoring during pregnancy, and follow-up at the 4-year period. The case is presented to specify the importance of an early assessment of fetal spine and diagnosis of various conditions, including hemivertebrae, considering the significant association with other anomalies (cardiovascular, urinary, skeletal, gastrointestinal, and central nervous systems), which are most commonly involved. Moreover, the need to counsel future parents on the risks implied by this anomaly is important for the obstetrician. We underline the inclusion of these types of congenital conditions in high-risk pregnancy because of the frequent association with high cesarean delivery rates, growth restriction, delivery before term, and higher morbidity rates.

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“…In addition to the impacts on surveillance system estimates, it's important to consider the potential implications of abortion legislation on maternal mental health, morbidity, and mortality. Carrying a fetus with a fatal anomaly to term can increase the risk of obstetric complications and place a heavy psychological burden on the pregnant person and their family (McNamara et al, 2013; Quaresima et al, 2019). We must also consider the impact on the healthcare system, including public health systems for referrals to care, and the associated costs.…”

Section: Abortion Legislation and Birth Defect Surveillancementioning

confidence: 99%

Implications of abortion legislation on birth defect surveillance

Elmore,

Heinke,

Tanner

et al. 2024

Birth Defects Research

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BackgroundSurveillance of birth defects is critical to track prevalence and inform prevention efforts. Previous studies suggest that restricting abortion may lead to an increase in birth defect prevalence. However, it is unclear how abortion legislation will impact birth defect prevalence estimates reported by state‐based surveillance programs.MethodsWe described current abortion legislation and surveillance program methodology, by state, as a foundation for understanding the program‐level impact on surveillance. We estimated the quantitative effect of abortion legislation on birth defect prevalence for various scenarios using first‐order Monte Carlo simulation. Finally, we discuss the implications for interpreting birth defect prevalence estimates following abortion legislation.ResultsAmong states that restrict abortion ≤18 weeks and have a surveillance program (N = 19), eight programs (42%) capture elective terminations (<20 weeks) and 17 (89%) include fetal deaths (≥20 weeks) in their estimates. Abortion bans increased the prevalence of any birth defect by 16.6%, 15.8%, and 8.7% for systems with live births only, all outcomes ≥20‐weeks, and all outcomes ≥10‐weeks, respectively. We found the largest change in prevalence for anencephaly with an estimated 32.5% increase among systems with live births only.ConclusionsAbortion legislation is likely to further exacerbate the difficulties of multi‐state birth defect research and surveillance, while also hindering analysis of intra‐state prevalence trends. Birth defect surveillance systems in states with abortion bans may wish to consider monitoring and reporting changes in pregnancy outcomes and infant survival, in addition to birth defect prevalence, to inform public health and health care service needs.

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Obstetric complications in pregnancies with life-limiting malformations

Cited by 12 publications

References 88 publications

Omphalocele: clinical and epidemiological profile of patients born in a tertiary care center in Rio de Janeiro

Omphalocele: clinical and epidemiological profile of patients born in a tertiary care center in Rio de Janeiro

First-Trimester Diagnosis of Supernumerary Hemivertebra

Implications of abortion legislation on birth defect surveillance

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