2 articles
Umbilical cord pathology can contribute to neonatal asphyxia, stillbirth, and postnatal death in numerous cases. However, the diagnosis of umbilical cord pathology remains imperfect, and its impact on pregnancy course and outcome is often underestimated. Therefore, prenatal diagnosis of umbilical cord pathology is becoming increasingly important in preventing intra- and postnatal morbidity and mortality. Early detection of these abnormalities enables the development of necessary strategies for optimal pregnancy and delivery management.
The study included 190 patients divided into 2 groups: L1 – 95 patients with UC abnormalities, and L0 – 95 with a normal UC. A p-value of less than 0.05 was regarded as statistically significant.
The development of umbilical cord pathology was frequently observed in pregnant women exposed to harmful workplace factors (psychological and emotional stress, p=0.01), harmful habits (smoking, p=0.04), and primiparas (p=0.005) with complicated gynecological and somatic histories, as well as those with a history of UC pathology in previous pregnancies (p<0.0001). Pregnancy and labor progression in patients with cord pathology showed a high rate of complications compared to control group, including urinary tract disorders (p=0.02), preterm labor at 27-28 weeks (p=0.01), polyhydramnios, which was ten times more frequent (p=0.002), and fetal growth restriction (p=0.02). In the study group, a prolonged second stage of labor was observed (p=0.01), along with acute fetal hypoxia, which required urgent pregnancy termination (p=0.01) through vacuum extraction (p=0.0009) or C-section (p=0.04).
The analysis of the anamnestic and clinical peculiarities of the perinatal period in patients with UC pathology, compared to pregnant women without this pathology, confirmed that this commonly encountered obstetric condition represents a considerable risk factor for perinatal complications.
The literature suggests that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.
A retrospective observational case-control study was carried out. The study included 352 pregnant women with a singleton pregnancy and at least one previous cesarean section: 177 pregnant women with two or more previous cesarean sections (experimental group) and 175 with a primary cesarean section (control group). Excel tables were used to organize the data. For comparing categorical variables in groups, the χ² test was used. A p < 0.05 was considered statistically significant.
Termination of the pregnancy by cesarean section at 39 + 0 – 39 + 6 weeks of gestation (56.5% and 27.4%, respectively; p < 0.001) was statistically significantly more frequent in the experimental group. Analysis of deliveries revealed that emergency cesarean sections in pregnancy (18.9% and 9.0%, respectively; p < 0.01) and emergency cesarean sections during labor (60.6% and 30.5%, respectively; p < 0.001) were performed statistically significantly more frequently in the control group. Planned cesarean sections during pregnancy (60.5% and 20.6%, respectively; p < 0.001) were performed statistically significantly more frequently in the experimental group. The rate of full-term neonates was statistically significantly higher in women from the experimental group (96.6% and 83.4%, respectively; p < 0.001), and the rate of post-term neonates was statistically significantly higher in women from the control group (12.0%; p < 0.001). The Apgar score values 1 minute after birth equal to 8–10 points (130 – 84.4% and 10 – 47.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women without acute fetal distress during labor, and the Apgar score values 1 minute after birth equal to 1–7 points (11 – 52.4% and 24 – 15.6%, respectively; p < 0.001) were statistically significantly more frequent in pregnant women with acute fetal distress during labor. Similar results were found in the Apgar score at 5 minutes after birth.
In our research, it was demonstrated that the mode and timing of delivery have a greater impact on adverse neonatal outcomes than the number of previous cesarean sections.