Early pregnancy renal anhydramios (EPRA) comprises congenital renal disease that results in fetal anhydramnios by 22 weeks of gestation. It occurs in over 1 in 2000 pregnancies and affects 1500 families in the US annually. EPRA was historically considered universally fatal due to associated pulmonary hypoplasia and neonatal respiratory failure. There are several etiologies of fetal renal failure that result in EPRA
Objective. Our objective was determining if abnormal Doppler evaluation had a higher prevalence of placental pathology compared to normal Doppler in suspected fetal growth restriction (FGR) of cases delivered at 37 weeks. Study Design. This retrospective cohort study of suspected FGR singletons with antenatal Doppler evaluation delivered at 37 weeks had a primary outcome of the prevalence of placental pathology related to FGR. Significance was defined as p ≤ 0.05. Results. Of 100 pregnancies 46 and 54 were in the abnormal and normal Doppler cohorts, respectively. Placental pathology was more prevalent with any abnormal Doppler, 84.8% versus 55.6%, odds ratio (OR) 4.46, 95% confidence interval (CI): 1.55, 13.22, and p = 0.002. Abnormal middle cerebral artery (MCA) Doppler had a higher prevalence: 96.2% versus 54.8%, OR 20.7, 95% CI: 2.54, 447.1, and p < 0.001. Conclusion. Abnormal Doppler was associated with more placental pathology in comparison to normal Doppler in fetuses with suspected FGR. Abnormal MCA Doppler had the strongest association.
progression. We tested the hypothesis that women with cHTN are more likely to have a longer first stage of labor. STUDY DESIGN: This was a retrospective cohort study of all women with singleton term pregnancies that reached 10 cm cervical dilation at a tertiary care center from 2004 to 2014. Labor curves were compared between patients with and without cHTN and was then stratified by labor type (induction vs spontaneous) and by need for anti-hypertensive agent during pregnancy. T-tests & Mann Whitney U tests were used for continuous variables and chi-square/Fisher's exact tests for categorical variables. Interval-censored regression was used to estimate median times for cervical change. RESULTS: Of the 21,841 patients with term pregnancies that reached 10 cm cervical dilation, 746 (3.4%) had cHTN. Compared to those without cHTN, patients with cHTN were more likely to be 35 or older, obese, African-American, diabetic, have a prior cesarean, undergo induction, and receive oxytocin augmentation. Patients with cHTN were less likely to nulliparous. cHTN patients were more likely to have a longer first stage of labor with a longer time to dilate from 4 to 10 cm (adjusted median 5.86 vs 4.67 hours, p< .01), even after adjusting for confounders. After stratifying by antihypertensive use, there was no difference in labor progression between patients with and without antihypertensive use. CONCLUSION: Women with cHTN had longer first stages of labor than women without cHTN, even after adjusting for relevant confounders and accounting for induction of labor. As the number of pregnant women with cHTN increases, understanding the natural history of labor in this population is essential to the modern practice of obstetrics.
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