Objectives: The primary aim was to investigate whether preterm delivery was an independent risk factor for blood or blood products transfusion in the intrapartum or postpartum period, considered as a proxy for severe obstetric bleeding. Methods: Throughout a nine-month-period, 216 uncomplicated singleton deliveries were included in a cross-sectional design following exclusion of severe maternal and fetal morbidity such as chorioamnionitis, and use of medications including tocolytics. Maternal and neonatal data were evaluated and compared across preterm (between 24 0/7-36 6/7 weeks of gestation) and term (between 37 0/7-41 6/7 weeks of gestation) deliveries. Primary and secondary outcomes were requirement for blood or blood products transfusion until discharge and change in hemoglobin value and hematocrit from baseline to postpartum hour 6, respectively. Logistic regression models were constructed to evaluate the effect of preterm delivery on the primary outcome. Results: There were 90 (41.7%) preterm deliveries with an overall Caesarean section rate of 77.8%. Preterm delivery was not an independent risk factor for the primary outcome, when route of delivery, maternal body-mass index, antenatal steroid administration, and baseline admission platelet and leukocyte counts were controlled for (adjusted risk ratio, 2.46; 95% confidence interval, 0.69-8.77; p = 0.16). Subgroup analysis including Caesarean deliveries revealed similar result (adjusted risk ratio, 1.65; 95% confidence interval, 0.42-6.48; p = 0.47). Secondary outcomes including decrease in mean or percent values of hemoglobin and hematocrit measurements were also similar across preterm and term groups, both after vaginal and Caesarean deliveries (for all comparisons, p > 0.05). Conclusions: Preterm delivery is not independently associated with increased requirement for blood transfusions or decreased hemoglobin and hematocrit values following otherwise uncomplicated vaginal or Caesarean delivery of singletons.
VP46.16Second trimester cervical length and maternal characteristics in predicting preterm delivery among singleton pregnancies in a Filipino population
The aim of the study was to evaluate the changes in diagnostics of Trisomy 21 in a 10 mil population between 1994-2018. Methods: Data from the national registries. Results: There were 5496 fetuses with trisomy 21 in the studied period. The detection rate increased from 40.7% (1994) to 87.66 (2018). The number of invasive procedures varied between 1757.6/10000 newborns (2007) and 580.9/10000 newborns (2018). Indications for invasive testing were 80% combined first-trimester screening (FTS) and 20% morphologic findings on ultrasound and second-trimester screening. The number of trisomy 21 newborns per 10000 decreased from 7.79 in 1994 to 3.42 in 2018. The gestational age at the final diagnosis decreased from 20.33 weeks in 1994 to 14.24 weeks in 2018. Since 2015, 122 cases of Trisomy 21 were detected with NIPT. Conclusions: Since 1994 the screening methods developed to FTS and NIPT. The Trisomy 21 screening has already in 2006 reached a plateau: the percentage of detected cases in the whole population exceeded 80% and was improving until 2020 to 87.6%. High sensitivity and specificity of FTS caused a steep decrease in invasive procedures. In the same time period, the maternal age was significantly increased without affecting the detection rates. We could not assess the effect of NIPT due to the small number of examinations. It can not be expected, that in real life, higher detection rates would be achieved in the whole population, even with new, more sensitive technologies. Research grant provided by the Czech Ministry of Health AZV17-29622A and RVO-VFN64165.
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