The relationship between maternal hematocrit and pregnancy outcome

Article Abstract:

Anemia (insufficient numbers of red blood cells, which carry oxygen) during pregnancy is thought to be a risk factor for premature delivery and other poor outcomes of pregnancy. However, studies have disagreed as to the hematocrit level (the test that determines the concentration of red blood cells) that is related to poor outcomes. Some of the variability among studies may be due to the fact that hematocrits have been measured at different times during the pregnancy. To better understand the relationship between hematocrit and pregnancy outcome, a retrospective study of 17,149 pregnancies managed at one medical institution was carried out. The pregnant women had received supplementation with iron and folate during pregnancy. Of particular interest were two negative outcomes: prematurity (delivery between weeks 20 and 37 of gestation); and fetal growth retardation (birth weight below the tenth percentile for gestational age). Results showed that the average hematocrit was 38 percent at 10 weeks of gestation (a normal value for females is approximately 42 percent, with values a few points higher or lower still considered normal). The hematocrit fell to 34 percent between 21 and 27 weeks' gestation and rose to 36 percent by delivery. High hematocrits (greater than 40 percent) measured before 20 weeks' and at 31 to 34 weeks' gestation were associated with premature delivery and with fetal growth retardation. It is possible that these effects are due to the failure of the woman's body to increase blood volume during pregnancy, a condition necessary for normal fetal growth and development. Hematocrit should be measured in pregnant women at the initial clinic visit and then again between 31 and 34 weeks' gestation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Physiological aspects, Pregnant women, Premature labor, Hematocrit

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Health behavior and outcomes in sequential pregnancies of black and white adolescents

Article Abstract:

Second pregnancies among teenagers appear to be associated with a higher incidence of preterm delivery and poorer utilization of prenatal care than first pregnancies. Among 737 women who gave carried two pregnancies for at least 20 weeks while they were teenagers, the average gestation at the time of the first clinic visit for prenatal care was 17.3 weeks for the first pregnancy and 20.1 weeks for the second. During the second pregnancy, teenagers made fewer visits for prenatal care, and the time between visits was greater. The average birth weight among the infants increased from the first to second pregnancies, and the rate of fetal growth retardation decreased. However, the preterm delivery rate increased from about 15% for first pregnancies to 19% for second pregnancies. The recurrence rates for fetal growth retardation and preterm delivery in the second pregnancies were 13% and 46%, respectively. Black mothers had poorer utilization of prenatal care than whites, and recurrence rates of adverse outcomes were higher among blacks than whites.

Usage, Risk factors, Premature birth, Teenage pregnancy

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The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound

Article Abstract:

Elective cesareans to prevent shoulder dystocia in infants who are larger than normal may be appropriate in diabetic pregnant women but not in non-diabetic pregnant women. Infants who are larger than normal have a condition called macrosomia, which can lead to shoulder injuries. Researchers estimated that at least 2,345 cesareans would have to be performed at a cost of $4.9 million to prevent one case of shoulder dystocia in infants weighing 4,000 grams or more as revealed by ultrasound. If limited to diabetic pregnant women, at least 489 cesareans costing $880,000 would have to be performed.

Economic aspects, Prevention, Complications and side effects, Cesarean section, Dystocia, Fetal macrosomia, Shoulder joint, Shoulder dislocation

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