Gestational diabetes mellitus(GDM)is the most common metabolic abnormality of pregnancy and is associated with early and late adverse outcomes for both mothers and fetuses.Conventionally,GDM is diagnosed between 24 an...Gestational diabetes mellitus(GDM)is the most common metabolic abnormality of pregnancy and is associated with early and late adverse outcomes for both mothers and fetuses.Conventionally,GDM is diagnosed between 24 and 28 gestational weeks(GW)(late-onset GDM).With the increasing prevalence of prediabetes among women of reproductive age,GDM is increasingly being diagnosed before 24 GW in high-risk populations(early-onset GDM).Compared with late-onset GDM pregnancies,early-onset GDM pregnancies are at greater risk for neonatal adverse events,such as perinatal mortality,neonatal hypoglycemia,neonatal respiratory distress syndrome,and macrosomia.The TOBOGM study revealed that the initiation of treatment before 20 GW can modestly reduce composite neonatal outcomes,mainly due to a reduction in the rate of neonatal respiratory distress syndrome.The benefit was greater when treatment was initiated before 14 GW.The probable mechanisms for early-onset hyper-glycemiainduced neonatal adverse events are decidual and placental defects,interference with fetal lung development,and fetal glucose steal.There is no international consensus on the GDM screening strategy in early pregnancy,and its cost-effectiveness is questioned by several professional bodies.Further prospective randomized controlled studies are strongly recommended to alleviate confusion in clinical practice regarding the management of mild hyperglycemia in early pregnancy.展开更多
Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antena...Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.展开更多
Since the first report of COVID-19 in December 2019, our knowledge and treatment modalities have</span><span style="font-family:""> </span><span style="font-family:Verdana;&quo...Since the first report of COVID-19 in December 2019, our knowledge and treatment modalities have</span><span style="font-family:""> </span><span style="font-family:Verdana;">evolved at great pace understanding its impact on the maternal and neonatal outcomes. Whilst pregnant patients are not more susceptible to acquiring the infection as compared to the general population, they may be at higher risk of developing severe symptoms given the physiological changes, relative immune-compromised state of pregnancy, and their neonates at risk of consequent iatrogenic preterm deliveries. Our review article discusses outcomes of pregnant women and neonates with COVID-19 from several countries including the UK, USA, France, Italy and China</span><span style="font-family:""> </span><span style="font-family:Verdana;">and provides a narrative review of literature from November 2019 till December 2020.展开更多
Objective:The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology,classification,and diagnosis.This study was designed to evaluate the association...Objective:The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology,classification,and diagnosis.This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes;to what extent would these outcomes be modified after the obstetric interventions,including use of glucocorticoid,magnesium sulfate,and progesterone.Methods:This was a retrospective cohort study conducted at Tongji Hospital(composed of Main Branch,Optical Valley Branch and Sino-French New City Branch)in Wuhan.A total of 900 pregnant women and 1064 neonates were retrospectively enrolled.The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery,the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes,and to what extent these outcomes could be modified by obstetric interventions.Results:Eight clusters were identified using two-step cluster analysis,including premature rupture of fetal membranes(PPROM)phenotype,abnormal amniotic fluid(AF)phenotype,placenta previa phenotype,mixed condition phenotype,fetal distress phenotype,preeclampsia-eclampsia&hemolysis,elevated liver enzymes,and low platelets syndrome(PE-E&HELLP)phenotype,multiple fetus phenotype,and no main condition phenotype.Except for no main condition phenotype,the other phenotypes were associated with one or more complications,which conforms to the clinical practice.Compared with no main condition phenotype,some phenotypes were significantly associated with short-term adverse neonatal outcomes.Abnormal AF phenotype,mixed condition phenotype,PE-E&HELLP phenotype,and multiple fetus phenotype were risk factors for neonatal small-for gestation age(SGA);placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min;mixed condition phenotype was associated with low APGAR scores,SGA,mechanical ventilation,and gradeⅢ-Ⅳintraventricular hemorrhage(IVH);fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation;PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min,SGA and neonatal intensive care unit(NICU)admission;multiple fetus phenotype was not a risk factor for the outcomes included except for SGA.Not all neonates benefited from obstetric interventions included in this study.Conclusion:Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes.This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically,with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.展开更多
Hypertensive disorders of pregnancy (HDP) are the most common maternal and perinatal health challenges. Globally, the incidence of HDP increased from 16.30 million to 18.08 million, with a total increase of about 10.9...Hypertensive disorders of pregnancy (HDP) are the most common maternal and perinatal health challenges. Globally, the incidence of HDP increased from 16.30 million to 18.08 million, with a total increase of about 10.9% from 1990 to 2019. Umbilical Doppler study in hypertensive disorders of pregnancy helps to predict neonatal outcomes and prevent neonatal and maternal morbidity and mortality. Objective: This study aims to determine the incidence of abnormal umbilical Doppler among hypertensive pregnant women, to identify the adverse neonatal outcomes associated with abnormal umbilical Doppler, and also to detect the diagnostic predictive values of umbilical Doppler to neonatal outcomes at KCMC. Material and methods: A hospital-based prospective cohort study included women with hypertensive disorders of pregnancy from the gestational age of 28 weeks and above, followed up to delivery during the study period from August 2022 to March 2023. Multivariate logistic regression analysis was used to determine the association between AUD and neonatal outcomes. Results: Out of 112 women with HDP, the incidence of abnormal umbilical Doppler was 38 (33.93%). Abnormal umbilical Doppler was associated with neonates with low birth weight aOR (95% of CI) of 4.52 (1.59 - 12.83) p = 0.005 and neonatal ICU admission 9.71 (2.90 - 32.43) p Conclusion: The incidence of abnormal umbilical Doppler is high in hypertensive disorders of pregnancy which is associated with an increase in neonatal low birth weight and neonatal ICU admissions, the sensitivity of abnormal umbilical Doppler in prediction of low birth weight and neonatal ICU admission is significant hence the routine use of umbilical Doppler assessment among hypertensive pregnant women is crucial.展开更多
Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum h...Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to different treatment methods,they were divided into control group(treated with misoprostol combined with oxytocin,40 cases)and observation group(treated with misoprostol and oxytocin combined with calcium gluconate,40 cases),compared the clinical efficacy,delivery time,postpartum hemorrhage 2 hour after delivery,postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth.Results:The total effective rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).The third delivery stage in the observation group was shorter than that in the control group,and the postpartum hemorrhage volume was less than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in Apgar score of the two groups of newborns(P>0.05).Conclusion:Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient,which not only can effectively reduce postpartum hemorrhage and shorten the delivery time,but also is beneficial for neonatal outcome and worthy of clinical application.展开更多
Background Preterm births(PTBs)and associated costs in the USA are a public health concern.This study evaluated maternal and neonatal hospital-based outcomes,resource use and costs during delivery and up to 30 days po...Background Preterm births(PTBs)and associated costs in the USA are a public health concern.This study evaluated maternal and neonatal hospital-based outcomes,resource use and costs during delivery and up to 30 days postdischarge following PTB.Methods This study was conducted in the USA among individuals who delivered at≥23 weeks gestation(1 January 2016-30 September 2021)captured in the Premier Al Healthcare Database.Linked neonatal data were used.Regression modelling and sensitivity analyses among spontaneous PTBs were performed.Costs were inflated to US$2022.In-hospital outcomes,resource use and costs were analysed.Results 4303772 deliveries were included;14.8%were linked to neonatal records.Compared with term delivery,adjusted ORs for the<32 and 32 to<37 weeks gestation cohorts,respectively,were 1.33(1.29-1.36)and 0.96(0.95-0.98)for postpartum complications;5.79(5.58-6.01)and 2.73(2.66-2.81)for maternal intensive care unit(ICU)admission;4.20(3.01-5.86)and 1.84(1.38-2.46)for maternal death;1.40(1.37-1.43)and 1.01(1.00-1.02)for maternal readmission;76.92(72.28-81.85)and 5.14(5.03-5.25)for neonatal morbidity;89.58(84.59-94.87)and 10.07(9.84-10.31)for neonatal ICU admission;155.51(130.98184.63)and 8.81(7.24-10.73)for neonatal death and 1.49(1.41-1.58)and 1.16(1.13-1.19)for neonatal readmission.Relative to term births,PTBs had significantly higher per-person maternal and neonatal resource use and costs.The results were robust to sensitivity analyses.Conclusions PTBs present a considerable maternal,neonatal and hospital burden compared with term birth.展开更多
Objective:To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.Methods:This institution-based prospective cohort study was conducted from March ...Objective:To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.Methods:This institution-based prospective cohort study was conducted from March 1 to October 30,2022,in three primary hospitals in the Hadiya zone of Southern Ethiopia.Participants were categorized into exposed(Hb<11 g/dL)and non-exposed(Hb≥11 g/dL)groups based on hemoglobin levels measured before delivery.Baseline characteristics were comparable between groups.Maternal and neonatal complications were considered as outcomes.Data were analyzed using STATA version 15.Descriptive statistics summarized baseline characteristics,and Chi-square tests assessed associations.Generalized linear models with a log link calculated adjusted relative risks(aRRs)with 95%CIs.Statistical significance was set at P<0.05.Multivariable models adjusted for confounders,and sensitivity analyses evaluated robustness using multiple imputations for missing data.Results:A total of 490 participants were enrolled in the study,with 245 in each of the exposed and non-exposed groups.Due to loss to follow-up,220 participants in the exposed group and 239 in the non-exposed group were assessed for outcomes.Prolonged labor(adjusted RR(aRR)=3.235;95%CI:1.658,6.312;P=0.003)and postpartum hemorrhage(aRR=2.901;95%CI:1.202,7.910;P=0.045)were identified as adverse maternal pregnancy outcomes of anemia.We observed low birth weight(aRR=3.020;95%CI:1.233,6.010;P=0.002)and respiratory distress syndrome(aRR=4.820;95%CI:2.901,9.012;P=0.001)as neonatal complications.Furthermore,having no previous history of anemia reduced the risk of prolonged labor(aRR=0.078;95%CI:0.033,0.188;P=0.015)and low birth weight(aRR=0.480;95%CI:0.370,0.592;P=0.001).Conclusion:Mothers who have experienced maternal anemia in the past or present face serious consequences for both themselves and their children.Preventing anemia should thus start before conception and continue through pregnancy.展开更多
Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnan...Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnant women were separated into two groups:(1)women aged 19 and younger;(2)women aged 20-34 years.Main outcome measures include preterm birth,maternal comorbidities,preeclampsia,eclampsia,low birth weight(LBW),intrauterine growth restriction(IUGR),placenta abnormalities,placenta abruption,cho-rioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacer-ations,postpartum hemorrhage,childbirth trauma,shoulder dystocia,congenital malformation,and unfavorable maternal and neonatal outcome.Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.Results:Of 7033 deliveries,92.4%of women were adults,and 7.6%were adolescents.Adolescents residing in rural districts were more common than adults(42.3%vs.33.7%).However,access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy.There was no difference in the risk of preeclampsia,placenta abruption,placenta previa,fetal distress,preterm labor,shoulder dystocia,perineal lacerations,childbirth trauma,congenital malformation,postpartum hemorrhage,intensive care unit admission,maternal death,and unfavorable neonatal outcome including stillbirth,neonatal intensive care unit admission,neonatal death in adolescent pregnancies compared to adults.Adolescents had a significantly higher risk of LBW(OR:1.47,95%CI:1.01-2.73),IUGR(OR:1.96,95%CI:1.31-2.45),and meconium fluid(OR:1.74,95%CI:1.41-2.32),however,there was no statistically significant difference after adjusting the confounding factors.Compared with adults,adolescents had a significantly lower risk of CS(aRR:0.67,95%CI:0.51-0.77)and a lower risk of gestational diabetes(aRR:0.78,95%CI:0.51-0.95).Conclusions:Although we found no serious consequences of adolescent pregnancy,more research is needed to reach a more accurate conclusion about teenage pregnancy.展开更多
Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Far...Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.展开更多
Background Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid(MAF)presents a challenge for healthcare providers.We aimed to compare the neonatal outcome of MAF cases delivered via ...Background Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid(MAF)presents a challenge for healthcare providers.We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section(CS)versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.Methods In this retrospective study,we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas,Iran,between January 2020-2022.Mothers with certain adverse pregnancy conditions were excluded from the study.These conditions included:abnormal fetal heart rate and pattern,bloody amniotic fluid,malpresentation,abnormal placentation,chorioamnionitis,intrauterine growth restriction,intrauterine fetal death,obstructed labor,and maternal comorbidities.The MAF mothers were divided into two groups based on the method of delivery:those who had CS and those who had a normal vaginal delivery(NVD).Demographic factors,obstetrical factors,and neonatal outcomes were compared between the two groups.Results Out of 746 MAF mothers,213(28.5%)underwent CS,while 533(71.4%)had NVD.There were no significant differences between the groups in terms of demographic characteristics.Among MAF mothers who had CS,66.2%were primiparous,and 33.8%were multiparous.For those who had NVD,35.1%were primiparous,and 64.9%were multiparous.The first and 5-min Apgar values,rates of asphyxia,neonatal intensive care unit(NICU)admission,and neonatal death were not statistically different between the two delivery modes.The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery.Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS(11.1%vs.2.3%),no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.Conclusions Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers.Further studies are needed to provide more substantial evidence to support this conclusion.展开更多
Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or force...Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.展开更多
Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was e...Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.展开更多
The disease caused by the SARS-CoV-2 virus has spread very rapidly th<span "=""><span>rough</span><span>out the world, causing various clinical manifestations and affecting sever...The disease caused by the SARS-CoV-2 virus has spread very rapidly th<span "=""><span>rough</span><span>out the world, causing various clinical manifestations and affecting several organs and systems. However, the possibility of vertical transmission of C</span><span>OVID-19 in symptomatic pregnant women has been questioned. The aim of this work was to report cases of possible vertical transmission in pregnant women affected by the SARS-CoV-2 virus, as well as its clinical repercussions on the newborn. In this paper, we conducted a cross-sectional retrospective study by analyzing medical records of pregnant women admitted at the military hospital, </span></span><span>in </span><span>Rio de Janeiro, Brazil, diagnosed with COVID-19 and who had positive newborns. To evaluate epidemiological data, clinical manifestations, laborator</span><span>ial</span><span> and histopathological changes </span><span>were </span><span>related to </span><span>such</span><span> vertical transmission. Only six tested newborns </span><span>were </span><span>positive for COVID-19. The mothers had no respiratory symptoms, and the gestational age was at term, except for one newborn born prematurely due to detection of pericadial effusion. Three neonates had respiratory symptoms, requiring ventilatory support. None of the mothers or newborns died. During the pandemic, possible vertical transmission cases of infected pregnant women in the third trimester of pregnancy were observed. According to the case reports published in the literature, they illustrate phenotypes of neonatal involvement with varied clinical manifestations and severity;however, further scientific studies are needed to prove the effective vertical transmission of SARS-C</span><span>o</span><span>V-2 in positive pregnant women.展开更多
<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Data showed that maternal anaemia during pregnancy negatively ...<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Data showed that maternal anaemia during pregnancy negatively affects maternal/fetal outcomes. We here attempted to re-confirm this in this specific region of Sudan, with special reference to fetal/neonatal outcome. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> This cross-sectional observational study was carried out at Omdurman Maternity and Khartoum North Teaching Hospitals-Sudan from March 2018 to March 2019, with 246 pregnant women presented in labour enrolled. Maternal characteristics, haemoglobin (Hb) measured after labour initiation and fetal/neonatal outcomes were analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> When maternal anemia was defined as Hb less than 10.0 g/dL, 80 (32.5%) had anemia and 166 had not. Anemic women (Hb;8.3 ± 0.31), compared with non-anemic women (Hb;11.4 ± 0.61), were significantly more likely to have low birth weight (LBW) infants (40% vs. 15.7%) and still birth (12.5% vs. 4.8%). There was a correlation between hemoglobin concentration and the followings: LBW, respiratory distress syndrome, neonatal nursery admission, still birth, early neonatal death, and low Apgar score. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Maternal aneamia negatively affected fetal/neonatal outcomes. This data may be useful to make health policy in this area.</span></span>展开更多
Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonat...Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonatal outcome among term mothers with anaemia compared to non-anaemic pregnant women at a tertiary care centre in Sri Lanka. Method: A comparative cross-sectional study was performed by recruiting anaemic and non-anaemic term mothers who delivered at the Teaching Hospital Peradeniya during the period March 2018-March 2019. Pregnant mothers whose haemoglobin level was less than 10.5 g/dl were considered as anaemic and compared with the mothers whose haemoglobin level was above this level. With written consent, demographic data, etiological factors, maternal and neonatal outcomes of term mothers were evaluated by an interview and blood samples were withdrawn to carry out anaemia related investigations. Results: Among 2854 pregnancies, a total of 234 (8.19%) term pregnant mothers were anaemic and they were and compared with 199 non-anaemic mothers. Out of the anaemic mothers (Hb < 105 g/l), 133 (56.76%) had moderate anaemia, 100 (42.79%) had mild anaemia and 1 mother (0.45%) had severe anaemia. Low monthly family income was significantly associated with the incidence of anaemia. Anaemia was also associated with low weekly consumption of red meat (OR 8.994;95% CI, 5.74 - 14.09, p < 0.05) and high weekly tea intake (OR 0.217;95% CI 0.144 - 0.327, p < 0.05). Among anaemic mothers, 215 (67.44%) had low serum ferritin (<30 ng/mL) while most of them were diagnosed with iron deficiency anaemia (58.24%) (n = 113) based on haemoglobin. Most anaemic mothers had undergone elective caesarean section (46.26%) while vaginal deliveries (33.33%) were common among non-anamic group. Conclusions: A moderate prevalence of anaemia among term pregnant women in Peradeniya, Sri Lanka was observed and was associated with low socio economic status, low consumption of tea and poor nutrition lacking in red meat.展开更多
<strong><em>Backgrounds</em></strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> T...<strong><em>Backgrounds</em></strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> Teenage pregnancies are generally considered as a high-risk however, sufficient data is lacking in the area, Cairo Egypt. We attempted to </span><span style="font-family:Verdana;">determine whether teenage pregnancies show poorer outcomes than adult-age </span><span style="font-family:Verdana;">pregnancies. </span><b><i><span style="font-family:Verdana;">Objectives</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Finding out the prevalence of teenage pregnancy and its maternal and fetal outcome in comparison. </span><b><i><span style="font-family:Verdana;">Subjects</span></i> <i><span style="font-family:Verdana;">and</span></i> <i><span style="font-family:Verdana;">methods</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A retrospective analytical case-control study was conducted on patients who had attended for delivery at Al-Galaa Maternity Teaching Hospital during the period of one year from March 2015 to February 2016. A total of included 538 patients aged 16 - 19 years as study group and adult age group: included 609 patients aged 25 - 29 years as the control group. The only primigravid was enrolled. The study records were retrieved for review. Comparisons were made between the two groups regarding maternal demographics, socioeconomic status, medical disorders, major antenatal complications, the outcome of labor, mode of delivery, and perinatal complications. </span><b><i><span style="font-family:Verdana;">Results</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> The prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered the significant prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered significant. Teenagers had a lower antenatal care attendance (63.8% vs 76.7%;P = 0.001), a higher incidence of Eclampsia (2.1% vs 0%;P = 0.000), vaginal deliveries (70.1% vs 51.9%;P = 0.000). And a higher maternal ICU admission (1.4% vs 0.0.7%), and maternal death (0.5% vs 0%),especially in low socioeconomic. On the other hand, the adult group pregnancies had a higher incidence of gestational hypertension, gestational diabetes, and cesarean delivery. </span><b><i><span style="font-family:Verdana;">Conclusions</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Teenager primigravid women should be considered as a high-risk pregnancy and thus require special medical attention to avoid adverse maternal and neonatal outcomes.</span></span></span></span>展开更多
Severe preeclampsia (SPE) is associated with fetal complications including intrauterine growth retardation (IUGR), prematurity and in utero fetal death. Its treatment remains child birth that often is planned before t...Severe preeclampsia (SPE) is associated with fetal complications including intrauterine growth retardation (IUGR), prematurity and in utero fetal death. Its treatment remains child birth that often is planned before term. However, this attitude can lead to fetal complications related to prematurity. Several studies on preeclampsia have already been studied in the DRC and several aspects have already been realized, but to date, the neonatal outcome has not yet been addressed. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is cross-sectional study performed in four public hospitals in Kinshasa (Democratic Republic of Congo). We included 400 cases of induced prematurity (IP) for SPE;the analysis compared pregnant women who gave birth before 34 weeks of amenorrhea (WA) and those after 34 WA. The comparison of the proportions was made by the Chi</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">square test and the calculation of Means by the Student’s test. The significance level was set at P < 0.05. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To determine the frequency of induced prematurity for severe preeclampsia (SPE), to identify the indications and to evaluate neonatal outcome. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The IP frequency for SPE was 46.2%. The retro placental hematoma was the most indication in pregnancies before 34 WA 24.9%, while high blood pressure 54.5% in the after 34 WA group. </span><i><span style="font-family:Verdana;">In</span></i> <i><span style="font-family:Verdana;">utero</span></i><span style="font-family:Verdana;"> death was more common in pregnant women who gave birth before 34 weeks 25.4%;chronic fetal distress was elevated in the after 34 WA group 19.5%. Neonatal infection was more common in the group after 34 WA </span><span style="font-family:Verdana;">49.4%, while respiratory distress 39.6%, intra and periventricular hemorrhage 19.5% and neonatal death 39.6% were more in group before 34</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">WA. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prematurity induced for SPE is related to a poor neonatal</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> prognosis.展开更多
To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Method...To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Methods: We retrospectively identified all eligible patients at a single institution from January 1990 to December 2012. A thorough research was made through patients’ medical and obstetrical records. The various causes of late APH were compared to each other regarding the parameters of the neonatal outcome. Multiple regression models were applied for gestational age (GA) at birth, birth weight, Apgar score at first and fifth minute and selection of modus of delivery. Results: 480 patients were included in the study, in a total of 7221 pregnancies. The causes of APH were: cervical dilatation (n = 54, 11.3%), central placental abruption (n = 57, 11.9%), peripheral placental abruption (n = 59, 12.3%), placenta previa (n = 140, 29.2%), others non-related to pregnancy (n = 42, 8.8%), uterine rupture (n = 2, 0.4%) and unknown etiology (n = 126, 26.3%). Overall, 253 neonates (52.7%) were born prematurely at gestational age below 37th week. 37 pregnancies (7.7%) resulted in giving birth prior to 32 weeks of gestation. In multivariable analysis, the cause of hemorrhage was found to be an important independent predictive factor for gestational age (GA) at birth, birth weight, Apgar scores at first and fifth minute and modus of delivery. Preeclampsia, diabetes, thyroid disorder and smoking were associated with decrease of GA at birth. Birth weight below 1500 gr and GA at birth was found to be significant independent factors for Apgar score at first and fifth minute respectively. Modus of delivery did not significantly alter Apgar score. Conclusions: Late APH required immediate evaluation of the general condition of the pregnant woman and the fetus. The cause of APH was important in the prognosis of the neonatal outcome. As long as maternal and fetal status were ensured, expectant management, instead of emergency CS, seemed to be more beneficial even for late preterm neonates.展开更多
Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situ...Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.展开更多
文摘Gestational diabetes mellitus(GDM)is the most common metabolic abnormality of pregnancy and is associated with early and late adverse outcomes for both mothers and fetuses.Conventionally,GDM is diagnosed between 24 and 28 gestational weeks(GW)(late-onset GDM).With the increasing prevalence of prediabetes among women of reproductive age,GDM is increasingly being diagnosed before 24 GW in high-risk populations(early-onset GDM).Compared with late-onset GDM pregnancies,early-onset GDM pregnancies are at greater risk for neonatal adverse events,such as perinatal mortality,neonatal hypoglycemia,neonatal respiratory distress syndrome,and macrosomia.The TOBOGM study revealed that the initiation of treatment before 20 GW can modestly reduce composite neonatal outcomes,mainly due to a reduction in the rate of neonatal respiratory distress syndrome.The benefit was greater when treatment was initiated before 14 GW.The probable mechanisms for early-onset hyper-glycemiainduced neonatal adverse events are decidual and placental defects,interference with fetal lung development,and fetal glucose steal.There is no international consensus on the GDM screening strategy in early pregnancy,and its cost-effectiveness is questioned by several professional bodies.Further prospective randomized controlled studies are strongly recommended to alleviate confusion in clinical practice regarding the management of mild hyperglycemia in early pregnancy.
基金supported by the National Science Foundation of China(No.81873843)the National Science and Technology Pillar Program of China during the Twelfth Five-Year Plan Period(No.2014BA105B05)the Fundamental Research Funds for the Central Universities(No.2017 KFYXJJ102 and No.2019 KFYXKJC053).
文摘Objective Great obstetrical syndrome(GOS)represents a group of pregnancy-related diseases that result in inadequate placentation.Most GOS cases end in preterm,either spontaneously or indicatively,and the use of antenatal corticosteroids(ACS)is inevitably discussed.The placenta is an important,transient fetal-derived organ and is the embodiment of maternal or fetal well-being.However,few studies provide histological evidence of the placenta in GOS.This study aims to address these issues.Methods A total of 831 pregnant women were prospectively recruited.Placenta tissue was collected immediately and fixed with 4%paraformaldehyde solution for future H&E analysis.A novel checklist was devised to evaluate maternal vascular malperfusion sections on the basis of the commonly accepted Amsterdam placental workshop group consensus statement.Results A total of 131 patients were classified as having GOS.Comparisons between those with and without GOS revealed significant differences,including higher levels of distal villous hypoplasia,increased syncytial knots,accelerated villous maturation,and higher total scores in GOS.We found significant negative associations between GOS and neonatal weight,neonatal height,head circumference,placental surface area,placental volume,and placenta gross examination score.GOS neonates were 1.25 times more likely to have hyperbilirubinemia.Regarding the effect of ACS,a significant reduction in birthweight,height,and head circumference was observed,along with an increased risk of hyperbilirubinemia.Conclusion This study provides histological evidence of the GOS that supports the defective deep placentation hypothesis.Our research also contributes to benefit-risk consultation in the GOS,such as in cases of PE and FGR,where a balance between fetal lung maturation and short-term neonatal outcomes is crucial.
文摘Since the first report of COVID-19 in December 2019, our knowledge and treatment modalities have</span><span style="font-family:""> </span><span style="font-family:Verdana;">evolved at great pace understanding its impact on the maternal and neonatal outcomes. Whilst pregnant patients are not more susceptible to acquiring the infection as compared to the general population, they may be at higher risk of developing severe symptoms given the physiological changes, relative immune-compromised state of pregnancy, and their neonates at risk of consequent iatrogenic preterm deliveries. Our review article discusses outcomes of pregnant women and neonates with COVID-19 from several countries including the UK, USA, France, Italy and China</span><span style="font-family:""> </span><span style="font-family:Verdana;">and provides a narrative review of literature from November 2019 till December 2020.
基金supported by the National Science Foundation of China(No.81873843)the National Science and Technology Pillar Program of China during the Twelfth Five-Year Plan Period(No.2014BAI05B05)the Fundamental Research Funds for the Central Universities(Nos.2017KFYXJJ102,2019KFYXKJC053).
文摘Objective:The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology,classification,and diagnosis.This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes;to what extent would these outcomes be modified after the obstetric interventions,including use of glucocorticoid,magnesium sulfate,and progesterone.Methods:This was a retrospective cohort study conducted at Tongji Hospital(composed of Main Branch,Optical Valley Branch and Sino-French New City Branch)in Wuhan.A total of 900 pregnant women and 1064 neonates were retrospectively enrolled.The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery,the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes,and to what extent these outcomes could be modified by obstetric interventions.Results:Eight clusters were identified using two-step cluster analysis,including premature rupture of fetal membranes(PPROM)phenotype,abnormal amniotic fluid(AF)phenotype,placenta previa phenotype,mixed condition phenotype,fetal distress phenotype,preeclampsia-eclampsia&hemolysis,elevated liver enzymes,and low platelets syndrome(PE-E&HELLP)phenotype,multiple fetus phenotype,and no main condition phenotype.Except for no main condition phenotype,the other phenotypes were associated with one or more complications,which conforms to the clinical practice.Compared with no main condition phenotype,some phenotypes were significantly associated with short-term adverse neonatal outcomes.Abnormal AF phenotype,mixed condition phenotype,PE-E&HELLP phenotype,and multiple fetus phenotype were risk factors for neonatal small-for gestation age(SGA);placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min;mixed condition phenotype was associated with low APGAR scores,SGA,mechanical ventilation,and gradeⅢ-Ⅳintraventricular hemorrhage(IVH);fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation;PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min,SGA and neonatal intensive care unit(NICU)admission;multiple fetus phenotype was not a risk factor for the outcomes included except for SGA.Not all neonates benefited from obstetric interventions included in this study.Conclusion:Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes.This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically,with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.
文摘Hypertensive disorders of pregnancy (HDP) are the most common maternal and perinatal health challenges. Globally, the incidence of HDP increased from 16.30 million to 18.08 million, with a total increase of about 10.9% from 1990 to 2019. Umbilical Doppler study in hypertensive disorders of pregnancy helps to predict neonatal outcomes and prevent neonatal and maternal morbidity and mortality. Objective: This study aims to determine the incidence of abnormal umbilical Doppler among hypertensive pregnant women, to identify the adverse neonatal outcomes associated with abnormal umbilical Doppler, and also to detect the diagnostic predictive values of umbilical Doppler to neonatal outcomes at KCMC. Material and methods: A hospital-based prospective cohort study included women with hypertensive disorders of pregnancy from the gestational age of 28 weeks and above, followed up to delivery during the study period from August 2022 to March 2023. Multivariate logistic regression analysis was used to determine the association between AUD and neonatal outcomes. Results: Out of 112 women with HDP, the incidence of abnormal umbilical Doppler was 38 (33.93%). Abnormal umbilical Doppler was associated with neonates with low birth weight aOR (95% of CI) of 4.52 (1.59 - 12.83) p = 0.005 and neonatal ICU admission 9.71 (2.90 - 32.43) p Conclusion: The incidence of abnormal umbilical Doppler is high in hypertensive disorders of pregnancy which is associated with an increase in neonatal low birth weight and neonatal ICU admissions, the sensitivity of abnormal umbilical Doppler in prediction of low birth weight and neonatal ICU admission is significant hence the routine use of umbilical Doppler assessment among hypertensive pregnant women is crucial.
文摘Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to different treatment methods,they were divided into control group(treated with misoprostol combined with oxytocin,40 cases)and observation group(treated with misoprostol and oxytocin combined with calcium gluconate,40 cases),compared the clinical efficacy,delivery time,postpartum hemorrhage 2 hour after delivery,postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth.Results:The total effective rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).The third delivery stage in the observation group was shorter than that in the control group,and the postpartum hemorrhage volume was less than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in Apgar score of the two groups of newborns(P>0.05).Conclusion:Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient,which not only can effectively reduce postpartum hemorrhage and shorten the delivery time,but also is beneficial for neonatal outcome and worthy of clinical application.
文摘Background Preterm births(PTBs)and associated costs in the USA are a public health concern.This study evaluated maternal and neonatal hospital-based outcomes,resource use and costs during delivery and up to 30 days postdischarge following PTB.Methods This study was conducted in the USA among individuals who delivered at≥23 weeks gestation(1 January 2016-30 September 2021)captured in the Premier Al Healthcare Database.Linked neonatal data were used.Regression modelling and sensitivity analyses among spontaneous PTBs were performed.Costs were inflated to US$2022.In-hospital outcomes,resource use and costs were analysed.Results 4303772 deliveries were included;14.8%were linked to neonatal records.Compared with term delivery,adjusted ORs for the<32 and 32 to<37 weeks gestation cohorts,respectively,were 1.33(1.29-1.36)and 0.96(0.95-0.98)for postpartum complications;5.79(5.58-6.01)and 2.73(2.66-2.81)for maternal intensive care unit(ICU)admission;4.20(3.01-5.86)and 1.84(1.38-2.46)for maternal death;1.40(1.37-1.43)and 1.01(1.00-1.02)for maternal readmission;76.92(72.28-81.85)and 5.14(5.03-5.25)for neonatal morbidity;89.58(84.59-94.87)and 10.07(9.84-10.31)for neonatal ICU admission;155.51(130.98184.63)and 8.81(7.24-10.73)for neonatal death and 1.49(1.41-1.58)and 1.16(1.13-1.19)for neonatal readmission.Relative to term births,PTBs had significantly higher per-person maternal and neonatal resource use and costs.The results were robust to sensitivity analyses.Conclusions PTBs present a considerable maternal,neonatal and hospital burden compared with term birth.
基金funded by Hossana Health Science College(HHSC-1205/21).
文摘Objective:To assess the adverse maternal and neonatal outcomes of anemia among pregnant women in primary hospitals in Southern Ethiopia.Methods:This institution-based prospective cohort study was conducted from March 1 to October 30,2022,in three primary hospitals in the Hadiya zone of Southern Ethiopia.Participants were categorized into exposed(Hb<11 g/dL)and non-exposed(Hb≥11 g/dL)groups based on hemoglobin levels measured before delivery.Baseline characteristics were comparable between groups.Maternal and neonatal complications were considered as outcomes.Data were analyzed using STATA version 15.Descriptive statistics summarized baseline characteristics,and Chi-square tests assessed associations.Generalized linear models with a log link calculated adjusted relative risks(aRRs)with 95%CIs.Statistical significance was set at P<0.05.Multivariable models adjusted for confounders,and sensitivity analyses evaluated robustness using multiple imputations for missing data.Results:A total of 490 participants were enrolled in the study,with 245 in each of the exposed and non-exposed groups.Due to loss to follow-up,220 participants in the exposed group and 239 in the non-exposed group were assessed for outcomes.Prolonged labor(adjusted RR(aRR)=3.235;95%CI:1.658,6.312;P=0.003)and postpartum hemorrhage(aRR=2.901;95%CI:1.202,7.910;P=0.045)were identified as adverse maternal pregnancy outcomes of anemia.We observed low birth weight(aRR=3.020;95%CI:1.233,6.010;P=0.002)and respiratory distress syndrome(aRR=4.820;95%CI:2.901,9.012;P=0.001)as neonatal complications.Furthermore,having no previous history of anemia reduced the risk of prolonged labor(aRR=0.078;95%CI:0.033,0.188;P=0.015)and low birth weight(aRR=0.480;95%CI:0.370,0.592;P=0.001).Conclusion:Mothers who have experienced maternal anemia in the past or present face serious consequences for both themselves and their children.Preventing anemia should thus start before conception and continue through pregnancy.
文摘Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnant women were separated into two groups:(1)women aged 19 and younger;(2)women aged 20-34 years.Main outcome measures include preterm birth,maternal comorbidities,preeclampsia,eclampsia,low birth weight(LBW),intrauterine growth restriction(IUGR),placenta abnormalities,placenta abruption,cho-rioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacer-ations,postpartum hemorrhage,childbirth trauma,shoulder dystocia,congenital malformation,and unfavorable maternal and neonatal outcome.Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.Results:Of 7033 deliveries,92.4%of women were adults,and 7.6%were adolescents.Adolescents residing in rural districts were more common than adults(42.3%vs.33.7%).However,access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy.There was no difference in the risk of preeclampsia,placenta abruption,placenta previa,fetal distress,preterm labor,shoulder dystocia,perineal lacerations,childbirth trauma,congenital malformation,postpartum hemorrhage,intensive care unit admission,maternal death,and unfavorable neonatal outcome including stillbirth,neonatal intensive care unit admission,neonatal death in adolescent pregnancies compared to adults.Adolescents had a significantly higher risk of LBW(OR:1.47,95%CI:1.01-2.73),IUGR(OR:1.96,95%CI:1.31-2.45),and meconium fluid(OR:1.74,95%CI:1.41-2.32),however,there was no statistically significant difference after adjusting the confounding factors.Compared with adults,adolescents had a significantly lower risk of CS(aRR:0.67,95%CI:0.51-0.77)and a lower risk of gestational diabetes(aRR:0.78,95%CI:0.51-0.95).Conclusions:Although we found no serious consequences of adolescent pregnancy,more research is needed to reach a more accurate conclusion about teenage pregnancy.
基金This study complies with the Declaration of Helsinki and was performed according to ethics committee approval.The Ethics and Research Committee of the Hormozgan University of Medical Sciences approved the study(number:HUMS.REC.1401.115).
文摘Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.
文摘Background Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid(MAF)presents a challenge for healthcare providers.We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section(CS)versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.Methods In this retrospective study,we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas,Iran,between January 2020-2022.Mothers with certain adverse pregnancy conditions were excluded from the study.These conditions included:abnormal fetal heart rate and pattern,bloody amniotic fluid,malpresentation,abnormal placentation,chorioamnionitis,intrauterine growth restriction,intrauterine fetal death,obstructed labor,and maternal comorbidities.The MAF mothers were divided into two groups based on the method of delivery:those who had CS and those who had a normal vaginal delivery(NVD).Demographic factors,obstetrical factors,and neonatal outcomes were compared between the two groups.Results Out of 746 MAF mothers,213(28.5%)underwent CS,while 533(71.4%)had NVD.There were no significant differences between the groups in terms of demographic characteristics.Among MAF mothers who had CS,66.2%were primiparous,and 33.8%were multiparous.For those who had NVD,35.1%were primiparous,and 64.9%were multiparous.The first and 5-min Apgar values,rates of asphyxia,neonatal intensive care unit(NICU)admission,and neonatal death were not statistically different between the two delivery modes.The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery.Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS(11.1%vs.2.3%),no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.Conclusions Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers.Further studies are needed to provide more substantial evidence to support this conclusion.
文摘Background: The maternal and neonatal morbidity caused by prolonged labour, maternal exhaustion and other factors push clinicians to speed up the delivery process by employing equipment such as vacuum suction or forceps to save the newborn. The purpose of this study was to determine the prevalence of vacuum-assisted vaginal delivery (VAVD) and its associated short-term maternal and neonatal outcomes at Ndola Teaching Hospital. Methods: A retrospective cross-sectional descriptive study through the analysis of routine data for women with singleton-term pregnancies who delivered by vacuum compared with spontaneous vaginal delivery was done at a tertiary hospital for the years 2020 and 2021. Chi-square and Logistic regression were used to investigate factors of vacuum delivery and to adjust for potential confounders. Results: Results showed that VAVD was mostly performed in women who had delayed second stage of labour (25.4%), maternal exhaustion (16.0%), foetal distress in the second stage of labour (12.3%). The overall VAVD prevalence was 3.7% (581/15591). Logistic regression showed that multiparous women were noted to be 87.5% (aOR 0.125;95% CI 0.025 - 0.629;p = 0.012) less likely to undergo VAVD compared to nulliparous women. Registrars were almost 6 times (aOR 5.650;95% CI 1.458 - 22.222, p = 0.012) more likely to conduct VAVD compared to midwives. Episiotomy was 3 times (aOR 3.390;95% CI 1.185 - 9.524;p Conclusion: The findings indicate the underutilisation of VAVD at NTH based on the low prevalence of 3.7%. VAVD outcomes were affected by multiparity, skill level and Episiotomy procedure, in addition, VAVD influenced admission to the NICU. Hence, there is a need to increase skills in VAVD among first-line healthcare workers such as midwives and intern doctors.
文摘Objective: To examine the effects of comprehensive nursing interventions on maternal and infant outcomes in pregnant women diagnosed with gestational diabetes mellitus (GDM). Methods: A quasi-experimental design was employed, involving 60 pregnant women with GDM who were purposively selected and randomly allocated into experimental and control groups, each comprising 30 participants. The experimental group received comprehensive nursing interventions and pregnancy monitoring, while the control group received standard nursing care. Data collection was conducted using demographic questionnaires, pregnancy indicators, and maternal-infant outcome measurement tools. The collected data were analyzed using Microsoft Excel and the Statistical Package for Social Sciences (SPSS). Results: The findings indicated significant improvements in fasting blood glucose, postprandial blood glucose, amniotic fluid index, and neonatal birth weight in the experimental group compared to the control group. However, no statistically significant differences were observed in body mass index (BMI) or pregnancy weight gain. Comprehensive nursing interventions were associated with a significant reduction in maternal complications, including polyhydramnios, postpartum hemorrhage, and preeclampsia, as well as neonatal complications such as neonatal pneumonia, macrosomia, and hypoglycemia. Conclusion: Comprehensive nursing interventions have a positive impact on maternal and neonatal outcomes in pregnant women with GDM.
文摘The disease caused by the SARS-CoV-2 virus has spread very rapidly th<span "=""><span>rough</span><span>out the world, causing various clinical manifestations and affecting several organs and systems. However, the possibility of vertical transmission of C</span><span>OVID-19 in symptomatic pregnant women has been questioned. The aim of this work was to report cases of possible vertical transmission in pregnant women affected by the SARS-CoV-2 virus, as well as its clinical repercussions on the newborn. In this paper, we conducted a cross-sectional retrospective study by analyzing medical records of pregnant women admitted at the military hospital, </span></span><span>in </span><span>Rio de Janeiro, Brazil, diagnosed with COVID-19 and who had positive newborns. To evaluate epidemiological data, clinical manifestations, laborator</span><span>ial</span><span> and histopathological changes </span><span>were </span><span>related to </span><span>such</span><span> vertical transmission. Only six tested newborns </span><span>were </span><span>positive for COVID-19. The mothers had no respiratory symptoms, and the gestational age was at term, except for one newborn born prematurely due to detection of pericadial effusion. Three neonates had respiratory symptoms, requiring ventilatory support. None of the mothers or newborns died. During the pandemic, possible vertical transmission cases of infected pregnant women in the third trimester of pregnancy were observed. According to the case reports published in the literature, they illustrate phenotypes of neonatal involvement with varied clinical manifestations and severity;however, further scientific studies are needed to prove the effective vertical transmission of SARS-C</span><span>o</span><span>V-2 in positive pregnant women.
文摘<strong>Objective:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Data showed that maternal anaemia during pregnancy negatively affects maternal/fetal outcomes. We here attempted to re-confirm this in this specific region of Sudan, with special reference to fetal/neonatal outcome. </span><b><span style="font-family:Verdana;">Methodology:</span></b><span style="font-family:Verdana;"> This cross-sectional observational study was carried out at Omdurman Maternity and Khartoum North Teaching Hospitals-Sudan from March 2018 to March 2019, with 246 pregnant women presented in labour enrolled. Maternal characteristics, haemoglobin (Hb) measured after labour initiation and fetal/neonatal outcomes were analyzed. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> When maternal anemia was defined as Hb less than 10.0 g/dL, 80 (32.5%) had anemia and 166 had not. Anemic women (Hb;8.3 ± 0.31), compared with non-anemic women (Hb;11.4 ± 0.61), were significantly more likely to have low birth weight (LBW) infants (40% vs. 15.7%) and still birth (12.5% vs. 4.8%). There was a correlation between hemoglobin concentration and the followings: LBW, respiratory distress syndrome, neonatal nursery admission, still birth, early neonatal death, and low Apgar score. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Maternal aneamia negatively affected fetal/neonatal outcomes. This data may be useful to make health policy in this area.</span></span>
文摘Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonatal outcome among term mothers with anaemia compared to non-anaemic pregnant women at a tertiary care centre in Sri Lanka. Method: A comparative cross-sectional study was performed by recruiting anaemic and non-anaemic term mothers who delivered at the Teaching Hospital Peradeniya during the period March 2018-March 2019. Pregnant mothers whose haemoglobin level was less than 10.5 g/dl were considered as anaemic and compared with the mothers whose haemoglobin level was above this level. With written consent, demographic data, etiological factors, maternal and neonatal outcomes of term mothers were evaluated by an interview and blood samples were withdrawn to carry out anaemia related investigations. Results: Among 2854 pregnancies, a total of 234 (8.19%) term pregnant mothers were anaemic and they were and compared with 199 non-anaemic mothers. Out of the anaemic mothers (Hb < 105 g/l), 133 (56.76%) had moderate anaemia, 100 (42.79%) had mild anaemia and 1 mother (0.45%) had severe anaemia. Low monthly family income was significantly associated with the incidence of anaemia. Anaemia was also associated with low weekly consumption of red meat (OR 8.994;95% CI, 5.74 - 14.09, p < 0.05) and high weekly tea intake (OR 0.217;95% CI 0.144 - 0.327, p < 0.05). Among anaemic mothers, 215 (67.44%) had low serum ferritin (<30 ng/mL) while most of them were diagnosed with iron deficiency anaemia (58.24%) (n = 113) based on haemoglobin. Most anaemic mothers had undergone elective caesarean section (46.26%) while vaginal deliveries (33.33%) were common among non-anamic group. Conclusions: A moderate prevalence of anaemia among term pregnant women in Peradeniya, Sri Lanka was observed and was associated with low socio economic status, low consumption of tea and poor nutrition lacking in red meat.
文摘<strong><em>Backgrounds</em></strong><span><span><span style="font-family:""><span style="font-family:Verdana;"><strong>:</strong> Teenage pregnancies are generally considered as a high-risk however, sufficient data is lacking in the area, Cairo Egypt. We attempted to </span><span style="font-family:Verdana;">determine whether teenage pregnancies show poorer outcomes than adult-age </span><span style="font-family:Verdana;">pregnancies. </span><b><i><span style="font-family:Verdana;">Objectives</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Finding out the prevalence of teenage pregnancy and its maternal and fetal outcome in comparison. </span><b><i><span style="font-family:Verdana;">Subjects</span></i> <i><span style="font-family:Verdana;">and</span></i> <i><span style="font-family:Verdana;">methods</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> A retrospective analytical case-control study was conducted on patients who had attended for delivery at Al-Galaa Maternity Teaching Hospital during the period of one year from March 2015 to February 2016. A total of included 538 patients aged 16 - 19 years as study group and adult age group: included 609 patients aged 25 - 29 years as the control group. The only primigravid was enrolled. The study records were retrieved for review. Comparisons were made between the two groups regarding maternal demographics, socioeconomic status, medical disorders, major antenatal complications, the outcome of labor, mode of delivery, and perinatal complications. </span><b><i><span style="font-family:Verdana;">Results</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> The prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered the significant prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered significant. Teenagers had a lower antenatal care attendance (63.8% vs 76.7%;P = 0.001), a higher incidence of Eclampsia (2.1% vs 0%;P = 0.000), vaginal deliveries (70.1% vs 51.9%;P = 0.000). And a higher maternal ICU admission (1.4% vs 0.0.7%), and maternal death (0.5% vs 0%),especially in low socioeconomic. On the other hand, the adult group pregnancies had a higher incidence of gestational hypertension, gestational diabetes, and cesarean delivery. </span><b><i><span style="font-family:Verdana;">Conclusions</span></i><span style="font-family:Verdana;">:</span></b><span style="font-family:Verdana;"> Teenager primigravid women should be considered as a high-risk pregnancy and thus require special medical attention to avoid adverse maternal and neonatal outcomes.</span></span></span></span>
文摘Severe preeclampsia (SPE) is associated with fetal complications including intrauterine growth retardation (IUGR), prematurity and in utero fetal death. Its treatment remains child birth that often is planned before term. However, this attitude can lead to fetal complications related to prematurity. Several studies on preeclampsia have already been studied in the DRC and several aspects have already been realized, but to date, the neonatal outcome has not yet been addressed. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is cross-sectional study performed in four public hospitals in Kinshasa (Democratic Republic of Congo). We included 400 cases of induced prematurity (IP) for SPE;the analysis compared pregnant women who gave birth before 34 weeks of amenorrhea (WA) and those after 34 WA. The comparison of the proportions was made by the Chi</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">square test and the calculation of Means by the Student’s test. The significance level was set at P < 0.05. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To determine the frequency of induced prematurity for severe preeclampsia (SPE), to identify the indications and to evaluate neonatal outcome. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The IP frequency for SPE was 46.2%. The retro placental hematoma was the most indication in pregnancies before 34 WA 24.9%, while high blood pressure 54.5% in the after 34 WA group. </span><i><span style="font-family:Verdana;">In</span></i> <i><span style="font-family:Verdana;">utero</span></i><span style="font-family:Verdana;"> death was more common in pregnant women who gave birth before 34 weeks 25.4%;chronic fetal distress was elevated in the after 34 WA group 19.5%. Neonatal infection was more common in the group after 34 WA </span><span style="font-family:Verdana;">49.4%, while respiratory distress 39.6%, intra and periventricular hemorrhage 19.5% and neonatal death 39.6% were more in group before 34</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">WA. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Prematurity induced for SPE is related to a poor neonatal</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> prognosis.
文摘To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Methods: We retrospectively identified all eligible patients at a single institution from January 1990 to December 2012. A thorough research was made through patients’ medical and obstetrical records. The various causes of late APH were compared to each other regarding the parameters of the neonatal outcome. Multiple regression models were applied for gestational age (GA) at birth, birth weight, Apgar score at first and fifth minute and selection of modus of delivery. Results: 480 patients were included in the study, in a total of 7221 pregnancies. The causes of APH were: cervical dilatation (n = 54, 11.3%), central placental abruption (n = 57, 11.9%), peripheral placental abruption (n = 59, 12.3%), placenta previa (n = 140, 29.2%), others non-related to pregnancy (n = 42, 8.8%), uterine rupture (n = 2, 0.4%) and unknown etiology (n = 126, 26.3%). Overall, 253 neonates (52.7%) were born prematurely at gestational age below 37th week. 37 pregnancies (7.7%) resulted in giving birth prior to 32 weeks of gestation. In multivariable analysis, the cause of hemorrhage was found to be an important independent predictive factor for gestational age (GA) at birth, birth weight, Apgar scores at first and fifth minute and modus of delivery. Preeclampsia, diabetes, thyroid disorder and smoking were associated with decrease of GA at birth. Birth weight below 1500 gr and GA at birth was found to be significant independent factors for Apgar score at first and fifth minute respectively. Modus of delivery did not significantly alter Apgar score. Conclusions: Late APH required immediate evaluation of the general condition of the pregnant woman and the fetus. The cause of APH was important in the prognosis of the neonatal outcome. As long as maternal and fetal status were ensured, expectant management, instead of emergency CS, seemed to be more beneficial even for late preterm neonates.
文摘Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.
