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Objectives: to analyze the level of anxiety in high risk pregnant women admitted in the maternity ward of the Hospital Universitário Lauro Wanderley (HULW) of the Federal University of Paraíba. Methods: an observational, descriptive, cross-sectional study of quantitative character, with a sample composed of 100 pregnant women diagnosed as high risk interned at HULW. Data collection was performed using the Beck Anxiety Inventory (BAI), used to assess the level of anxiety the patient is in and the existing symptoms. For the statistical analysis, the Mann Whitney, Kruskal Wallis and Spearman correlation tests were used, considering p

Vertical transmission is a condition in which the virus is infected from mother to child and can have some consequences and risks during pregnancy and at the time of delivery. It is estimated that the incidence of vertical transmission occurs in 25% of pregnancies of infected women when there are no prophylactic measures and therapeutic interventions, resulting in high rates of mortality and disease progression. Contact with contaminated fluids can lead children to contract the virus in the first few months of life. The factors involved include several failures in the health system and maternity. Thus, the present study is based on the following justification: In health services and in the social context, there are difficulties and gaps that contribute to the risk factors of vertical transmission of HIV, constituting negative results for the control of the disease. In view of this, the objective of this research is to identify in the literature which are the existing difficulties that influence the prophylactic measures of vertical transmission. This study was carried out through an integrative literature review, through a survey of data in the scientific bases: LILACS, SCIELO and BDENF. The results obtained indicate that the failure to take prophylactic measures during pregnancy, due to negligence in prenatal consultations, is considered one of the aggravating factors for the risk of VT. Without early diagnosis, without knowledge of the virus, the pregnant woman does not undergo treatment with antiretroviral medication, with this, the immune system is more vulnerable to weakening and risks of complications during pregnancy.

Introduction: Identification of high risk pregnancy can be done by using various scoring systems which is highly predictive in determining maternal and perinatal outcome. Objectives: The objectives of the study were to identify high- risk pregnancy and to compare the maternal and perinatal outcome of high-risk with low-risk pregnancies. Methodology: This study was conducted in the department of obstetrics and gynaecology, Manipal Teaching Hospital, Pokhara, from 1st August 2020 to 31st January 2021. Study included pregnant women coming for delivery after 28 weeks of gestation. Antenatal scoring system involving various risk factors, was used to stratify women as low-risk (score 0-3), high-risk (score 4-6) and extremely high-risk group ( score ≥7). All women were followed up in intrapartum and postpartum period and complications noted. Neonates were also followed up. Maternal and perinatal outcome of three groups were compared. Results: There were 67.3% women in low-risk, 20% in high-risk and 12.7% in extremely high-risk groups. Operative deliveries were 89.9% in extremely high- risk, 77.9% in high- risk as compared to 51% in low- risk group. Maternal complications, total amount of blood loss and duration of hospital stay was more in extremely high-risk and high-risk pregnancies. Low birth weight was more common in extremely high risk (60%) and high-risk (26%) pregnancies compared to low- risk pregnancies (15%). Neonates with low Apgar scores at 1 and 5 minutes were more in high-risk pregnancies. Thirty-two percent neonates in extremely high-risk pregnancy required neonatal intensive care admission which was significantly higher as compared to high-risk and low-risk pregnancies. Perinatal deaths were more frequent in extremely high-risk pregnancies. Conclusions: Identifying high risk pregnancy using scoring system is useful to identify women at risk of developing maternal and perinatal complications.

Purpose: This study aimed to develop and evaluate the effects of the Unpleasant Symptom-Relief Program to mitigate preterm labor stress, anxiety, physical discomfort, and situational discomfort in hospitalized high-risk pregnant women.Methods: This study used a nonequivalent control group nonsynchronized design and analyzed 23 participants from the experimental group and 23 from the control group. The participants from both the groups were matched and diagnosed with preterm labor, incompetent internal os of the cervix, preterm premature rupture of membrane, placenta previa, or gestational diabetes mellitus. The effects of the Unpleasant Symptom-Relief Program were measured using tools such as preterm labor stress, anxiety, physical discomfort, and situational discomfort. The data were analyzed with IBM SPSS Statistics ver. 21.0 using descriptive statistics, t-test, chi-square test, paired t-test, and repeated measures analysis of variance.Results: The Unpleasant Symptom-Relief Program was effective in reducing preterm labor stress (F= 8.24, p=0.001), anxiety (F=17.80, p≤0.001), and situational discomfort (F=5.95, p=0.004). However, it was not effective in reducing the physical discomfort (F=1.20, p=0.311). Post hoc analysis between time points revealed effective reduction in the preterm labor stress and anxiety in both the groups immediately after the end of the program and at 7 days after the program. Situational discomfort was reduced at 7 days after the end of the program in both the groups.Conclusion: The Unpleasant Symptom-Relief Program can be applied in practice by nurses. It can contribute to alleviating the symptoms and discomfort of high-risk pregnant women.

Background: The uterine and umbilical artery Doppler scan is a valuable tool for evaluation of utero-placental blood flow in pregnancy. They help in detecting uteroplacental insufficiency thus predicting preeclampsia and other effects of faulty placentation which increase the risk of adverse effects on both mother and fetus. Aims and Objective: This study aimed to evaluate and compare the uterine artery and umbilical artery Doppler indices in second and third trimester for prediction of preeclampsia in high-risk pregnancies. Materials and Methods: In this prospective observational study done over a years’ time, 50 high-risk pregnant mothers were recruited and the Doppler scans were done at 21-25 weeks and 31-35 weeks. The necessary clinical observations were recorded throughout the antenatal period and the data analysis was done. Results: Majority (56%) were in 20-29 years range with mean age of 24±6.1 years. Out of the 50 women, 21 had abnormal uterine artery Doppler and 12 had umbilical artery abnormality along with uterine derangement. Preeclampsia developed in 3 of them. The hypertensive disorders of pregnancy were diagnosed in 13 women, preeclampsia in 3, eclampsia in 1and other HDPs in 9. The persistence of notch in uterine artery was observed in 7 women, of these 2 developed PIH. Only one patient had uterine artery PI>1.45 at 24 weeks who subsequently developed preeclampsia. Among 4 patients of preeclampsia and eclampsia, 3 had 2nd trimester uterine and 3rd trimester umbilical Doppler abnormalities and only 1 had normal doppler indices. In 2nd trimester the sensitivity, specificity and PPV are higher for uterine artery PI as compared to umbilical artery PI. Hence, uterine artery doppler seems to be a better screening tool for early prediction of PIH. The third trimester umbilical artery PI with higher specificity (96%) and PPV (50%) can diagnose preeclampsia better. One patient had absent diastolic flow and she developed preeclampsia and IUGR. The combined uterine and umbilical artery doppler is a better screening modality as it has a higher sensitivity (75%) and NPV (99.26%). Conclusion: The uterine and umbilical artery Doppler velocimetry are potential tools for uteroplacental surveillance of high-risk pregnancies which can identify patients at risk and help in taking timely action to prevent complications.

Background : Globally; high-risk’ pregnancies account for a significant proportion of perinatal morbidity and mortality worldwide. Risk perception in relation to pregnancy and birth is a complex process influenced by multiple personal, psychological and societal factors. Aim: This study aimed to assess pregnant women’s perception regarding risky pregnancy and it’s correlation to their current pregnancy risk condition. Design: A descriptive correlational design was utilized in this study. Setting: This study conducted in Al-Hadeka center at Fayoum governorate, Egypt. Sample: A purposive sample of 200 pregnant women was included in this study. Tools of data collection: Four tools were utilized to collect data in this study (1) Structured Interviewing schedule, (2)Modified high risk pregnancy scoring tool, (3) Women’s perception regarding risky pregnancy questionnaire and (4): Perception of pregnancy risk Questionnaire(self-rating) ( PPRQ). Results: This study revealed that the highest percentage of participants was reported low and fair level of perception regarding risky pregnancy (72%). More than half of participants were categorized as high and moderate risk pregnancy (53%), and a significant negative correlation was reported between pregnant women’s perception regarding risky pregnancy and their current pregnancy risk score (P. 0.0001). Conclusions: A statistical significant negative correlation reported between pregnant women’s perception regarding risky pregnancy and their current pregnancy risk condition score (r = -0.42) with (P.0.0001). Recommendations: Designing extensive intervention program is recommended to improve women perception in relation to risky pregnancy, and further studies can be replicated on large sample at different settings to validate and generalize findings of the current study

To compare Doppler alterations and perinatal outcomes in pregnant women who evolved with early- and late-onset fetal growth restriction (FGR).A retrospective, observational cohort study with pregnant women who evolved with FGR treated between January 2018 and April 2019, in which all live births from singleton pregnancies, over 24 weeks, with FGR ultrasound diagnosis and under 2700 g weight were included in the study.Pregnancies with early-onset FGR were more associated with hypertensive disorders (Early-onset FGR had a lower prevalence but was associated with higher maternal and fetal morbidity and mortality than late-onset FGR.

Background: High risk pregnancy causes some complications, one of them is death among pregnant women. Recently, the number of mother’s death was increasing. One of the causes is lack of knowledge among pregnant women. Aim: The aim of this study was to describe the level of knowledge of pregnant women in Puskesmas Cepogo related to high risk pregnancy. Method: This study was a descriptive study. The research population was 250 repondents. The sampling method was proportionate stratified random sampling and the sample of this study was 71 respondents. This study was using questionnaire to measure the variables. Univariate analysis was using in this study. Results: This study found that among pregnant women in The Puskesmas Cepogo, the majority (49 repondents/ 69.0%) had lower knowledge about high risk pregnancy. Most of the pregnant women was younger than 20 years and got basic education (SD/SMP). For the income, most of the pregnant women only got less than 1 million rupiah per month. Conclusion: In the Puskesmas Cepogo, the level of knowledge among pregnant women related to the high risk pregnancy was lower.

Background: Anxiety is very common during pregnancy, could be due to high risk pregnancy, history of miscarriage, history of anxiety or depression. High levels of anxiety during pregnancy have adverse effect on mother and baby. Aims: To identify the difference in level of anxiety after application of Benson’s Relaxation Therapy among antenatal mothers with high risk pregnancy Setting and design: The study was conducted in Guwahati Medical College and Hospital, Assam. Preexperimental research design was adopted for the study Materials and methods: 30 antenatal mothers with high risk pregnancy were selected by convenient sampling technique. Self administered structured questionnaire and Perinatal Screening Anxiety Scale (PASS) were used for data collection. Benson’s relaxation therapy was administered for 5 days. Validity and reliability were done. Statistical analysis: Data were analyzed through SPSS Version 24. The level of anxiety before intervention 19(63.3%) had severe symptoms of anxiety, 6(20%) had mild to moderate symptoms and 5(16.7%) were asymptomatic whereas after intervention 16(53.3%) were asymptomatic, 9(30%) had severe symptoms and 5(16.7%) had mild to moderate symptoms. Results: The mean score before intervention was 46.9618.64 and after intervention was 32.0618.53 with mean difference of 14.90. The calculated‘t’ value was 4.656, which was greater than table value indicates statistically highly significant. Conclusion: The study showed difference in level of anxiety between pre test and post test scores. Hence, this intervention is simple, effective, has mind-body approach to reduce anxiety among antenatal mothers with high risk pregnancy Keywords: Anxiety, Benson’s Relaxation Therapy, High risk pregnancy.

Introduction: High-risk pregnancies are found in pregnant women who are too old, too young, too many, and too close (4T). Many risk factors become screening/early detection of pregnant women in the Poedji Rochjati scorecard, including maternal age 35 years, and mothers who have children 4 or more. Objective: The aim of this study was to describe the 4T risk incidence in pregnant women at the Jatinangor Community Health Center in 2020. Methods: The type of research used was descriptive-analytic with a quantitative approach and cross-sectional design. The population in this study were all pregnant women who were in Jatinangor Health Center. January-September 2020 period, amounting to 2357 people, using accidental sampling technique and obtained a total sample of 149 people. Data analysis using descriptive data analysis with frequency distribution. Results: The results showed that respondents who had the highest risk of 4T were 63.19% at the age of more than 35 years, and multiparity of 43.62%. Conclusion: In this study, it was found that the incidence of 4T risk in pregnant women at the Jatinangor Health Center in 2020 was mostly at the risk of being too old by 58.3% which was dominated by multiparity.

Objective—the objective of this study was to assess the accuracy of placental growth factor (PlGF), soluble Fms-like Tyrosine Kinase 1 (sFlt-1), and endoglin (sEng) in the diagnosis of suspected preeclampsia (PE) with and without fetal growth restriction (FGR) near delivery. Methods—this is a secondary analysis of a dataset of 125 pregnant women presenting at the high risk pregnancy clinic with suspected PE, FGR or PE + FGR in the University Medical Center of Slovenia. The dataset included 31 PE cases, 16 FGR cases, 42 PE + FGR cases, 15 cases who developed with unrelated complications before 37 weeks (wks) (PTD), and 21 unaffected controls who delivered a healthy baby at term. We also analyzed a sub-group of women who delivered early (&lt, 34 wks) including 10 PE, 12 FGR, 28 PE + FGR, and six PTD. Clinical management adhered to hospital guidelines. Marker levels were extracted from the dataset and were used to develop Receiver Operating Characteristic (ROC) curves and to calculate the area under the curve (AUC), the detection rates (DRs), and the false positive rates (FPRs). Previously published marker cutoffs for yes/no admission to hospital wards were extracted from the literature. Negative and positive predictive values (NPVs and PPVs) were evaluated for their value in determining whether hospital admission was required. Non-parametric tests were applied for statistical analysis, p &lt, 0.05 was considered significant. Results—near delivery, all the pro-and anti-angiogenic markers provided diagnostic (ROC = 1.00) accuracy for the early (&lt, 34 wks) group of FGR. Diagnostic or near diagnostic (ROC = 0.95) accuracy was achieved by all marker for early PE + FGR but lower accuracy was achieved for early PE. For all cases, all markers, especially PlGF reached diagnostic or near diagnostic accuracy for FGR and PE + FGR. At this accuracy level, they can contribute to the clinical management of FGR, and PE + FGR. All the markers were less accurate for all PE cases. The use of published cutoffs was adequate for clinical management of FGR, whether early or for all cases, using an NPV &gt, 90%. For PE + FGR, the PPV value approached 100%, especially for early cases, and can thus be implemented in clinical management. Neither NPV nor PPV were high enough for managing all cases of PE. There was no added value in measuring the PlGF/(sFlt-1 + sEng) ratio. Conclusion—This is the first study on a Slovenian population. It shows that near-delivery angiogenic biomarkers tests may be useful for confirming the diseases in cases where there is a diagnostic doubt. However, the clinical use of the biomarkers needs to be weighed against resources available and degree of certainty of the diagnosis made with and without them for managing suspected FGR and PE + FGR requiring delivery &lt, 34 wks, where they are very accurate, and furthermore in the management of all cases of FGR and FGR+PE. The markers were less accurate for the clinical diagnosis of PE.

Purpose: High-risk pregnancy, resulting in major complications, such as abortion, gestational hypertension, and preterm labor, are on the rise, requiring intervention. Increased concentration of particulate matter that is 10 μg per cubic meter or less in diameter (PM10) due to increased air pollution and industrialization has recently been noted as a risk factor for health problems, and prior studies have reported that PM10 is related to abortion, gestational hypertension, and preterm labor.Methods: This study used data from the Korean medical panel between 2008 and 2016 to identify 879 women with normal pregnancies and 301 women diagnosed with high-risk pregnancies. The association between high-risk pregnancy and PM10 was analyzed using the annual average regional concentration during the same period by the Korea Environment Corporation.Results: At 35 years of age or older, the risk of abortion (p3, the probability of preterm labor was 2.2 times higher in groups exposed to particulate matter concentration of ≥50 μg/m3 (p10 was related to preterm labor, and the risk of preterm labor was high if the average annual concentration of PM10 in the individual’s residential area exceeded 50 μg/m3.

The purpose of this review was to search for articles on human studies investigating the relationship between melatonin and high-risk pregnancy. An electronic search was conducted in the MEDLINE and PubMed databases from September 2010 to October 2020. The initial search produced 441 articles in PubMed and 407 in MEDLINE. After sorting the titles and abstracts, and removing duplicates, we had nine articles in PubMed and three in Medline. The results of these studies mainly show that the association between melatonin receptor 1B polymorphisms and gestational diabetes mellitus is the most common physiological mechanism relating to melatonin and high-risk pregnancy in this review. In addition, the circadian rhythm, decreased melatonin production, and anti-inflammatory and antioxidant effects were explored. The findings of our review of the literature suggest that this indoleamine is essential in high-risk pregnancy for its potent anti-inflammatory and antioxidant effects, regulation of the circadian rhythm, and genic receptor expression.

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Pre-pregnancy care is an important approach for maternal and child health. This study aimed to determine the knowledge about pre-pregnancy care and factors associated with good pre-pregnancy care knowledge among women with high risk pregnancy in Kinta, Perak. A cross-sectional study was conducted among women diagnosed as high-risk pregnancy in governmental health clinics in Kinta. Stratified random sampling was applied and interviewer-guided questionnaires were administered. A proforma and the validated Pre-pregnancy Care Knowledge and Practice Questionnaire were used, consisting of 21 items on knowledge. Good pre-pregnancy care knowledge was defined as those with the total score of more than 12. Logistic regression analysis was conducted using SPSS software. Of the 490 women, their mean age was 29.98 (SD 5.51) years. Less than half (48.6%) had good knowledge of pre-pregnancy care. Education level and attended pre-pregnancy care services were significantly associated with good pre-pregnancy care knowledge. Compared to women with secondary and below education, those with tertiary education had two times odds of having good pre-pregnancy care knowledge (Adjusted odds ratio 2.06; 95% CI: 1.41, 3.03; p

Introduction: Conducting dental consultations during pregnancy is considered an important challenge in the context of Maternal and Child Health Policies, as it is surrounded by myths rooted among users and health professionals. In this sense, it is important to identify barriers and facilitators to the search for dental assistance in this period, in order to support strategies that make this practice feasible. Objective: To analyze the search for dental care during high-risk pregnancies, according to sociodemographic, gestational and health characteristics. Methods: Observational study with a cross-sectional design, carried out with high-risk pregnant women referred to a teaching hospital in southern Brazil, from January to May 2018. Data collection was performed using an unprecedented structured form and considered as a dependent variable the search for dental care during pregnancy and as independent variables sociodemographic, gestational and dental characteristics. Pearson's chi-square association test and Fisher's exact test were used. Results: To reach the sample of 190 pregnant women at high gestational risk, a total of 230 women considered valid were approached, counting on the following losses: refusal to participate (n=23), no answer to any question (n=10), duplicity in participant approach (n=7). Advanced maternal age (p=0.000) and history of premature birth in previous pregnancies (p=0.047) were factors associated with a lower frequency of seeking dental care in the current pregnancy. On the other hand, the habit of dental consultation prior to the gestational period (p=0.001), the knowledge about the importance of this monitoring (p=0.050), as well as the safety (p=0.000) in performing dental prenatal care, were related positively to the search during pregnancy. Conclusion: Specific incentive strategies and access to dental prenatal care are necessary to neutralize barriers that may compromise the search for oral health services during pregnancy. For this reason, identifying the facilitators and hinders to the dental service is essential for planning effective actions related to prenatal care.

Objectives: to estimate the prevalence of drug abuse in pregnant women and to associate with the variables education, family income, race and number of pregnancies. Methods: descriptive, cross-sectional, quantitative research. Developed in the municipality of Bandeirantes-PR, from June 2016 to December 2017. The population was 114 pregnant women and the dependent variables were alcohol / tobacco use and illicit drugs and the independent variables were education, race, family income and number of pregnancies. The analysis was the comparison between the variables and Microsoft Excel 2007 and SPSS 20.0 was used. It was approved by the Ethics Committee. Results: the use of drugs of abuse during pregnancy was 19.2%, presenting as a sociodemographic profile characterization the age between 19 to 29 years, predominance of nonwhite race, with study time ≤ 9 years, with income from 1 to 2 minimum wages and multiparous women. The most commonly used drug of abuse was alcohol, followed by tobacco. Concomitant use between drugs was significant with alcohol and tobacco / illicit drugs and tobacco. Conclusions: drug use had a prevalence of 19.2% and acts in conjunction with social issues and this case, intervening is necessary with an individualized care plan, thus ensuring the promotion and prevention of maternal and child health. Resumo Objetivos: estimar a prevalência do uso de drogas de abuso nas gestantes e associar com as variáveis escolaridade, renda familiar, raça e número de gestações. Métodos: pesquisa descritiva, transversal, quantitativa. Desenvolvida no município de Bandeirantes-PR, no período de junho/2016 a dezembro/2017. A população foi de 114 gestantes e as variáveis dependentes foram uso de álcool/tabaco e drogas ilícitas e as independentes foram escolaridade, raça, renda familiar e número de gestações. A análise foi a comparação entre as variáveis e utilizado o Microsoft Excel 2007 e o SPSS 20.0. Foi aprovado pelo Comitê de Ética. Resultados: o uso de drogas de abuso na gestação foi de 19,2%, apresentando como caracterização de perfil sociodemográfico a idade entre 19 a 29 anos, predomínio da raça não branca, com tempo de estudo ≤ 9 anos, com renda de 1 a 2 salários mínimos e multi-gestas. A droga de abuso mais utilizada foi o álcool, seguido de tabaco. O uso concomitante entre as drogas apresentou-se significativo sendo álcool/tabaco e drogas ilícitas/tabaco. Conclusão: o uso de drogas teve uma prevalência de 19,2% e atua em conjunto com questões sociais, intervir neste caso se faz necessário com um plano de cuidado individualizado, garantindo assim a promoção e prevenção a saúde materno e infantil.

Background and Objectives: To evaluate the role of Doppler ultrasonography in predicting the perinatal outcome in high-risk pregnancy and to establish its role in management of high-risk pregnancy. Materials and Methods: The present study is a prospective study of Doppler ultrasound evaluation of uterine artery, umbilical artery and middle cerebral artery in 100 high-risk pregnant women, performed between 28 and 34 weeks of gestation. Doppler index Pulsatility index (PI) for each above mentioned artery and cerebro-placental ratio (CPR) will be calculated. Doppler Pulsatility index for the corresponding gestational age were compared with the reference values. The results of the Doppler ultrasound and AFI will be used for analysis of mode of delivery and perinatal outcome in the form of birth weight, APGAR score, NICU admission, perinatal mortality. Results: Among newborns 46(46%) were admitted to NICU, 64(64%) of neonates had birth weight less than 2.5kg, there were 17 perinatal deaths. Of the 17 perinatal deaths, 2 cases had reverse end diastolic Flow (REDF) and 12 had absent end diastolic Flow (AEDF). Uterine artery PI was most sensitive(72.3%) than Umbilical artery PI(sensitivity 59.6%) and MCA PI(sensitivity 68.1%). Diagnostic accuracy of Cerebroplacental ratio (accuracy71%) was better than Umbilical artery PI (accuracy 65%) and MCA PI(accuracy 70%) in predicting adverse outcomes. Conclusion: Triple vessel colour Doppler sonography is very useful in high-risk pregnancy diagnosis and in predicting perinatal outcome.

Objective: In the present study, for which reasons fetal cardiac evaluation was requested from our pediatric cardiology clinic, the effects of routine fetal cardiac evaluation in obstetric ultrasonography (USG) on the detection of congenital heart disease (CHD) and the distribution of intrauterine diagnosis of CHD according to pregnancy risk profiles were retrospectively analyzed. Materials and Methods: Fetal echocardiography reports which containing the nineteen-month period were retrospectively examined. We performed a fetal echocardiography for all pregnant women who were referred to pediatric cardiology clinic after detail obstetric USG screening. The pregnancies were categorized into two groups based on the risk of CHD: Low-risk and high-risk groups. Detected congenital cardiac structural malformations were classified as complex, moderate, and mild according to perinatal mortality risk. Results: Of the 736 pregnancies, 22 were twin, and fetal cardiac evaluation was performed in 758 fetuses. There were 341 (46.3%) pregnancies in the high-risk group and 395 (53.6%) pregnancies in the low-risk group. The most common reason for fetal cardiac evaluation request was inability to adequately visualize the fetal heart (36.1%), while suspected fetal cardiac abnormality was the second most common cause (21.3%). Number of fetuses detected with cardiac abnormalities was 80 (23.5%) among high-risk pregnancies, and 20 (5%) among low-risk pregnancies. The most common type of malformation was simple cardiac abnormalities (6%) followed by complex lesions (4.1%). The most common cardiac abnormality was ventricular septal defect comprised of 18 cases (2.4%) while the most common complex cardiac abnormality was pulmonary atresia (1.2%). The rate of consistency was 40.1% between obstetricians and pediatric cardiologist in terms of the diagnosis of the congenital cardiac malformations. Conclusion: Routine evaluation of the fetal heart by means of obstetric USG, including four chambers, outflow tracts’ and three vessel views, would allow for diagnosing congenital cardiac malformations to a large extent during the intrauterine period.

The objective of this study was to explore the correlation between cervical insufficiency (CI) and polycystic ovary syndrome (PCOS) in Chinese women undergoing assisted reproductive technology (ART) treatment. The retrospective study enrolled 2978 women including 1489 with PCOS and 1489 without PCOS, among which 34 women were diagnosed with CI (1.14%). The prevalence of CI in PCOS women was statistically higher than that in women without PCOS. Among those women with CI, 23 cases exhibited PCOS, and those cases had an average gestational age of 26.09 ± 5.91 weeks at the end of pregnancy, which was earlier than that of women without PCOS, and the pregnancy outcomes were worse than in the non-PCOS group though not statistically significant. Multivariable logistic regression showed that PCOS status (odds ratio: 2.050, 95% confidence interval: 1.009-4.206) were associated with increased risk of CI. Our study revealed that among those Chinese women who conceived by ART treatment, the prevalence of CI in women with PCOS was higher than that in women without PCOS. Co-morbidity of CI with polycystic ovarian syndrome negatively impacts prognosis.Impact statement

Pregnancy can be in a high-risk category, which is grouped according to Poedji Rochjati Scoring Card that causes anxiety. Anxiety in a pregnant woman can trigger contractions, abortus, increasing blood pressure that can trigger the occurrence of preeclampsia, etc. One of the therapies to deal with anxiety is murottal of Quran therapy and Benson relaxation. Murottal of Quran therapy is a complementary therapy that is applied by listening to the passage of Ar Rahman letter, whereas, Benson relaxation is a complementary therapy that is done by guiding clients to unite beliefs and regulate breathing. Both therapies have a relaxing effect, which can reduce stress and anxiety. The purpose of this research is to know the influence of therapeutic murottal Quran and Benson relaxation on pregnancy anxiety high-risk. This research use Quasy experimental design with the design of two group pretests and a posttest involving 39 respondents with the criteria of high-risk expectant mothers experiencing anxiety in Kelurahan Setiawargi Kecamatan Tamansari Tasikmlaya City. The analysis of data in this study used quantitative analysis by describing the characteristics of each research variable and assessing the influence of therapy Murottal Quran and Benson relaxation of high risk expectant pregnant mothers using paired T-test samples. The result of this study was obtained that the anxiety of pregnant mothers high-risk decreased after intervention in each group. Based on the explanation above, it can be concluded that there is a therapeutic influence of murottal Quran and Benson relaxation to the anxiety of high-risk expectant mothers.

Background: High-risk pregnancies are associated with adverse perinatal and maternal outcomes. Aim: To know the overall perinatal outcome in high-risk pregnancies. Methods: Present observational study was conducted in the Obstetrics and Gynecology department of a rural tertiary center of Northern India over eight months (February-October 2018) on 3,085 antenatal women at gestation ≥ 28 weeks with 1,309 high-risk cases and 1,776 normal pregnancy cases after Institutional ethical committee approval and informed written consent from the participants. The demographic features including age, gravidity, parity, gestation, high-risk factors, the onset of labor, mode of delivery of all the selected antenatal women at gestation ≥ 28 weeks were recorded on a preformed datasheet by trained staff. All the participants were observed till delivery and the perinatal outcome was recorded. Statistical analysis was done using software SPSS 22.0 version and a p-value Results: Of total 1,309 high-risk pregnancies, 365(27.9%) were preterm, 936(71.5%) term and eight (0.6%) post-term cases. Of 1,309 neonates delivered, 66(5.04%) were intra-uterine dead fetuses, 1,243 live fetuses, of which nine (0.7%) had intrapartum still-birth, 278(22.4%) required neonatal intensive care unit admission, 70(5.6%) intubated, 238(19.1%) needed oxygen support, 343(27.6%) developed complications, while 11(0.9%) had early neonatal deaths. The average birth weight of neonates delivered to high-risk mothers was 2.47±0.571 Kg with 271(20.7%) neonates having low birth weight ( Conclusion: High-risk pregnancy was associated with an adverse overall perinatal outcome with increased risk of perinatal morbidities and mortalities.

[No Abstract Available] Saudi Med J 2020; Vol. 41 (8): 779-790doi: 10.15537/smj.2020.8.25222 How to cite this article:Yaser A. Faden, Nadia A. Alghilan, Samiha H. Alawami, Eman S. Alsulmi, Hythem A. Alsum, Yasir A. Katib, Yasser S. Sabr, Fadwah H. Tahir, Nabeel S. Bondagji. Saudi Society of Maternal-Fetal Medicine guidance on pregnancy and coronavirus disease 2019. Saudi Med J 2020; Vol. 41 (8): 779-790. doi: 10.15537/smj.2020.8.25222.

Introduction: Fetal echocardiography is a screening tool mostly reserved for high risk pregnant women. Early identification of cardiac anomalies improves perinatal outcomes. However this tool need not be restricted to high risk cases only but can be used for all pregnant women. Materials and Methods: This 6 month observational study included singleton pregnant women aged 18-40yrs attending antenatal clinic with one to two decisive risk factors for fetal congenital heart disease (CHD). A fetal echocardiography was done between 18 to 24 week of pregnancy. Results: Of the 50 cases a total of 4 cases of CHD’s were diagnosed by abnormal fetal echocardiography. The remaining 46 cases showed a complete accord between fetal and postnatal echo findings except one case where a membranous VSD with Left to Right shunt, was detected by pretnatal echo but was absent in the post natal finding. Conclusion: Our study strongly endorse all mothers to undergo fetal echocardiogram by trained specialists who are at risk of congenital heart disease such as maternal congenital heart disease and diabetes in pregnancy. Keywords: Fetal echocardiography, Congenital heart disease, High risk pregnancy.

Background: Antepartum evaluation of the fetus at risk for damage or death in utero remains a major challenge in modern obstetrics. Freeman & Lee (1975) 1 and colleagues introduced the non-stress test to describe acceleration of fetal heart rate is a sign of fetal health in response to fetal movement. Aims: Role of Non stress test in antepartum fetal surveillance and perinatal outcome in high risk pregnancy. To prove the efficacy of NST as an effective tool for evaluation of fetal well-being. To decrease perinatal morbidity and mortality. Materials and Methods: Hospital based prospective study. 50 pregnant women with high risk factors as study group and 50 healthy pregnant women as control group were randomly selected from period of July 2015 to December 2015 in the department of Obst & Gynae Dr. S. N. Medical college Jodhpur. Non stress test performed and results were analysed. Results: Non stress test as screening test for antenatal fetal surveillance has high specificity and high negative predictive value. Conclusion: The ideal test for fetal reserve should be safe, inexpensive, readily available, quickly exerted and devoid of either false positive or false negative results. As yet no such test exists which is perfect, still NST has been shown to be most acceptable modality for evaluating the fetus in utero. Keywords: Non stress test, High risk pregnancy.

Background Pregnant women with mechanical heart valves are at significant risk of obstetric/cardiac complications. This study compares the anticoagulation management in two obstetric cardiac centres. Methods Retrospective case-note review from Chelsea and Westminster/Royal Brompton Hospitals (CR) and Erasmus Medical Centre (EMC). Main outcome measure was mechanical heart valve thrombosis. Results Nineteen pregnancies from CR and 25 pregnancies from EMC were included. Most women were on low-molecular-weight heparin (LMWH) throughout pregnancy at CR, whereas at EMC most had LMWH in the first trimester and vitamin K antagonists in subsequent trimesters. Peak anti-factor Xa were performed monthly at CR, levels 0.39–1.51 IU/mL (mean 0.82 IU/mL). Anticoagulation management peri-partum was inconsistent. Delivery was mainly by caesarean section at CR (74%) and vaginal delivery at EMC (64%). No maternal deaths and only one mechanical heart valve thrombosis at CR. Two mechanical heart valve thromboses and one maternal death at EMC. Conclusion Peri-partum anticoagulation strategies, anticoagulation monitoring and mode of delivery inconsistencies reported.

High risk pregnancy associated with any physical, social or psychological factors that increase the risk of woman or fetal morbidity or mortality. Aim: The aim of the study was to evaluate the nursing intervention of high risk hypertension pregnancy in family medicine centers. Design: A quasi experimental design was used in this study. Settings: This study was conducted at 5 family medicine centers in Giza. Sample: Purposive sample of 130 women was used with a predetermined inclusion criteria. Tools: Two tools were used for data collection, first tool was an interviewing questionnaire for collecting data related to socio-demographic data of women, women knowledge related to pregnancy & women practices related to antenatal care, the second tool was follow up sheet of outcome after delivery about woman &fetus and medical record analysis. Results: This study found that total knowledge of the pregnant women had unsatisfactory in pre intervention it was improved to majority in post intervention & none of the pregnant women were done their antenatal practices satisfactory in pre intervention while it was improved to majority in post intervention. Majority of the outcomes of pregnant women (the fetus) had not any congenital anomalies and had viability of life. Conclusion: The nursing intervention was effective in improving women knowledge & practices regarding high risk hypertension pregnancy and their pregnancy outcomes. Recommendation: Develop nursing intervention program for high risk hypertension pregnant women about antenatal care, high risk hypertension factor in pregnancy, proper nutrition and proper practices during pregnancy in family medicine centers.

Summary. Purpose of research. Development of a method for prevention of placental insuffi ciency (PN) in high-risk pregnancy in women of the Republic of North Ossetia-Alania (RSO-A) with the complex use of antihypoxant limontar and ozone therapy (OT). Material and methods. Observations were made of 75 pregnant residents of RSO-A with diagnosed PN, whose average age was 32,6 ± 8,14 years. Using a simple randomization method, 3 groups were formed: in the main group (OG), patients received prevention of PN by using OT and antihypoxant limontar; in the comparison group (GS), only limontar; in the control group (KG), pregnant women did not receive prevention of PN. All patients observed before and after PN prevention were examined for placental lactogen and estriol, ultrasound of the fetoplacental complex (FPC), Doppler examination of the uterine blood fl ow and ultrasound examination of the placenta structure, and morphological examination of the placenta. Results. Based on identifi ed pathogenetic mechanisms of the disorders in the system “mother — placenta — fetus” are defined by a high clinical effi cacy of combined pharmaco-ozone therapy (CT) in the prevention of PN in pregnant women at risk, which was manifested by the lack of progression of PN, whereas in GS, where patients received only pharmacotherapy with limontar, progression was noted in 31,8 % of cases, in KG, where there was no prevention, is 56 %. Conclusion. In the present study, the positive effect of OT and antihypoxant limontar on the processes of microcirculation, metabolism, and adaptation of the body, which provides a signifi cant reduction in the frequency of pregnancy complications, increasing the adaptive capabilities of the fetus and improving perinatal outcomes.

High-risk pregnancy is the probability of adverse pregnancy outcome is increased over the general pregnant population. Some high-risk pregnancy is the result of a medical condition present before pregnancy. In other cases, a medical condition that develops during pregnancy causes a pregnancy to become high risk. The reason why high-risk pregnancy is important is detecting the risk factors for high risk pregnancy early and preventing the complicated pregnancy. Korean society of Obstetrics and Gynecology (KSOG) announced the classification of high-risk pregnancy including 95 risk factors: obstetrics risk factors, medical risk factors, physical risk factors and risk factors of current pregnancy. However, this announcement of high-risk pregnancy by KSOG was limited for maternal-fetal healthcare providers to apply their working and making policy. First this didn't include the conception of the complicated pregnancy and high-risk delivery. Second this did not separate the risk factors depend on before and during pregnancy. This review briefly evaluates the classification of high-risk pregnancy by KSOG and suggest the new classification including the complicated pregnancy and high-risk delivery for maternal-fetal healthcare providers.

The purpose of this study was to obtain an overview of pregnancy risk factors in pregnant women accompanied by young doctor from the IKM-KK department of the Faculty of Medicine at Tadulako University during a stase at the Primary Health Care in the city of Palu. The design of this study was descriptive in order to obtain an overview of pregnancy risk factors obtained from the checklist for assisting pregnant women. The population in this study were all pregnant women who received young doctor from the IKM-KK department in the last 2 (two) years, totaling 147 pregnant women. While the sample in this study was 3rd trimester pregnant women whose notes in the accompanying book are complete. The results showed that: 1) Compliance with the lowest Antenatal Care standard in laboratory tests (70%); 2) Pregnant Women with Low Risk Pregnancy (KRR) of 58.2%, High Risk Pregnancy (KRT) of 32.2% and Very High Risk Pregnancy (KRST) of 9.6%; 3) The three highest risk factors for pregnancy are getting pregnant too soon again

Objective: To compare prenatal attachment in women hospitalised due to high-risk pregnancy with prenatal attachment in non-hospitalised patients. To describe the impact of social support, socio-demographic factors and the nature of the pregnancy on prenatal attachment, anxiety and depression. Study Design: An exploratory, cross-sectional and descriptive study utilising the Maternal Antenatal Attachment Scale, the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory. The sample comprised 80 hospitalised and 88 non-hospitalised patients. Result: No difference in prenatal attachment was found between the two groups. The hospitalised group presented higher levels of depressive symptomatology and anxiety. Social support had a significant effect on the hospitalised group, improving attachment quality. Conclusion: Incorporation of members of the patient's support network may help to improve quality of prenatal attachment during hospitalisation. Detection and treatment of anxiety and/or depression in hospitalised patients is recommended given their impact on the mental health of mother and baby.

The vaginal microbiota may be important for pregnancy prognosis because vaginal dysbiosis during pregnancy appears to be related to preterm birth (PTB) or pregnancy loss. Previous reports have indicated that a Lactobacillus-poor microbial flora in the vagina and intrauterine infection by diverse anaerobes ascending from the vagina are associated with undesirable delivery outcomes. However, no research has involved the use of pyrosequencing analysis to examine vaginal microbiota profiles or their potential associations with high-risk pregnancy in Korean women. Vaginal swabs were collected from 500 Korean women for the identification of community state types (CSTs). Of these, 137 samples were further analyzed using a Roche/454 GS Junior pyrosequencer. Three distinct CSTs were identified based on the dominant vaginal microbes: CST I (Lactobacillus crispatus dominated), CST III (Lactobacillus iners dominated), and CST IV (with diverse species of anaerobes). Twelve of the 67 pregnant women had undesirable pregnancy outcomes (four miscarriages and eight PTBs). The dominant microbe in the vaginal microbiota of women who gave birth at full-term was L. crispatus. In contrast, L. iners was the dominant vaginal microbe in women who miscarried. Most (n = 6/8) vaginal microbiota profiles of women who experienced PTB could be classified as CST IV, with diverse bacteria, including anaerobic vaginal species. The present study provides valuable information regarding the characteristics of the vaginal microbiota of Korean women related to high-risk pregnancy. Investigation of the vaginal microbiotic structure in pregnant Korean women is necessary to enable better prediction of adverse pregnancy outcomes.

Covid 19 pandemic has led to significant mortality and long term morbidity globally. Pregnant women are at increased risk of severe illness from COVID 19 infection. There is an urgent need for all health authorities and Governments to offer vaccination to all pregnant women especially those with high risk pregnancy.

Knowing maternal satisfaction linked to interventionism is essential to improve care processes. The aim of this research is to analyze women satisfaction according to the sociodemographic variables, clinical variables related to childbirth assistance and interventionism, in order to identify those predictors. A descriptive and cross-sectional study was carried out with the participation of 301 women assisted in an obstetric unit in Girona. It was concluded that the women assisted by midwives, with a lobour at term, started spontaneously and without administration of oxytocin showed greater satisfaction, personal capacity, participation and security. Instrumental delivery, inductions of labour, and admissions at the neonatal unit were identified as barriers to maternal satisfaction, as well as low participation, low perception of safety and personal capability, manifesting that interventionism is also a barrier to maternal satisfaction Conèixer la satisfacció materna lligada a l’intervencionisme és essencial per millorar els processos assistencials. L’objectiu de la investigació és analitzar la satisfacció de les dones segons les variables sociodemogràfiques, les variables clíniques relacionades amb l’assistència i l’intervencionisme al part, i identificar els factors predictors d’aquesta satisfacció. Es va realitzar un estudi descriptiu i transversal on van participar 301 dones ateses a una unitat obstètrica de Girona. Es va concloure que les dones ateses per la llevadora, en un part a terme, d’inici espontani i sense administració d’oxitocina manifesten major satisfacció, capacitat personal, participació i seguretat. Es va identificar com a barreres de la satisfacció materna, la manca de participació, la baixa sensació de seguretat i capacitat personal, els parts distòcics, induïts i amb ingrés del nadó a la unitat de nounats, posant de manifest que l’intervencionisme també és una barrera per la satisfacció matern Programa de Doctorat en Biologia Molecular, Biomedicina i Salut

The purpose of the study was to develop the Uncertainty Scale for Women Hospitalized with High-Risk Pregnancies (USWHHP) and to evaluate its validity and reliability. The USWHHP was developed through four steps: generation of the initial items, evaluation of content validity, preliminary survey, and evaluation of validity and reliability in a large sample survey. The final USWHHP scale includes 27 items in seven subdomains, which are scored using a 5-point Likert scale. The total possible score ranges from 27 to 135, and a higher score indicates a greater level of uncertainty. The USWHHP had a Cronbach’s alpha coefficient of 0.93. The USWHHP is an easy-to-apply questionnaire specifically designed to measure uncertainty levels of women hospitalized with high-risk pregnancies.

IntroductionNigeria constitutes 1% of the world’s population yet accounts for 10% of global maternal mortality. Risk analyses within rural regions of Nigeria are not routinely conducted, yet could help inform access to skilled birth care. The objectives of this study were to assess the proportion of women at risk for mortality or morbidity in Benue State, Nigeria by analysing data collected during routine antenatal visits and through the Community Maternal Danger Score (CMDS), a validated risk-analysis tool.MethodsTwo cohorts, comprised of pregnant women presenting to primary healthcare centres within Gboko, Benue State between 2015-2017 and 2020-2021, were included in this study. The 2015-2017 cohort had their risk assessed retrospectively through analysis of routinely collected data. Identification of risk was based on their age, parity, and disease status (HIV and diabetes). The 2020-2021 cohort had their risk assessed prospectively using the CMDS.ResultsRoutinely collected data from 2015-2017 demonstrated that up to 14.9% of women in Gboko were at risk for mortality or morbidity. The CMDS reported that up to 21.5% of women were at a similar level of risk; a significant difference of 6.6% (p=0.006). The CMDS was more efficient in obtaining and assessing this data, and the identification was available in real-time for midwives and pregnant women.ConclusionRoutine data collected in Gboko identifies a high proportion of pregnant women at risk for mortality or morbidity. The CMDS is an evidence-based risk analysis tool that expands on this assessment by also estimating individual and community-level risk, which allows for more efficient mitigation and prevention strategies of maternal mortality.

Pregnancy is one of the important stages for women. As several complications arise during pregnancy, it may lead to high risk for both mother and foetus. One such is the incidence of hypertension associated with pregnancy which leads to increased maternal and foetal deaths during pregnancy and childbirth. Due to its high incidence rate and associated complications, the study of this disorder has been a subject of numerous investigations in an attempt to determine its prevention and improve the treatment. In this context, this work uses the data mining (DM) technique to predict rules for high-risk pregnancy due to hypertension. The JRip classification rule and EM clustering are applied on various parameters from the collected data for predicting hypertensive disorders during III trimester of pregnancy. The Jrip classification rules generated for the data have 97% true positive rate and EM clustering generated similar clusters enabling a good proposed model.

Background: The physiological changes in pregnancy may serve to protect the mother from the hazard of bleeding imposed by placentation and delivery, but they also carry the risk of an exaggerated response, localized or generalized, to coagulant stimuli. After correlating the trends of coagulation profile in all three trimesters of pregnancy with parameters [Body Mass Index (BMI), Glycemic status, Blood Pressure Status]; We can find out high risk pregnancies so that special attention can be given during pregnancy, labour and postpartum period. Material & Methods: A observational prospective analytic study done on 100 Pregnant ladies who were visited to routine antenatal clinic in the department of Obstetrics & Gynecological SMS Medical College and attached group of hospitals, on outdoor basis were selected in their first trimester (after 8 week gestation) in SMS medical college & attached group of hospitals during April 2017 to March 2018. The study protocol was approved by the Institutional Ethics Committee. All participants submitted informed consent before enrolment. After taking proper history, all the subjects underwent clinical examination comprising of general physical examination, assessment of vital parameters and systemic examination. Results: Our study that the mean age of study subjects was 26.46 ± 3.34 years. There was significant but weak positive correlation of D Dimer with BMI and Blood sugar in all trimesters of pregnancy. Significant correlation was found between APLA with DBP and MAP in 1st trimester of pregnancy. No correlation was found between APLA and other parameters in any trimester of pregnancy. Conclusion: We concluded that there were increased in FDP, D-Dimer, INR, APLA while platelets count, PT and aPTT were decreased. Further prospective study will be required to measure the outcome of pregnancy so we can define a high-risk pregnancy and those will get special attention in peripartum period. Keywords: Trimester, Pregnancy, D Dimer, BMI, Blood pressure, Correlation

Cortical venous thrombosis is a rare complication of pregnancy resulting in stroke. The risk of stroke is higher in pregnancy than normal individuals because of high progesterone. Keywords: CVT, Pregnancy, Caesarean section, High risk pregnancy, Hypercoagulable state, Enoxaparin, Aspirin.

The most common cause of maternal death is bleeding (30.3%), followed by hypertension in pregnancy (27.1%), infection (7%). Other causes, 45%, are quite large, including non-obstetric causes. High maternal mortality is also caused by the high number of unexpected pregnancies. Approximately 65% of pregnancies still occur because "4 too" associated with pregnancies "too young (less than 20 years)," too old: (more than 35 years), "too often (pregnancy interval less than 2 years," too many”(more than 3 children). Most maternal deaths can be prevented if adequate treatment is provided in health care facilities. Time and transportation factors are very decisive in referring to high-risk cases. Therefore, detection of risk factors in mothers is good by personnel. Health and society is one of the important efforts in preventing death and morbidity. To avoid the risk of complications in pregnancy and childbirth, every pregnant woman needs at least 4 antenatal care, namely once in the first trimester (0-12 weeks gestation), one times in the second trimester (12-24 weeks of gestation), and twice in the second trimester third steer (24 weeks gestation until delivery). Keywords: Early Detection Of High Risk Pregnancy, Pregnancy Test.

Little is known about how women with medically high-risk pregnancy manage their emotions while worried about their pregnancies. This study aimed to phenomenologically explore 16 hospitalized women’s emotional reactions and coping during medically high-risk pregnancy with a focus on how emotion management techniques were utilized and what rationales women used for employing them, along with their interpretations of health care providers’ and family members’ advice regarding emotional expression. Respondents universally feared that experienced stress and the resulting distress (negative emotions such as anxiety, sadness, and anger) could harm their fetus. They experienced double binds including believing they must “be positive” to enhance fetal health, despite anxiety and sadness; feeling responsible for housework yet being told not to do it; and needing medical treatments they feared would harm their fetus. In attempting to avoid tears and fears, they expended tremendous energy, leaving themselves depleted and less able to cope. Ubiquitous “think positive” messages amplify women’s sense of failure when distress due to the medically high-risk pregnancy spills over. With little attention to women’s emotional experiences, even to the point of complimenting them as “good incubators,” health care providers may unintentionally shift emotional labor onto vulnerable women. Understanding women’s needs for assistance with emotion management during medically high-risk pregnancy provides important guidance for development of best practices for this population.

Este estudo teve como objetivo caracterizar o acompanhante nas primeiras 48 horas após o parto de gestações classificadas como de alto risco. Este é um estudo quantitativo realizado em uma instituição pública. A coleta de dados ocorreu de novembro de 2016 a julho de 2017. Os dados foram compilados no programa SPSS® versão 20.0. Participaram do estudo cento e setenta acompanhantes (61,2%), com idades entre 20 e 40 anos (65,8%), brancas (56,5%) e ocupações remuneradas (77,0%). três salários mínimos (53,5%), desconheciam a existência da lei do acompanhante (52,3%) e foram informados pelos profissionais de enfermagem (56,4%); portanto, a presença do acompanhante já promoveu conforto à puérpera (75, 5 %) Conclusão: O estudo foi importante para conhecer as gestantes que possuem determinantes primários para near miss e, assim, adequar os cuidados.