Search

Purpose: Women who face pregnancy complications may require hospitalization in a high-risk pregnancy unit (HRPU), and this may have a negative impact on the pregnant woman's mental health. The purpose of this study was to screen for depressive symptoms in pregnant women admitted in a high-risk pregnancy unit and also to investigate associated risk factors., Methods: This was a cross-sectional study that enrolled pregnant women admitted at ≥24 gestational weeks in a university hospital HRPU, between September 2014 and November 2015. The Edinburgh Postnatal Depression Scale was used to assess depressive symptoms on admission. A cutoff score ≥13 was considered as indicative of depression. Test results were then correlated with the reasons that led to the women's admission as well as socio-demographic characteristics., Results: Overall, 157 of the women admitted in the HRPU during the study period were eligible for the study and agreed to complete the questionnaire. The mean age of the pregnant women was 30 ± 6 years, and the mean gestational week at admission was 32 ± 3 weeks. The prevalence of antenatal depression (score ≥13) was 28 % (44/157). In the multivariate analysis, antenatal depression was significantly correlated with smoking (OR = 2.681, 95 % CI 1.089-6.601) and the existence of thoughts for pregnancy termination (OR = 3.624, 95 % CI 1.149-11.427)., Conclusions: Approximately one quarter of pregnant women hospitalized in the HRPU may show signs of depression at the time of admission. Smoking and an unwanted pregnancy were found to be independently associated with antenatal depression, whereas no association was found with any obstetric parameters.

Objective The aim of this study was to review and compare the most recently published influential guidelines on postnatal care practices, as the ongoing health care provision of both the mother and her offspring helps to timely identify and effectively manage any arising complications and therefore secure maternal and infant short- and long-term well-being. Methods A comprehensive review of guidelines from the American College of Obstetricians and Gynecologists, the World Health Organization, the National Institute for Health and Care Excellence, and the Public Health Agency of Canada regarding postnatal care was carried out. Results All the reviewed guidelines underline the importance of postnatal health care provision, including home visits and midwifery services and the use of telemedicine for the facilitation of communication with the patient, and agree on the appropriate preparation for discharge and the discharge criteria. There is also agreement on the clinical aspects that should be evaluated at each postnatal visit, although discrepancies exist with regard to the contact schedule. In addition, there is consensus concerning the management of postnatal infections, perineal pain, fecal and urinary incontinence, and physical activity guidance. Clinicians should address mental health issues at each postnatal visit, according to all medical societies, but routine screening for depression is not recommended universally. As for the optimal interpregnancy interval, the American College of Obstetricians and Gynecologists recommends avoiding pregnancy for at least 6 months postpartum, whereas the National Institute for Health and Care Excellence recommends a 12-month interval. Discrepancies were identified with regards to the nutrition guidance, the recommended contraceptive methods, and the postpartum management of pregnancy complications. Of note, the World Health Organization is the only one to provide guidance regarding the prevention of specific infections during the postpartum period. Conclusion Although the puerperium is a critical period for the establishment of motherhood and the transition to primary care, postnatal care remains a relatively underserved aspect of maternity care. Therefore, it is crucial to develop consistent international strategies for the optimal care and support of women during this period to safely guide clinical practice and subsequently reduce maternal and neonatal morbidity. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis, prevention and management of fetal macrosomia and shoulder dystocia, which are both associated with adverse pregnancy outcomes. Methods A comparative review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Department for Health and Wellbeing of the Government of South Australia on macrosomia and shoulder dystocia was conducted. Results The American and the Australian College of Obstetricians and Gynecologists agree that macrosomia should be defined as birthweight above 4000-4500g regardless of the gestational age, while the National Institute for Health and Care Excellence defines macrosomia as an estimated fetal weight above the 95th percentile. According to the first two medical societies, ultrasound scans and clinical estimates can be used to rule out fetal macrosomia, although lacking accuracy. Exercise, appropriate diet and pre-pregnancy bariatric surgery are mentioned as preventive measures. It is unanimously discouraged to routinely induce labor before 39 weeks of gestation with the sole indication of suspected fetal macrosomia, but an individualized counseling should be provided. There is also agreement among the reviewed medical societies concerning the definition and the diagnosis of should dystocia with the “turtle sign” being the most frequent sign for its recognition as well as the poor predictability of the reported risk factors. In addition, there is consensus on the algorithm of shoulder dystocia management with McRoberts technique suggested as first-line maneuver. Moreover, all guidelines agree that appropriate staff training, thorough documentation and time keeping are crucial aspects of shoulder dystocia management. As for the prevention, the American and the Royal College of Obstetricians and Gynecologists recommend elective caesarean section in case of an estimated fetal weight above 4500g or 5000g for diabetic and non-diabetic women, respectively, while the Department for Health and Wellbeing of the Government of South Australia is against elective birth in non-diabetic women with suspected fetal macrosomia. Conclusion Macrosomia is associated not only with shoulder dystocia but also with maternal and neonatal complications. Similarly, shoulder dystocia can lead to permanent neurologic sequalae as well as perinatal death if managed in a suboptimal way. Therefore, the development of consistent international practice protocols for their prompt diagnosis and effective management is of paramount importance in order to safely guide clinical practice and improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to review and compare the recommendations from the most recently published guidelines on the screening, prevention, diagnosis and management of neonatal hypoglycemia. Methods We conducted a comparative review of guidelines from the American Academy of Pediatrics, the British Association of Perinatal Medicine, the European Foundation for the Care of the Newborn Infants, the Queensland Clinical Guidelines-Australia, the Canadian Pediatric Society and the Pediatric Endocrine Society on this frequent metabolic disturbance encountered by the neonate. Results There is agreement among the reviewed guidelines concerning the risk factors, the clinical manifestations of neonatal hypoglycemia as well as the main preventive strategies. Moreover, the early recognition of infants at risk, the timely identification of neonatal hypoglycemia and the prompt initiation of treatment are universally considered as cornerstones for the improvement of neonatal outcomes. In addition, all guidelines, except Pediatric Endocrine Society, recommend screening for neonatal hypoglycemia in asymptomatic high-risk and symptomatic newborns, but they disagree regarding the screening policy. Furthermore, the diagnosis should be confirmed by laboratory methods of blood glucose levels measurement, although treatment should not be deferred until then. The definition of neonatal hypoglycemia lacks uniformity, but it is agreed that a single blood glucose value cannot accurately define this clinical entity. Thus, the use of operational thresholds for the management of neonatal hypoglycemia is endorsed by all the reviewed guidelines, although discrepancies exist regarding the recommended cut-off values, the optimal treatment and surveillance strategies of both symptomatic and asymptomatic hypoglycemic neonates as well as the treatment targets. Conclusion Neonatal hypoglycemia is a matter of keen debate in contemporary neonatology and one of the leading causes of term admission to Neonatal Intensive Care Unit. The development of consistent international protocols for the management of this biochemical abnormality seems of insurmountable importance in order to prevent brain injury and neurodevelopmental impairment and optimize the outcomes of hypoglycemic neonates. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques and timing of placing and removal of cervical cerclage, which represents one of the limited effective measures currently available for the prevention of preterm labor caused by cervical insufficiency contributing in the reduction of neonatal morbidity and mortality rates, worldwide. Methods A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynaecologists, the Society of Obstetricians and Gynaecologists of Canada and the International Federation of Gynaecology and Obstetrics on cervical cerclage was carried out. Results There is consensus among the reviewed guidelines regarding the recommended techniques, the physical examination-based indications for cervical cerclage, the contraindications as well as the optimal timing of placement and removal. All medical societies also agree that ultrasound-indicated cerclage is justified in women with history of prior spontaneous preterm labor or mid-trimester loss and a short cervical length detected on ultrasound. In addition, following cerclage, serial sonographic measurement of the cervical length, bed rest and routine use of antibiotics, tocolysis and progesterone are unanimously discouraged. In case of established preterm labor, cervical cerclage should be removed, according to the American, the English and the Canadian guidelines. Furthermore, the Royal College of Obstetricians and Gynaecologists and the Society of Obstetricians and Gynaecologists of Canada agree on the prerequisites that should be met before attempting CC. These two guidelines along with the International Federation of Gynaecology and Obstetrics recommend history-indicated cerclage for women with three or more previous preterm deliveries and/or 2nd trimester pregnancy losses, while the American College suggests the use of cerclage in singleton pregnancies with one or more previous 2nd trimester miscarriages related to painless cervical dilation or prior cerclage due to painless cervical dilation in the 2nd trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue cerclage remains a matter of debate. As for preterm premature rupture of membranes, the Royal College points out that if it occurs between 24 and 34 weeks of gestation and there are no signs of infection or preterm labor, cerclage removal should be delayed for 48 hours in order to allow in utero transfer. Conclusion Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm labor in women considered as high-risk for these common pregnancy complications. The development of uniform international practice protocols for the insertion of cervical cerclage seems of paramount importance and will hopefully improve the outcomes of such pregnancies. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to review and compare the most recently published influential guidelines on the management of pregnancies complicated by fetal growth restriction, a frequent pregnancy complication and a major contributor of fetal and neonatal morbidity and mortality. Methods: A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, the International Federation of Gynecology and Obstetrics, the International Society of Ultrasound in Obstetrics and Gynecology, the Royal College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the Perinatal Society of Australia and New Zealand, the Royal College of Physicians of Ireland, the French College of Gynecologists and Obstetricians, and the German Society of Gynecology and Obstetrics on FGR was carried out. Results: The definition of fetal growth restriction and small-for-gestational-age fetuses and the diagnostic criteria lack uniformity. On the contrary, all the reviewed guidelines highlight the importance of early universal risk stratification for fetal growth restriction to accordingly modify the surveillance protocols. It is unanimously recommended to evaluate low-risk pregnancies by serial symphysis fundal height measurement, while the high-risk ones warrant increased sonographic surveillance. After fetal growth restriction diagnosis, there is consensus that umbilical artery Doppler assessment is required to further guide management. Amniotic fluid volume evaluation is recommended by some medical societies. In case of early, severe or accompanied by structural abnormalities fetal growth restriction, most of the medical societies support the performance of prenatal diagnostic testing. There is also agreement regarding the importance of continuous fetal heart rate monitoring during labor, the optimal timing and mode of delivery, and the need for histopathological examination of the placenta after delivery. On the other hand, discrepancies were identified with regards to the frequency of fetal growth and Doppler velocimetry evaluation, although the majority of the reviewed guidelines recommend an average interval of 2 weeks, reduced to weekly or less when umbilical artery abnormalities are detected. In addition, inconsistency exists concerning the appropriate timing for corticosteroids and magnesium sulfate administration, the need of testing for congenital infections, as well as the administration of aspirin as a preventive measure. Cessation of smoking, alcohol consumption, and illicit drug use are proposed for fetal growth restriction prevention. Conclusion: Fetal growth restriction is a clinical entity associated with numerous adverse antenatal and postnatal events mainly due to the lack of effective screening, prevention, and management policies and the absence of definitive cure apart from delivery. Therefore, it seems of insurmountable importance to develop and implement uniform international protocols for the early recognition, the adequate surveillance, and the optimal management of growth-restricted fetuses in order to ameliorate the perinatal outcomes of such pregnancies. [ABSTRACT FROM AUTHOR]

The impact of the COVID-19 pandemic and the public health measures introduced to control it, on mental health, is largely unknown. Research conducted during past epidemics found that pregnant women are more vulnerable psychologically. The aim of this study was to investigate antenatal depressive and anxiety symptoms during this pandemic in Greece. All women receiving routine antenatal care, during a three-month period, starting one week after the total lockdown in Greece, in a University department, were asked to fill in two questionnaires, the Edinburg Postnatal Depression Scale (EPDS) and the State-Trait Anxiety Inventory (STAI). Overall, 505 women (93.3% of the eligible population) agreed to participate. The prevalence of antenatal depression (EPDS score≥13) in the population of the study was 13.5%. Unplanned pregnancy (OR: 2.447; 95% CI: 1.235–4.846), smoking (OR: 2.268; 95% CI: 1.166–4.411) and antenatal anxiety (OR: 5.074; 95% CI: 2.898–8.883) increased the risk of antenatal depression during the COVID-19 pandemic. State (current)-anxiety affected 34.1% of the participants, whereas Trait (lifetime)-anxiety affected 15.8%. The State-anxiety score (median) was significantly higher than the Trait-anxiety (median) (41 vs. 36; p<0.001), revealing an increase in the levels of anxiety in the pandemic, while there was also a positive linear correlation between the two scales (rho=0.592; p<0.001). The unprecedented situation of the COVID-19 pandemic has increased anxiety, but not depression levels of pregnant women in Greece. Population level interventions to address adverse effects on anxiety status in the initial phases of similar situations may be helpful in the future. [ABSTRACT FROM AUTHOR]

Background: Spontaneous preterm birth (sPTB) has a detrimental impact on perinatal outcome, as well as on the resources of health systems in high-income countries. Thus, the objective of the current study was to determine the incidence of modifiable risk factors in pregnancy and their impact on the rate of sPTB. Methods: All nulliparous pregnant women, in singleton pregnancies, with free medical and obstetric history, were eligible to participate in this study. The primary outcome of interest was the incidence of specific modifiable risk factors for sPTB. The correlations between these risk factors and sPTB were also investigated. Results: Overall, 2027 women were eligible for the study and agreed to participate. The incidence of sPTB was 4.9%; 25.5% (n = 518) of the participants were in extreme maternal age (<20 or >35 years), 34.5% (n = 701) had an abnormal body mass index (BMI) (<18.5 or ≥25 kg/m2), 4.4% (n = 89) reported use of assisted reproductive technology (ART) and 10.9% (n = 220) reported themselves as smokers in pregnancy. In the multivariate analysis, sPTB was significantly correlated with ART conception [odds ratio (OR): 2.494, 95% confidence interval (CI): 1.196–5.199]. Conclusion: Approximately one in 20 primiparous pregnant women in the study had a sPTB. The study population included a high percentage of women of advanced maternal age, with abnormal BMI and smokers, but these characteristics did not affect the incidence of sPTB. On the other hand, conception following ART increased two-fold the risk of sPTB. [ABSTRACT FROM AUTHOR]

Purpose: Antenatal depression is a common mental health problem among pregnant women that negatively affects maternal and neonatal outcomes. Women with obstetric complications, defined as high-risk pregnancies, seem to be at particularly increased risk for developing depressive symptomatology. The purpose of this study was to review the prevalence of antenatal depression among pregnant women with obstetric complications and to identify possible associated factors.Methods: A literature search was performed in the PubMed database and a scoping review was conducted to identify studies with data on the prevalence of antenatal depression and associated factors among high-risk pregnancies due to obstetric complications. The included studies were written in English and published up to 31/12/2018.Results: The prevalence of antenatal depression among pregnant women with high-risk pregnancies ranges from 12.5 to 44.2% among the reviewed studies. The associated factors significantly associated with antenatal depression include maternal age, maternal education, dwelling place, relationship with the partner, previous psychiatric diagnosis, perceived stress, antenatal attachment, abortion thoughts, smoking, diabetes, parity, number of pregnancies, gestational age, threatened preterm labour, preeclampsia and oligohydramnios.Conclusions: Our findings indicate a high prevalence of depressive disorders in women with obstetric complications, suggesting the need for more rigorous screening among this population. The identification of associated factors also merits clinical attention. Further research is warranted to develop evidence-based effective screening strategies and relevant interventions. [ABSTRACT FROM AUTHOR]

Objective: Uterine fibroids affect 2-10 % of pregnant women. Although usually asymptomatic, they may be associated with pregnancy complications. Myomectomy is preferably avoided antenatally, however, it has been reported in symptomatic cases that did not respond to conservative management. The aim of this study was to summarize the published literature and present the reported outcomes and associated risks of this procedure.Study Design: A systematic research of the literature was conducted in PubMed/MEDLINE, Scopus and the Cochrane Library, including case reports and case series. An effort was made to numerically analyse all parameters included in the case reports.Results: Overall, 54 relevant articles were identified, including 97 patients. The median gestational age at diagnosis was 13 (range 6-26) weeks, while the median age at myomectomy was 16 (range 6-26) weeks. Abdominal pain, not responding to medical treatment was the most common indication for surgery. The median number of fibroids removed per patient was one (range 1-5). Most of them were subserous pedunculated or subserous and fundal. Laparotomy (78.4 %) was the principal surgical approach, however, laparoscopic and vaginal operations were also reported. The median duration of surgery was 53 (range 20-150) min. The histopathology revealed necrosis and degeneration as the main findings of removed fibroids. The pregnancy outcome was favourable in most of the cases, with few complications reported.Conclusion: Based on the limited published data, myomectomy during pregnancy appears as a safe procedure in cases of symptomatic uterine fibroids not responding to conservative management and therefore it may be considered, following appropriate counselling regarding the associated risks. [ABSTRACT FROM AUTHOR]