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Aim: Fontan surgery is a palliative procedure commonly performed for functional single‐ventricle heart diseases. Fontan circulation is characterized by elevated central venous pressure and low cardiac output. It causes placental hypoxia, which could lead to poor obstetric outcomes. During post‐Fontan pregnancies, ultrasonography may detect abnormal appearance of the placenta. We have focused on higher incidences of unexpected onset of labor when this ultrasonographic finding is present. In this study, we aimed to investigate whether this finding could be an indicator of premature delivery before pre‐scheduled dates in post‐Fontan pregnancies. Methods: During post‐Fontan pregnancies, the placenta exhibits a mosaic pattern with areas of low and high echogenicity and unusually thick on ultrasonography. We refer to these changes as "ultrasonographic placental edematous changes." We retrospectively analyzed clinical charts and ultrasonograms for post‐Fontan pregnancies between 2015 and 2022. Results: Fifteen patients were included in this study. Ultrasonographic placental edematous changes in the placenta during pregnancy were detected in eight cases (53%). Six (75%) of these patients experienced unexpected premature labor. Two patients underwent vaginal delivery because of sudden onset of labor. Four patients underwent emergency cesarean sections. Two patients underwent planned preterm cesarean sections. In the seven pregnancies without placental edematous changes, all deliveries occurred on the pre‐scheduled dates determined based on the maternal heart condition. Conclusions: Pregnancies with ultrasonographic placental edematous changes have a higher risk of unexpected preterm delivery than those without these changes. Ultrasonographic placental edematous changes may serve as predictive markers for unplanned preterm births in post‐Fontan pregnancies. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has resulted in a crippled healthcare system worldwide. In this unprecedented situation, it is important to analyse the impact on the vulnerable population of pregnant women, especially those with high-risk pregnancies and those undergoing a Caesarean section (CS). Aim: To analyse the clinical profile, foetomaternal outcomes, and co-morbidities in COVID-19-affected pregnancy cases undergoing a CS. Materials and Methods: This was a retrospective observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, and New Civil Hospital in Surat, Gujarat, India during the first wave of the COVID-19 pandemic from April 2020 to December 2020. The study included a total of 65 cases of COVID-19-positive mothers undergoing a C-section. Demographic parameters such as age, obstetric history, details of the C-section (like gestational age at the time of the procedure, indication, and category of the C-section), associated co-morbidities, severity of COVID-19-related symptoms and treatment, neonatal parameters {such as birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and COVID-19 status of the baby at birth} were analysed. Additionally, a comparison of the C-section rate and complications such as the development of severe anaemia requiring blood transfusion, postoperative development of urinary tract infections, surgical site infections, and the association of hypertensive disorders of pregnancy was conducted between COVID-19-affected and unaffected pregnancies undergoing a C-section during the study period. Data on COVID-19 negative cases were obtained from the monthly labour room statistics submitted to the department. The Chi-square test and Fisher’s-exact test were used to compare parameters of the COVID-19 positive and negative groups and a p-value of less than 0.05 was considered statistically significant. Results: Out of a total of 6246 deliveries conducted at the institute during the study period, the CS rate among affected and non affected women was 44.5% (65 out of 146) vs. 32.8% (2006 out of 6100) {p=0.003, Relative Risk (RR) 1.3, 95% Confidence Interval (CI) 1.12-1.62}. The mean age of women with COVID-19 undergoing a CS was 25.3 years. The difference in the rate of blood transfusion requirement in COVID-19-affected cases was 9 out of 65 (13.8%) vs. 120 out of 2006 (6%) in COVID-19 negative pregnancies (RR 2.3, 95% CI: 1.2-4.3). The difference in the rate of urinary tract infections in the postoperative period was statistically significant in COVID-19-infected patients, 5 out of 65 (7.7%) vs. 58 out of 2006 (2.9%) in non infected patients (p=0.0451, RR 2.6, 95% CI 1.1-6.4). The prevalence of hypertensive disorders among COVID-19 positive and negative mothers undergoing CS was very high in the present study (16 out of 65, 24.6% vs. 160 out of 2006, 8.1%, RR 3.08, 95% CI 1.9-4.8). Neonatal parameters like low APGAR score at birth were seen in 5 cases (8%), low birth weight in 20 cases (30%), and 3 babies (4.5%) were COVID-19 positive at birth. Conclusion: Higher rates of caesarean sections, increased prevalence of hypertensive disorders of pregnancy, anaemia requiring blood transfusion, and postoperative development of urinary tract infections among COVID-19-affected mothers undergoing a caesarean section.

Esta revisión examina la literatura sobre el impacto de la telesalud aplicada en modelos de atención en salud ambulatorios sobre los resultados en salud (funcionales, costos, satisfacción y calidad de vida) en población gestante de alto riesgo. Dada la heterogeneidad en los métodos de estudio, las tecnologías utilizadas y las medidas de resultado, los resultados se analizaron y presentaron en una descripción general narrativa de la literatura. Se concluye que la implementación de esos modelos es factible en términos técnicos y podrían representar un ahorro de costos para el proveedor de servicio y las pacientes. Sin embargo, se requiere más claridad sobre los desenlaces clínicos, con evidencia de alta calidad, para que las políticas que habilitan dichos servicios evolucionen al ritmo de la tecnología.

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has resulted in a crippled healthcare system worldwide. In this unprecedented situation, it is important to analyse the impact on the vulnerable population of pregnant women, especially those with high-risk pregnancies and those undergoing a Caesarean section (CS). Aim: To analyse the clinical profile, foetomaternal outcomes, and co-morbidities in COVID-19-affected pregnancy cases undergoing a CS. Materials and Methods: This was a retrospective observational study conducted at the Department of Obstetrics and Gynaecology, Government Medical College, and New Civil Hospital in Surat, Gujarat, India during the first wave of the COVID-19 pandemic from April 2020 to December 2020. The study included a total of 65 cases of COVID-19-positive mothers undergoing a C-section. Demographic parameters such as age, obstetric history, details of the C-section (like gestational age at the time of the procedure, indication, and category of the C-section), associated co-morbidities, severity of COVID-19-related symptoms and treatment, neonatal parameters {such as birth weight, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score, and COVID-19 status of the baby at birth} were analysed. Additionally, a comparison of the C-section rate and complications such as the development of severe anaemia requiring blood transfusion, postoperative development of urinary tract infections, surgical site infections, and the association of hypertensive disorders of pregnancy was conducted between COVID-19-affected and unaffected pregnancies undergoing a C-section during the study period. Data on COVID-19 negative cases were obtained from the monthly labour room statistics submitted to the department. The Chi-square test and Fisher's-exact test were used to compare parameters of the COVID-19 positive and negative groups and a p-value of less than 0.05 was considered statistically significant. Results: Out of a total of 6246 deliveries conducted at the institute during the study period, the CS rate among affected and non affected women was 44.5% (65 out of 146) vs. 32.8% (2006 out of 6100) {p=0.003, Relative Risk (RR) 1.3, 95% Confidence Interval (CI) 1.12-1.62}. The mean age of women with COVID-19 undergoing a CS was 25.3 years. The difference in the rate of blood transfusion requirement in COVID-19-affected cases was 9 out of 65 (13.8%) vs. 120 out of 2006 (6%) in COVID-19 negative pregnancies (RR 2.3, 95% CI: 1.2-4.3). The difference in the rate of urinary tract infections in the postoperative period was statistically significant in COVID-19-infected patients, 5 out of 65 (7.7%) vs. 58 out of 2006 (2.9%) in non infected patients (p=0.0451, RR 2.6, 95% CI 1.1-6.4). The prevalence of hypertensive disorders among COVID-19 positive and negative mothers undergoing CS was very high in the present study (16 out of 65, 24.6% vs. 160 out of 2006, 8.1%, RR 3.08, 95% CI 1.9-4.8). Neonatal parameters like low APGAR score at birth were seen in 5 cases (8%), low birth weight in 20 cases (30%), and 3 babies (4.5%) were COVID-19 positive at birth. Conclusion: Higher rates of caesarean sections, increased prevalence of hypertensive disorders of pregnancy, anaemia requiring blood transfusion, and postoperative development of urinary tract infections among COVID-19-affected mothers undergoing a caesarean section. [ABSTRACT FROM AUTHOR]

Introduction: Multifetal gestation is a high-risk pregnancy that leads to more maternal and fetal challenges because of the linked maternal and neonatal morbidity and mortality. The rate of multiple pregnancy has dramatically increased during the past decades, along with the diffusion of assisted reproduction technology (ART). Aim and Objectives: To determine the maternal outcome in multifetal gestation. Material & Methods: The prospective observational study was carried in the department of obstetrics and gynaecology, Jorhat Medical College and Hospital, Assam from August 2023 to January 2024 included 50 women with multifetal gestation with gestational age of 28 weeks or more . All cases of multifetal gestation either admitted from antenatal clinics or from emergency labour room were included in the study. Results: These were recorded as per the proforma. Out of total 4744 births during this study period, 49 were twin pregnancies and 1 was triplet pregnancy. The incidence was 1.05%. In present study 62% of women are in the age group 21-29 years. Majority 80% were unbooked. 62% were primigravida. 12% women conceive after infertility treatment. Maximum 58% delivered between 29-36 weeks of gestation. Mostly 64% were dichorionic diamniotic twins. Maternal complications observed were anaemia in 62%, preterm labour 58%, hypertensive disorders of pregnancy in 14% patients, PPROM and PROM in 14% and 12% respectively, APH in 6% and PPH in 10% patients. 38% cases were having both babies with cephalic presentation. Majority 62% delivered by LSCS and 38% delivered vaginally. Most common indication for LSCS is Malpresentation. No maternal mortality occurred. Conclusions: Our findings showed the importance of antenatal care playing a major role in the final outcome of multifetal pregnancy. Early detection of high-risk cases, timely referral, frequent antenatal visits and early hospitalization with optimum obstetrics care and intensive neonatal care set up are necessary to improve maternal and perinatal outcomes. [ABSTRACT FROM AUTHOR]

Introduction: There is a paucity of objectively verified data on substance use among Danish pregnant women. We estimated the prevalence of substance use including alcohol and nicotine among the general population of Danish pregnant women. Material and Methods: In this anonymous, national, cross‐sectional, descriptive study, pregnant women were invited when attending an ultrasound scan between November 2019 and December 2020 at nine Danish hospitals. Women submitted a urine sample and filled out a questionnaire. Urine samples were screened on‐site with a qualitative urine dipstick for 15 substances including alcohol, nicotine, opioids, amphetamines, cannabis, and benzodiazepines. All screen‐positive urine samples underwent secondary quantitative analyses with gold standard, liquid chromatography‐tandem mass spectrometry (LC–MS/MS) analysis. Results were compared to questionnaire information to analyze the validity of self‐reporting and to examine possible cross‐reactions. Results: A total of 1903 of 2154 invited pregnant women participated (88.3%). The prevalence of dipstick‐positive urine samples was 25.0%. 44.0% of these were confirmed positive, resulting in a total confirmed prevalence of 10.8%. The prevalence of nicotine use was 10.1%—and for all other substances, <0.5%. Nicotine use was more prevalent among younger pregnant women, while other substance use appeared evenly distributed over age groups. Self‐reporting of use of nicotine products was high (71.1%), but low for cannabis and alcohol intake (0% and 33.3%, respectively). Prescription medication explained almost all cases of oxycodone, methylphenidate, and benzodiazepine use. Conclusions: Substance use among pregnant women consisted mainly of nicotine. Dipstick screening involved risks of false negatives and false positives. Except for alcohol intake and cannabis use, dipstick analyses did not seem to provide further information than self‐reporting. LC–MS/MS analyses remain gold standard, and future role of dipstick screenings should be discussed. [ABSTRACT FROM AUTHOR]

HIGHLIGHTS 1. This review focuses on maximizing the effectiveness of "Kartu Skor Poedji Rochyati" (KSPR) in Indonesia's maternal referral system. 2. It addresses the lack of information about Indonesia's maternal referral system, offering valuable insights. 3. Underlining the high rates of maternal and fetal deaths due to referral errors, the article stresses the urgency of understanding KSPR's function for high-risk pregnant women. ABSTRACT Maternal Mortality Rate (MMR) represents fatalities during pregnancy, childbirth, and the postpartum period due to complications, not external factors. Timely detection is crucial for preventing maternal deaths, necessitating integrated planning. The "Kartu Skor Poedji Rochjati" (KSPR) emerges as a vital tool for identifying high-risk pregnancies, facilitating urgent referrals to mitigate complications and enhance healthcare. A literature review on maternal mortality, risk assessment tools, and KSPR effectiveness will be conducted to address the issues. The findings are expected to highlight KSPR's pivotal role in identifying at-risk pregnant women, enabling prompt referrals, and reducing maternal mortality rates. Case studies and data analysis will enrich our understanding of the tool's impact on maternal healthcare. The apex of public health involves embracing health-conscious lifestyles, reflected in indicators like mortality and morbidity. Proactively identifying high-risk pregnancies using KSPR is a strategic step in averting maternal mortality. Leveraging KSPR allows early intervention, reducing complications and contributing to enhanced maternal health, aligning with the goal of minimizing mortality risks.

Objective(s): Adolescent pregnancy is one of the important challenges of reproductive health. Factors such as family conflict, poor social support, and low self-esteem among adolescent mothers can expose them to postpartum depression. Therefore, the present study was performed to determine the prevalence of postpartum depression and its relationship with birth experience among adolescent mothers. Methods: The present study was a cross-sectional study that was conducted on 202 adolescent mothers referred to urban and suburban health centers in Tabriz, Iran. Sampling method was census and done in the period of 1 to 3 months after birth in 2022. After checking the eligibility criteria, childbirth experience questionnaire version 2.0 (CEQ 2.0) and Edinburgh Postnatal Depression Scale (EPDS) were completed through interview. Data analysis was done using SPSS software and logistic regression test. Results: The mean (SD) of postpartum depression score was 7.5 (5.6) ranging from 0 to 30. The prevalence of postpartum depression and negative birth experience were approximately 23.8% and 11.4%, respectively. After adjusting the effect of possible confounding variables, there was no statistically significant relationship between the negative experience of birth and postpartum depression (p= 0.310). In mothers with unwanted pregnancy compared to mothers with wanted pregnancy, the probability of postpartum depression was 2.22 times higher [Odds Ratio (95% Confidence Interval) = 2.22 (4.71 to 1.05); p= 0.037]. Conclusion: Although in this study, approximately one-fifth of adolescent mothers were exposed to postpartum depression; there was no significant relationship between the negative birth experience and postpartum depression. The results of this study can be used to identify high-risk mothers, especially mothers with unwanted pregnancies, referring them for counseling, and prevent postpartum depression.

High-risk pregnancy is the leading cause of maternal mortality in Indonesia. The role of community health workers (CHWs) is crucial in efforts to improve maternal health through the early detection of high-risk pregnancies. When CHWs are provided with the appropriate training and knowledge, they can help detect high-risk pregnancies. PANAH SRIKANDI program was conducted as a community service activity with the aim of providing information to enhance the knowledge and skills of health cadres in screening for early detection of high-risk pregnancies in pregnant women. The program utilized various teaching methods, including lectures, demonstrations, simulations. Impact was evaluated through pre-tests and post-tests. The results showed an improvement in the abilities, knowledge, and understanding of health cadres regarding high-risk pregnancies, with 77% of cadres demonstrating an increase in their knowledge. Additionally, four out of five simulation groups scored above 80%. In conclusion, the educational intervention for CHWs in this program significantly improved their knowledge and skills of the early detection of high-risk pregnancies. [ABSTRACT FROM AUTHOR]

• Homeless pregnant women are at higher risk of preterm birth compared to those with stable living arrangements. • Homeless women are more likely be affected by other adverse social determinants of health. • We report a ten fold increase in pregnant women reporting homelessness over the study period. To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01–2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements. [ABSTRACT FROM AUTHOR]

Objective(s): Adolescent pregnancy is one of the important challenges of reproductive health. Factors such as family conflict, poor social support, and low self-esteem among adolescent mothers can expose them to postpartum depression. Therefore, the present study was performed to determine the prevalence of postpartum depression and its relationship with birth experience among adolescent mothers. Methods: The present study was a cross-sectional study that was conducted on 202 adolescent mothers referred to urban and suburban health centers in Tabriz, Iran. Sampling method was census and done in the period of 1 to 3 months after birth in 2022. After checking the eligibility criteria, childbirth experience questionnaire version 2.0 (CEQ 2.0) and Edinburgh Postnatal Depression Scale (EPDS) were completed through interview. Data analysis was done using SPSS software and logistic regression test. Results: The mean (SD) of postpartum depression score was 7.5 (5.6) ranging from 0 to 30. The prevalence of postpartum depression and negative birth experience were approximately 23.8% and 11.4%, respectively. After adjusting the effect of possible confounding variables, there was no statistically significant relationship between the negative experience of birth and postpartum depression (p= 0.310). In mothers with unwanted pregnancy compared to mothers with wanted pregnancy, the probability of postpartum depression was 2.22 times higher [Odds Ratio (95% Confidence Interval) = 2.22 (4.71 to 1.05); p= 0.037]. Conclusion: Although in this study, approximately one-fifth of adolescent mothers were exposed to postpartum depression; there was no significant relationship between the negative birth experience and postpartum depression. The results of this study can be used to identify high-risk mothers, especially mothers with unwanted pregnancies, referring them for counseling, and prevent postpartum depression. [ABSTRACT FROM AUTHOR]

Introduction: In early‐onset fetal growth restriction the fetus fails to thrive in utero due to unmet fetal metabolic demands. This condition is linked to perinatal mortality and severe neonatal morbidity. Maternal administration of corticosteroids in high‐risk pregnancies for preterm birth at a gestational age between 24 and 34 weeks has been shown to reduce perinatal mortality and morbidity. Practice variation exists in the timing of the administration of corticosteroids based on umbilical artery monitoring findings in early‐onset fetal growth restriction. The aim of this study was to examine differences in neonatal outcomes when comparing different corticosteroid timing strategies. Material and methods: This was a post‐hoc analysis of the Dutch STRIDER trial. We examined neonatal outcomes when comparing institutional strategies of early (umbilical artery pulsatility index >95th centile) and late (umbilical artery shows absent or reversed end‐diastolic flow) administration of corticosteroids. The primary outcomes were neonatal mortality and a composite of neonatal mortality and neonatal morbidity, defined as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis or retinopathy of prematurity. We also analyzed predictors for adverse neonatal outcomes, including gestational age at delivery, birthweight, maternal hypertensive disorders, and time interval between corticosteroids and birth. Results: A total of 120 patients matched our inclusion criteria. In 69 (57.5%) the early strategy was applied and in 51 (42.5%) patients the late strategy. Median gestational age at delivery was 28 4/7 (± 3, 3/7) weeks. Median birthweight was 708 (± 304) g. Composite primary outcome was found in 57 (47.5%) neonates. No significant differences were observed in the primary outcome between the two strategies (neonatal mortality adjusted odds ratio [OR] 1.22, 95% CI 0.44–3.38; composite primary outcome adjusted OR 1.05, 95% CI 0.42–2.64). Only gestational age at delivery was a significant predictor for improved neonatal outcome (adjusted OR 0.91, 95% CI 0.86–0.96). Conclusions: No significant differences in neonatal outcomes were observed when comparing early and late strategy of antenatal corticosteroid administration on neonatal outcomes in pregnancies complicated by early‐onset fetal growth restriction. We found no apparent risk contribution of interval between corticosteroid administration and delivery in multivariate analysis. Gestational age at delivery was found to be an important predictor of neonatal outcome. [ABSTRACT FROM AUTHOR]

Amniotic fluid embolism (AFE) is an obstetric emergency with high maternal and fetal mortality and morbidity. The most important factor in determining the prognosis is early diagnosis and treatment. We present a case of amniotic fluid embolism that was successfully treated with early diagnosis and intime management. Respiratory arrest developed during labor in a 20-year-old patient who underwent urinoma drainage and cordocentesis for fetal renal anomaly 10 days ago and then profuse bleeding occurred approximately 90 minutes after vaginal delivery. With our definition of AFE, massive blood transfusion, fibrinogen replacement and intrauterine balloon were applied quickly. The diagnosis of AFE was made clinically and excluding differential diagnoses. She was discharged without complications. [ABSTRACT FROM AUTHOR]

Introduction: Infection due to SARS-CoV-2 virus has become a pandemic that has caused great number of complications and is usually fatal for pregnant and newlydelivered women. Objective: To describe the clinical and epidemiological characteristics of pregnant and newly-delivered women with Covid-19 admitted to intensive care units. Methods: An observational descriptive, cross-sectional study of 56 pregnant and newlydelivered women with confirmed diagnosis of Covid-19 was carried out; they were admitted to the Intensive Care Unit of Dr. Joaquín Castillo Duany Teaching Provincial Hospital in Santiago de Cuba during 2021. The analyzed variables were age, past health history, cause of admission, state when discharged from the institution and the main cause of death. For this purpose, the frequencies, percentages and case fatality rate were calculated. Results: There was a prevalence of pregnant women in all the age groups (58.9%) relative to the newly-delivered women (41.1%), mainly in the 31- 35 age group (30.3%). Hypertension was the most frequent comorbidity with 71.4 and 28.6%, for pregnant and newly-delivered women, respectively; as long as, 66.6% of the first ones and 33.3% of the second ones were admitted due to pneumonia. All the pregnant women were discharged alive and 7 newly-delivered women died. Case fatality rate was 12.5 and multiple organ dysfunction syndrome appeared in 57.2% of those affected. Conclusions: Hypertension was the most frequent comorbidity, viral pneumonia was the main admission diagnosis and multiple organ dysfunction syndrome, the first direct cause of death. [ABSTRACT FROM AUTHOR]

Introduction: High-risk pregnancy is defined as one which is complicated by factors or factors that adversely affect the pregnancy outcome (maternal, perinatal or both). Early detection and effectivemanagement of high risk pregnancy helps in achieving favorable maternal and perinatal outcomes. This study aimed to find the prevalence of high risk pregnancy and its outcome among pregnant women admitted for delivery in the obstetrics and gynecology department of a tertiary care hospital Methods: A descriptive cross sectional study was conducted in a tertiary care hospital among high risk pregnant women admitted for delivery using structured proforma, from April 2023 to September 2023 after obtaining ethical approval from the Institutional Review Committee. Convenience sampling was used among pregnant women who met the inclusion criteria. Data was entered in excel and analysis was done using IBM SPSS Statistics. Point estimate was calculated at 95% Confidence Interval Results: Among 350 deliveries, high risk pregnancy was seen in 91 (26%) (16.15-32.00, 95% Confidence Interval). The high risk factors were previous history of cesarean section 25 (27.47 %) followed by hypothyroidism 19 (20.87%) and gestational diabetes mellitus 15 (16.48%). Out of 90 high risk pregnancy, 84 (92.30%) had term delivery. Lower segment cesarean section was done in 69 (75.82%) patients of which 26 (28.57%) underwent emergency cesarean section. The total number of births among high risk preganancies were 93 with two sets of twin births. A total of 13 (13.97%) of the babies had low-birth weight. Conclusions: The prevalence of high risk pregnancy was found to be similar as compared to studies done in similar settings.

Background and objective: There are no local investigation on the role of the abnormal umbilical cord on neonatal and maternal outcomes in this region. This study aimed to examine the association of umbilical cord abnormalities on neonatal and maternal outcomes in Iraqi Kurdistan. Methods: This is a cross-sectional study, the patients who attended the Duhok Obstetrics and Gynecology Teaching Hospital in Duhok city were examined between 1/11/2020 and 1/11/2021. The sample size is 500 women, inclusion criteria are age>18 years, acceptance to participate, gestational age >24 weeks and singleton pregnancy. The exclusion criteria are women who refused to participate, multiple pregnancy and stillbirth. Results: The mean age of the pregnant women was 29.0 (16 - 45 years old). The most prevalent maternal complications were placenta Previa (7.06%), Polyhydramnios (9.88%), and post-partum hemorrhage (7.06%). In this study the most common abnormalities of UC were abnormal diameter of UC (29.4%), decreased Wharton jelly content (15.5%) and short UC (11.9%).Most of the patients’ babies had normal weight (79.64%), (16.94%) had low birth weight and (3.43%) had very low birth weight. A percentage of the babies died either early neonatal (1.41%) or stillbirth (5.24%). The study found that the patients with abnormal diameter of UC cord were more likely to have babies with low birth weight (35.62% vs. 9.14%, P

Pemphigus vulgaris (PV) is a rare autoimmune disorder that causes flaccid vesiculobullous lesions and erosions on the skin, with an annual incidence of 0.09–1.8% in India. Its occurrence during pregnancy is even rarer, with only 47 cases reported in the literature over a 49 years. The condition can worsen during the first and second trimesters and postpartum, with a phase of waning during the third trimester, which may be associated with endogenous corticosteroid secretion. The condition can affect various parts of the body, including pressure points, skin-to-skin contact areas, and oral and nasal mucosae. It can also lead to a transient benign form of neonatal lesions called pemphigus neonatorum due to transplacental transmission. Complications such as infertility and stillbirth can occur in women suffering from PV. This is a case of ART with IVF conception and managed successfully by our hospital, it was well-controlled with oral steroids and had an uneventful course in pregnancy, transient neonatal lesions also appeared after birth, which were managed successfully. Exacerbation postpartum was also seen but occurred due to non-compliance with corticosteroid therapy by the patient. [ABSTRACT FROM AUTHOR]

Abstract Introduction CCL2 and CXCL10 are putative biomarkers for the prediction of spontaneous preterm birth. This study evaluates these markers in a cohort of pregnant high-risk women. Material and methods In our prospective study, we included 109 women with signs of preterm labor between 20 + 0 and 31 + 6 weeks of gestation. Inclusion criteria were regular (

Abstract Objective Takayasu arteritis (TAK) is a rare chronic granulomatous vasculitis that affects large vessels and usually begins in women of childbearing age, so it is not uncommon for pregnancies to occur in these patients. However, there is limited information about these pregnancies, with reports of adverse maternal and obstetric outcomes. The objective of this study is to evaluate adverse maternal, fetal and neonatal events in pregnant patients with TA. Methods This is a cross-sectional study with retrospective data collection. We reviewed 22 pregnancies in 18 patients with TAK, according to the American College of Rheumatology criteria, that were followed up in a high-risk prenatal clinic specialized in systemic autoimmune diseases and thrombophilia (PrAT) at Hospital Universitário Pedro Ernesto, from 1998 to 2021. Results In twenty-two pregnancies, the mean age of patients was 28.09 years and the mean duration disease was 10.9 years. Of the 18 patients with TAK studied, only one had the diagnosis during pregnancy and had active disease. All other patients had a previous diagnosis of TAK and only 3 had disease activity during pregnancy. Twelve patients (66.6%) had previous systemic arterial hypertension and eleven (61.1%) had renal involvement. Among maternal complications, eight patients (36.3%) developed preeclampsia and six (27.2%) had uncontrolled blood pressure without proteinuria, while 10 (45%) had puerperal complications. Four (18.1%) births were premature, all due to severe preeclampsia and eight newborns (34.7%) were small for gestational age. When all maternal and fetal/neonatal outcomes included in this study were considered, only 6 (27.2%) pregnancies were uneventful. Conclusion Although there were no maternal deaths or pregnancy losses in this study, the number of adverse events was considerably high. Hypertensive disorders and small for gestational age newborns were more common than general population, while the number of patients with active disease was low. These findings suggest that pregnancies in patients with TAK still have several complications and a high-risk prenatal care and delivery are necessary for these patients.

Introduction: The placenta with the umbilical cord is a vital link between the mother and fetus. Umbilical cord supplies water, nutrients and oxygen from the mother to the fetus. The most unique character of the umbilical cord is its coiling, where the contents of the cord course in a coiled helical fashion. The umbilical coiling index(UCI) can be measured antenatally using ultrasonography. In the present study we have attempted to assess the UCI antenatally by ultrasound screening and correlate abnormal antenatal UCI with the adverse maternal and neonatal outcome of pregnancy. Aims: To study umbilical coiling index ultrasonographically and to correlate it with pregnancy outcome. Methodology: 150 antenatal cases in the second trimester of pregnancy between 22 and 28weeks of gestation attending the outpatient department were included for the study in a continuous manner and subjected to antenatal UCI measurement. The cases were followed up till delivery and various factors were noted. Results: We confirmed that maternal medical comorbidities ( gestational hypertension and anemia) have a significant correlation with abnormal umbilical cord coiling index, either hyper-coiling or hypo-coiling or both.Some studies have shown a particular adverse effect being manifested in both hypo and hypercoiling. In the present study significant correlation of abnormal coiling has been found with only anaemia and hypertension in pregnancy. The question, therefore, arises:“Does abnormal UCI have any significant role in prediction of adverse outcome in pregnancy or is it just a random association?” This study does not reflect any significant role of abnormal UCI in the prediction of adverse perinatal outcome. Hence efforts to monitor UCI in the antenatal period may not have any justification in the present scenario. The latest edition of William’s Obstetrics also makes a similar comment. A population based larger study to generate cut offs for hypo and hyper coiling and finding any association between abnormal coiling and perinatal outcome may throw more light on the utility of UCI as a predictor of adverse outcome in pregnancy.

Background: The present study was conducted for analyzing incidence of pre-term birth among known population. Materials & methods: 108 control & 108 cases admitted in BMC Sagar who were satisfying the inclusion and exclusion criteria of the study were enrolled conveniently after their written informed consent. For Cases, patients of High-risk pregnancy were enrolled. For controls, Primigravida & Multigravida subjects with no risk pregnancy were enrolled. General physical examination and systemic, abdominal, and pelvic examinations were carried out. All the results were recorded in Microsoft excel sheet and were subjected to statistical analysis using SPSS software. Results:In our study, out of 108 control maximum patients occurred between the age group 18-25 years (34%) followed by the age group 26-30 (13%) and age group 31-35 (1%), and the age group 36-40 years (0%). Incidence of pre-term deliveries was 3.703 percent in the control group an was 7.407 in the high-risk pregnancy group. Conclusion: Preterm is a significant health issue prevalent among a significant patient population. Addressing the burden of preterm birth is crucial for reducing preterm-related neonatal and child mortality. [ABSTRACT FROM AUTHOR]

Assisted reproductive therapy (ART) is not currently included in UK national guidelines as an indication for specific antenatal, intrapartum or postpartum care even though ART pregnancies have a higher risk of complications compared to spontaneous conception singleton pregnancies. Risks include venous thromboembolism, hypertensive disorders, psychological sequelae and preterm birth. ART alone is not an indication for early induction of labour or continuous electronic fetal monitoring in labour or closer postpartum surveillance. Albeit ART pregnancies may have pregnancy complications that require obstetric-led care. Holistic and personalised care is a priority for all pregnancies and this should include pregnancies after ART with their increased risks related to the therapy itself and/or the underlying cause of infertility. This article outlines the considerations clinicians caring for a pregnancy following ART may need to contemplate. [ABSTRACT FROM AUTHOR]

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Abstract Background The aim of this study was to evaluate the pregnancy feasibility of women with mild pulmonary hypertension according to pregnancy outcomes. Methods This systematic review and meta-analysis compared the differences in maternal and fetal outcomes between mild and moderate-to-severe pulmonary hypertension. Relevant English and Chinese literature were searched in the PubMed, Embase, Cochrane Central Register of Controlled Trials (COCHRANE), CNKI, WanFang Data, and VIP databases between January 1st, 1990 and April 18th, 2023, and the references of the included articles and relevant systematic reviews were reviewed to determine whether studies were missed. The inclusion criteria were randomized controlled and observational studies (including case-control studies and cohort studies) examining maternal and fetal pregnancy outcomes with pulmonary hypertension. Conference abstracts, case reports, case series reports, non-comparative studies, and review articles were excluded. Results This meta-analysis included 32 studies. In this study, maternal and fetal outcomes were better in the mild pulmonary hypertension group than in the moderate-to-severe group. Regarding maternal mortality, the mild group was much lower than the moderate to severe group. We found a significant decrease in maternal mortality in the mild group after 2010. However, no significant difference in maternal mortality before and after 2010 was observed in the moderate to severe group. Cardiac complications, ICU admission, neonatal preterm birth, small for gestational age infants, low birth weight infants, neonatal asphyxia, and neonatal mortality were significantly lower in the mild pulmonary hypertension group than in the moderate to severe pulmonary hypertension group. The cesarean section rates of the two groups were similar. However, the vaginal delivery rate in the mild pulmonary hypertension group was significantly higher than that in the moderate to severe pulmonary hypertension group. Conclusions This meta-analysis confirmed that pregnancies with mild pulmonary hypertension had significantly better maternal and fetal outcomes than those with moderate to severe pulmonary hypertension. For patients with mild pulmonary hypertension and good cardiac function, continued pregnancy or even delivery should be considered under multidisciplinary monitoring. However, maternal and fetal complications with moderate to severe pulmonary hypertension significantly increase. Hence, it is essential to evaluate pregnancy risk and terminate it in time.

The main risk in pregnancies occur at 4T (too many, too young, too old, and too close birth spacing). The distance between the previous delivery and the next pregnancy and the previous method of delivery are two of the many other factors that affect the condition of the mother and the fetus that will be born later. This case report aims to analyze the effect of spacing between the last child and history of previous births on the outcome of the mother and her baby. This report describes data on pregnant women participating in the Continuity of Care (CoC) program. The results show that the outcomes obtained by the mother in this second delivery are within normal limits. However, this does not mean the possibility for pregnancies that are not planned properly to cause events that are detrimental to the mother and fetus are none.

Background: Unexpected and unanticipated obstetric problems that can have a direct or indirect impact on the well-being of mothers and babies are considered high-risk pregnancies. Uncertainty in health conditions is felt as a life-threatening event that can threaten the lives of mothers and babies. This condition will trigger various stress responses felt by the mother. Moderate to severe stress during pregnancy greatly increases the risk of developing postpartum depression. One of the important coping sources to deal with stress is self-efficacy. Personal abilities are all aspects of an individual that can be utilized to solve problems. One of the interventions that can be used to improve coping mechanisms is self-help groups. Self Help group is a group approach to help its members solve their problems. Purpose: This study aims to determine the impact of self-help groups as therapy in the community to reduce stress responses and increase self-efficacy in high-risk pregnant women. Methods: The research design used was a quasi-experimental one-group pre-test post-test design. 15 respondents were given intervention in 3 sessions for 90 minutes in each session. Stress response and self-efficacy were measured before and after the intervention. Data analysis was carried out using the paired sample T-test. Results: This study shows that the average assessment stress response and self-efficacy score of mothers before the self-help group therapy is 128 and 35. After the therapy, the average response stress and self-efficacy score of mothers was 86 and 53. The study shows the effect of self-help group therapy on stress response (?-value = 0,012) and self-efficacy (?-value = 0,021). Conclusion: It was concluded that self-help group therapy was effective in decreasing stress respons and improving self-efficacy for high-risk pregnant women.

Background: With 30,000 estimated maternal deaths in a year across the country, high MMR remains a matter of grave concern, and thus it is paramount to ensure quality ANC to each pregnant woman, identify the high risk pregnancies (HRPs) and track these for counselling, management birth preparedness and referral till the outcome to close the loop. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016, as a fixed-day, assured, comprehensive quality ANC service on the 9th of every month to every pregnant woman across the country. Screening, identification, line listing and appropriate management of high-risk pregnancies by OBGY/CEmOC/ BEmOCspecialist and referral to appropriate higher facilities are some of the fundamental elements of PMSMA Objective: To determine the level of satisfaction among beneficiaries under PMSMA scheme Methodology: A cross-sectional study was done among 300 pregnant women who were delivered within 6 months from the date of the study and who had registered & availed the Ante-Natal Care (ANC) services under Rural field Practice area of Guntur Medical college. Guntur. Andhra Pradesh. The data thus collected were entered into Microsoft-Excel spreadsheet and was analyzed using IBM SPSS software Version 24.0 Results: Out of 300 beneficiaries, 237(79%) were satisfied with the cleanliness of wards & toilets followed by 278(92.69%) with Adequate privacy During Examination, 287(97.67%) with basic laboratory investigation, 166(55.34%) with transport facilities during discharge. The majority of study participants were in the age group of 20-30 years i.e. 269 (89.70%) and most of their educational status above intermediate i.e. 207(69%) Conclusion: If every pregnant woman in India is examined by a Medical Officer/Specialist and Investigated appropriately at least once during the PMSMA, the Abhiyan can play a crucial role in reducing the number of maternal deaths & High-Risk Pregnancy (HRP) in our country

Introduction: CCL2 and CXCL10 are putative biomarkers for the prediction of spontaneous preterm birth. This study evaluates these markers in a cohort of pregnant high-risk women. Material and methods: In our prospective study, we included 109 women with signs of preterm labor between 20 + 0 and 31 + 6 weeks of gestation. Inclusion criteria were regular (< 3/30 min) or painful contractions, cervical length < 25 mm or a history of previous preterm birth (PTB). Blood samples were obtained upon first admission to our clinic. Biomarker concentrations were measured using pre-coated sandwich immunoassays (ELISA). Primary study outcome was spontaneous preterm birth < 34 weeks, secondary outcome was delivery < 37 weeks or within seven days after study inclusion. Results: Sixteen women (14.7%) delivered < 34 weeks and twenty women between 34 + 0 and 36 + 6 weeks (18.4%). Six patients (5.5%) gave birth within seven days after study admission. CXCL10 showed higher medium serum levels in women with PTB < 34 weeks (115 pg/ml compared to 61 pg/ml ≥ 34 weeks; p < 0.001) and < 37 weeks (103 pg/ml vs. 53 pg/ml; p < 0.001). In contrary, lower CCL2 serum levels were associated with PTB < 34 weeks (46 pg/ml vs. 73 pg/ml; p = 0.032) and birth within 7 days (25 pg/ml vs. 73 pg/ml; p = 0.008). The CXCL10/CCL2-ratio further improved the predictive model with a ROC-AUC of 0.83 (95% CI 0.73–0.93, p < 0.001) for delivery < 34 weeks. These corresponds to a sensitivity, specificity and positive predictive value of 0.67, 0.86 and 0.43 at a cut-off of 2.2. Conclusion: Low maternal serum CCL2 levels are associated with a higher risk of preterm delivery within seven days. High CXCL10 serum levels are more associated with a high risk for preterm birth < 34 weeks. Elevated CXCL10/CCL2-ratio is showing the best predictive performance. Trial registration number (DRKS-ID): DRKS00010763, Registration date: September 02, 2016. [ABSTRACT FROM AUTHOR]

The case report of a 20 years pregnant woman is presented, who went to the maternal block emergency room of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba due to run-down, nausea and diffuse discomfort. During the physical exploration sweaty and cold skin, tachycardia and jaundice were found. Diverse complementary exams were carried out and a hepatic disorder was verified, as well as low figures of glycemia. Acute fatty liver of pregnancy was diagnosed. After several days hospitalized with an unfavorable clinical course until getting to the critical state, the patient died due to multiple organ dysfunction syndrome. [ABSTRACT FROM AUTHOR]

Copyright of Revista Psicologia Clínica is the property of Faculdades Catolicas - Pontificia Universidade Catolica do Rio de Janeiro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is a paucity of research on experiences and views of women at higher risk of preterm birth of midwifery continuity of care. Midwifery continuity of care (MCoC) has been associated with improved maternal outcomes and with lower levels of preterm births and stillbirths. The majority of MCoC studies have focused on women without risk factors and little has been published on women with obstetric complexities. The aim of this study is to explore the views and experiences of women identified as a higher risk of preterm birth who have had continuity of care from midwives. Face-to-face, semi-structured interviews with 16 women identified as at increased risk of preterm birth and experienced continuity of midwifery care across pregnancy, birth and the postnatal period. Care had been provided by the pilot intervention group for the pilot study of midwifery practice in preterm birth including women's experiences (POPPIE) trial. Women valued continuity of midwifery care across the care pathway and described the reassurance provided by having 24 h a day, seven days a week access to known midwives. Consistency of care, advocacy and accessibility to the team were described as the main factors contributing to their feelings of safety and control. Recognising that known midwives were 'there all the time' made women feel listened to and actively involved in clinical decision making, which contributed to women feeling less stressed and anxious during their pregnancy, birth and early parenthood. When developing MCoC models for women with obstetric complexities: access, advocacy and time should be embedded to ensure women can build trusting relationships and reduce anxiety levels. [ABSTRACT FROM AUTHOR]

Abstract Aim: Pregnancies complicated with diabetes are risky pregnancies with different maternal characteristics and increased maternal complications compared to the normal pregnant group. In this study, it is aimed to determine maternal characteristics and maternal complications in pregnant women with different glucose intolerance or blood glucose levels, and to compare them with the information in the literature and to investigate the effectiveness of our follow-up and treatment protocols. Material and Method: This study is carried out with 223 patients at Ümraniye Training and Research Hospital between May 2009 and March 2010. Group 1 in the study, normal glycemic group; Group 2, group with 1 value higher in 100 g oral glucose tolerance test (OGTT); Group 3, gestational diabetes mellitus (GDM), is the blood sugar regulated group; Group 4, the uncontrolled group diagnosed with GDM and whose blood sugar is not regulated; Group 5 consisted of patients with pregestational diabetes mellitus, with or without regulated blood sugar. Results: Considering the maternal characteristics, it is seen that the age, gravida, parity, body mass index (BMI) of Group 3, Group 4 and Group 5 patients are significantly higher than the patients in Group 1 and Group 2. The rates of preeclampsia, macrosomic baby and preterm birth are significantly higher in groups 4 and 5. In terms of delivery types, normal birth rate is high in Group 1, while cesarean section rates are high in Groups 4 and 5. According to the groups, the cases with a 1st minute apgar score less than 7 are significantly higher in Group 4 and Group 5. Conclusion: It is revealed that different glucose intolerances cause some problems in pregnancy, increase complications, and uncontrolled blood glucose levels increase these problems and complications. In pregestational and gestational periods; In such cases, it should be aimed and ensured that these problems and complications are reduced to the lowest possible level with appropriate diagnosis and treatment approaches.

Abstract 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

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The aim of this study was to evaluate the pregnancy feasibility of women with mild pulmonary hypertension according to pregnancy outcomes. Methods: This systematic review and meta-analysis compared the differences in maternal and fetal outcomes between mild and moderate-to-severe pulmonary hypertension. Relevant English and Chinese literature were searched in the PubMed, Embase, Cochrane Central Register of Controlled Trials (COCHRANE), CNKI, WanFang Data, and VIP databases between January 1st, 1990 and April 18th, 2023, and the references of the included articles and relevant systematic reviews were reviewed to determine whether studies were missed. The inclusion criteria were randomized controlled and observational studies (including case-control studies and cohort studies) examining maternal and fetal pregnancy outcomes with pulmonary hypertension. Conference abstracts, case reports, case series reports, non-comparative studies, and review articles were excluded. Results: This meta-analysis included 32 studies. In this study, maternal and fetal outcomes were better in the mild pulmonary hypertension group than in the moderate-to-severe group. Regarding maternal mortality, the mild group was much lower than the moderate to severe group. We found a significant decrease in maternal mortality in the mild group after 2010. However, no significant difference in maternal mortality before and after 2010 was observed in the moderate to severe group. Cardiac complications, ICU admission, neonatal preterm birth, small for gestational age infants, low birth weight infants, neonatal asphyxia, and neonatal mortality were significantly lower in the mild pulmonary hypertension group than in the moderate to severe pulmonary hypertension group. The cesarean section rates of the two groups were similar. However, the vaginal delivery rate in the mild pulmonary hypertension group was significantly higher than that in the moderate to severe pulmonary hypertension group. Conclusions: This meta-analysis confirmed that pregnancies with mild pulmonary hypertension had significantly better maternal and fetal outcomes than those with moderate to severe pulmonary hypertension. For patients with mild pulmonary hypertension and good cardiac function, continued pregnancy or even delivery should be considered under multidisciplinary monitoring. However, maternal and fetal complications with moderate to severe pulmonary hypertension significantly increase. Hence, it is essential to evaluate pregnancy risk and terminate it in time. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between spousal support and depression, anxiety, stress, and prenatal attachment in high-risk pregnant women. Materials and Methods: Data were collected from 375 high-risk pregnant women in their 2nd/3rd trimesters in November 2021-February 2022. An introductory information form, the Spouse Support Scale (SSS), the Depression, Anxiety, and Stress Scale (DASS-21), and the Prenatal Attachment Inventory (PAI) were used to collect data. Results: Median SSS score was 76 (29-81), median PAI score was 74 (31-84). Median anxiety scale score was 4 (0-21), depression scale score was 2 (0-21), and stress scales score was 3 (0-21). There was a positive significant relationship between spousal support and prenatal attachment, and a negative significant relationship between spousal support and anxiety, depression, and stress (p<0.001). Conclusion: Inadequate spousal support in high-risk pregnancies is a risk factor for prenatal attachment, anxiety, depression, and stress levels. [ABSTRACT FROM AUTHOR]

The primary aim was to assess if a clinical consensus regarding the management of pregnancy post myomectomy existed amongst consultant obstetricians and gynaecologists. Secondary objectives were to evaluate factors which influence the clinician's decision making in this group of women. Electronic survey sent to all consultants working in the North Central and East London deanery, Kent Surrey and Sussex deanery and Imperial NHS Trust to assess opinions on mode of birth post myomectomy, intervals advised to pregnancy post myomectomy, factors influencing the management of delivery in the scarred uterus post myomectomy, opinions on induction of labour and questions relating to operative notes. 209 consultant responses received between 07/03/2022–07/05/2022 (44% response rate); 77% (161/209) practicing obstetricians and gynaecologists, 10% (21/109) pure gynaecologists and 13% (27/209) pure obstetricians. The majority would support a vaginal birth after open myomectomy (75%) and laparoscopic myomectomy (79%). No consensus was found as to the optimal time interval between myomectomy and pregnancy. Higher frequency of performing myomectomy and a greater level of experience were significantly associated with a shorter interval to pregnancy advised. The most important operative factors influencing decision to support trial of labour post myomectomy were breach of uterine cavity; location of fibroids removed and number of incisions on the uterus. 77% believe women should be given a choice regarding mode of delivery post myomectomy in a similar way to previous LSCS. 82.8% would support enrolment of patients into a prospective trial to investigate delivery post myomectomy. We present a comprehensive survey of clinician opinions on pregnancy post myomectomy demonstrating that the majority of consultant obstetricians and gynaecologists sampled would support vaginal birth post myomectomy; counselling patients in a similar way to VBAC; a standardised myomectomy operation note and enrolment of patients in a future prospective trial. Wide variation in opinion regarding interval to pregnancy post myomectomy has been highlighted. We believe this information will facilitate counselling discussions and empower women with subsequent pregnancies after myomectomy to make an informed decision on mode of birth post myomectomy. [ABSTRACT FROM AUTHOR]

Objective: Health problems experienced during pregnancy may increase anxiety level during pregnancy and affect motherbaby attachment. The present study aimed to compare pregnancy-related anxiety and prenatal attachment levels between low-risk pregnant women and pregnant women with preeclampsia and/or gestational diabetes mellitus (GDM). Material and Methods: One hundred fifty women were recruited in this cross-sectional descriptive study (55 preeclampsia and/or GDM, 95 low-risk) pregnant women. Data were collected using descriptive data form, Pregnancy-Related Anxiety Questionnaire-Revised-2 (PRAQ-R2), and Prenatal Attachment Scale (PAS). Results: Prenatal attachment scores of the working pregnant women in the low-risk group were higher than those in the non-working pregnant women (p<0.05). Prenatal attachment scores of primiparous women in the preeclampsia/GDM group were higher than multiparous women (p<0.05). No statistically significant differences were found between the groups with regard to PAS, PRAQ-R2 and PRAQ-R2 subdimensions scores (p>0.05). Conclusion: In line with the study results, it was found that low-risk and working pregnant women had higher prenatal attachment levels. Levels of prenatal attachment were higher in primiparous pregnant women in the high-risk group. As pregnancy-related anxiety levels of high-risk and healthy pregnant women increased, concern about one’s own appearance scores increased. Therefore, reducing anxiety levels of pregnant women during pregnancy may be an effective intervention in reducing concerns about their appearance. [ABSTRACT FROM AUTHOR]

Objectives: The incidence of PAS is increasing day by day as a life-threatening condition. The purpose of the present study was to determine the factors affecting PAS formation in primiparous pregnant women and to define possible risk factors for the mother and the baby. Material and methods: Bursa Yüksek İhtisas Training and Research Hospital, department of obstetrics and gynecology, Bursa, Turkey, between June 2016 and December 2020. A total of 58,895 patients were included in the study. After the exclusion criteria, the study was continued with 27 primiparous PAS and 54 non-primiparous PAS patients. The primary purpose is to evaluate PAS risk factors. The secondary aim is to examine maternal and neonatal characteristics. Results: When the parameters that are significant in terms of PAS risk factors were analyzed by Logistic Regression Analysis, it was found that the increase in age also increased the development of PAS 1.552 times (95% CI: 1.236-1.948) and a history of abortion was 7.928. times (95% CI: 1.408-44.654) and 11,007 times (95% CI: 2.059-58.832) with history of myomectomy postoperative HB values (p < 0.001), an estimated amount of bleeding (p < 0.001), need for transfusion (p = 0.002), and use of drains (< 0.001) were statistically significant different between two groups. When the neonatal results between patients with and without PAS were examined, birth weight (p < 0.001) and gestational week (< 0.001) were statistically significant. Conclusions: PAS does not occur only in multiparous patients who have a history of previous cesarean section. It may also occur in primiparous patients and is a life-threatening condition. [ABSTRACT FROM AUTHOR]

Abstract Objective To qualitatively assess the barriers and facilitators to uptake of referral services amongst high-risk pregnant women in rural Rajasthan. Methods A purposive sample of pregnant women with high-risk conditions requiring referral follow-up care (severe hypertension, moderate anemia, and severe anemia) were considered for inclusion. In-depth individual interviews were conducted in the local dialect, Mewari. Interviews were transcribed, coded, and organized for thematic generation as per the analytical framework described in the socio-ecological model. Results 19 high risk pregnant women of low socioeconomic backgrounds across 15 villages were interviewed. Barriers to referral care included lack of transportation, household responsibilities, and limited awareness, education, and social support. The most prominent barrier was lack of accompaniment to the referral center by a family member or health worker. Facilitators included available husbands, engaged heath workers, supportive neighbors, and other female family members who shared past experiences. Conclusions Social support at the interpersonal and community level was key to overcoming referral care barriers faced by high-risk pregnant women in rural Rajasthan. Interventions that enhance social support may improve uptake of referral care services by high-risk pregnant women.

Objective (s): Pregnancy at a young age is high risk for both mother and child. The aim of this study was to evaluate the demographic and socioeconomic correlators of pregnancy status of girls under 19 years old in Iran. Methods: This was a secondary analysis of the data based on the 2016 census. The study population included 10- to 19-years-old girls in Iran who participated in the sampling of 2% of the 2016 (n =107346). Using the number of live births, the girls were divided into three groups: never married, married without children and married with children. Results: Most girls were unmarried before the age of 14, at the age of 15, 7% of girls were married and 1% had children. About 40% of girls were married at the age of 19 and 14% of them had children. Most girls who had children were not studying, they were illiterate, living in rural areas, and mostly were in low-income provinces. Conclusion: The relationship between development-related variables and childbearing at an early age indicates that the fertility of girls at an early age is a socioeconomic phenomenon. Girls who were illiterate and have dropped out of school seems are less aware of healthy reproductive conditions and this need to be considered in health policies in order to have a healthy delivery.

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<0.05. Results: it was observed that 68% of pregnant women have moderate to high anxiety, with heat, fear of the worst happening, faster heartbeat, emotional instability and nervousness listed as the most common symptoms. The presence of an anxious condition was independent of maternal age, marital status or parity, however the gestational trimester, history of abortions and length of hospital stay were identified as risk factors for anxiety. Conclusion: pregnant women with a high risk diagnosis hospitalized at HULW presented anxiety, thus identifying the need for a multiprofessional support network, such as family assistance. [ABSTRACT FROM AUTHOR]

Research objective: to study the possibilities of improving perinatal results by optimizing pergravid preparation in women with high perinatal risk. Materials and methods. The first stage – a cross-sectional study – consisted in determining the vitamin D (VD) status and assessing the course of pregnancy in 459 women in the II and III trimester; the second stage was a randomized controlled study of women with VD deficiency in group IIA (planning stage, 54 women) and IIB (I trimester, 60 women), who received the vitamin and mineral complex (VMC) Pregna-5 with a high calcitriol content and perinatal results were evaluated. VD in the blood was determined by the enzyme-linked immunosorbent assay. Results. VD level was optimal only in 30.7% of pregnant women (group ІА), in 69.3% of women its insufficiency or deficiency was found (group ІB). The frequency of threatened termination (9.9 vs. 45.6%; p < 0.01), preeclampsia (2.0 vs. 11%; p < 0.05), intrauterine growth retardation (7% only in group IIB, p < 0.01) was significantly higher against the background of BD deficiency. Normalization of the VD level (groups IIA and IIB) after VMC administration was observed within 1–3 months. Pregnancy complications value was higher in the group where the VMC was started in the first trimester: early gestosis (15 vs. 28.57%; p < 0.05), the threat of termination (22.2 vs. 36.7%; p < 0.05), bacterial vaginosis (7.4 vs. 31.7%; p < 0.05), placental dysfunction (18.5 vs. 40.0%; p 0.05) and anemia (16.6 vs. 28.3%; p > 0.05) were insignificant. Analysis of the childbirth results showed a significantly higher frequency of cesarean sections in group IIB (38.3 vs. 22.2%; p < 0.05), the average weight of newborns was less (3299.11 ± 128 g vs. 3643.24 ± 136 g; p < 0.01). The most effective was the VMC start at the stage of pregnancy planning (F = 13.35482; p = 0.000016); a significant difference was revealed in the course of pregnancy in the groups where VMC started in the first, second and third trimesters of pregnancy (Q = 4.67, p = 0.00458). Conclusions. Timely donation of VMC with a high content of cholecalciferol in women with high perinatal risk may lead to a positive course of pregnancy. Further research is required to obtain a convincing evidence base.