The effect of risk perception and COVID‑19 anxiety in pregnancy on decision‑making via the Internet and prenatal care quality:A cross‑sectional multivariate analysis

Background:Risk perception and COVID‑19 anxiety in pregnant women restrict access to health services,cause pregnant women to resort to alternative channels such as the Internet,and affect prenatal care quality(PCQ)negatively.Purpose:The purpose of this study was to examine the effect of risk perception and COVID‑19 anxiety in pregnancy on decision‑making via the Internet(DMI)and PCQ with multivariate analysis.Materials and Methods:This cross‑sectional study was conducted with 406 pregnant women selected using the convenience sampling method in a training and research hospital,in Turkey.The data were collected using the information form,the perception of pregnancy risk questionnaire,the Coronavirus Anxiety Scale,the DMI Scale,and the PCQ Scale.The data obtained were subject to descriptive analysis and the multivariate analysis of variance.Results:Approximately 24.9%of the pregnant women were found to have a high perception of risk and 18%had symptoms of COVID‑19 anxiety.Pregnant women with high COVID‑19 anxiety and a higher perception of risk perceived the Internet as less influential for decision‑making(P<0.05).Pregnant women with a high‑risk perception had lower PCQ(P<0.05).Conclusion:The findings can be used to enhance mental health and resilience in pregnant women and to formulate appropriate intervention strategies.

Status of Equities in Prenatal Care Utilization and Changing Patterns among Women in China

Objective To assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China. Methods Data were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple Logistic regression were employed to compare the administrative rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis. Results The total systematic management rate was 22.1% in 1994 and 57.4% in 2000. The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas, the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from O. 002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas. Conclusion Inequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

Association between Prenatal Care Utilization and Risk of Preterm Birth among Chinese Women

It is recognized that prenatal care plays an important role in reducing adverse birth. Chinese pregnant women with medical condition were required to seek additional health care based on the recommended at least 5 times health care visits. This study was to estimate the association between prenatal care utilization（PCU） and preterm birth（PTB）, and to investigate if medical conditions during pregnancy modified the association. This population-based case control study sampled women with PTB as cases; one control for each case was randomly selected from women with term births. The Electronic Perinatal Health Care Information System（EPHCIS） and a questionnaire were used for data collection. The PCU was measured by a renewed Prenatal Care Utilization（APNCU） index. Logistic regression models were used to estimate odds ratios（OR） and the 95% confidence interval（95% CI）. Totally, 2393 women with PTBs and 4263 women with term births were collected. In this study, 695（10.5%） women experienced inadequate prenatal care, and 5131（77.1%） received adequate plus prenatal care. Inadequate PCU was associated with PTB（adjusted OR： 1.41, 95% CI： 1.32–1.84）; the similar positive association was found between adequate plus PCU and PTB. Among women with medical conditions, these associations still existed; but among women without medical conditions, the association between inadequate PCU and PTB disappeared. Our data suggests that women receiving inappropriate PCU are at an increased risk of having PTB, but it does depend on whether the woman has a medical condition during pregnancy.

Assessing the influence of digital technologies on antenatal care visits in Zimbabwe:insights from 2019 Zimbabwe Multiple Indicator Cluster Survey

Background and objective:To provide good health and well-being as established by the Sustainable Development Goal(SDG)3,access to digital technologies can act as conduits to achieve such progress in a population.As guided by the World Health Organization,antenatal care(ANC)attendance is one of the measures promoted to curtail the global health burden of maternal and infant mortality.ANC services are seldom utilized to their full potential in Zimbabwe.This study explores if any of the women's digital technology characteristics were associated with antenatal care visits.Methods:The study analyzed population-based cross-sectional data with a subsample of 1932 women aged 15-49 years from the 2019 Zimbabwe Multiple Indicator Cluster Survey.Test of associations with chi-square test,bivariate,and multivariate multinomial logistic regression analyses were used to examine the predictors of adequate(4-7)and optimal(≥8)ANC visits relative to undesirable(1-3)antenatal care visits among women who had given births 2 years before the survey.Results:The results indicate that 64.5%(1246/1932)of the women attained adequate ANC while about 9.8%(189/1932)attained optimal ANC.Reading a newspaper/magazine at least once a week(odds ratio[OR] 1.73,β'=0.551,t=2.030,P=0.043)and watching television at least once a week(OR 1.72,β=0.545,t=2.454,P=0.015),listening to the radio less than once a week(OR 1.28,β'=0.247,t=1.750,P=0.080),and owning a mobile phone(OR 1.48,β'=0.394,t=3.020,P=0.003)were positively associated with adequate ANC.Optimal ANC was significantly associated with women being able to read a newspaper at least once a week(OR 2.93,β'=1.074,t=3.120,P=0.002),listen to the radio less than 0nce a week(OR 2.07,p'=0.73,t=2.700,P=0.007)and have ownership of a mobile phone(OR 1.88,β'=0.631,t=2.620,P=0.009).Conclusion:Access to a newspaper,radio,television,and mobile phone were important predictors of a woman's ability to achieve her ANC attendance.Policies to improve the knowledge of ANC packages can be facilitated using digital technology to achieve adequate and preferably optimal ANC in Zimbabwe.It is important to improve digital infrastructure to support digital technologies in providing ANC services.

Receiving antenatal care via mobile clinic: Lived experiences of Jordanian mothers

Objective To understand the perceptions of pregnant Jordanian women who received antenatal care via mobile clinic,and to contribute new insights into the experiences of these mothers and how they evaluated the services that were available.Methods Ten Jordanian mothers who had received antenatal care at a mobile clinic discussed their experiences in semi-structured,audiotaped interviews in a study that adopted a qualitative research design.The analysis was done using interpretative phenomenological analysis.Results Three main themes were identified:Being informed about the medical campaign or missing the opportunity of being informed;The experience of receiving antenatal care was wonderful,although there was only one thing lacking;and they safeguard our life and take any opportunity to educate us.Conclusion Data indicate that the mothers were largely satisfied with most facets of the antenatal care services they had received at the mobile clinics.However,while services are generally well received,there are clear opportunities for ameliorating the quality of services provided.For mothers living in remote,deprived areas,outreach is not just an‘optional extra’but rather an essential service.

Participant attrition and perinatal outcomes in prenatal vitamin Dsupplemented gestational diabetes mellitus patients in Asia: A metaanalysis

BACKGROUND The role of vitamin D supplementation in gestational diabetes mellitus(GDM)patients is unclear.AIM To determine the burden and risk of post-randomization GDM patient attrition from vitamin D-supplemented arms of randomized controlled trials(RCTs).The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.METHODS RCTs were searched in the PubMed,Embase,and Scopus databases.Randomeffect prevalence and pairwise meta-analysis were performed for the primary objective.The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.Fixed-effect network meta-analyses were undertaken for the secondary goals.All analyses were performed using Stata software,and statistical significance was determined at P<0.05.RESULTS Thirteen RCTs from Iran and China were reviewed.The participant attrition burden in vitamin D recipients was 6%[95%confidence interval(CI):0.03,0.10],and its risk did not vary from non-recipients.Vitamin D and calcium co-supplementation reduced the cesarean section incidence in GDM patients[risk ratio(RR):0.37;95%CI:0.18,0.74].The hyperbilirubinemia or hospitalization risk in their newborns decreased with vitamin D supplementation(RR:0.47;95%CI:0.27,0.83)and co-supplementation with calcium(RR:0.35;95%CI:0.16,0.77)or omega3 fatty acids(RR:0.25;95%CI:0.08,0.77).Vitamin D and probiotics co-supplementation decreased newborn hyperbilirubinemia risk(RR:0.28;95%CI:0.09,0.91).FPG levels and macrosomia risk did not vary across interventions.CONCLUSION In RCTs,vitamin D supplementation or co-supplementation in GDM patients showed a low participant attrition burden and low risk of cesarean section,newborn hyperbilirubinemia,and newborn hospitalization.

Partner profile of pregnant women who have obstetric prenatal high risk in a university hospital south of Brazil

This study aimed to relate the social and obstetric risk factors presented by pregnant women who underwent high risk prenatal in a southern Brazil hospital unit. This is a quantitative research. The data collection was conducted from January to September 2012, where 12 high-risk pregnancies and nine companions with diversified social and obstetric conditions were seen. The analysis was by simple statistics. Pregnant women social profile results indicated that predominant age group was 31 to 40 years old;all had some degree of education;84% Catholic;75% of pregnant women were accompanied by someone of their choice during high risk prenatal care;and 50% of the choices were for her spouse;half of these pregnant women have a professional occupation. Obstetrics findings demonstrated that the majority of women were not planning on the pregnancy, only 17% started prenatal care in the first trimester, 42% had already presented risk in previous pregnancy, 58% of women were classified as high risk due to fetal abnormalities. Given these findings, it is clear that high-risk pregnancy as a period involving several factors, including social and obstetric that, when connected, can compromise the process of gestating for both the mother and the fetus.

Effects of Prenatal Perineal Massage and Kegel Exercises on the Integrity of Postnatal Perine

Aim: This randomize controlled experimental study has been carried out to investigate the effects on the integrity of perine of perineal massage and Kegel exercises applied prenatally to women who experienced vaginal delivery. Methods: Research was carried out between January 2012 and 2013, with a total of 101 pregnant women who referred to Ege University Hospital in ?zmir. Data Collection Form, Kegel Exercise Training Brochure, Practice Observation Form and Prenatal Perinea Massage Learning Guide for Implementer were used. Researcher continued to perform this massage once a week until delivery. Kegel exercises were asked to perform exercises at home and also to register them until delivery. When exercise group came to weekly controls or when they were contacted at home they were asked if they have performed daily exercise or not. The pregnant women in control group did not receive any application. One to one interview was performed during delivery and postnatal 24 hours at the hospital and a telephone interview was performed 15 days postnatal, so three groups were evaluated. The chi-square, Mann-Whitney U test and Kruskal Wallis test were used. Results: A statistically significant difference was found between study and control groups in terms of episiotomy rates, laceration, postnatal 24 hours and 15 days perineal pain and improvement (p < 0.05). Conclusion: It was found that perineal massage and Kegel exercises are important in maintaining the integrity of perineal significantly. It is thought that when the perineal massage and Kegel exercise being performed during pregnancy is supported by health professional, it will play a significant role in women’s quality of life.

Mapping the quality of prenatal and postnatal care and demographic differences on child mortality in 26 low to middle-income countries

Background Closing the gap between child mortality in low-and middle-income countries(LMICs)and high-income countries is a priority set by the WHO in sustainable development goals(SDGs).We aimed to examine poor nutrition and prenatal and postnatal care that could increase the risk of child mortality in LMICs.Methods The Demographic and Health Survey(DHS)was used to examine data from 26 countries to compare prenatal,postnatal,nutritional,and demographic factors across LMICs.Outcome of child death was classified into death before one month of age,between 1 to 11 months,between one to two years,between three to five years,and overall death before five years.Chi-square analyses identified differences in prenatal care,postnatal care,nutrition,and demographic factors between children who died and those who survived.Logistic regression identified factors that increased child mortality risk.Results The majority of deaths occurred before the ages of one month and one year.Considerably poorer quality of prenatal care,postnatal care,and nutrition were found in low-income and low-middle-income countries in the contemporary 2020s.High child mortality and poor quality of prenatal and postnatal care coincide with low income.Children in LMICs were exposed to less vitamin A-rich foods than children in higher-middle-income countries.The use of intestinal parasite drugs and the absence of postpartum maternal vitamin A supplementation significantly increased child mortality risk.Significant socio-demographic risk factors were associated with an increased mortality rate in children,including lack of education,maternal marital status,family wealth index,living rurally,and financial problems hindering access to healthcare.Conclusions Poor nutrition remains a vital factor across all LMICs,with numerous children being exposed to foods low in iron and vitamin A.Significantly,most deaths occur in neonates and infants,indicating an urgent need to address risk factors associated with early child death.

Assessment of reproductive health service utilization in urban slums: Evidence from Western Rajasthan

Objective:To assess the utilization of reproductive health services in urban slum of Jodhpur city,India.Methods:A community based cross-sectional study was conducted in an urban slums of Jodhpur city amongst 300 married women of reproductive age between March and June 2021.Semi-structured questionnaire was used to gather demographic data and information about utilization of antenatal care(ANC)services,delivery and post-partum services.Results:The majority of females were aged less than 25 years(n=195;65.0%),married after 18 years(n=240;80%),living in extended families(n=265;88.3%)and with monthly family income less than 10000 rupees(n=182;60.7%).Statistically significant associations were found between≥4 ANC visits and educational level of secondary and above(OR 2.47,95%CI 1.03–6.28;P=0.04),older age(OR 15.70,95%CI 14.87–16.54 for women aged 26-35 years,OR 16.14,95%CI 12.12–20.01 for women aged≥36 years;P<0.01),and backward and general castes(OR 15.91,95%CI 13.57–17.85 for backward caste and OR 8.11,95%CI 8.07–8.26 for general category of caste;P<0.01).Seven percent of females had undergone parturition.Older age was associated with higher risks of postpartum complications(OR 1.06,95%CI 1.01–1.57 for women aged 26-35 years,OR 3.56,95%CI 1.29–4.69 for women aged≥36 years;P<0.01).In addition,risks of postpartum complications were associated with backward and general castes(OR 1.69,95%CI 1.34–2.13 for backward classes and OR 5.01,95%CI 4.29–5.31 for general category castes;P<0.01),and more than 4 ANC visits(OR 0.20,95%CI 0.09–0.34;P<0.01).Conclusions:More frequent ANC visits are associated with a lower risk of postpartum complications.Furthermore,a high utilization of reproductive health services represents good implementation of reproductive and child health programme at the peripheral level resulting in a stark rise in maternal health indicators in the state of Rajasthan.

Efficacy of transvaginal ultrasound-guided local injections of absolute ethanol for ectopic pregnancies with intrauterine implantation sites

BACKGROUND Cervical pregnancies,interstitial tubal pregnancies,and cesarean scar pregnancies,which are ectopic pregnancies with intrauterine implantation sites exhibit increasing trends with the recent widespread use of assisted reproductive technologies and increased rate of cesarean deliveries.The development of highsensitivity human chorionic gonadotropin testing reagents and the increased precision of transvaginal ultrasonic tomography have made early diagnosis possible and have enabled treatment.Removal of ectopic pregnancies using methotrexate therapy and/or uterine artery embolization has been reported.However,delayed resumption of infertility treatments after methotrexate therapy is indicated,and negative effects on the next pregnancy after uterine artery embolization have been reported.AIM To examine the efficacy and safety of ultrasound-guided topical absolute ethanol injection in ectopic pregnancies with an intrauterine implantation site.METHODS In this study,we retrospectively examined the medical records of 21 patients who were diagnosed with an ectopic pregnancy with an intrauterine implantation site at our hospital,between April 2010 and December 2018,and underwent transvaginal ultrasound-guided local injections of absolute ethanol to determine the treatment outcomes.We evaluated the treatment methods,treatment outcomes,presence of bleeding requiring hemostasis measures and blood transfusion,complications,and treatment periods.Successful treatment was defined as the completion of treatment using transvaginal ultrasound-guided local injections of absolute ethanol alone.RESULTS There were 21 total cases comprising 10 cervical pregnancies,10 interstitial tubal pregnancies,and 1 cesarean scar pregnancy.All patients completed treatment with this method.No massive hemorrhaging or serious adverse reactions were observed during treatment.The mean gestation ages at the time of diagnosis were 5.9 wk(SD,±0.9 wk)for cervical and 6.9 wk(SD,±2.1 wk)for interstitial tubal pregnancies.The total ethanol doses were 4.8 mL(SD,±2.2 mL)for cervical pregnancies and 3.3 mL(SD,±2.2 mL)for interstitial pregnancies.The treatment period was 28.5days(SD,±11.7 d)for cervical pregnancies and 30.0±8.1 d for interstitial pregnancies.Positive correlations were observed between the bloodβ-human chorionic gonadotropin level at the beginning of treatment and the total ethanol dose(r=0.75;P=0.00008),as well as between the total ethanol dose and treatment period(r=0.48;P=0.026).CONCLUSION Transvaginal ultrasound-guided local injections of absolute ethanol could become a new option for intrauterine ectopic pregnancies when fertility preservation is desired.

Study of the Effects of Lower Limb Muscle Strengthening Exercises on Hospitalized Pregnant Women on Bed Rest for Prevention of Miscarriage

Objective: Against a background of the two-child policy in China, the objective is to explore the effects of lower limb strengthening exercises on hospitalized pregnant women put on bed rest for prevention of miscarriage. Method: Sixty cases of pregnant women admitted to the Department of Obstetrics in one of the highest ranking hospitals in Guangzhou, China, during the period from November 2018 to December 2019 for the purpose of preventing miscarriage were selected. They were divided into an experimental group and a control group of 30 cases each. The control group was put under routine care while the intervention group conducted lower limb muscle strengthening exercise on top of the routine care. After the intervention, the conditions of lower limbs, the psychological states and the results of pregnancy for the two groups were compared. Results: After the intervention, the scores of the experimental group in anxiety, depression and postpartum depression were lower and leg circumferences were smaller compared to the control group. The difference is statistically significant (P < 0.05). The experimental group had longer gestation than the control group and was able to get out of bed earlier than the control group after delivery, with statistically significant difference (P < 0.05). Conclusion: Lower limb muscle strengthening exercises can effectively improve the physiological and psychological states of pregnant women hospitalized for prevention of miscarriage and promote their postpartum recovery.

Prevelance of Pregnancy Complications among Women Aged 15 - 49 in Oğuzeli, Turkey

As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. The objective of this study was to determine pregnancy complications and prenatal care among women aged 15 - 49 in O&#287;uzeli, Turkey, and to provide data for prevention in the field. This descriptive, cross-sectional study was conducted between February and May 2013 in O&#287;uzeli distinct, Turkey. The total women registered to family doctors in O&#287;uzeli was listed and, 470 women were selected using a stratified and simple random sampling technique. Pregnancy complications were asked for the last pregnancy of each women. Of the women, 23.9% (n = 109) declared that they experienced pregnancy complications during their pregnancies. The most frequent problems were anemia (11.1%) hypertension (3.7%) and diabetes mellitus (2.4%) respectively. Women having chronic diseases before their pregnancy were more likely to have pregnancy complications compared to healthy women (p = 0.005). The mean number of prenatal care among women having pregnancy complications was 5.47 ± 3.57, while it was 3.84 ± 3.00 among healthy women (p = 0.000). Women having chronic diseases should be handled carefully and, pregnancy should be delayed until the chronic disease’s remission. Family planning in primary care is the key measure to archive this. Early diagnosis of hypertension among young women is highly important for the women’s and infants’s health during pregnancy, and for the women’s future heath. During prenatal care, women should be trained about correct eating habits and activity.

Care Bundles:Enhanced Recovery After Delivery

The care of obstetrics patients has improved dramatically over the past few decades.Unfortunately,rates of cesarean section remain high,and decreasing this rate requires close care and follow-up in the prenatal outpatient setting.Counseling regarding cesarean delivery and vaginal delivery is imperative.Opportunities still exist in helping patients objectively weigh the decision for cesarean delivery versus vaginal delivery.Additional developments have occurred in the intrapartum and the postpartum setting,with an aim to improve patient and neonatal outcomes.Changes have been implemented for patients undergoing cesarean delivery including preoperative and intraoperative treatment of pain,nausea,and vomiting,as well as postoperative care bundles that improve patient outcomes.Innovations have also occurred in the care of postpartum patients after vaginal delivery,again with improvements in patient outcomes.This article summarizes the current evidence,provides care recommendations,and identifies the next steps in improving obstetrics care.

Women Who Develop Diabetes Later in Life Have Diabetes-Associated Complications during Preceding Pregnancies

Aims:?The aim of this study was to explore the outcome of previous pregnancies in women who later developed diabetes. Method: A Swedish population based cohort of 23,524 women from 1990 aged 45 - 85 yr in 2000 when they self reported health status in a questionnaire. To identify which women who delivered we matched it towards the Swedish Medical Birth Register (SMBR). We identified 14,856 women who appeared in both registers and a total of 30,559 new birth registrations. Among these women 216 had developed diabetes after their pregnancy (ies) and additional twelve women were reported to have gestational diabetes in SMBR. These 228 women and their 455 pregnancies were compared with women without diabetes. Results: Women who developed diabetes later in life were already heavier before the pregnancy (ies) (69.2 ± 13.9 vs. 63.2 ± 10.3 kg;p < 0.001) but had less weight gain during pregnancy (13.3 ± 5.4 vs. 14.1 ± 4.6 kg;p = 0.03) compared to women without diabetes. Newborns to women with diabetes diagnosed any time after pregnancy had higher birth weight (3602 vs. 3507 g;p < 0.001), were more often large for gestational age (10.5% vs. 3.1%;p < 0.001), were more often delivered by caesarean section (4.8% vs. 2.7%;p = 0.005) and had lower Apgar scores. Conclusion: Women who developed diabetes after pregnancy had hyperglycaemia-associated complications during their pregnancy (ies). We therefore postulated that women with Type 2 diabetes are mainly recruited from women with earlier GDM. A general screening for GDM should identify these women and enable life style intervention that may prevent or at least delay diabetes.

Eating practices during pregnancy:perceptions of select Maasai women in Northern Tanzania

Background:Globally,pregnant women are challenged to meet sufficient and necessary dietary intake in order to improve maternal and neonatal outcomes.These challenges are amplified in traditional communities,such as the Maasai,where the historical and cultural practices may further curtail,or impact on this dyad’s potential success.The research is intended to enhance understanding of Maasai women’s pregnancy and nutrition traditions as well as their beliefs.Method:Interviews with 12 pregnant Maasai women,all originally from the(Ngorongoro Conservation Area Authority NCAA)area and have spent most or all of their adult lives in the NCAA,sought to answer two research questions:how do these women describe their current dietary pattern and what do they believe is the role of nutrition during pregnancy.Results:Interpretive description methodology was used to reveal five themes:(1)Eating less food makes baby come easier,(2)Not producing food means more dependence,(3)Working hard harms my baby,(4)Knowing what is needed for a good pregnancy and(5)Preferring our traditional ways for pregnancy and birth.Conclusions:There is an imperative to address nutrition throughout the perinatal period within the Maasai population and the women recognize how important nutrition is for them and their babies.Opportunities to incorporate cultural values and practices must be embedded in programmes/services to achieve success and sustainability.It is important for future prenatal programming with the Maasai in northern Tanzania and other vulnerable groups of pregnant women to build on the women’s knowledge of what leads to good pregnancy outcomes.

Impact of COVID-19 infection during pregnancy on maternal and fetal outcomes

Objectives:The objective of this study is to assess the impact of coronavirus disease 2019(COVID-19)infection during pregnancy on maternal and fetal outcome in relation to gestational age.Methods:This retrospective study was conducted between May 2020 and July 2021.Sixty-five women infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)and hospitalized at a quarantine hospital were included.Thirty-four women received prenatal care at the hospital until delivery,while 31 dropped out from the study due to COVID-19 recovery and discharge before delivery.Results:COVID-19 was found in 83%of the pregnant women after 20 weeks of pregnancy.The most common symptoms were cough and fever.Medical complications included severe pneumonia and thrombosis.The maternal mortality rate was 9.2%.Premature rupture of membranes and severe hypertension during labor affected nearly 9%of the pregnant women who completed prenatal care until delivery at the hospital.Preterm labor occurred at a rate of 38.2%.There were seven(20.8%)stillbirths and two cases of infant mortality.Conclusion:Hospitalized pregnant women who have coronavirus infection,lymphopenia,and a high C-reactive protein level were at a higher risk of developing severe illness,which can lead to maternal and neonatal complications.

Exploring Experiences with "321" Model Management for High-Risk Pregnancy: A Qualitative Study

To editor:In recent years,obstetricians have needed to managemore complex pregnancies involving acute and chronicmedical disorders,and a greater number of pregnancieseach year are now delivered by critical care services.1Datafrom the United States show that poorly controlled maternal medical conditions can have an adverse impact on preg-nancy outcomes.

Autoimmune-associated Congenital Heart Block： A New Insight in Fetal Life

Objective： Congenital heart block （CHB） is a rare but life-threatening disorder. More than half of CHB cases are associated with maternal autoimmune, which are termed as autoimmune-associated CHB. This review summarized the recent research findings in understanding autoimmune-associated CHB, discussed the current diagnostic approaches and management strategies, and summarized the problems and future directions for this disorder. Data Sources： We retrieved the articles published in English from the PubMed database up to January 2017, using the keywords including＂Autoimmune-associated＂, ＂Autoimmune-mediated＂, and ＂Congenital heart block＂. Study Selection： Articles about autoimmune-associated CHB were obtained and reviewed. Results： Observational studies consistently reported that transplacental maternal antibodies might recognize fetal or neonatal antigens in various tissues and result in immunological damages, but the molecular mechanisms underlying CHB pathogenesis still need illuminated. Multiple factors were involved in the process of atrioventricular block development and progression. While several susceptibility genes had been successfully defined, how these genes and their protein interact and impact each other remains to be explored. With currently available diagnostic tools, fetal ultrasound cardiography, and fetal magnetocardiography, most of CHB could be successfully diagnosed and comprehensively evaluated prenatally. The efficacy of current approaches for preventing the progression and recurrence of CHB and other autoimmune-mediated damages was still controversial. Conclusions： This review highlighted the relationships between autoimmune injuries and CHB and strengthened the importance of perinatal management and therapy for autoimmune-associated CHB.

Which fetal growth charts should be used?A retrospective observational study in China

Background:The fetal growth charts in widest use in China were published by Hadlock>35 years ago and were established on data from several hundred of American pregnant women.After that,>100 fetal growth charts were published around the world.We attempted to assess the impact of applying the long-standing Hadlock charts and other charts in a Chinese population and to compare their ability to predict newborn small for gestational age(SGA).Methods:For this retrospective observational study,we reviewed all pregnant women(n=106,455)who booked prenatal care with ultrasound measurements for fetal biometry at the Shenzhen Maternity and Child Healthcare Hospital between 2012 and 2019.A fractional polynomial regression model was applied to generate Shenzhen fetal growth chart ranges for head circumference(HC),biparietal diameter(BPD),abdominal circumference(AC),and femur length(FL).The differences between Shenzhen charts and published charts were quantified by calculating the Z-score.The impact of applying these published charts was quantifed by calculating the proportions of fetuses with biometric measurements below the 3rd centile of these charts.The sensitivity and area under the receiver operating characteristic curves of published charts to predict neonatal SGA(birthweight<10th centile)were assessed..Results:Following selection,169,980 scans of fetal biometry contributed by 41,032 pregnancies with reliable gestational age were analyzed.When using Hadlock references(<3rd centile),the proportions of small heads and short femurs were as high as 8.9%and 6.6%in late gestation,respectively.The INTERGROWTH-21st standards matched those of our observed curves better than other charts,in particular for fat-free biometry(HC and FL).When using AC<10th centile,all of these references were poor at predicting neonatal SGA.Conclusions:Applying long-standing Hadlock references could misclassify a large proportion of fetuses as SGA.INTERGROWTH-21st standard appears to be a safe option in China.For fat-based biometry,AC,a reference based on the Chinese population is needed.In addition,when applying published charts,particular care should be taken due to the discrepancy of measurement methods.