BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is ver...BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.METHODS: A retrospective cross sectional study was conducted using data available at MizanAman General Hospital during a period of 3 years(January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant.RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours(AOR=5.6, 95%CI 1.3–24.1) latency >24 hours(AOR=2.8, 95%CI 1.7–11.8), residing in rural areas(AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.展开更多
BACKGROUND Primiparas are usually at high risk of experiencing perinatal depression,which may cause prolonged labor,increased blood loss,and intensified pain,affecting maternal and fetal outcomes.Therefore,interventio...BACKGROUND Primiparas are usually at high risk of experiencing perinatal depression,which may cause prolonged labor,increased blood loss,and intensified pain,affecting maternal and fetal outcomes.Therefore,interventions are necessary to improve maternal and fetal outcomes and alleviate primiparas’negative emotions(NEs).AIM To discusses the impact of nursing responsibility in midwifery and postural and psychological interventions on maternal and fetal outcomes as well as primiparas’NEs.METHODS As participants,115 primiparas admitted to Quanzhou Maternity and Child Healthcare Hospital between May 2020 and May 2022 were selected.Among them,56 primiparas(control group,Con)were subjected to conventional midwifery and routine nursing.The remaining 59(research group,Res)were subjected to the nursing model of midwifery and postural and psychological interventions.Both groups were comparatively analyzed from the perspectives of delivery mode(cesarean,natural,or forceps-assisted),maternal and fetal outcomes(uterine inertia,postpartum hemorrhage,placental abruption,neonatal pulmonary injury,and neonatal asphyxia),NEs(Hamilton Anxiety/Depressionrating Scale,HAMA/HAMD),labor duration,and nursing satisfaction.RESULTS The Res exhibited a markedly higher natural delivery rate and nursing satisfaction than the Con.Additionally,the Res indicated a lower incidence of adverse events(e.g.,uterine inertia,postpartum hemorrhage,placental abruption,neonatal lung injury,and neonatal asphyxia)and shortened duration of various stages of labor.It also showed statistically lower post-interventional HAMA and HAMD scores than the Con and pre-interventional values.CONCLUSION The nursing model of midwifery and postural and psychological interventions increase the natural delivery rate and reduce the duration of each labor stage.These are also conducive to improving maternal and fetal outcomes and mitigating primiparas’NEs and thus deserve popularity in clinical practice.展开更多
Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outc...Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a normal anatomy ultrasound scan at 20 to 22 weeks gestation. Results: There were 35 placentas (35%) with gross placental anomalies at the delivery triage. Additionally 7 placentas (7%) were reported to be abnormal at the pathology examination. Conclusion: The prevalence of abnormal placental findings in our studied population was 42%.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Urinary tract infection (UTI) is common in pregnancy...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and </span><span style="font-family:Verdana;">health expenditure. The burden of this condition has been understudied in Came</span><span style="font-family:Verdana;">roon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Re</span><span><span style="font-family:Verdana;">ferral Hospital. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We conducted an analytic matched case-control study </span></span><span style="font-family:Verdana;">of 206 pregnant wom</span><span style="font-family:Verdana;">en with evid</span><span style="font-family:Verdana;">ence of uri</span><span style="font-family:Verdana;">nary tract infectio</span><span style="font-family:Verdana;">n (103 cases)</span><span style="font-family:Verdana;"> an</span><span style="font-family:Verdana;">d </span><span style="font-family:Verdana;">those without (103 controls) who underwent antenatal care and gave birth at </span><span style="font-family:Verdana;">the DRH from January 2019 to April 2019. Socio-demographic, laboratory and</span> <span style="font-family:Verdana;">maternal-fetal outcome data were collected using a pre-tested structured questionnai</span><span style="font-family:Verdana;">re and analyzed with SPSS version 23. Statistical significance was set at </span><span><span style="font-family:Verdana;">p < 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b> <i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> (51.5%), </span><i><span style="font-family:Verdana;">Proteus mirabilis</span></i><span style="font-family:Verdana;"> (15.5%), </span><i><span style="font-family:Verdana;">S</span></i></span><i><span style="font-family:Verdana;">taphylococcus aureus</span></i><span style="font-family:Verdana;"> (11.7%) and </span><i><span style="font-family:Verdana;">Klebsiella sp</span></i><span style="font-family:Verdana;">. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1;95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4;95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6;95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1;95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13;95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5;95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> was the main uropathogenic </span><span style="font-family:Verdana;">agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyel</span><span style="font-family:Verdana;">onephritis, preterm labor and delivery while fetal outcomes include: low-birth </span><span style="font-family:Verdana;">weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.</span></span></span></span>展开更多
Objective: The aim of this study was to evaluate the clinical characteristics, maternal and fetal outcomes of trauma in pregnants. Methods: This is a retrospective analysis of all traumatised pregnants who admitted to...Objective: The aim of this study was to evaluate the clinical characteristics, maternal and fetal outcomes of trauma in pregnants. Methods: This is a retrospective analysis of all traumatised pregnants who admitted to Yüzüncü Yil University teritary referral hospital from June 2010 and December 2012. One hundred seventy-nine pregnants in whom referred for trauma analysed for the data about mechanism of trauma, demographic and obstetric parameters on admission, diagnostic and surgical procedures performed, maternal and fetal outcomes. The SAS statistical package version 9.2 was used in data analysis. Results: Overall, the medical records of 179 patients were reached and included in the study. The mean age was 27.5 ± 5.8. Gestational age ranged from 6 to 39 weeks (mean, 26.2 weeks), with most trauma (49.1%) being in the third trimester. Road trrafic accident (RTA) was the main mechanism of trauma (41.5%) followed by falls (26.4%). Trauma due to animal recoil was seen in three patients. The most injured body area was extremity (34.2%). Traumatised pregnants resulted in metarnal (4 cases) and fetal (16 cases) loss. Most of the fetal loss (49.1%) was seen third trimester, with the main cause detected as placental abruption (8 cases). When compared the complicated pregnancy according to trauma site, abdominal trauma (33.3%) was significantly related to complication in pregnancy than non-abdominal trauma (21.9%) (p = 0.014). Conclusions: Trauma in pregnancy carries risks for both mother and baby. Trauma to abdominal region and trauma in second or third trimester pregnancy is associated with significantly higher maternal and fetal complications.展开更多
Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Rando...Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Randomized selection of 100 patients in our hospital delivery and late pregnancy monitoring of uterine artery and fetal hemodynamics in patients. (1) There were compared and analyzed the hemodynamic parameters (PSV, EDV, RI, PI, S/D) of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 36 elderly patients with normal pregnancy outcome (≥35 years old, observation group) and 32 patients with normal age of normal pregnancy (<35 years old, control group). (2) There were compared and analyzed the hemodynamic parameters of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 32 elderly patients with abnormal pregnancy outcome and 36 elderly patients with normal pregnancy outcome. Results: (1) Normal pregnancy outcomes in different age groups, the hemodynamic parameters of uterine artery, umbilical artery and fetal middle cerebral artery were not significantly different. (2) The high age group had different pregnancy outcomes,Fetal middle cerebral artery PI was statistically significant, there was no significant difference in Uterine artery and umbilical artery of the hemodynamic parameters. Conclusion: Color Doppler ultrasonography to evaluate the PI value of fetal middle cerebral artery in older pregnant women has a certain reference value to judge whether there is hypoxia and distress and neonatal prognosis in the fetus, and to provide some reference information for clinicians to predict the pregnancy outcome of the older pregnant women.展开更多
Objective: To evaluate the frequency of adverse maternal and perinatal outcomes in teenage pregnancies at secondary hospital Hyderabad. Methods: Retrospective record review was conducted between January 2012 to Januar...Objective: To evaluate the frequency of adverse maternal and perinatal outcomes in teenage pregnancies at secondary hospital Hyderabad. Methods: Retrospective record review was conducted between January 2012 to January 2016. Total No. of deliveries was 15,395 out of which No. of teenage was 452. Results: Rate of teenage pregnancy in our hospital during study period was 2.93%. Majority of women were uneducated. Teenage mother more likely to develop pregnancy induced hypertension 19.5%, frequency of mild, moderate, and severe anemia were reported to be 69.9%, 28.8% and 1.3% respectively. Conclusion: Fetal and neonatal outcome was not adversely affected. Teenage pregnancy outcome can be achieved favorable with good antenatal care.展开更多
Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimest...Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimesters of pregnancy were correlated with Xanthine oxidase (XO) activity, mean arterial pressure (MAP) and fetal birth weight. The mean ± SD of uric acid (2.01 ± 0.85, 4.8 ± 1.93), calcium (10.88 ± 1.97, 9.72 ± 2.04), MAP (84.32 ± 6.71, 78.40 ± 8.53) and XO activity (11.96 ± 1.91, 14.05 ± 3.09) of the study group (n=86) were observed in the first and second trimesters respectively. First trimester normotensive group (n=79) and preeclampsia cases (n = 7), showed a mean ± SD of uric acid (1.93 ± 0.80, 2.9 ± 0.88), Calcium (10.92 ± 1.9, 10.6 ± 1.72), MAP (84.19 ± 6.75, 85.71 ± 6.58) XO activity (11.82 ± 1.83, 13.57 ± 2.21). In the second trimester, normotensive group and preeclampsia cases showed a mean ± SD uric acid (4.6 ± 1.75, 7.3 ± 2.19), Calcium (9.4 ± 1.85, 12.9 ± 1.04), MAP (76.41 ± 5.41, 100.95 ± 2.52) and XO activity (13.37 ± 1.93, 21.70 ± 3.50). Statistical analysis revealed a non-significant positive correlation in first trimester between uric acid and MAP (r = +0.116, p = 0.288), negative correlations between uric acid and fetal birth weight (r = -0.118, 0.279) and between calcium and MAP (r =?-0.288, p = 0.007). In the second trimester, significant positive correlations were observed between uric acid (r = +0.246, p = 0.022), calcium (r = +0.326, p = 0.007) with MAP along with a significant negative correlation between uric acid (r = -0.641, p = 0.000), calcium (r = -0.316, p = 0.003), Proteinuria (r = -0.514, p = 0.000) with fetal birth weight. The screening of first and second trimesters XO activity, uric acid, calcium and MAP during pregnancy is beneficial in identifying women likely to develop preeclampsia with poor fetal outcome.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Meconium stained amniotic fluid (MSAF), especially o...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Meconium stained amniotic fluid (MSAF), especially observed before term, is considered a sign of fetal jeopardy. Although many studies characterized this condition and associated it with delivery mode, data is lacking in this area, Saudi Arabia. Thus, we attempted to study it. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> All data were retrieved from pregnant patients with MSAF who delivered at King Abdul, Saudi Arabia, from January 2015 to December 2018. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 758 showed MSAF, of which 83% had vaginal delivery, whereas remaining 17% had an emergency caesarean section. Of them, 32 (4.2%) infants developed meconium aspiration syndrome, and 7 (21.8%) were admitted to the NICU. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> It was reconfirmed that MSAF is associated with a newborn risk, especially meconium aspiration syndrome. Patients had a higher rate for emergent caesarean section and baby admission to NICU. These data may be useful to make health/reproductive-health poly-making in this area.</span></span></span></span>展开更多
Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remai...Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1<sup>st</sup> 2004 and December 31<sup>st</sup> 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X<sup>2</sup>(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X<sup>2</sup>(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X<sup>2</sup>(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X<sup>2</sup>(3) = 15.528, P = 0.001 and 5 minutes X<sup>2</sup>(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.展开更多
Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in ...Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in our setting. We sought to study the clinical presentation, management, and materno-fetal outcome of patients with HELLP syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). Methods: This was a cross-sectional, analytical study with a retrospective data collection of patients, diagnosed with HELLP syndrome at the YGOPH between 1st January 2020 and 31st July 2021. Data were analyzed using the software R version 4.0.2. Results are presented as mean ± standard deviation, frequencies and percentages. P values < 0.05 were considered statistically significant. Results: Of 254 cases of severe preeclampsia, 17 developed HELLP syndrome, giving us a frequency of 6.7%. One patient who presented with hepatitis B was excluded. The mean age was 27.19 ± 6.44 years. Most patients (56.3%) had poor follow up during antenatal contacts. The most common symptom was headache (93.8%). Most cases (56.3%) were diagnosed during post-partum, prepartum (25.0%), and per partum (18.8%). Obstetrical management was done by cesarean section (62.5%) and vaginal delivery (37.5%). Post-partum management of HELLP syndrome consisted of antihypertensive medication, anticonvulsants, sedatives, transfusion of blood and blood products, and fluid resuscitation. Of the 50% of patients who presented with acute kidney injury, only 12.5% (1) were referred for dialysis. Over 50% of our study participants presented severe complications after delivery, but 43.8% recovered, while 56.2% finally died. The fetal outcome was: still birth (31.2%), intra-uterine growth restriction/low birth weight (12.5%), term delivery (≥37 weeks) (31.3%), and preterm deliveries (<37 weeks) (68.7%). Three (18.8%) of the neonates delivered alive presented with a poor Apgar score at the 5th minute. Conclusion: Although rare, HELLP syndrome exists in our setting. Proper management in appropriate centers is key to improving maternal and fetal outcomes.展开更多
Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health fac...Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi<sup>2</sup> test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.展开更多
Objective:To report the clinical maternal and fetal outcomes of pregnant women with coronavirus disease 2019(COVID-19),along with any associated pregnancy complications,in Hong Kong,China,and to assess the impact of C...Objective:To report the clinical maternal and fetal outcomes of pregnant women with coronavirus disease 2019(COVID-19),along with any associated pregnancy complications,in Hong Kong,China,and to assess the impact of COVID-19 vaccination on these outcomes.Methods:This prospective registry-based observational study included pregnant women who were recruited through convenient sampling and had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection with a cycle threshold(Ct)value result available on admission to eight local hospitals in Hong Kong,China.Data on clinical symptoms,laboratory results,medical treatments,delivery timing and mode,and pregnancy complications were extracted from the Hospital Authority’s electronic medical record system.Maternal,fetal,and pregnancy outcomes were compared between unvaccinated pregnant women with COVID-19 and those who had received at least one dose of COVID-19 vaccine before diagnosis.Nonparametric continuous variables and categorical variables were analyzed using the Mann-Whitney U test and the Pearson’s chi-squared test respectively.A P value less than 0.05 was considered statistically significant.Results:A total of 164 pregnant women were included,of whom 78(47.56%)were nulliparous.COVID-19 was diagnosed before 28 weeks’gestation in 30(18.29%),while 134(81.71%)were diagnosed at or after 28 weeks’gestation.Sixty-two(37.80%)women received at least one dose of COVID-19 vaccine.There were no significant differences between vaccinated and unvaccinated groups in the time interval between COVID-19 diagnosis and delivery,the Ct value,and the gestational age at infection onset or delivery(P>0.05).The majority of women were symptomatic at diagnosis regardless of vaccination status 55(88.71%)in vaccinated group vs.78(76.47%)in unvaccinated group(P=0.052).Symptoms did not significantly differ between groups except for cough(62.90%vs.47.06%,P=0.049).The overall rate of severe COVID-19 in pregnant women was low.In total,5(3.05%)patients experienced severe COVID-19,with vaccinated patients more likely to receive low molecular weight heparin(LMWH)as part of their treatment(62.90%vs.42.16%,P=0.010).Ninety-two(56.10%)women had a spontaneous vaginal delivery,7(4.27%)had an instrumental delivery,and 44(26.83%)and 21(12.80%)underwent emergency and elective cesarean sections respectively.For fetal outcomes,14(8.48%)babieswere born preterm and four(2.65%of nonpreterm babies,n=151)had low birthweight.The median birthweight percentile was 52.18th.There were no statistically significant differences in pregnancy complications or fetal outcomes between vaccinated and unvaccinated groups.Conclusion:The overall rate of severe COVID-19 in pregnant women was low.COVID-19 vaccination did not significantly impactmaternal outcomes,except for the use of LMWH.Additionally,the study found no significant differences in fetal outcomes and pregnancy complications between vaccinated and unvaccinated individuals.展开更多
Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 wome...Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.展开更多
Objective To explore the effects of prenatal exposure to polybrominated diphenyl ethers(PBDEs)on placental size and birth outcomes.Methods Based on the perspective Wenzhou Birth Cohort,this nested case-control study i...Objective To explore the effects of prenatal exposure to polybrominated diphenyl ethers(PBDEs)on placental size and birth outcomes.Methods Based on the perspective Wenzhou Birth Cohort,this nested case-control study included 101 fetal growth restriction(FGR)and 101 healthy newborns.Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry.The basic information of mother-newborn pairs was collected from questionnaires,whereas the placental size and birth outcomes of newborns were obtained from hospital records.Results A total of 19 brominated diphenyle ether(BDE)congeners were detected in maternal serum samples.Higher concentrations of BDE-207,-208,-209,and∑19PBDEs were detected in FGR cases than in controls.Increased BDE-207,-208,-209,and∑19PBDEs levels in maternal serum were related to decreased placental length,breadth,surface area,birth weight,birth length,gestational age,and Quetelet index of newborns.After adjusting for confounders,BDE-207 and∑19PBDE concentrations in maternal serum were significantly associated with an increased risk of FGR.Conclusion A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes.Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.展开更多
<strong>Objective:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> To investigate the effect of aspirin on pregnancy out...<strong>Objective:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> To investigate the effect of aspirin on pregnancy outcome and serum levels of endothelin-1 (ET-1) and thrombomodulin (TM) in pregnancy patients with chronic hypertension. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Selected patients with chronic hypertension (mild to moderate) during pregnancy, who were enrolled and delivered in the Beijing Tongren Hospital Department of Obstetrics and Gynecology between January 1, 2019 and December 30, 2020. The patients were randomly divided into control group (60) and experimental group (60). The control group was treated with labetalol and the test group was treated with labetalol and aspirin. The therapeutic effect and pregnancy outcome of the two groups were compared. The serum levels of ET-1 and TM were measured before treatment and one week after treatment. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Systolic blood pressure (SBP) decreased significantly one week after treatment in the two groups (P < 0.05). One week after treatment, the values of ET-1 and TM in the experimental group were significantly lower than those in the Control Group, the difference is statistically significant (P < 0.05). The incidence of Preeclampsia, intrauterine growth retardation, oligohydramnios, placental abruption, Cesarean section and preterm birth in the experimental group was significantly lower than that in the control group. There was significant difference between the two groups, especially Preeclampsia and Intrauterine Growth Retardation (P < 0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Besides routine treatment, aspirin can improve the outcome of pregnant women with chronic hypertension, which may be related to the regulation of ET-1 and TM by aspirin.</span></span></span></span>展开更多
Objectives: Present prospective study was carried out to know the frequency of transplacental fetomaternal hemorrhage in pregnancies complicated by third trimester vaginal bleeding and it’s correlation with fetoneona...Objectives: Present prospective study was carried out to know the frequency of transplacental fetomaternal hemorrhage in pregnancies complicated by third trimester vaginal bleeding and it’s correlation with fetoneonatal outcome. Material methods: One hundred, out of 170 Rh-positive primigravida/multigravida with singleton pregnancy of more than 28 weeks gestation, admitted with third trimester vaginal bleeding with no other obstetric disorder, were the study subjects and 100 controls were women with no bleeding, admitted immediately after the study case with same inclusion and exclusion criteria. Maternal peripheral blood was collected at admission and at 2 hours of delivery and volume of FMH was calculated by Kleihauer’s formula. Results: Statistically significantly more perinatal deaths occurred in women with FMH, 35% in study subjects compared to 2.7% amongst controls. Conclusion: In the cases of third trimester bleeding and fetomaternal hemorrhage, chances of perinatal deaths are more.展开更多
Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, ...Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, especially in Nepal, a low-income region where women have an increased risk of developing iodine deficiency during pregnancy. Hence this study is to analyze fetomaternal outcomes in maternal hypothyroidism complicating pregnancies. Methods: This retrospective observational study was carried out at Paropakar Maternity and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal women with a singleton pregnancy with hypothyroidism admitted for delivery in the obstetrics ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including heart disease, diabetes, and hypertension were excluded. Routine hematological parameters and estimations of T3, T4, and thyroid stimulating hormone (TSH) were conducted. Patients with hypothyroidism were divided into overt and subclinical and were subsequently assessed for maternal and fetal complications. The occurrence of maternal outcomes and perinatal outcomes were recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled in the study and the remaining 140 were excluded. In our study, the incidence of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio placenta, and postpartum hemorrhage were the adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant. Concerning fetal outcome APGAR score <6 in 5 min, Intrauterine growth restriction (IUGR), NICU admission, neonatal Respiratory distress syndrome (RDS), Intrauterine fetal death (IUFD), and congenital anomaly were found with a higher percentage in overt hypothyroidism. Conclusion: Since the impact of hypothyroidism on fetomaternal morbidities have been identified so screening for hypothyroidism to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcome.展开更多
文摘BACKGROUND: Premature rupture of membrane(PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia.METHODS: A retrospective cross sectional study was conducted using data available at MizanAman General Hospital during a period of 3 years(January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically signifi cant.RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours(AOR=5.6, 95%CI 1.3–24.1) latency >24 hours(AOR=2.8, 95%CI 1.7–11.8), residing in rural areas(AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes.CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders.
文摘BACKGROUND Primiparas are usually at high risk of experiencing perinatal depression,which may cause prolonged labor,increased blood loss,and intensified pain,affecting maternal and fetal outcomes.Therefore,interventions are necessary to improve maternal and fetal outcomes and alleviate primiparas’negative emotions(NEs).AIM To discusses the impact of nursing responsibility in midwifery and postural and psychological interventions on maternal and fetal outcomes as well as primiparas’NEs.METHODS As participants,115 primiparas admitted to Quanzhou Maternity and Child Healthcare Hospital between May 2020 and May 2022 were selected.Among them,56 primiparas(control group,Con)were subjected to conventional midwifery and routine nursing.The remaining 59(research group,Res)were subjected to the nursing model of midwifery and postural and psychological interventions.Both groups were comparatively analyzed from the perspectives of delivery mode(cesarean,natural,or forceps-assisted),maternal and fetal outcomes(uterine inertia,postpartum hemorrhage,placental abruption,neonatal pulmonary injury,and neonatal asphyxia),NEs(Hamilton Anxiety/Depressionrating Scale,HAMA/HAMD),labor duration,and nursing satisfaction.RESULTS The Res exhibited a markedly higher natural delivery rate and nursing satisfaction than the Con.Additionally,the Res indicated a lower incidence of adverse events(e.g.,uterine inertia,postpartum hemorrhage,placental abruption,neonatal lung injury,and neonatal asphyxia)and shortened duration of various stages of labor.It also showed statistically lower post-interventional HAMA and HAMD scores than the Con and pre-interventional values.CONCLUSION The nursing model of midwifery and postural and psychological interventions increase the natural delivery rate and reduce the duration of each labor stage.These are also conducive to improving maternal and fetal outcomes and mitigating primiparas’NEs and thus deserve popularity in clinical practice.
文摘Objective: Obstetricians, Neonatologists, and Pathologists have studied gross histological analysis of human placentas in search of specific alterations in placental functions that can be correlated with neonatal outcomes. Our study assessed the prevalence of abnormal placental findings associated with non-reassuring fetal monitoring in labor requiring emergent instrumental or cesarean delivery, followed by an excellent neonatal outcome. Study Design: One hundred consecutive emergency deliveries, instrumental or cesarean, performed due to non-reassuring fetal monitoring while in labor were retrospectively evaluated. All patients were low-risk for obstetric complications, and had a singleton, term pregnancy. They had a normal antenatal routine testing and a normal anatomy ultrasound scan at 20 to 22 weeks gestation. Results: There were 35 placentas (35%) with gross placental anomalies at the delivery triage. Additionally 7 placentas (7%) were reported to be abnormal at the pathology examination. Conclusion: The prevalence of abnormal placental findings in our studied population was 42%.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and </span><span style="font-family:Verdana;">health expenditure. The burden of this condition has been understudied in Came</span><span style="font-family:Verdana;">roon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Re</span><span><span style="font-family:Verdana;">ferral Hospital. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We conducted an analytic matched case-control study </span></span><span style="font-family:Verdana;">of 206 pregnant wom</span><span style="font-family:Verdana;">en with evid</span><span style="font-family:Verdana;">ence of uri</span><span style="font-family:Verdana;">nary tract infectio</span><span style="font-family:Verdana;">n (103 cases)</span><span style="font-family:Verdana;"> an</span><span style="font-family:Verdana;">d </span><span style="font-family:Verdana;">those without (103 controls) who underwent antenatal care and gave birth at </span><span style="font-family:Verdana;">the DRH from January 2019 to April 2019. Socio-demographic, laboratory and</span> <span style="font-family:Verdana;">maternal-fetal outcome data were collected using a pre-tested structured questionnai</span><span style="font-family:Verdana;">re and analyzed with SPSS version 23. Statistical significance was set at </span><span><span style="font-family:Verdana;">p < 0.05. </span><b><span style="font-family:Verdana;">Results:</span></b> <i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> (51.5%), </span><i><span style="font-family:Verdana;">Proteus mirabilis</span></i><span style="font-family:Verdana;"> (15.5%), </span><i><span style="font-family:Verdana;">S</span></i></span><i><span style="font-family:Verdana;">taphylococcus aureus</span></i><span style="font-family:Verdana;"> (11.7%) and </span><i><span style="font-family:Verdana;">Klebsiella sp</span></i><span style="font-family:Verdana;">. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1;95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4;95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6;95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1;95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13;95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5;95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. </span><b><span style="font-family:Verdana;">Conclusion:</span></b> <i><span style="font-family:Verdana;">Escherichia coli</span></i><span style="font-family:Verdana;"> was the main uropathogenic </span><span style="font-family:Verdana;">agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyel</span><span style="font-family:Verdana;">onephritis, preterm labor and delivery while fetal outcomes include: low-birth </span><span style="font-family:Verdana;">weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.</span></span></span></span>
文摘Objective: The aim of this study was to evaluate the clinical characteristics, maternal and fetal outcomes of trauma in pregnants. Methods: This is a retrospective analysis of all traumatised pregnants who admitted to Yüzüncü Yil University teritary referral hospital from June 2010 and December 2012. One hundred seventy-nine pregnants in whom referred for trauma analysed for the data about mechanism of trauma, demographic and obstetric parameters on admission, diagnostic and surgical procedures performed, maternal and fetal outcomes. The SAS statistical package version 9.2 was used in data analysis. Results: Overall, the medical records of 179 patients were reached and included in the study. The mean age was 27.5 ± 5.8. Gestational age ranged from 6 to 39 weeks (mean, 26.2 weeks), with most trauma (49.1%) being in the third trimester. Road trrafic accident (RTA) was the main mechanism of trauma (41.5%) followed by falls (26.4%). Trauma due to animal recoil was seen in three patients. The most injured body area was extremity (34.2%). Traumatised pregnants resulted in metarnal (4 cases) and fetal (16 cases) loss. Most of the fetal loss (49.1%) was seen third trimester, with the main cause detected as placental abruption (8 cases). When compared the complicated pregnancy according to trauma site, abdominal trauma (33.3%) was significantly related to complication in pregnancy than non-abdominal trauma (21.9%) (p = 0.014). Conclusions: Trauma in pregnancy carries risks for both mother and baby. Trauma to abdominal region and trauma in second or third trimester pregnancy is associated with significantly higher maternal and fetal complications.
文摘Objective: The purpose of this study was to investigate the relationship between pregnancy outcome in older pregnant women and the uterine artery and fetal hemodynamic parameters in the third trimester. Methods: Randomized selection of 100 patients in our hospital delivery and late pregnancy monitoring of uterine artery and fetal hemodynamics in patients. (1) There were compared and analyzed the hemodynamic parameters (PSV, EDV, RI, PI, S/D) of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 36 elderly patients with normal pregnancy outcome (≥35 years old, observation group) and 32 patients with normal age of normal pregnancy (<35 years old, control group). (2) There were compared and analyzed the hemodynamic parameters of the uterine artery, umbilical artery and fetal middle cerebral artery in the third trimester between 32 elderly patients with abnormal pregnancy outcome and 36 elderly patients with normal pregnancy outcome. Results: (1) Normal pregnancy outcomes in different age groups, the hemodynamic parameters of uterine artery, umbilical artery and fetal middle cerebral artery were not significantly different. (2) The high age group had different pregnancy outcomes,Fetal middle cerebral artery PI was statistically significant, there was no significant difference in Uterine artery and umbilical artery of the hemodynamic parameters. Conclusion: Color Doppler ultrasonography to evaluate the PI value of fetal middle cerebral artery in older pregnant women has a certain reference value to judge whether there is hypoxia and distress and neonatal prognosis in the fetus, and to provide some reference information for clinicians to predict the pregnancy outcome of the older pregnant women.
文摘Objective: To evaluate the frequency of adverse maternal and perinatal outcomes in teenage pregnancies at secondary hospital Hyderabad. Methods: Retrospective record review was conducted between January 2012 to January 2016. Total No. of deliveries was 15,395 out of which No. of teenage was 452. Results: Rate of teenage pregnancy in our hospital during study period was 2.93%. Majority of women were uneducated. Teenage mother more likely to develop pregnancy induced hypertension 19.5%, frequency of mild, moderate, and severe anemia were reported to be 69.9%, 28.8% and 1.3% respectively. Conclusion: Fetal and neonatal outcome was not adversely affected. Teenage pregnancy outcome can be achieved favorable with good antenatal care.
文摘Preeclampsia is a pregnancy complication;early identification with increased risk is one of the key goals in obstetrics. In a nested case control study, serum uric acid and calcium measured in first and second trimesters of pregnancy were correlated with Xanthine oxidase (XO) activity, mean arterial pressure (MAP) and fetal birth weight. The mean ± SD of uric acid (2.01 ± 0.85, 4.8 ± 1.93), calcium (10.88 ± 1.97, 9.72 ± 2.04), MAP (84.32 ± 6.71, 78.40 ± 8.53) and XO activity (11.96 ± 1.91, 14.05 ± 3.09) of the study group (n=86) were observed in the first and second trimesters respectively. First trimester normotensive group (n=79) and preeclampsia cases (n = 7), showed a mean ± SD of uric acid (1.93 ± 0.80, 2.9 ± 0.88), Calcium (10.92 ± 1.9, 10.6 ± 1.72), MAP (84.19 ± 6.75, 85.71 ± 6.58) XO activity (11.82 ± 1.83, 13.57 ± 2.21). In the second trimester, normotensive group and preeclampsia cases showed a mean ± SD uric acid (4.6 ± 1.75, 7.3 ± 2.19), Calcium (9.4 ± 1.85, 12.9 ± 1.04), MAP (76.41 ± 5.41, 100.95 ± 2.52) and XO activity (13.37 ± 1.93, 21.70 ± 3.50). Statistical analysis revealed a non-significant positive correlation in first trimester between uric acid and MAP (r = +0.116, p = 0.288), negative correlations between uric acid and fetal birth weight (r = -0.118, 0.279) and between calcium and MAP (r =?-0.288, p = 0.007). In the second trimester, significant positive correlations were observed between uric acid (r = +0.246, p = 0.022), calcium (r = +0.326, p = 0.007) with MAP along with a significant negative correlation between uric acid (r = -0.641, p = 0.000), calcium (r = -0.316, p = 0.003), Proteinuria (r = -0.514, p = 0.000) with fetal birth weight. The screening of first and second trimesters XO activity, uric acid, calcium and MAP during pregnancy is beneficial in identifying women likely to develop preeclampsia with poor fetal outcome.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Meconium stained amniotic fluid (MSAF), especially observed before term, is considered a sign of fetal jeopardy. Although many studies characterized this condition and associated it with delivery mode, data is lacking in this area, Saudi Arabia. Thus, we attempted to study it. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> All data were retrieved from pregnant patients with MSAF who delivered at King Abdul, Saudi Arabia, from January 2015 to December 2018. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> 758 showed MSAF, of which 83% had vaginal delivery, whereas remaining 17% had an emergency caesarean section. Of them, 32 (4.2%) infants developed meconium aspiration syndrome, and 7 (21.8%) were admitted to the NICU. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> It was reconfirmed that MSAF is associated with a newborn risk, especially meconium aspiration syndrome. Patients had a higher rate for emergent caesarean section and baby admission to NICU. These data may be useful to make health/reproductive-health poly-making in this area.</span></span></span></span>
文摘Background: Placenta praevia accounts for significant maternal morbidity and perinatal morbidity and mortality. Despite advances in blood transfusion technique and surgical procedure, abnormal placentation still remains a difficult challenge for obstetricians. Objective: To determine the influence of booking status on the fetal and maternal outcome among parturients with placenta praevia that underwent caesarian delivery. Methodology: This was a comparative and retrospective study between booked and unbooked subjects with significant placenta praevia that were delivered by caesarian section between January 1<sup>st</sup> 2004 and December 31<sup>st</sup> 2008 with respect to maternal and fetal outcome. Result: Out of 14,344 deliveries during study period, 123 cases of placenta praevia that underwent caesarian delivery were identified giving a prevalence rate of 0.86%. 49 subjects were booked while 74 were unbooked. There was no statistically significant difference between booked and unbooked cases with respect to risk factors (30.6% of booked and 23% of unbooked), X<sup>2</sup>(4) = 7.203, P = 0.126 and the mean blood loss at surgery (870.4 ± 486.9 ml in booked versus 779.7 ± 380.96 ml in unbooked), X<sup>2</sup>(1) = 0.202, P = 0.653. However, antepartum transfusion (12.2% booked versus 34.7% unbooked) and postpartum transfusion (51% booked versus 72% unbooked) showed statistically significant difference, X<sup>2</sup>(1) = 9.744, P = 0.002. One maternal death occurred amongst the unbooked cases and none among the booked cases. Statistically significant differences were also noted in the apgar score at 1 minute X<sup>2</sup>(3) = 15.528, P = 0.001 and 5 minutes X<sup>2</sup>(3) = 12.912, P = 0.005 respectively. More babies died in the unbooked group (19) compared to two (2) in the booked mothers. Conclusion: Unbooked status in placenta previa significantly increases the risk for antepartum and postpartum transfusion, is associated with higher mortality, increased preterm delivery, poorer apgar scores and higher perinatal mortality rate.
文摘Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in our setting. We sought to study the clinical presentation, management, and materno-fetal outcome of patients with HELLP syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). Methods: This was a cross-sectional, analytical study with a retrospective data collection of patients, diagnosed with HELLP syndrome at the YGOPH between 1st January 2020 and 31st July 2021. Data were analyzed using the software R version 4.0.2. Results are presented as mean ± standard deviation, frequencies and percentages. P values < 0.05 were considered statistically significant. Results: Of 254 cases of severe preeclampsia, 17 developed HELLP syndrome, giving us a frequency of 6.7%. One patient who presented with hepatitis B was excluded. The mean age was 27.19 ± 6.44 years. Most patients (56.3%) had poor follow up during antenatal contacts. The most common symptom was headache (93.8%). Most cases (56.3%) were diagnosed during post-partum, prepartum (25.0%), and per partum (18.8%). Obstetrical management was done by cesarean section (62.5%) and vaginal delivery (37.5%). Post-partum management of HELLP syndrome consisted of antihypertensive medication, anticonvulsants, sedatives, transfusion of blood and blood products, and fluid resuscitation. Of the 50% of patients who presented with acute kidney injury, only 12.5% (1) were referred for dialysis. Over 50% of our study participants presented severe complications after delivery, but 43.8% recovered, while 56.2% finally died. The fetal outcome was: still birth (31.2%), intra-uterine growth restriction/low birth weight (12.5%), term delivery (≥37 weeks) (31.3%), and preterm deliveries (<37 weeks) (68.7%). Three (18.8%) of the neonates delivered alive presented with a poor Apgar score at the 5th minute. Conclusion: Although rare, HELLP syndrome exists in our setting. Proper management in appropriate centers is key to improving maternal and fetal outcomes.
文摘Introduction: Cesarean section is a surgical intervention which consists in the extraction of a fetus from the uterus after its incision. The rate of cesarean section varies depending on the country and the health facility. For this reason, in 2015, the World Health Organization (WHO) recommended the use of Robson’s classification to evaluate the practice of cesarean sections in order to identify the groups of women who had abnormally high rates. The objective of our study was to evaluate cesarean sections using the Robson’s classification in CHRACERH and in the Yaoundé Central Hospital (YCH). Methodology: We carried out a retrospective cross sectional and descriptive study in two (02) university hospitals in Yaoundé which took place from December 2017 to May 2018. We included in our study all women who gave birth over a period of two (02) years from January 2016 to December 2017 in these two health facilities. Our sampling was exhaustive over the study period. The parturients’ information was collected using an anonymous and pretested questionnaire. The Robson’s group of every parturient was determined. Descriptive parameters like mean and proportions were calculated. We compared the rates and indications of cesarean sections between the both hospitals using Chi<sup>2</sup> test. Results: Out of 330 deliveries realized in CHRACERH, we had 90 cesarean sections;hence, a rate of 27.2%. Out of 1863 deliveries carried out at the YCH, 462 were by cesarean section, hence a rate of 24.8%. The women who belonged to groups 1, 3 and 5 contributed to the highest rates of cesarean sections in both hospitals: in CHRACERH, group 5 (31.1%), group 3 (20%) and group 1 (15.6%), at YCH: group 3 (22.5%), group 1 (21.6%) and group 5 (17.3%). The indications of the cesarean sections varied depending on the Robson’s group and the hospital, the principal indication in group 1 was acute fetal distress (28.6%) in CHRACERH and cephalopelvic disproportion (36.7%) at YCH. Cephalopelvic disproportion was the predominant indication in groups 3 of CHRACERH (44.4%) and YCH (39.2%). In groups 5, CHRACERH and of YCH, a scarred uterus was the principal indication for the cesarean section at 82.4% and 78.4% respectively. At CHRACERH, the maternofetal complications were more frequent in groups 1 and 2 at the YCH, this was the case mostly in groups 1 and 3. Conclusion: The Robson’s classification is an adequate tool for the evaluation and comparison of the rates of cesarean sections. The rates of cesarean section in CHRACERH (27.2%) and at YCH (24.8%) were higher than the rates recommended by WHO. Robson’s groups 1, 3 and 5 were identified as the groups most at risk for cesarean sections in the both hospitals.
基金supported by funding from Ferring Pharmaceuticals(Saint-Prex,Switzerland).
文摘Objective:To report the clinical maternal and fetal outcomes of pregnant women with coronavirus disease 2019(COVID-19),along with any associated pregnancy complications,in Hong Kong,China,and to assess the impact of COVID-19 vaccination on these outcomes.Methods:This prospective registry-based observational study included pregnant women who were recruited through convenient sampling and had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection with a cycle threshold(Ct)value result available on admission to eight local hospitals in Hong Kong,China.Data on clinical symptoms,laboratory results,medical treatments,delivery timing and mode,and pregnancy complications were extracted from the Hospital Authority’s electronic medical record system.Maternal,fetal,and pregnancy outcomes were compared between unvaccinated pregnant women with COVID-19 and those who had received at least one dose of COVID-19 vaccine before diagnosis.Nonparametric continuous variables and categorical variables were analyzed using the Mann-Whitney U test and the Pearson’s chi-squared test respectively.A P value less than 0.05 was considered statistically significant.Results:A total of 164 pregnant women were included,of whom 78(47.56%)were nulliparous.COVID-19 was diagnosed before 28 weeks’gestation in 30(18.29%),while 134(81.71%)were diagnosed at or after 28 weeks’gestation.Sixty-two(37.80%)women received at least one dose of COVID-19 vaccine.There were no significant differences between vaccinated and unvaccinated groups in the time interval between COVID-19 diagnosis and delivery,the Ct value,and the gestational age at infection onset or delivery(P>0.05).The majority of women were symptomatic at diagnosis regardless of vaccination status 55(88.71%)in vaccinated group vs.78(76.47%)in unvaccinated group(P=0.052).Symptoms did not significantly differ between groups except for cough(62.90%vs.47.06%,P=0.049).The overall rate of severe COVID-19 in pregnant women was low.In total,5(3.05%)patients experienced severe COVID-19,with vaccinated patients more likely to receive low molecular weight heparin(LMWH)as part of their treatment(62.90%vs.42.16%,P=0.010).Ninety-two(56.10%)women had a spontaneous vaginal delivery,7(4.27%)had an instrumental delivery,and 44(26.83%)and 21(12.80%)underwent emergency and elective cesarean sections respectively.For fetal outcomes,14(8.48%)babieswere born preterm and four(2.65%of nonpreterm babies,n=151)had low birthweight.The median birthweight percentile was 52.18th.There were no statistically significant differences in pregnancy complications or fetal outcomes between vaccinated and unvaccinated groups.Conclusion:The overall rate of severe COVID-19 in pregnant women was low.COVID-19 vaccination did not significantly impactmaternal outcomes,except for the use of LMWH.Additionally,the study found no significant differences in fetal outcomes and pregnancy complications between vaccinated and unvaccinated individuals.
文摘Objective: To identify the risk factors of intrapartal fetal death in a tertiary hospital in Yaoundé. Methods: It was a case-control study comparing 53 women who delivered with intrapartal fetal death to 106 women who delivered without intrapartal fetal death, carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, Cameroon. Results: The risk factors of intrapartal fetal death identified at bivariate analysis were: maternal age <20 years (OR = 3.1;CI = 1.1 - 8.3), absence of regular income (OR = 2.4;CI = 1.2 - 4.7), single motherhood (OR = 2.9;CI = 1.5 - 5.7), illiteracy and primary level of education (OR = 4.7;CI = 1.9 - 11.5), referral (OR = 5.0;CI = 2.5 - 9.9), parity 0 and 1 (OR = 2.3;CI = 1.1 - 4.5), no antenatal care (OR = 9.2;CI = 2.4 - 35.6), number of antenatal visits <4 (OR = 4.2;CI = 2.1 - 8.6), antenatal care in a health center (OR = 3.8;CI = 1.9 - 7.5), antenatal care by a midwife (OR = 2.5;CI = 1.3 - 4.9) or a nurse (OR = 5.2;CI = 1.4 - 18.7), absence of malaria prophylaxis (OR = 10.6;CI = 2.9 - 39.5), absence of obstetrical ultrasound (OR = 4.7;CI = 1.9 - 10.9), prematurity (OR = 3.4;CI = 1.5 - 7.3), abnormal presentation (OR = 2.6;CI = 1.1 - 5.9), ruptured membranes at admission (OR = 2.7;CI = 1.3 - 5.4), ruptured membranes >12 hours at admission (OR = 5.1;CI = 2.5 - 10.3), stained amniotic fluid (OR = 4.8;CI = 2.4 - 9.7), labor lasting more than 12 hours (OR = 18.1;CI = 8.0 - 41.0), presence of maternal complications (OR = 4.7;CI = 2.2 - 10.3), and presence of fetal complications (OR = 48.6;CI = 18.3 - 129), particularly acute fetal distress (OR = 52.3;CI = (14.6 - 186), cord prolapse (OR = 12.1;CI = 3.3 - 43.4), and birth weight <2500 g (OR = 2.8;CI = 1.2 - 6.6). Conclusion: Close attention should be offered to pregnant women, so as to identify these risk factors and promptly provide an appropriate management.
基金the National Natural Science Foundation of China[No.21577026]。
文摘Objective To explore the effects of prenatal exposure to polybrominated diphenyl ethers(PBDEs)on placental size and birth outcomes.Methods Based on the perspective Wenzhou Birth Cohort,this nested case-control study included 101 fetal growth restriction(FGR)and 101 healthy newborns.Maternal serum samples were collected during the third trimester and measured for PBDEs by gas chromatography tandem mass spectrometry.The basic information of mother-newborn pairs was collected from questionnaires,whereas the placental size and birth outcomes of newborns were obtained from hospital records.Results A total of 19 brominated diphenyle ether(BDE)congeners were detected in maternal serum samples.Higher concentrations of BDE-207,-208,-209,and∑19PBDEs were detected in FGR cases than in controls.Increased BDE-207,-208,-209,and∑19PBDEs levels in maternal serum were related to decreased placental length,breadth,surface area,birth weight,birth length,gestational age,and Quetelet index of newborns.After adjusting for confounders,BDE-207 and∑19PBDE concentrations in maternal serum were significantly associated with an increased risk of FGR.Conclusion A negative association was found between PBDE levels in maternal serum and placental size and birth outcomes.Prenatal PBDE exposure may be associated with elevated risk of the incidence of FGR birth.
文摘<strong>Objective:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> To investigate the effect of aspirin on pregnancy outcome and serum levels of endothelin-1 (ET-1) and thrombomodulin (TM) in pregnancy patients with chronic hypertension. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Selected patients with chronic hypertension (mild to moderate) during pregnancy, who were enrolled and delivered in the Beijing Tongren Hospital Department of Obstetrics and Gynecology between January 1, 2019 and December 30, 2020. The patients were randomly divided into control group (60) and experimental group (60). The control group was treated with labetalol and the test group was treated with labetalol and aspirin. The therapeutic effect and pregnancy outcome of the two groups were compared. The serum levels of ET-1 and TM were measured before treatment and one week after treatment. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Systolic blood pressure (SBP) decreased significantly one week after treatment in the two groups (P < 0.05). One week after treatment, the values of ET-1 and TM in the experimental group were significantly lower than those in the Control Group, the difference is statistically significant (P < 0.05). The incidence of Preeclampsia, intrauterine growth retardation, oligohydramnios, placental abruption, Cesarean section and preterm birth in the experimental group was significantly lower than that in the control group. There was significant difference between the two groups, especially Preeclampsia and Intrauterine Growth Retardation (P < 0.05). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Besides routine treatment, aspirin can improve the outcome of pregnant women with chronic hypertension, which may be related to the regulation of ET-1 and TM by aspirin.</span></span></span></span>
文摘Objectives: Present prospective study was carried out to know the frequency of transplacental fetomaternal hemorrhage in pregnancies complicated by third trimester vaginal bleeding and it’s correlation with fetoneonatal outcome. Material methods: One hundred, out of 170 Rh-positive primigravida/multigravida with singleton pregnancy of more than 28 weeks gestation, admitted with third trimester vaginal bleeding with no other obstetric disorder, were the study subjects and 100 controls were women with no bleeding, admitted immediately after the study case with same inclusion and exclusion criteria. Maternal peripheral blood was collected at admission and at 2 hours of delivery and volume of FMH was calculated by Kleihauer’s formula. Results: Statistically significantly more perinatal deaths occurred in women with FMH, 35% in study subjects compared to 2.7% amongst controls. Conclusion: In the cases of third trimester bleeding and fetomaternal hemorrhage, chances of perinatal deaths are more.
文摘Background: Thyroid disorders are the most common endocrine disorders in pregnancy accounting for 10% of subclinical hypothyroidism in all pregnancies. Screening for hypothyroidism is essential in all pregnant women, especially in Nepal, a low-income region where women have an increased risk of developing iodine deficiency during pregnancy. Hence this study is to analyze fetomaternal outcomes in maternal hypothyroidism complicating pregnancies. Methods: This retrospective observational study was carried out at Paropakar Maternity and Women Hospital, a tertiary center located in Kathmandu, Nepal. The Subjects of this study were 330 antenatal women with a singleton pregnancy with hypothyroidism admitted for delivery in the obstetrics ward, and informed consent was obtained. Women were chosen irrespective of age, parity, residency, and socioeconomic status. Women with multiple pregnancies and any preexisting medical disorders including heart disease, diabetes, and hypertension were excluded. Routine hematological parameters and estimations of T3, T4, and thyroid stimulating hormone (TSH) were conducted. Patients with hypothyroidism were divided into overt and subclinical and were subsequently assessed for maternal and fetal complications. The occurrence of maternal outcomes and perinatal outcomes were recorded. Result: Out of 470 total hypothyroid cases, 330 were enrolled in the study and the remaining 140 were excluded. In our study, the incidence of hypothyroidism in pregnancy was 2.11% with 1.7% of subclinical hypothyroidism and 0.31% of overt hypothyroidism. The mean age of the patient was >30 years with 53.3% (n = 176) primigravida. Mostly 70.3% (n = 232) from rural areas. Pre-Eclampsia, gestational diabetes abruptio placenta, and postpartum hemorrhage were the adverse maternal outcome with a higher percentage of these in overt hypothyroidism which was statistically significant. Concerning fetal outcome APGAR score <6 in 5 min, Intrauterine growth restriction (IUGR), NICU admission, neonatal Respiratory distress syndrome (RDS), Intrauterine fetal death (IUFD), and congenital anomaly were found with a higher percentage in overt hypothyroidism. Conclusion: Since the impact of hypothyroidism on fetomaternal morbidities have been identified so screening for hypothyroidism to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcome.