Predictors of Adverse Pregnancy Outcomes Following Traumatic Injuries

Objective After traumatic injury in pregnant women,providing timely and appropriate management for high-risk patients is crucial for both pregnant women and fetuses.This study aimed to identify risk factors that predict adverse pregnancy outcomes after traumatic injury.Methods A retrospective cohort study including 317 pregnant patients who experienced trauma was conducted.The collected data included general demographics,injury mechanisms and adverse pregnancy outcomes.Patients were divided into two subgroups based on the absence or presence of trauma-related adverse pregnancy outcomes.Univariate and multivariate logistic regressions were conducted to estimate the associations between clinical variables and adverse pregnancy outcomes.Results A total of 41(12.93%)patients experienced adverse pregnancy outcomes within the first 24 h post-trauma.This study revealed that age>35 years(OR=14.995,95%CI:5.024–44.755,P<0.001),third trimester trauma(OR=3.878,95%CI:1.343–11.204,P=0.012),abdominal pain(OR=3.032,95%CI:1.221–7.527,P=0.017),vaginal bleeding(OR=3.226,95%CI:1.093–9.523,P=0.034),positive scan in focused assessment with sonography for trauma(FAST)positive(OR=8.496,95%CI:2.825–25.555,P<0.001),9≤injury severity score(ISS)<16(OR=3.039,95%CI:1.046–8.835,P=0.041)and ISS≥16(OR=5.553,95%CI:1.387–22.225,P=0.015)increased the probability of posttraumatic adverse pregnancy outcomes.Maternal age,gestational age at delivery,vaginal bleeding and positive FAST results were risk factors for abnormal delivery.Conclusion Advanced maternal age,third trimester,and positive FAST results should alert multidisciplinary trauma teams to closely monitor patients to prevent adverse pregnancy outcomes.

Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation(BHGAL)due to severe postpartum hemorrhage

Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.

Outcomes of long-acting injectable antipsychotics use in pregnancy:A literature review

BACKGROUND Women with a history of serious psychotic disorders are at increased risk of disease relapse during pregnancy.Long-acting injectable(LAI)antipsychotics have been widely used to improve adherence and prevent relapse in patients with various severe psychotic disorders,but there is a lack of high-quality data from previous research on the safety of LAI antipsychotics during pregnancy.AIM To summarize relevant data on maternal,pregnancy,neonatal,and developmental outcomes from published cases of LAI antipsychotic use in pregnancy.METHODS A literature search was performed through November 11,2023,using three online databases:PubMed/MEDLINE,Scopus,and Web of Science.Case reports or case series that reported information about the outcomes of pregnancy in women who used LAI antipsychotics at any point in pregnancy,with available full texts,were included.Descriptive statistics,narrative summation,and tabulation of the extracted data were performed.RESULTS A total of 19 publications satisfied the inclusion criteria:3 case series,15 case reports,and 1 conference abstract.They reported the outcomes of LAI antipsychotic use in 74 women and 77 pregnancies.The use of secondgeneration LAI antipsychotics was reported in the majority(n=47;61.0%)of pregnancies.First-generation LAI antipsychotics were administered during 30 pregnancies(39.0%).Most of the women(approximately 64%)had either satisfactory control of symptoms or no information about relapse,while approximately 12%of them had developed gestational diabetes mellitus.A minority of cases reported adverse outcomes such as stillbirth,spontaneous abortion,preterm birth,low birth weight,congenital anomalies,and neurological manifestations in newborns.However,there were no reports of negative long-term developmental outcomes.CONCLUSION Currently available data seem reassuring,but further well-designed studies are required to properly evaluate the risks and benefits of LAI antipsychotic use during pregnancy.

Comparative effects of insulin pump and injection on gestational diabetes mellitus pregnancy outcomes and serum biomarkers

BACKGROUND Insulin injection is the basic daily drug treatment for diabetic patients.AIM To evaluate the comparative impacts of continuous subcutaneous insulin infusion(CSII).METHODS Based on the treatment modality received,the patients were allocated into two cohorts:The CSII group and the multiple daily injections(MDI)group,with each cohort comprising 210 patients.Comparative assessments were made regarding serum levels of serum-secreted frizzled-related protein 5,homocysteine,and C1q/TNF-related protein 9.Furthermore,outcomes such as fasting plasma glucose,2-hour postprandial glucose levels,pain assessment scores,and the incidence of complications were evaluated post-treatment.RESULTS The CSII group displayed notably lower fasting plasma glucose and 2-h postprandial glucose levels in comparison to the MDI group(P<0.05).Subsequent analysis post-treatment unveiled a significantly higher percentage of patients reporting no pain in the CSII group(60.00%)in contrast to the MDI group(36.19%)(P<0.05).Additionally,the CSII group exhibited a markedly reduced occurrence of fetal distress and premature rupture of membranes compared to the MDI group(P<0.05).However,there were no significant variances observed in other pregnancy outcomes between the two groups(P>0.05).A statistical analysis revealed a significant difference in the incidence of complications between the groups(χ^(2)=11.631,P=0.001).CONCLUSION The utilization of CSII via an insulin pump,as opposed to MDI,can significantly enhance the management of insulin administration in patients with GDM by diversifying the sites of insulin delivery.This approach not only promotes optimal glycemic control but also regulates metabolic factors linked to blood sugar,reducing the likelihood of adverse pregnancy outcomes and complications.The clinical relevance and importance of CSII in GDM management highlight its wide-ranging clinical usefulness.

Abnormal Umbilical Doppler: Incidence and Neonatal Outcomes among Hypertensive Disorders in Pregnancy at KCMC: A Hospital-Based Prospective Cohort Study

Hypertensive disorders of pregnancy (HDP) are the most common maternal and perinatal health challenges. Globally, the incidence of HDP increased from 16.30 million to 18.08 million, with a total increase of about 10.9% from 1990 to 2019. Umbilical Doppler study in hypertensive disorders of pregnancy helps to predict neonatal outcomes and prevent neonatal and maternal morbidity and mortality. Objective: This study aims to determine the incidence of abnormal umbilical Doppler among hypertensive pregnant women, to identify the adverse neonatal outcomes associated with abnormal umbilical Doppler, and also to detect the diagnostic predictive values of umbilical Doppler to neonatal outcomes at KCMC. Material and methods: A hospital-based prospective cohort study included women with hypertensive disorders of pregnancy from the gestational age of 28 weeks and above, followed up to delivery during the study period from August 2022 to March 2023. Multivariate logistic regression analysis was used to determine the association between AUD and neonatal outcomes. Results: Out of 112 women with HDP, the incidence of abnormal umbilical Doppler was 38 (33.93%). Abnormal umbilical Doppler was associated with neonates with low birth weight aOR (95% of CI) of 4.52 (1.59 - 12.83) p = 0.005 and neonatal ICU admission 9.71 (2.90 - 32.43) p Conclusion: The incidence of abnormal umbilical Doppler is high in hypertensive disorders of pregnancy which is associated with an increase in neonatal low birth weight and neonatal ICU admissions, the sensitivity of abnormal umbilical Doppler in prediction of low birth weight and neonatal ICU admission is significant hence the routine use of umbilical Doppler assessment among hypertensive pregnant women is crucial.

Pregnancy and Obstetrical Outcomes Following Treatment for Cervical Intra-Epithelial Neoplasia (CIN) in Two Hospitals of a Low-Resource Country

Objective: In Cameroon, more than 80% of women suffering from cervical intraepithelial neoplasia (CIN) are within the reproductive age. This study intended to analyze the pregnancy outcomes following cervical treatment in Cameroon. Methods: This was a cohort study with two years retrospective data collection involving 82 women who underwent cervical treatment for CIN in two Cameroonian hospitals from January 2015 to December 2017. Data were collected from CIN treatment to end of pregnancy where applicable. Data analysis was done using Epi Info software version 3.5.4. Results: We collected data from 82 patients aged 27 to 48 years, with a mean age of 36.5 (SD: 5.3) years. During the study period, 33 out of 82 participants became pregnant 40.2 [29.56 - 51.66]%. The factor associated with pregnancy occurrence after treatment was age less than 35 years (Odds ratio = 4.37 [1.7 - 11.2]. From the 33 pregnancies recorded, 17 (51.5%) ended in a delivery, amongst which 15 (88.2%) were vaginal. Conclusion: Pregnancy frequency over two years following cervical treatment for CIN was relatively good, and younger women (age 35 years) were significantly more like to have conceived compared to their older counterparts. Post-treatment delivery outcomes seem to be similar to those in the general population.

Adverse Pregnancy Outcomes Following Cryotherapy, Thermal Ablation and Loop Electrosurgical Excision Procedure for Cervical Intraepithelial Neoplasia Treatment: A Pilot Study among Zambian Women

Background: Cervical Intraepithelial neoplasia treatments have become essential interventions to manage cervical lesions. Majority of the recipients of these treatments are women within the reproductive age group, who according to literature may be at risk of adverse pregnancy outcomes. This pilot study is part of a study investigating adverse pregnancy outcomes among women who received Cryotherapy, Thermal ablation and Loop Electrosurgical Excision Procedure compared to the untreated women in Zambia. Materials and Methods: This descriptive study analyzed records of 886 (n = 443 treated and n = 443 untreated) women aged 15 - 49 years. The women were either screened with Visual Inspection with Acetic Acid or treated for Cervical Intraepithelial neoplasia at the Adult Infectious Disease Centre between January 2010 and December 2020. Women meeting the criteria were identified using the Visual Inspection with Acetic Acid screening records and telephone interviews to obtain the adverse pregnancy outcome experienced. Data were analysed using STATA version 16 to determine the prevalence and obtain frequency distribution of outcomes of interest. Univariate and multivariable binary logistic regression estimated odds of adverse pregnancy outcomes across the three treatments. Results: The respondents were aged 15 to 49 years. Adverse pregnancy outcomes were observed to be more prevalent in the treatment group (18.5%) compared to the untreated group (5.4%). Normal pregnancy outcomes were lower in the treated (46.3%;n = 443) than the untreated (53.7%;n = 443). The treated group accounted for the majority of abortions (85.2%), prolonged labour (85.7%) and low birth weight (80%), whereas, the untreated accounted for the majority of still births (72.7%). Women treated with cryotherapy (aOR = 2.43, 95% CI = 1.32 - 4.49, p = 0.004), thermal ablation (aOR = 6.37, 95% CI = 0.99 - 41.2, p = 0.052) and Loop Electrosurgical Excision Procedure (aOR = 9.67, 95% CI = 2.17 - 43.1, p = 0.003) had two-, six- and ten-times higher odds of adverse pregnancy outcomes respectively, relative to women who required no treatment. Conclusion: Adverse pregnancy outcomes are prevalent among women who have received treatment in Zambia. The findings indicate that treating Cervical Intraepithelial Neoplasia has been linked to higher chances of experiencing abortion, delivering low birth weight babies and enduring prolonged labor that may result in a caesarean section delivery. Cervical neoplasia treatments, particularly Loop Electrosurgical Excision Procedure, are associated with significantly increased odds of adverse pregnancy outcomes. It is essential to include information about prior Cervical Intraepithelial neoplasia treatment outcomes in obstetric care.

COVID-19 in pregnancy:Perinatal outcomes and complications

BACKGROUND The risk of severe coronavirus disease 2019(COVID-19)in pregnant women is elevated.AIM To examine the outcomes of pregnant women with COVID-19 and report perinatal outcomes and complications,while providing a brief review of current literature.METHODS The study included pregnant women presenting from April 2020 to February 2022 to the emergency department(ED)of a tertiary hospital.We retrospectively recorded the maternal and perinatal files,including patient epidemiological and clinical characteristics,laboratory values,outcomes,treatment modalities and associations were explored.RESULTS Among the 60 pregnant women,25%required hospitalization,all of whom were symptomatic.Preterm delivery occurred in 30%of cases.Ten percent of neonates required admission to the neonatal intensive care unit,and 5%were classified as small for their gestational age.All mothers survived COVID-19 and pregnancy,with 6.6%requiring invasive mechanical ventilation.Preterm delivery rates did not differ between hospitalized and non-hospitalized pregnant women;composite unfavorable perinatal outcomes,including stillbirth,small for gestational age,or neonatal intensive care unit(ICU)admission,did not significantly increase in the cases hospitalized for COVID-19(P=0.09).The odds of hospitalization increased 2.3-fold for each day of delayed ED presentation[adj.OR(95%CI:1.46-3.624),P<0.001].Comorbidity status was an independent predictor of hospitalization,albeit with marginal significance[adj.OR=16.13(95%CI:1.021-255.146),P=0.048].No independent predictors of adverse fetal outcome(composite)were identified,and eventual hospitalization failed to reach statistical significance by a slight margin(P=0.054).CONCLUSION Delayed ED presentation and comorbidities increase hospitalization odds.This study highlights the importance of continuous and specific guidance for managing pregnant COVID-19 patients,including timely and appropriate interventions to minimize maternal and perinatal morbidity and mortality.

Analysis of Cardiac Functional Status and Factors Influencing Adverse Pregnancy Outcomes in Pregnant Women with Combined Heart Disease

Objective:To investigate the cardiac function of pregnant women with complicated heart disease during pregnancy and the factors influencing the adverse pregnancy outcome.Methods:A total of 162 cases of pregnant women with complicated heart disease admitted to the Beijing Anzhen Hospital from October 2021 to December 2023 were selected to compare the occurrence of adverse pregnancy outcomes in pregnant women with complicated heart disease at different levels of cardiac function and to analyze the single and multi factors leading to adverse pregnancy outcomes in pregnant women with complicated heart disease.Results:Among 162 pregnant women with combined heart disease in pregnancy,the highest percentage of heart disease type was congenital heart disease(80/49.38%),and the lowest percentage was other(9/5.56%);the overall incidence of adverse pregnancy outcomes in pregnant women with combined heart disease in pregnancy with cardiac function grades of 3–4 cardiac function(30/68.18%)was higher than that in pregnant women with combined heart disease in cardiac function grades of 1–2(40/33.90%)(P=0.000);age,marital status,hypertension,and past history of all pregnant women were not statistically significant(P>0.05);gestational age,type of heart disease,and cardiac function grading were statistically significant(P<0.05),and these factors were all independent risk factors for adverse pregnancy resolution in pregnant women with combined heart disease(P<0.05).Conclusion:The overall incidence of adverse pregnancy outcomes was higher in pregnant women with heart disease than in those with heart disease grades 1–2,and the number of pregnancies,the type of heart disease,and heart function grades were all independent risk factors for adverse pregnancy outcomes in pregnant women with heart disease.

A Study on the Correlation of Body Mass Management During Pregnancy with Adverse Pregnancy Outcomes and Labor Progression

Objective:To investigate the effects of body mass management during pregnancy on adverse pregnancy outcomes,duration of labor,and neonatal birth weight.Methods:472 pregnant women who visited Beijing Anzhen Hospital from January to December 2023 were selected,and the pregnant women were divided into 236 each in the observation group and the control group.Body mass of pregnant women was measured and BMI was calculated in early and late pregnancy respectively,and the pregnant women in the control group were guided by routine management,while the observation group was guided by body mass management during pregnancy.The growth of maternal body mass,mode of delivery,postpartum hemorrhage,neonatal score,neonatal blood glucose at birth,and umbilical artery blood,as well as the comparison of the duration of labor,were observed.Results:The observation group was significantly better than the control group in terms of mode of delivery,postpartum hemorrhage,and body mass growth,with statistically significant differences(P<0.05),and there was no statistical significance in terms of neonatal scores,neonatal blood glucose at birth,and umbilical artery blood(P>0.05);the time of the first stage of labor and the time of the second stage of labor of the mothers in the observation group was significantly better than that of the control group,with statistical differences(P<0.05),and the time of the third stage of labor of the mothers in the observation group was statistically better than that of the control group.There was no statistically significant difference between the time of the third stage of labor in the observation group and the control group(P>0.05),and the time of the total stage of labor in the observation group was statistically better than that in the control group(P<0.05).Conclusion:Body mass management during pregnancy can effectively improve maternal control of weight gain,reduce labor time,and decrease the occurrence of adverse pregnancy outcomes.

Analysis of the Effects of Maternal Body Mass Index and Gestational Weight Gain on Maternal and Neonatal Outcomes in Twin Pregnancy

Objective:To investigate the effects of maternal body mass index(BMI)and gestational weight gain on maternal and neonatal outcomes in twin pregnancies.Methods:Five hundred cases of twin pregnancies were divided into a low body weight group(68 cases),a normal weight group(355 cases),an overweight group(65 cases),and an obesity group(12 cases)according to the World Health Organization(WHO)Body Mass Index(BMI)classification guidelines Results:Comparison of weight gain during different pregnancies revealed that pregnant women were mainly of low weight and average weight.The higher the BMI before pregnancy,the higher the incidence of excessive weight gain during pregnancy.The incidences of gestational diabetes mellitus(GDM)and premature rupture of membranes in women with low weight gain were significantly higher than those in women with average weight gain and high weight gain(P<0.05).The incidences of gestational hypertension,preeclampsia,and anemia in women with high weight gain were significantly higher than those in women with low weight gain and average weight gain(P<0.05).The incidence of neonatal birth weight,fetal distress,and macrosomia in the high weight gain group was significantly higher than those in the low weight gain and average weight gain groups(P<0.05).The birth weight of newborns in low-weight gain mothers was significantly lower than that of normal-weight gain mothers(P<0.05).Conclusion:Poor maternal and infant outcomes were common in women with insufficient or excessive weight gain during pregnancy.Therefore,for women with twin pregnancies,weight management is crucial to ensure maternal and infant health.

Clinical Presentation and Treatment Outcomes of Pregnancy-Related Acute Kidney Injury among Pregnant Women Admitted at the Benjamin Mkapa Hospital in Tanzania

Background: Globally, PRAKI is among the leading causes of death in pregnant women. The prevalence, causes and outcome of this condition vary among countries due to differences in environmental, socioeconomic, and health delivery systems. The common causes that have been reported in several studies are PIH, Haemorrhages and Sepsis while the outcomes may be either complete renal recovery, progression to CKD and hence dialysis dependency or death. This study aimed at determining clinical presentation and treatment outcomes of Pregnancy-Related Acute Kidney Injury in Pregnant women admitted at the Benjamin Mkapa Hospital, Dodoma, Tanzania. Results: Out of 4007 pregnant women who were admitted to the maternity ward 51 pregnant women were found to have PRAKI. Of those with PRAKI, 74.5% were between 21 to 25 years. The leading causes of PRAKI were PPH 12 (23.53%), Eclampsia 12 (23.53%), and pre-eclampsia 12 (23.5%). Hemodialysis therapy was provided to 22 (43.1%) patients, 15 (29.4%) individuals recovered spontaneously with medical management and 14 (27.5%) missed haemodialysis therapy due to various reasons. The mortality due to PRAKI was 17 (33.3%). Conclusion and Recommendation: Pre-eclampsia/eclampsia and post-partum haemorrhage were found to be the main causes of PRAKI. The mortality related to PRAKI is high and Hemodialysis therapy is vital help to prevent deaths for pregnant women with PRAKI. Pregnant women who develop acute kidney injury should be followed closely and a nephrologist should be consulted early. Early referral should be done by the lower level facilities for all at-risk pregnant women to a specialized multidisciplinary health facility.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment:A prospective study

Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus.It is the most common gynecological disorder,affecting up to 80%of women of reproductive age.Uterine fibroids can cause various symptoms such as abnormal uterine bleeding,pelvic pain,infertility,and pregnancy complications.The treatment options for uterine fibroids include medical therapy,surgical intervention,and minimally invasive techniques.AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization(UAE).METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE,and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments.The two groups were matched for age,body mass index,parity,and baseline characteristics of uterine fibroids.The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),and anti-Müllerian hormone(AMH),as well as ovarian reserve tests,such as antral follicle count(AFC)and ovarian volume(OV).The secondary outcome was fertility that was evaluated based on the menstrual cycle,ovulation,conception,pregnancy,and delivery.The participants were followed-up for 36 months and assessed at 1,3,6,12,24,and 36 months after treatment.RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women,resolving within a week.No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones(FSH,LH,E2,AMH)and ovarian reserve indicators(AFC,OV)at any point up to 36 months post-treatment.Additionally,there were no significant differences in conception,pregnancy,or delivery rates,with the average time to conception and gestational age at delivery being similar between the two groups.Birth weights were also comparable.Finally,there was no significant correlation between ovarian function,fertility indicators,and the type or amount of embolic agent used or the change in fibroids posttreatment.CONCLUSION UAE resulted in significantly positive pregnancy outcomes,no adverse events post-treatment,and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

The Obstetric and Perinatal Outcomes of Adolescent Pregnancies in a Developed Cosmopolitan Middle Eastern Country: A Retrospective Pearl-Peristat Registry

Background: Early marriage is prevalent in Middle Eastern culture. The objective of this study was to investigate the pregnancy outcomes of married pregnant adolescents in a prosperous and highly developed Middle Eastern society, when they receive sufficient prenatal care and social assistance. Methods: A retrospective analysis was performed on the Peristat-based Maternal-Newborn registry utilizing hospital data acquired from four main governmental hospitals in Qatar. The study analyzed the pregnancy outcomes of young adults [ages 20 - 24) who experienced their first pregnancy and compared them to the pregnancy outcomes of adolescents aged 15 to 19 years old. Results: The study comprised a cohort of 3152 pregnant married women. This cohort included 2674 women between the ages of 20 and 24, as well as 478 adolescents aged 15 to 19 years old. In comparison to the young adult group, the non-Qatari population in the adolescent group was significantly higher (78.6% (376/478) vs. 71.5% (1914/2674), p-value = 0.003). Other Arab nationalities accounted for more than half of the adolescent population. All the mothers were married, did not use alcohol, and were nonsmokers. There were no documented mothers under the age of 15. Attending antenatal clinics was significantly higher in the adolescent group (p < 0.001). There was no significant difference in the mean gestational age at birth between adolescents and young adults (38.5 ± 2.3 weeks vs. 38.7 ± 2.1 weeks, p = 0.06). Furthermore, adolescent mothers had a higher rate of low birth weight (13.6% vs. 10.4%, p < 0.001) than young mothers. There was a non-statistically significant rise in pre-eclampsia incidence. Other unfavorable pregnancy outcomes were less common among them, such as diabetes, operative vaginal delivery, caesarean section, stillbirth, NICU hospitalization, and an Apgar score of less than 7 at five minutes. There were no maternal deaths;however, there was a comparable rate of neonatal in-hospital mortality. Conclusion: Pregnancy during adolescence may not relate to significant problems in a well-tolerant culture that ensures dedicated antenatal and social support.

Normal pregnancy outcome after first-trimester exposure to semaglutide in an overweight woman: a case report

We reported a case of an overweight 34-year-old woman who unexpectedly became pregnant while undergoing semaglutide in early pregnancy and delivered a healthy male infant by caesarean section at 37 weeks and 4 days of gestation.Until now,the safety of semaglutide for use during pregnancy was unknown.This report may contribute to the limited knowledge available on pregnant women exposure to semaglutide.

Effect of Internet+continuous midwifery service model on psychological mood and pregnancy outcomes for women with highrisk pregnancies

BACKGROUND There are many drawbacks to the traditional midwifery service management model,which can no longer meet the needs of the new era.The Internet+continuous midwifery service management model extends maternal management from prenatal to postpartum,in-hospital to out-of-hospital,and offline to online,thereby improving maternal and infant outcomes.Applying the Internet+continuous midwifery service management model to manage women with highrisk pregnancies(HRP)can improve their psycho-emotional opinion and,in turn,minimize the risk of adverse maternal and/or fetal outcomes.AIM To explore the effectiveness of a midwife-led Internet+continuous midwifery service model for women with HRP.METHODS We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital(affiliated to the Shanghai Jiao Tong University School of Medicine)from April to December 2022.Among them,239 pregnant women underwent routine obstetric management,and 200 pregnant women underwent Internet+continuous midwifery service mode management.We used the State-Trait Anxiety Inventory,Edinburgh Postnatal Depression Scale,and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups.RESULTS The data showed that in early pregnancy,the anxiety and depression levels of the two groups were similar;the levels gradually decreased as pregnancy progressed,and the decrease in the continuous group was more significant[31.00(29.00,34.00)vs 34.00(32.00,37.00),8.00(6.00,9.00)vs 12.00(10.00,13.00),P<0.05].The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group,and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group[267.50(242.25,284.75)vs 256.00(233.00,278.00),74.00(69.00,78.00)vs 71.00(63.00,78.00),P<0.05].The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group,and nursing satisfaction was higher[10.50%vs 18.83%,8.50%vs 15.90%,24.00%vs 42.68%,89.50%vs 76.15%,P<0.05].CONCLUSION The Internet+continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.

Prevalence and Adverse Pregnancy Outcomes Associated with Maternal Obesity in the Bamenda Regional Hospital

Introduction: Obesity is one of the most common problems of reproductive age women and has been associated with diverse adverse pregnancy outcomes. Its prevalence in pregnancy is estimated at 14% in Cameroon. Objective: The main objective of this study was to determine the adverse pregnancy outcomes associated with obesity in the Regional Hospital Bamenda. Methodology: This was a hospital-based cross-sectional study. We recruited 283 participants and their BMIs were used to classify them as underweight ( - 24.9), overweight (25 - 29.9) and obese (≥30). Ethical clearance, administrative authorisation and consent of participants were obtained. Data was collected using a pretested questionnaire. We collected data on sociodemographic characteristics, anthropometric characteristics, and adverse pregnancy outcomes. Data was analysed using Microsoft Excel version 2010. Fisher’s test was used to determine relative risk on bivariate logistic regression. P-values < 0.05 were considered statistically significant. Results: Most participants were in the age group 20 - 34 years, and were multigravida and multipara. The prevalence of maternal obesity was 31.4%. Obesity was associated with an increased risk of hypertensive disorders [RR: 7.7, 95% CI (2.13 - 42.39), p = 0.0003], caesarean section [RR: 2.9, 95% CI (1.11 - 4.01), p = 0.017] and macrosomia [RR: 7.3, 95% CI (3.03 - 19.61), p Conclusion: Maternal obesity is associated with hypertensive disorders, caesarean section and macrosomia.

Effect of Third Interstitial Fluid on Adverse Outcomes in Patients with Severe Pre-eclampsia and Twin Pregnancy:A 5-year Single-center Retrospective Study

Objective This study aims to identify the effect of third interstitial fluid on adverse outcomes in twin pregnancies with severe pre-eclampsia,and explore the differences in bad ending between twins and singletons.Methods The present retrospective cohort study was conducted on patients with severe pre-eclampsia,who delivered in Tongji Hospital,Wuhan,China,between 2017 and 2022.The adverse outcomes in singleton and twin pregnancies with severe pre-eclampsia were initially investigated.Then,the diverse maternal and fetal consequences between singleton and twin pregnancies in patients with severe pre-eclampsia were compared after merging with the third interstitial fluid.Results A total of 709 patients were included for the present study.Among these patients,68 patients had twin pregnancies,and 641 patients had singleton pregnancies.The rate of postpartum hemorrhage(2.81%vs.13.24%,P<0.001),and admission rate to the Neonatal Intensive Care Unit(NICU)after birth(30.73%vs.63.24%,P=0.011)were significantly higher in twin pregnancies.The neonatal weight of twins was statistically lower than singletons(1964.73±510.61 g vs.2142.92±731.25 g,P=0.008).For the groups with the third interstitial fluid,the delivery week(P=0.001)and rate of admission to the NICU after birth were significantly advanced in twin pregnancy group,when compared to singleton pregnancy group(P=0.032),and the length of hospital stay was shorter(P=0.044).Furthermore,there was no statistically significant difference between the twin pregnancy group and the singletony pregnancy group without the third interstitial fluid.Conclusion The maternal and fetal adverse outcomes of patients with severe pre-eclampsia increased in twin pregnancies,when compared to singleton pregnancies.Thus,when patients develop the third interstitial fluid,twin pregnancies would more likely lead to adverse fetal outcomes,when compared to singleton pregnancies,and there would be no significant difference in maternal adverse outcomes.More attention should be given to patients who merge with the third interstitial fluid.

Effect of polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine on pregnancy outcomes in intrahepatic cholestasis

BACKGROUND Intrahepatic cholestasis of pregnancy(ICP)is a liver disorder that occurs in pregnant women and can lead to a range of adverse pregnancy outcomes.The condition is typically marked by pruritus(itching)and elevated levels of liver enzymes and bile acids.The standard treatment for ICP has generally been ursodeoxycholic acid and ademetionine 1,4-butanedisulfonate,but the efficacy of this approach remains less than optimal.Recently,polyene phosphatidylcholine has emerged as a promising new therapeutic agent for ICP due to its potential hepatoprotective effects.AIM To evaluate the effect of polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine 1,4-butanedisulfonate on bile acid levels,liver enzyme indices,and pregnancy outcomes in patients with ICP.METHODS From June 2020 to June 2021,600 patients with ICP who were diagnosed and treated at our hospital were recruited and assigned at a ratio of 1:1 via randomnumber table method to receive either ursodeoxycholic acid/ademetionine 1,4-butanedisulfonate(control group,n=300)or polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine 1,4-butanedisulfonate(combined group,n=300).Outcome measures included bile acids levels,liver enzyme indices,and pregnancy outcomes.RESULTS Prior to treatment,no significant differences were observed between the two groups(P>0.05).Post-treatment,patients in both groups had significantly lower pruritus scores,but the triple-drug combination group had lower scores than the dual-drug combination group(P<0.05).The bile acid levels decreased significantly in both groups,but the decrease was more significant in the triple-drug group(P<0.05).The triple-drug group also exhibited a greater reduction in the levels of certain liver enzymes and a lower incidence of adverse pregnancy outcomes compared to the dual-drug group(P<0.05).CONCLUSION Polyene phosphatidylcholine/ursodeoxycholic acid/ademetionine 1,4-butanedisulfonate effectively relieves pruritus and reduces bile acid levels and liver enzyme indices in patients with ICP,providing a positive impact on pregnancy outcome and a high safety profile.Further clinical trials are required prior to clinical application.

Outcomes of Pregnancy with Group B Streptococcal Infections in Najran, Saudi Arabia

Background: The gram-positive, beta-hemolytic, and chain-forming Group B Streptococcus (GBS), commonly known as Streptococcus agalactiae, may asymptomatically invade the human gastrointestinal and vaginal tracts. However, GBS may become very invasive and pathogenic to the mother and baby during pregnancy, having negative effects. Study Aim: This study aims to investigate the pregnancy outcomes of women who tested positive for genitourinary GBS infection during pregnancy in Najran, Saudi Arabia. Methods: Data was collected retrospectively from patient files in Armed Forces Hospital, Najran, Saudi Arabia. Data collected were entered to a Microsoft Excel sheet, then imported and analysed using the Statistical Package for Social Sciences. Results: The study included 272 women of whom 66.5% were 31 to 45 years old. Gestational diabetes was diagnosed in 8.5% of the sample, 71.7% had a normal spontaneous vaginal delivery (NSVD), 1.8% had previous abortions, and 27.2% of new-borns were admitted to the NICU after delivery. There was a significant association between NICU admissions and women employment status (p = 0.001), gravidity (p = 0.001), parity (p = 0.001), history of abortions (p = 0.001), medical conditions (p = 0.049), and mode of delivery (p = 0.049). Conclusion: According to the findings of our study, GBS infection during pregnancy is associated to more NICU admissions. NICU admissions were significantly correlated with gestational diabetes, hypertension, and hypothyroidism in mothers but not with intrapartum antibiotic use.