8,445 research outputs found

    Is Screening of TORCH Worthwhile in Women with Bad Obstetric History: An Observation from Eastern Nepal

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    This pilot case-control study at a tertiary-care hospital over a four-month period was aimed at evaluating the possible usefulness of screening of TORCH (Toxoplasma gondii, rubella virus, cytomegalovirus, and Herpes simplex virus) in females with bad obstetric history. The study included 12 women with bad obstetric history and a similar number of matched controls with previous normal pregnancies. A serological evaluation of TORCH infections was carried out by detecting IgG and IgM antibodies against these infections by ELISA test-kit. Statistical analysis was not done to compare the results relating to the two groups due to a small number of cases and controls included in the study. Ten (83.3%) of the 12 cases with bad obstetric history and two (16.7%) of the 12 healthy controls were serologically positive at least for one of the TORCH agents. The seropositivity rate in women with bad obstetric history was quite high compared to that in the normal healthy controls. The results suggest that a previous history of pregnancy wastage and the serological evaluation of TORCH infections during current pregnancy must be considered while managing cases with bad obstetric history

    Incidence and pattern of infections in pregnant women with bad obstetric history

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    Background: Adverse outcomes have been seen in pregnant women who had prior bad obstetric history along with infection with TORCH [toxoplasma, other infections (syphilis, varicella zoster, hepatitis B), rubella, cytomegalovirus, herpes simplex]complex and bacterial vaginosis. These infections are known to affect the health of the fetus. Objective was to study incidence and pattern of infections in pregnant women with bad obstetric history.Methods: A total of 190 patients with bad obstetric history fulfilling the methodology criteria were evaluated. Serological and molecular evaluations were carried out for TORCH complex and bacterial vaginosis was detected by both gram stain and gold standard clinical Amsel criteria and outcomes were followed.Results: Out of 190 pregnant women with bad obstetric history, a total of 36 (18.8%) were detected to have infections causing bad obstetric history. Toxoplasma was positive in 7 (20%) of the cases, 3 (51.92%) of them had abortions. Rubella in 12 (32%) of the cases, 7 (60%) cases had sensorineural deafness. Cytomegalovirus in 1 (2%) of the cases, 1 (100%) of the case had microcephaly. Herpes in 8 (22%) cases, 6 (71.1%) cases had abortions. Bacterial vaginosis in 8 (22%) of the cases, 4 (48.6%) cases had preterm delivery. The presence of infections with TORCH complex and bacterial vaginosis was related to adverse pregnancy outcomes.Conclusions: Women with bad obstetric history are prone to infections during pregnancy and have been found out to be associated with adverse pregnancy outcomes. Hence pregnant women should be screened so that early diagnosis and treatment of infections can be done to have better pregnancy outcomes

    Primary hyperparathyroidism in pregnancy : case report and review

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    A twenty-six year old secundagravida booked her pregnancy at 14 weeks gestation. It was noted in the past obstetric history that the woman had lost her first child at 41 weeks gestation, delivering a stillborn baby weighing 4.2kg. At 34 weeks into the second pregnancy mild polyhydramnios was noted and the patient was admitted. During her hospitalisation the patient complained of having passed a small renal stone. Two serum calcium levels were found to be significantly elevated 3.36mmol/l and 3.2mmol/l. Serum parathormone was found to be significantly elevated - 247pg/ml (Normal levels: 12.0 - 72.0pg/ml) and an ultrasound scan of the neck confirmed the presence of a parathyroid adenoma. A parathyroidectomy was performed and the postoperative period was uneventful. The rest of the pregnancy was uneventful and at 38 weeks gestation a healthy child was delivered vaginally. In view of this woman’s past history and the events occurring during the second pregnancy it may be useful to consider obtaining serum levels of calcium in cases of idiopathic stillbirth.peer-reviewe

    To study the association of antiphospholipid syndrome in patients with bad obstetric history

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    Background: Antiphospholipid syndrome is an autoimmune condition characterized by vascular thrombosis and /or pregnancy morbidity in the presence of antiphospholipid antibodies. A failure or significant delay in recognizing APS as the underlying disease entity may leave to the loss of an opportunity to prevent serious consequences of the disease and the associated pregnancy complications. Aim of the study was to study the association of Antiphospholipid Syndrome (APS) in patients with bad obstetric history (BOH).Methods: Patients registered in Obstetrics and Gynecology Department SAT Hospital, Medical College, Trivandrum, Kerala with bad obstetric history (BOH) meeting the inclusion and exclusion criteria were recruited for the study. They were followed up in the postnatal ward after abortion and preterm delivery as per protocol for bad obstetrics outcome evaluation. They were offered lab test in standard labs for APL Syndrome especially LAC and anti-cardiolipin antibodies IgM and IgG. Those tested positive were retested 12 weeks later also to confirm the test. Then the various adverse pregnancy outcomes were studied in both APLA positive and negative groups.Results: The association of APLA with bad obstetric history (BOH) in the present study are as follows- Late miscarriages-16%, miscarriages less than 10 weeks-12%, Preterm- 10.8%, unexplained death-14%, Severe Pre-eclampsia-12.3%, IUGR-11.8%, Abruption-11.1% of which late miscarriages more than10 weeks was the commonest association.Conclusions: The study shows that women with bad obstetric history (BOH) and those cases where miscarriage occurred after the appearance of foetal cardiac activity should be investigated for APLA in the preconceptional period itself in the next pregnancy earlier and if positive should be given prophylaxis for the same to prevent a miscarriage in future pregnancy

    Chronic hypertension and adverse pregnancy outcome: a cohort study

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    Objective: To examine the association between chronic hypertension (CH) and a wide range of adverse pregnancy outcomes after adjustment for confounding factors in obstetric history and maternal characteristics. Methods: This was a prospective screening study for adverse pregnancy outcomes in women with singleton pregnancies attending the first routine hospital visit at 11+0-13+6 weeks’ gestation. Data on maternal characteristics, medical and obstetric history and pregnancy outcomes were collected. Regression analysis was performed to examine the association between CH and adverse pregnancy outcomes including late miscarriage, stillbirth, pre-eclampsia (PE), gestational diabetes mellitus (GDM), spontaneous and iatrogenic preterm birth (PTB), small for gestational age (SGA) neonate, large for gestational age (LGA) neonate and elective and emergency cesarean section (CS). Results: The study population of 109,932 pregnancies included 1,417 (1.3%) with CH. After adjusting for potential confounding variables from maternal characteristics, medical and obstetric history, CH was associated with increased risk of stillbirth OR 2.38, 95% CI 1.51-3.75), PE (OR 5.76, 95% CI 4.93-6.73), SGA (OR 2.06, 95% CI 1.79-2.39), GDM (OR 1.61, 95% CI 1.27-2.05), iatrogenic PTB <37 weeks (OR 3.73, 95% CI (3.07-4.53) and elective CS (OR 1.79, 95%CI 1.52-2.11), decreased risk of LGA (OR 0.65, 0.51-0.83), and had no significant effect on late miscarriage, spontaneous PTB or emergency CS. Conclusion: CH should be combined with other maternal characteristics and medical and obstetric history when calculating an individualised adjusted risk for adverse pregnancy complications. CH increases the risk for stillbirth, PE, SGA, GDM, iatrogenic PTB and elective CS and reduces the risk for LGA

    Skilled Care at Birth among Rural Women in Nepal: Practice and Challenges

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    In Nepal, most births take place at home, and many, particularly in rural areas, are not attended by a skilled birth attendant. The main objectives of the study were to assess the use of skilled delivery care and barriers to access such care in a rural community and to assess health problems during delivery and seeking care. This cross-sectional study was carried out in two Village Development Committees in Nepal in 2006. In total, 150 women who had a live birth in the 24 months preceding the survey were interviewed using a structured questionnaire. The sample population included married women aged 15-49 years. Forty-six (31%) women delivered their babies at hospital, and 104 (69%) delivered at home. The cost of delivery at hospital was significantly (p<0.001) higher than that of a delivery at home. Results of univariate analysis showed that women from Brahmin-Chhetri ethnicity, women with higher education or who were more skilled, whose husbands had higher education and more skilled jobs, had first or second childbirth, and having adverse previous obstetric history were associated with institutional delivery while women with higher education and having an adverse history of pregnancy outcome predicted the uptake of skilled delivery care in Nepal. The main perceived problems to access skilled delivery care were: distance to hospital, lack of transportation, lack of awareness on delivery care, and cost. The main reasons for seeking intrapartum care were long labour, retained placenta, and excessive bleeding. Only a quarter of women sought care immediately after problems occurred. The main reasons seeking care late were: the woman or her family not perceiving that there was a serious problem, distance to health facility, and lack of transport. The use of skilled birth attendants at delivery among rural women in Nepal is very poor. Home delivery by unskilled birth attendants is still a common practice among them. Many associated factors relating to the use of skilled delivery care that were identified included age, education and occupation of women, and education and occupation of husbands. Therefore, the availability of skilled delivery care services at the community, initiation of a primary health centre with skilled staff for delivery, and increasing awareness among women to seek skilled delivery care are the best solution

    Oral plus vaginal alpha-lipoic acid in women at risk for preterm delivery

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    Objective: The etiology of preterm labor is multifactorial. An inflammatory response is always involved with the activation of NF-kB that determines synthesis and release of inflammatory molecules, implicated in fetal membrane activation, cervical modifications, abdominal pain and spontaneous uterine contractions. There is a close relationship between preterm birth and cervical shortening in the second quarter of pregnancy. We evaluated the benefits of alpha-lipoic acid administration on women considered at risk of preterm delivery due to the presence of symptoms (pelvic pain and uterine contractions) or reduced cervical length. Patients and Methods: This prospective observational study was carried out at the Gynecology and Obstetrics Unit of Palermo University Hospital (Palermo, Italy), from October 2015 to April 2016. The inclusion criteria were: women aged 18-35, with gestational age between 24 and 33 weeks of amenorrhea, pregnancy at risk of preterm delivery due to cervical length between 35-25 mm (in presence of symptoms) or &lt; 30 and &gt; 15 mm (if asymptomatic), intact membranes and negative for vaginosis. Patients were treated daily with alpha lipoic acid orally (300 mg, twice a day for 30 days) and vaginally (10 mg, once a day for 10 days), or untreated (controls). Patients were evaluated at the baseline (T 0), after 7 days, after 30 days, and at 34 weeks of gestation considering: maternal characteristics, symptomology and cervical length. Results: Among 60 analyzed women, 50 were treated orally and vaginally with alpha-lipoic acid, whereas 10 did not undergo any therapy. In the treated group, 10 patients were asymptomatic and 40 symptomatic. The symptoms disappeared in 37 patients. In the untreated group, 4 women were symptomatic and 6 asymptomatic. At the end all women were symptomatic. Mean cervical length showed a reduction in the untreated group compared to the treated group. Conclusions: The vaginal/oral-combined administration with alpha-lipoic acid showed effectiveness in reducing symptoms and preventing cervical shortening in our set of patients. No adverse effects were detected during the treatment

    The Association Between Advanced Maternal Age and Short Interpregnancy Intervals on Preterm Labor

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    Background: Preterm birth is the leading cause of neonatal and infant mortality and has become a major health concern due to the increasing rates of infant deaths in the United States (WHO, 2017). Studying maternal risk factors for preterm labor provides insight to this obscure condition and can assist in the identification of high risk women, as well as facilitate appropriate pregnancy planning. Purpose: Although research can be found on interpregnancy intervals and maternal age as independent risk factors for premature labor, gaps exist within the relation of these variables. This study was done to investigate whether there is a significant risk association between advanced maternal age (35 years and older) and short interpregnancy intervals on premature labor, that deems transferring out of a low risk birthing center to a more advanced hospitalized setting. Methodology: De-identified data regarding obstetric history, medical history, and pregnancy morbidity was abstracted from women who delivered at Baby + Co., a birthing center in Nashville, Tennessee, between the years of 2015 and 2018. The population set included 1001 women, 5 of which delivered preterm. Means and standard deviations for the two groups were calculated, and two sided t-tests and corresponding p-values were calculated. Result: There was no statistical significance regarding maternal age and preterm transfers (p-value of 0.762). However, there was a positive correlation between short interpregnancy intervals and preterm birth (p-value .007). Discussion: Due to the low risk population included in this study, there is a need for additional research conducted within a higher risk population set to determine the significance and interaction between advanced maternal age and short interpregnancy intervals on preterm labor

    Time-to-birth prediction models and the influence of expert opinions

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    Preterm birth is the leading cause of death among children under five years old. The pathophysiology and etiology of preterm labor are not yet fully understood. This causes a large number of unnecessary hospitalizations due to high--sensitivity clinical policies, which has a significant psychological and economic impact. In this study, we present a predictive model, based on a new dataset containing information of 1,243 admissions, that predicts whether a patient will give birth within a given time after admission. Such a model could provide support in the clinical decision-making process. Predictions for birth within 48 h or 7 days after admission yield an Area Under the Curve of the Receiver Operating Characteristic (AUC) of 0.72 for both tasks. Furthermore, we show that by incorporating predictions made by experts at admission, which introduces a potential bias, the prediction effectiveness increases to an AUC score of 0.83 and 0.81 for these respective tasks

    Is induced abortion a risk factor in subsequent pregnancy?

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    Objective: To determine whether a history of terminations of pregnancy influences subsequent pregnancies in terms of pregnancy risks, prematurity and neonatal biometrics. Patients and methods: Based on the perinatal statistics of eight German federal states, data of 247,593 primiparous women with singleton pregnancies born between 1998 and 2000 were analyzed. The control group consisted of primiparous women without previous induced abortions. Maternal age was adjusted for. Results: There was an overall trend towards an increased rate of preterm delivery at &lt;= 36 weeks' gestation and early preterm delivery at &lt;= 31 weeks' gestation in women who had previous pregnancy terminations. For the cohort of 28-30 years, the observed rates of prematurity in women with one and with &gt;= 2 previous induced abortions were 7.8% and 8.5%, respectively, compared to 6.5% in the control population (P=0.015). Preceding terminations of pregnancy did not alter the rate of small-for-gestational-age newborns. Psychosocial stress and symptoms associated with prematurity such as cervical incompetence and vaginal bleeding before and after 28 weeks of gestation occurred more frequently in women with previous induced abortion compared to the control group (P&lt;0.0001). Conclusion: The rate of preterm births increases with the number of preceding abortions. Similarly, symptoms associated with prematurity are more common. The rate of small-for-gestational-age newborns was not affected by preceding terminations of pregnancy
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