Effect of massage on behavioural responses of preterm infants in an educational hospital in Iran

Objective: The aim of this study was to assess the effect of providing massage (tactile and kinesthetic stimulation) on behavioural responses for preterm infants.

Background: These infants have immature central nervous systems. Sleep–wake states during infancy have been shown to reflect severity of disease developments, and the nervous system and brain maturation.

Methods: This study is a quasi-experimental study with before and after design conducted on 45 preterm infants who were admitted in neonatal intensive care unit (NICU). The subjects received massage 15 min per day for 5 days using field massage technique. Behavioural responses were measured by behavioural state, motor activity and behavioural distress. Data were obtained 10 min before and 10 min after the providing massage period.

Results: An increase was observed in sleep state score after providing massage. And also, the awake, fidgeting and motor activity scores reduced after providing massage. No significant change was seen in the total behavioural distress.

Conclusion: The findings suggest that providing field massage had soothing and calming effect on preterm infants and could be beneficial in nursing intervention. Nurses working in neonatal intensive care unit need to be educated on how to performing the massage on preterm infants.

Abbreviation: NICU: Neonatal Intensive Care Unit     

Prevention of unintended pregnancies by using emergency contraception: the differences between levonorgestrel and ulipristal acetate. A theoretical model using data from a survey on the use of emergency contraception in Spain, 2017

Objective: To estimate the differences in unintended pregnancies avoided using either levonorgestrel (LNG) or ulipristal acetate (UPA) emergency contraception (EC).

Design: Cross-sectional study.

Setting: Survey carried out in Spain.

Participants: 1000 Spanish women reporting unprotected sex in 2017.

Main measurements: EC use, reasons for not using EC, calculation of the number of unintended pregnancies avoided.

Results: 39% of Spanish women having had unprotected sex used EC. 61% of those women did not use EC and 11% did not know the existence of this resource. In 2017 the use of EC prevented 101,271 unintended pregnancies. If instead of using LNG every woman had used UPA another 15,979 additional pregnancies could have been prevented.

Conclusions: If all Spanish women having unprotected sex used EC we could expect a significant decrease in the number of unintended pregnancies and abortions. Using UPA instead of LNG would have a greater impact on that reduction with the corresponding benefit for women and society as a whole.     

Are non-pregnant women afraid of childbirth? Prevalence and predictors of fear of childbirth in students

Introduction: Fear of childbirth (FOC) has been mostly studied in peripartum women; however, it can be present in non-pregnant young women, and the question is whether it occurs even before pregnancy planning.

Objective: (1) to determine the prevalence of clinically significant FOC in non-pregnant female students, and (2) to investigate the role of anxiety sensitivity (AS), trait anxiety, childbirth pain expectancy, and sources of birth knowledge for FOC.

Methods: Non-pregnant female students (N?=?374) from different study programmes (health studies, social sciences and humanities, and biotechnical studies) participated in the study. They completed

Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), The State–Trait Anxiety

Inventory (STAI-T), Anxiety Sensitivity Index (ASI), the average expected labor pain, and sources

of information about childbirth.

Results: The results showed that 25.9% of students reported clinically significant FOC. FOC could be predicted by postponing pregnancy planning, the high expectancy of labor pain, high trait anxiety, and high physical dimension of AS. Students from health sciences reported a lower level of FOC, as opposed to social science and humanities’ students. Students reported receiving the most information about childbirth from family and the least from the professional books.

Conclusions: Fear of childbirth is highly prevalent in the sample of young nulliparous women with one in four women reporting clinically significant fear. The higher levels of the FOC could be predicted, by AS, trait anxiety, expected labor pain, and sources of knowledge about the childbirth. Implications of the findings are discussed.     

Prenatal diagnosis of intra hepatic arterio venous fistula: case report and review of the literature

Aim: To describe the prenatal features and management of a congenital intra hepatic fistula.

Material and methods: Case report

Results: Congenital intra hepatic fistula are extremely rare. The prenatal ultrasound seiology is described.

Conclusion: Prenatal diagnosis of these anomalies may improve pre and post natal management.     

Ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis

Aim: To investigate ultrasound characteristics and outcome in fetuses with cholelithiasis.

Materials and methods: We report a small case series of three patients with prenatally diagnosed fetal cholelithiasis. Ultrasound features, pregnancy outcome and neonatal follow-up are presented and discussed.

Results: Sonographic pattern associated to fetal cholelithiasis is variable. Pregnancy issue is globally good with no ominous fetal or neonatal events.

Conclusions: Prenatally diagnosed fetal cholelithiasis is a rare finding and doesn’t seem to carry an adverse effect on the pregnancy.     

Protective effect of vitamin D supplementation in a rat modal of preeclampsia: a possible implication of chemerin

Background: Preeclampsia (PE) is a disorder of pregnancy associated with vitamin D (VD) deficiency. Chemerin is an adipokine significantly increased in preeclampsia and is regulated by VD.

Objectives: To determine whether VD supplementation would protect against development of PE through Chemerin reduction

Methods: PE was induced in albino rats by injection of 12.5 mg of deoxycorticosterone (DOCA). Rats were randomly divided into normal pregnant, PE group, VD supplemented PE group.

Results: VD supplementation decreased systolic blood pressure, proteinuria and decreased serum Chemerin level.

Conclusion: VD treatment reduced Chemerin level, and blood pressure in DOCA rat model of PE.     

Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit

Objective: This study aims to determine maternal stress and anxiety as perceived by mothers whose premature infants were admitted to the neonatal intensive care unit (NICU) and to identify maternal stress and its relationship with maternal and infant characteristics and anxiety.

Background: Vulnerable premature infants commonly require special care in the NICUs. In most cases, prolonged hospitalization results in stress and anxiety for the mothers.

Methods: A non-probability convenience survey was used in a public hospital, with 180 mothers completing the 26-item Perceived Stress Scale (PSS) and a 40-item State-Trait Anxiety Inventory (STAI).

Results: 56.5% of mothers had high levels of stress, 85.5% of mothers had a high level of state-anxiety and 67.8% of mothers had a high level of trait-anxiety. The stress experienced by these mothers had a significant relationship with anxiety, and was found to be associated with state and trait anxiety levels, but not with maternal and infant characteristics.

Conclusion: Mothers in this setting revealed high levels of stress and anxiety during their premature infants’ NICU admission. An immediate interventional programme focusing on relieving mothers’ anxiety and stress is needed to prevent maternal stress and anxiety at an early stage.     

Haptotherapy as a new intervention for treating fear of childbirth: a randomized controlled trial

Objective: To evaluate the effect of haptotherapy on severe fear of childbirth in pregnant women.

Design: Randomized controlled trial.

Setting: Community midwifery practices and a teaching hospital in the Netherlands.

Population or Sample: Primi- and multigravida, suffering from severe fear of childbirth (N?=?134).

Methods: Haptotherapy, psycho-education via Internet and care as usual were randomly assigned at 20–24?weeks of gestation and the effects were compared at 36?weeks of gestation and 6?weeks and 6?months postpartum. Repeated measurements ANOVA were carried out on the basis of intention to treat. Since there were crossovers from psycho-education via Internet and care as usual to haptotherapy, the analysis was repeated according to the as treated principle.

Main outcome measures: Fear of childbirth score at the Wijma Delivery Expectancy/Experience Questionnaire.

Results: In the intention to treat analysis, only the haptotherapy group showed a significant decrease of fear of childbirth, F(2,99)?=?3.321, p?=?.040. In the as treated analysis, the haptotherapy group showed a greater reduction in fear of childbirth than the other two groups, F(3,83)?=?6.717, p?<?.001.

Conclusion: Haptotherapy appears to be more effective in reducing fear of childbirth than psycho-education via Internet and care as usual.     

Urinary neutrophil gelatinase-associated lipocalin is associated with preeclampsia in a cohort of Turkish women

Purpose: We investigated the optimal cut-off level for urinary neutrophil gelatinase-associated lipocalin (NGAL) in preeclamptic patients to confirm the diagnosis.

Methods: Urinary NGAL concentrations were measured by specific enzyme-linked immunosorbent assay (ELISA).

Results: Patients with preeclampsia had significantly higher urinary NGAL concentrations than controls (mean: 387 ng/ml vs. 188 ng/ml, respectively; P< 0.001). Using a cutoff value 252 ng/ml for urinary NGAL to confirm diagnosis of preeclampsia, sensitivity, and specificity were 92% and 91%, respectively.

Conclusion: Urinary NGAL concentrations were significantly elevated in women with preeclampsia versus normotensive controls.     

The reduction of melatonin levels is associated with the development of preeclampsia: a meta-analysis

Objective: The aim of this analysis was to demonstrate the association between melatonin levels and the development of preeclampsia.

Methods: Standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using a random effects model.

Results: The pooled SMD between case and control was 1.40 (95% CI: 0.26, 2.55; P = 0.02). And the pooled SMD between mild PE and severe PE was 5.25 (95% CI: 1.5, 9.01; P = 0.006).

Conclusion: The meta-analysis illustrated that melatonin concentration was significantly lower in women with preeclampsia, and correlated with the severity of the disease.     

Hypertensive disorders of pregnancy increase the risk of developing neovascular age-related macular degeneration in later life

Background: Hypertensive disorders of pregnancy (HDP) and short-term adverse outcomes have long been recognized; however, survivors remain at risk of long-term complications. We investigated whether HDP is associated with the development of choroidal neovascular age-related macular degeneration (CNV AMD).

Methods: We identified 31,454 women who experienced HDP based on Utah birth certificates and 62,908 unexposed women matched 2:1 to the exposed. Risk of CNV AMD was estimated using Cox models.

Findings: Women with HDP exhibited an 80% higher risk for early CNV AMD (age < 70 y; 95%CI 1.23–2.58).

Conclusion: Our findings may have implications forearlier CNV AMD screening and detection.     

Breast milk oligosaccharides: effects of 2′-fucosyllactose and 6′-sialyllactose on the adhesion of Escherichia coli and Salmonella fyris to Caco-2 cells

Background: It is well known that human milk oligosaccharides play an important role as prebiotics, anti-inflammatory, and anti-infective agents. In the last few years, several studies have been performed using specific oligosaccharides, such as 2′-fucosyllactose and 6′-sialylactose, to evaluate their biological functions.

Objectives: The aim of the present study is to evaluate the anti-adhesive effect of the above oligosaccharides on Escherichia coli and Salmonella fyris.

Methods: Adhesion experiments were performed in the presence of 2′-fucosyllactose and 6′-sialyllactose as potential inhibitors of Escherichia coli and Salmonella fyris adhesion to Caco-2 cells. The oligosaccharides were used at different concentrations and the adhesion experiments were performed in triplicate and repeated at least three times.

Results: A significant reduction of Escherichia coli adhesion was observed in the presence of 2′-fucosyllactose and 6′-sialyllactose at the human milk concentration. On the contrary, no positive effects were observed in both oligosaccharides on Salmonella firis.

Conclusions: Our results suggest that the supplementation in infant formulas of 2′-fucosyllactose and 6′-sialyllactose, actually commercially available and absent in cow milk, could play positive effects in artificially fed infants.     

External validation of prognostic models for preeclampsia in a Dutch multicenter prospective cohort

Objective: To perform an external validation of all published prognostic models for first-trimester prediction of the risk of developing preeclampsia (PE).

Methods: Women <14 weeks of pregnancy were recruited in the Netherlands. All systematically identified prognostic models for PE that contained predictors commonly available were eligible for external validation.

Results: 3,736 women were included; 87 (2.3%) developed PE. Calibration was poor due to overestimation. Discrimination of 9 models for LO-PE ranged from 0.58 to 0.71 and of 9 models for all PE from 0.55 to 0.75.

Conclusion: Only a few easily applicable prognostic models for all PE showed discrimination above 0.70, which is considered an acceptable performance.     

Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study

Objective: To explore the gestational age of early-onset intrahepatic cholestasis (ICP) of pregnancy, and to analyze the relationship between the clinical biochemical indices and pregnancy outcomes in order to arrive at a reasonable diagnosis and administer appropriate treatment.

Design: This is a retrospective clinical study.

Population or sample: We selected 47,260 pregnant women who received prenatal care and underwent childbirth at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University from January 2014 to December 2016 for participating in this study. Of these 47,260 women, 407 developed ICP.

Methods: To calculate the gestational week cutoff between early- and late-onset ICP by the receiver-operating characteristic (ROC) curve and Youden’s index. Two independent samples t tests and chi square test were used to compare the differences in biochemical indices and pregnancy outcomes between the two groups.

Results: We found that 34 weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. Early-onset ICP is characterized by early onset, long disease duration and a higher incidence of preterm labor, fetal distress, and fetal low birth weight compared to late-onset ICP.

Conclusions: Thirty-four weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. And to reduce the adverse pregnancy outcomes in cases of early-onset ICP, we suggest prolonging gestation up to 37 weeks as far as possible before selecting iatrogenic birth.     

Increased circulating trimethylamine N-oxide plays a contributory role in the development of endothelial dysfunction and hypertension in the RUPP rat model of preeclampsia

Objective: We examined whether trimethylamine-N-oxide (TMAO) plays a role in endothelial dysfunction and hypertension in the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia (PE). 

Methods: Normal pregnant rats and RUPP rats were treated without or with 3,3-Dimethyl-1-butanol (DMB, a TMAO inhibitor) from gestational day 14. 

Results: On day 19 of gestation, RUPP rats had higher plasma TMAO, impaired vasodilation and hypertension, decreased interleukin (IL)-10, increased superoxide production and proinflammatory cytokines in the aorta. All of which were reversed by DMD. 

Conclusion: Increased circulating TMAO downregulates IL-10 and promotes vascular inflammation and oxidative stress, contributing to endothelial dysfunction and hypertension in PE.     

Neuropathological complications associated with hypertensive disorders of pregnancy

Objective: Hypertensive disorders in pregnancy particularly severe preeclampsia and eclampsia result in significant maternal and neonatal morbidity and mortality. Many of these misfunctions can aggravate some of the neuropathological complications of hypertensive disorders during pregnancy.

Method: In this review article, we described some of the neuropathological complications associated with hypertensive disorders of pregnancy.

Results and conclusion: It is explained how the possible mechanism of neuropathological events triggers some of the complications associated with hypertensive disorders of pregnancy.

Conclusion: A strong plea is made for the early detection of high blood pressure, its immediate control with rapid acting anti-hypertensive agents if necessary and timeous delivery of fetus as the exact pathogenesis of preeclampsia remains unknown.     

Investigation of elevation as a risk factor for hypertensive disorders of pregnancy among Colorado women between 2007 and 2015

Objective: The purpose of this study is to determine the association between high elevation and hypertensive disorders of pregnancy (HDP).

Methods: Retrospective cohort study using Colorado birth certificate data to compare HDP at high (≥8,000 ft), moderate (4,501–7,999 ft), or low (≤4,500 ft) elevation using logistic regression.

Results: Among the cohort (n = 314,431), 3.4% of women developed a HDP. High or moderate elevation was not significantly associated with HDP relative to low elevation (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 0.93–1.43; aOR 1.14, 95% CI 0.98–1.31, respectively).

Conclusion: Women living at high or moderate elevation do not have higher odds of HDP.     

Major liver resection in pregnancy: three cases with different etiologies and review of the literature

Background: Major liver resection during pregnancy is extremely rare. When required, the associated physiologic and anatomic changes pose specific challenges and greater risk for both mother and fetus

Materials and methods: Three cases of major liver resection during pregnancy due to different etiologies are presented. The relevant literature is reviewed and discussed.

Results: We present three cases of major liver resection due to giant liver hemangioma with Kasabach–Merrit syndrome, giant hydatid cyst, and intrahepatic cholangiocarcinoma, at gestational week (GW) 17, 19, and 30, respectively. All patients had an uneventful postoperative course, continued the pregnancy and gave birth at GW 38.

Conclusion: Major liver resection can be performed safely during pregnancy. A multidisciplinary team of surgeons, anesthesiologists and gynecologists, in a highly experienced tertiary hepatobiliary center, should be involved.     

Listeriosis in two twin pregnancies after in vitro fertilization with differential outcome and literature review

Purpose: In vitro fertilization (IVF) has become a very common procedure in the infertility practice due to its accessibility. The study is aiming at presenting two twin pregnancy-related infections caused by Listeria monocytogenes and reviewing the reported cases of listeriosis in multiple pregnancies.

Materials and methods: Two listeriosis cases with twin pregnancy after IVF were described and the literature on pregnancy-associated listeriosis was reviewed.

Results: The risk of listeriosis should be underscored in pregnant women after IVF, and timely diagnosis and rational treatment might result in a better outcome.

Conclusions: The current study highlights that the infections due to L. monocytogenes should be noted in multiple pregnancies after IVF.