Maternal obesity in early pregnancy and subsequent pregnancy outcome in a Nigerian population

Despite a rising prevalence worldwide, there is limited data on pregnancy outcome among African women with prepregnancy or early pregnancy obesity. This was a case-control study to determine the prevalence of maternal obesity in early pregnancy and compare the subsequent pregnancy outcome between 201 women with obesity and 201 non-obese controls in a University Teaching Hospital in Nigeria. The prevalence of obesity in early pregnancy was 9.63%. Obesity was significantly associated with advanced maternal age and parity > or =1. It was also a risk factor for pregnancy induced hypertension, admissions during pregnancy, caesarean delivery and associated with 5th minute apgar score < or =3 (0.044). Obesity in early pregnancy is a risk factor for adverse pregnancy outcome among pregnant Nigerian women. This information should be utilised by physicians to improve the outcome of pregnancy and promote safe motherhood.     

Postterm pregnancy: how can we improve outcomes?

Postterm pregnancy is defined as one which has progressed to 42 0/7 weeks or beyond. The most common reason to be diagnosed with a postterm pregnancy is inaccurate pregnancy dating, but it is also associated with obesity, nulliparity, and a prior history of postterm pregnancy. The rate of postterm pregnancy appears to be decreasing whether due to improved pregnancy dating or an increase in induction of labor. Postterm pregnancy is associated with both maternal and neonatal morbidity and fetal and neonatal mortality; similarly pregnancies beyond 41 weeks' gestation are associated with increases in these perinatal complications. Prevention of postterm pregnancies may include stripping or sweeping the membranes and unprotected coitus. Management of such pregnancies may include induction of labor and fetal antenatal monitoring. Individual patient management should involve careful counseling regarding the risks and benefits of each of the components of care. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall the increasing risks of poor outcomes associated with prolonged pregnancy, demonstrate knowledge regarding gestational dating and use of cervical ripening agents in their care of pregnant women, and use evidence-based information when counseling their term patients regarding postterm pregnancy management.     

Ruptured tubal pregnancy associated with intrauterine pregnancy complicated by fetal holoprosencephaly: a case report

BACKGROUND: Naturally occurring heterotopic pregnancy is rare. A surviving intrauterine pregnancy associated with a ruptured tubal pregnancy is extremely unusual. CASE: This is the first reported case of a patient presenting in hemorrhagic shock due to a ruptured tubal pregnancy that was associated with an ongoing intrauterine pregnancy complicated by fetal holoprosencephaly. CONCLUSION: Delays in diagnosis and treatment of heterotopic pregnancies may adversely affect maternal health as well as the outcome of the intrauterine pregnancy. Prenatal screening and/or diagnostic studies are necessary to evaluate the intrauterine pregnancy.     

The Discomforts of Pregnancy

During pregnancy, women may experience one or more of a wide variety of discomforts. Every pregnancy is different; discomforts felt during one pregnancy may not appear in another. Most discomforts experienced during pregnancy are thought to be the result of abundant hormonal changes. As pregnancy progresses, other discomforts are attributed to physical changes associated with the enlarging uterus. Selected discomforts of pregnancy are presented with suggestions for clinical management. Nurses can do something to decrease discomforts associated with pregnancy.     

Heterotopic pregnancy after 2 prior ectopic pregnancies: a case report

BACKGROUND: Heterotopic pregnancy is a rare occurrence, with spontaneous pregnancy often unsuspected and associated with delayed diagnosis. When previous ectopic pregnancy has been treated, future pregnancy is associated with an increased risk for ectopic pregnancy and potentially heterotopic pregnancy. Conservative treatment for ectopic pregnancy with either surgery or methotrexate leaves the patient with hope for potential future fertility, especially when assisted reproductive technology is not available. CASE: A woman who had been treated for ectopic pregnancy in both fallopian tubes presented with a spontaneous heterotopic pregnancy. CONCLUSION: Heterotopic pregnany may occur after treatment of previous ectopic pregnancy and may lead to a successful outcome when diagnosed and treated appropriately.     

Unplanned pregnancy: does past experience influence the use of a contraceptive method?

OBJECTIVE: To investigate whether women between the ages of 14 and 25 years with a past unplanned pregnancy were more likely to use a contraceptive method compared with women without a history of unplanned pregnancy. METHODS: We analyzed baseline data of 424 nonpregnant women between the ages of 14 and 25 years enrolled in a randomized trial to prevent sexually transmitted diseases and unplanned pregnancy (Project PROTECT). Women at high risk for sexually transmitted diseases or unplanned pregnancy were included. Participants completed a demographic, substance use, and reproductive health questionnaire. We compared women with and without a history of unplanned pregnancy using bivariate analysis and log binomial regression. RESULTS: The prevalence of past unplanned pregnancy in this sample was 43%. Women reporting an unplanned pregnancy were older, and had less education, and were more likely to be nonwhite race or ethnicity. History of an unplanned pregnancy was not associated with usage of a contraceptive method (relative risk 1.01, 95% confidence interval 0.87-1.16) in bivariate analysis or when potential confounders were accounted for in the analysis (adjusted relative risk 1.10, 95% confidence interval 0.95-1.28). CONCLUSION: Several factors were associated with both unplanned pregnancy and overall contraceptive method use in this population. However, a past unplanned pregnancy was not associated with overall contraceptive method usage. Future studies are necessary to investigate the complex relationship between unplanned pregnancy and contraceptive method use. LEVEL OF EVIDENCE: II-2.     

Factors associated with elective termination of pregnancy among Canadian and American women with nausea and vomiting of pregnancy

Case reports have associated severe nausea and vomiting of pregnancy (NVP) with elective termination of pregnancy. Therefore, our objective was to explore the determinants of consideration of termination and actual termination of pregnancy among women with NVP. From 1996 to 1997, callers to an advertised NVP Healthline underwent a semi-structured interview. From callers who retrospectively reported on NVP in a previous pregnancy, a nested unmatched case-control study was performed. Callers were divided into three groups: those who reported having electively terminated their pregnancy due to NVP, those who considered termination due to NVP and those who never considered termination. The severity of nausea and vomiting, and frequency of psychosocial morbidity, were compared between cases and controls, and multivariate logistic regression analysis was used to determine factors independently associated with termination and/or consideration of termination of pregnancy due to NVP. Of 3201 callers with NVP, 413 women reported having considered termination of pregnancy for NVP, 108 reported termination due to NVP and 2609 reported never having considered termination for NVP. The following factors were independently associated with a woman's consideration of termination of pregnancy due to NVP: unplanned pregnancy (p = 0.002), multiparity (p = 0.0001), more severe vomiting (p = 0.003), feelings of depression (p < 0.0001) and reported adverse effects of NVP on both her partner's daily life (p = 0.04) and her relationship with her partner (p = 0.0003). The following factors were independently associated with actual termination of pregnancy due to NVP: unplanned pregnancy (p < 0.0001), multiparity (p = 0.03) and feelings of depression (p = 0.001). There were no significant interactions between factors. Consideration of termination, or actual termination of pregnancy, due to NVP are associated with psychosocial circumstances, which should be taken into consideration when managing these women.     

Spontaneous expulsion of decidualized pseudopolyps in pregnant women with uterine malformation

Two cases concerning expulsion of decidualized polyps in early pregnancy associated with uterine malformation are described. The authors discuss the differential diagnosis between the expulsion of cervical polyps during pregnancy and the ectopic pregnancy associated with polyposis. They suggest that a spontaneous expulsion of polyps or pseudopolyps during early pregnancy may be a sign of the presence of uterine malformation.     

Respiratory complications of pregnancy.

The pregnant woman is susceptible to a variety of respiratory complications. When a pregnant patient presents with an abnormal chest x-ray or a pulmonary complaint, an understanding of the pathophysiology of pregnancy will guide the clinician in establishing a diagnosis. Pregnancy brings about many changes to a woman's body. One of the more intriguing is a decrease in the T helper cells, resulting in a state of relative immunosuppression. Despite this, the prevalence of infectious pneumonia is not increased in pregnancy. Complications from pneumonia, however, are increased in the pregnant host. Most notably are increases in both mortality related to influenza infection and the risk for dissemination of coccidioidomycosis.Other physiologic changes predispose the pregnant woman to certain disease processes. Hypercoagulability associated with pregnancy results in a marked increase in the incidence of thromboembolic disease. Although rare, pregnancy is also associated with other embolic phenomena including amniotic fluid embolism, air embolism, and trophoblastic embolism. Because of the increases in intravascular volume and cardiac output that occur in pregnancy, women with underlying structural heart disease will frequently present for the first time or have an exacerbation of their disease. This is especially true of mitral stenosis. Peripartum cardiomyopathy also can occur, and for the majority of patients, the heart remains damaged for life. Finally, although uncommon, lymphangioleiomyomatosis will often present or become exacerbated during pregnancy. Patients with this disorder need to be counseled concerning the increased risk associated with pregnancy. This paper reviews the various respiratory complications associated with pregnancy.     

Security associated with pregnancy and childbirth--experiences of pregnant women

The aim of this study was to describe security associated with pregnancy and childbirth. Security was described as a human need and as human value. Data were collected in semi-structured interviews in two maternity health care clinics. Data interpretation was based on the method of content analysis. A convenience sample of 20 volunteer Finnish women was interviewed during pregnancy. The elements creating security associated with pregnancy and childbirth were maternity health care, social support, sense of control, and attitudes. The feeling of security was manifested in different resources, feelings and behavior. If the feeling of security associated with pregnancy and childbirth was impaired, the participants would resort to their network of social support, contact health care or social welfare services, or try to achieve a sense of security by their own resources. Feeling secure during pregnancy influences the pregnant woman's resources, feelings and behavior. It is important that professionals in maternity health care talk with the client about issues that influence her individually-experienced security associated with pregnancy and childbirth. These include examination of the client's network of social support and informing the client about the health care and social welfare services available.     

Ocular changes during pregnancy

Pregnancy is often associated with ocular changes. Most of them are specifically associated with the pregnancy itself, rare disturb the normal visual function and are transient in nature. The ocular effects of pregnancy may be divided into physiologic changes, pathologic conditions or modifications of pre-existing conditions. Pregnancy is associated with changes in corneal sensitivity and thickness, decreased tolerance to contact lenses, decreased intraocular pressure, can affect refractive error. Pathologic conditions reported to develop during pregnancy include hypertensive and vascular disorders, central serous chorioretinopathy, uveal melanoma and others. The most significant modified pre-existing condition is diabetes mellitus. Pregnant women are at increased risk for the progression of preexisting proliferative diabetic retinopathy, and diabetic women should see an ophthalmologist before pregnancy or early in the first trimester. This review describes various ocular changes that occur during pregnancy and summarizes the ocular disturbances in these three categories.     

The choice for sons or daughters

The aim of this study was to describe security associated with pregnancy and childbirth. Security was described as a human need and as a human value. Data were collected in semi-structured interviews in two maternity health care clinics. Data interpretation was based on the method of content analysis. A convenience sample of 20 volunteer Finnish women was interviewed during pregnancy. The elements creating security associated with pregnancy and childbirth were maternity health care, social support, sense of control, and attitudes. The feeling of security was manifested in different resources, feelings and behavior. If the feeling of security associated with pregnancy and childbirth was impaired, the participants would resort to their network of social support, contact health care or social welfare services, or try to achieve a sense of security by their own resources. Feeling secure during pregnancy influences the pregnant woman's resources, feelings and behavior. It is important that professionals in maternity health care talk with the client about issues that influence her individually-experienced security associated with pregnancy and childbirth. These include examination of the client's network of social support and informing the client about the health care and social welfare services available.     

Thrombophilia and placental pathology

Thrombophilic states have been associated with a variety of adverse pregnancy outcomes. The underlying placental pathology linking thrombophilia to these outcomes closely resembles that seen in other pregnancy disorders associated with chronic obstruction of the maternal or fetal vasculature. No single placental lesion is pathognomonic for thrombophilia. However, the finding of typical pathologic lesions in the context of recurrent pregnancy loss, severe early onset disease, or neonatal coagulation abnormalities should prompt the consideration of an underlying thrombophilic state.     

Perceptions of pregnancy complications in Haiti.

OBJECTIVE: To determine the incidence of perceived pregnancy complications and associated factors. METHODS: During a census, 450 women identified themselves as pregnant and 388 were interviewed postpartum. RESULTS: Complications were reported by 58.6%. Bleeding post-delivery was the most frequent complication (42.5%), followed by great pain (33.8%), bleeding during pregnancy (20.1%), and fever post-delivery (11.6%). Prenatal care at either a dispensary or a clinic was associated with reports of bleeding during pregnancy (odds ratio [OR] 9.06; 95% confidence interval [CI], 1.71-48.00 and OR 7.58; 95% CI, 1.53-37.48, respectively). Women who visited a doctor were less likely to report bleeding during pregnancy (OR 0.20; 95% CI, 0.08-0.55) or fever post-delivery (P=0.015). Herb use was associated with reported bleeding during pregnancy (OR 2.22; 95% CI, 1.12-4.40) and great pain (OR 1.94; 95% CI, 1.05-3.58). CONCLUSION: The perceived pregnancy complication rate in Haiti is high and is associated with access to health care. The association between use of herbs and pregnancy complications warrants investigation.     

A Prospective Study of Urinary Prostaglandins E in Women with Normal and Hypertensive PmGNancies

Studies in vitro suggest that pregnancy induced hypertension, or toxemia, is associated with decreased placental pros-taglandins E (PGE) levels. To validate this observation in vivo PGE were measured weekly in 24h urine collections, in a prospective cross-sectional study in 9 women from 7 to 40 weeks. In addition, urinary PGE levels were also measured in 28 hospitalized pregnant women with either chronic hypertension or toxemia. Prostaglandins E were measured by radioimmunoassay after organic extraction and silicic acid separation. Urinary PGE levels during pregnancy (normotensive and chronic hypertensive women) were significantly elevated than those of the non-pregnant state. Mean urinary PGE levels in toxemic patients were significantly decreased compared to those of normal pregnancy and patients with chronic hypertension but they were similar to the mean levels of the non-pregnant state. One fetal death attributed to aggravation of chronic hypertension and one eclampsia were associated with undetectable levels of maternal urinary PGE. In conclusion, normal pregnancy is associated with a significant increase of urinary PGE; chronic hypertension and occurence of toxemia are associated with significant diminution of urinary PGE excretion.     

Fears associated with pregnancy and childbirth--experiences of women who have recently given birth

OBJECTIVE: To describe fears associated with pregnancy and childbirth and to see whether women who have recently given birth feel that their fears were justified. DESIGN: A qualitative study. Data were collected by semi-structured interviews. Data interpretation was based on the method of content analysis. SETTING: The maternity units of two university hospitals in Finland. PARTICIPANTS: A convenience sample of 20 women, 10 primiparae and 10 multiparae. The interviews were held 2 or 3 days after childbirth. FINDINGS: The most common fears associated with pregnancy and childbirth were concerned with the baby's well-being, the course of pregnancy, and childbirth. The fears found expression in different kinds of behaviours, emotions and physical sensations. Many of the participants felt that their fears had not been justified, but some maintained that their fears had been justifiable. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: There was much inter-individual variation in the fears associated with pregnancy and childbirth. It is important that diagnosis during pregnancy is undertaken sensitively and that midwifery staff remember that pregnant women may have very serious fears associated with pregnancy and childbirth. The participants in this study felt that fears associated with pregnancy and childbirth also had positive meanings. It may not be essential to try to protect women against these fears or to remove them altogether, but to give every pregnant women the opportunity to deal with her own fears and to obtain the help she needs in her situation.     

Hydatid cyst of urinary bladder associated with pregnancy:a case report

Echinococcosis or hydatid disease which is caused by Echinococcus group of cestodes is very rare in pregnancy. While liver and lungs are commonly involved, other sites can be rarely affected. The management of hydatid disease in pregnancy is challenging in view of varied presentation and manifestation. We report a case of hydatid cyst arising from the bladder associated with pregnancy and presenting with abdominal pain. The cyst was surgically removed and the bladder wash was given with povidone–iodine. The postoperative recovery was uneventful with ongoing pregnancy. This is to our knowledge, the first case of hydatid cyst arising from the bladder associated with pregnancy to be reported.     

Embarazo heterotópico espontáneo en pacientes con antecedente de embarazo gemelar familiar: 2 casos

Heterotopic pregnancy is the coexistence of an intrauterine pregnancy with an extrauterine pregnancy. There are two types: induced (associated with in vitro fertilization techniques, representing 1:1000 to 1:1,500 pregnancies) or spontaneous (1: 20,000 to 1: 80.000 pregnancies). Causal factors for spontaneous heterotopic pregnancies include pelvic inflammatory disease, use of hormonal or intrauterine devices, previous pelvic surgery and ectopic pregnancy. We report two cases of spontaneous heterotopic pregnancy in patients with a family history of twins.     

Management of gallstone pancreatitis during pregnancy and the postpartum period

In a 22 year study, 21 women had acute pancreatitis develop during pregnancy (11 women) or within six weeks post partum (ten women). Gallstones were the cause of the pancreatitis in all. Operation during the acute attack of pancreatitis was required in only two. Acute pancreatitis subsided in the remaining 19 patients; they were operated upon during the second trimester or the early postpartum period. During pregnancy, surgical treatment for gallstone pancreatitis should consist of cholecystectomy and exploration of the common bile duct without operative cholangiography. During the postpartum period, operative cholangiography is used to determine whether or not exploration of the common bile duct is necessary. Acute pancreatitis associated with pregnancy is "gallstone" pancreatitis; there is no evidence that pregnancy is a specific etiologic factor in pancreatitis. As opposed to nonoperative treatment of symptomatic gallstone pancreatitis in pregnancy, which is accompanied by maternal morbidity or fetal mortality, surgical treatment during the optimal time of the second trimester or early postpartum period was associated with no maternal morbidity or fetal mortality and no recurrent pancreatitis.     

Impact of prepregnant body mass index and maternal weight gain on the risk of pregnancy complications in Japanese women

BACKGROUND: To analyze the association of pregnancy complications with prepregnant body mass index and weight gain during pregnancy in Japanese women. METHODS: A retrospective cohort study was conducted with 21,718 Japanese women with a singleton pregnancy. Pregnant women were grouped by prepregnant body mass index and evaluated for association with pregnancy complications using multivariate logistic regression analysis. The women in each body mass index group were then divided into groups by weight gain during pregnancy using intervals of 0.05 kg/week to analyze the relationship between the weight gain and pregnancy complications by multivariate logistic regression association analysis. RESULTS: In both nulliparous and parous women, the least pregnancy complications were found among women with medium prepregnant body mass indexes (18-23.9). Significant risks of pregnancy complications were associated with low (< 18) and high (> or = 24) prepregnant body mass indexes, particularly high prepregnant body mass indexes. In nulliparous women, the optimal weight gain was 0.25-0.4 kg/week for low (< 18) prepregnant body mass index, 0.20-0.30 kg/week for medium (18-23.9) prepregnant body mass index, and > or = 0.05 kg/week for high (> or = 24) prepregnant body mass index. In parous women, the corresponding values were > or = 0.20, 0.20-0.30, and 0.05-0.30 kg/week. CONCLUSIONS: Japanese women with prepregnant body mass indexes from 18 to 23.9 are least associated with pregnancy complications, although there is a broad range of prepregnant body mass indexes associated with few pregnancy complications. Optimal weight gain is roughly inversely related to prepregnant body mass index.