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.     

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.     

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.     

Maternal and neonatal outcomes in triplet gestations by trial of labor versus planned cesarean delivery*

Objective: To determine the rate of vaginal delivery after vaginal trial of labor (TOL) among women with triplet gestations.

Study design: This is a retrospective cohort study of all women delivering a viable triplet gestation between 2005 and 2016. The primary outcome was rate of vaginal delivery among all women attempting vaginal delivery. Secondary outcomes included factors associated with undergoing triplet TOL, and maternal and neonatal complications by planned delivery approach.

Results: Of the 83 eligible women, 21 (25.3%) underwent TOL. A majority of these (57.1, 95% confidence interval 36.5–75.5%) achieved a vaginal delivery of all three triplets. Women who underwent TOL were more likely to be multiparous or to have spontaneous preterm labor. There were no differences in adverse maternal or neonatal outcomes by planned delivery approach.

Conclusions: The rate of vaginal delivery among women with triplet gestations is higher in this institution than in reported literature, without increased morbidity.     

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.     

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.     

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.     

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.     

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.     

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     

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.     

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.     

Quality of life in Japanese couples during the transition to parenthood

Objective: This study aimed to examine the quality of life (QOL) in Japanese couples during the transition to parenthood with their first child.

Background: Relevant literature suggests that the health status of women drop during pregnancy and the postpartum period. However, less is known about their partner’s well-being during the transition to parenthood and little research has addressed the relationship between couples’ QOL across multiple domains.

Method: Participants included 9216 married Japanese men and women, including 3729 couples, who were expecting or raising their first child under the age of three. They independently completed questionnaires on baseline demographics and on WHOQOL-BREF.

Results: Men showed higher scores for psychological QOL, while women had higher scores for social and environment QOL. A significant interaction between gender and stage of transition to parenthood was found. The moderating effect of age between the stage and QOL was found for men on the physical and psychological domains. Couples’ QOL scores were weakly to moderately correlated.

Conclusion: Findings suggest that both men and women had lower QOL, with the exception of women’s physical QOL, after childbirth, but they showed different trends during the transition to parenthood across different domains of QOL.     

Circulating HO-1 levels are not associated with plasma sFLT-1 and GTn HMOX1 polymorphism in preeclampsia

Objectives: We aimed to assess the plasma HO-1 level and its interrelationship with the plasma sFLT-1 level in preeclamptic and healthy pregnant women with different variants of microsatellite polymorphism (GTn) located in the promoter region of the HMOX-1 gene.

Methods: HO-1 and sFLT-1 were measured by ELISA. HMOX1 genotyping was performed using fragment analysis.

Results: We found similar and higher levels of plasma HO-1 and sFLT-1, respectively, in preeclampsia. Similar genotypes and alleles frequencies were found in both groups and the absence of modulation of HO-1 levels by genotypes were observed.

Conclusion: The plasma HO-1 levels are not increased in preeclampsia women and neither related to sFLT-1 levels and GT_n polymorphism.     

Cardiac function and tadalafil used for treating fetal growth restriction in pregnant women without cardiovascular disease

Background: The aim of the present study was to evaluate tadalafil for the treatment of fetal growth restriction (FGR) and the cardiac function in pregnant women without cardiovascular disease who used tadalafil for this reason.

Materials and methods: We examined nine pregnant women without cardiovascular disease who were using tadalafil to treat FGR. Maternal heart rate, systolic blood pressure (BP), and echocardiographic findings were assessed before and after tadalafil use.

Results: Diastolic BP was lower after compared to that before using tadalafil, but the difference was not significant. Echocardiographic findings were not significantly different before and after tadalafil use.

Conclusions: Tadalafil did not adversely affect pregnant women without cardiovascular disease and was considered acceptable for use since it did not affect the mother’s cardiac function.     

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.     

Israeli and British women's wellbeing and eating behaviours in pregnancy and postpartum

Objectives: The study had two main objectives: (a) track changes in self-esteem, eating behaviours and body satisfaction from early pregnancy to 24 months postpartum and (b) to compare changes by context (Israel vs. UK) and maternal body mass index (BMI).

Background: High maternal BMI is associated with negative body image and restrained eating, which are experienced differently across cultures.

Methods: 156 pregnant women were recruited from Israel and the UK. Seventy-three women were followed up every six months from early postpartum and until 24 months following birth. Women completed questionnaires assessing self-esteem (RSEQ), body image (BIS/BIDQ) and eating behaviours (DEBQ) and self-reported weights and heights so that BMI could be calculated.

Results: Women with higher BMI had higher levels of self-esteem and were less satisfied with their body. Healthy-weight women were more likely to lose all of their retained pregnancy weight compared to overweight and obese women. Self-esteem, body image and eating behaviours remained stable from pregnancy until 24 months postpartum. No significant differences were found for any measure by context.

Conclusion: BMI was the strongest predictor of self-esteem and body dissatisfaction and a higher BMI predicted less weight loss postpartum.     

PTSD post-childbirth: a systematic review of women’s and midwives’ subjective experiences of care provider interaction

Objective: Review primary research regarding PTSD Post-Childbirth (PTSD-PC) that focussed on Quality of Provider Interaction (QPI) from the perspective of women who developed PTSD-PC, or midwives.

Background: Up to 45% of women find childbirth traumatic. PTSD-PC develops in 4% of women (18% in high-risk groups). Women’s subjective experiences of childbirth are the most important risk factor in the development of PTSD-PC, with perceived QPI being key.

Methods: A systematic search was performed for PTSD-PC literature. Reviewed papers focussed on either women’s subjective childbirth experiences, particularly QPI, or midwives’ perspectives on QPI. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tools, and a narrative synthesis of findings produced.

Results: Fourteen studies were included. Three features of QPI contribute towards developing PTSD-PC: interpersonal factors; midwifery care factors; and lack of support.

Conclusion: QPI is a significant factor in the development of PTSD-PC and the identified key features of QPI have potential to be modified by midwives. The development of guidelines for midwives should be grounded on evidence highlighted in this review, along with further high-quality qualitative research exploring QPI from the perspective of women with PTSD-PC, but also midwives’ knowledge and needs regarding their role within QPI.