Placenta praevia: incidence,risk factors and outcome

Objective: Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia.

Methods: Data were prospectively collected from women diagnosed with placenta praevia in 10 Austrian hospitals in in the province of Styria between 1993 and 2012. We analyzed the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. Differences between women with major placenta praevia (complete or partial placenta praevia) and minor placenta praevia (marginal placenta praevia or low-lying placenta) were evaluated.

Results: 328 patients with placenta praevia were identified. The province wide incidence of placenta praevia was 0.15%. Maternal morbidity was high (ante-partum bleeding [42.3%], post-partum hemorrhage [7.1%], maternal anemia [30%], comorbid adherent placentation [4%], and hysterectomy [5.2%]) and neonatal complications were frequent (preterm birth [54.9%], low birth weight <2500?g [35.6%], Apgar-score after five minutes <7 [5.8%], and fetal mortality [1.5%]. Women with major placenta praevia had a significant higher incidence of preterm delivery, birthweight <2500?g and Apgar-score after five minutes <7.

Conclusions: Placenta praevia was associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. The extent of placenta praevia was not related with differences regarding risk factors and maternal outcome.     

Adolescent sexual risk assessment

This article describes the use of a self-administered event history calendar and interviews about sexual partners, sexual activity, and contraception within the broader context of the adolescent's life. Constant comparative analysis was used to analyze the event history calendar interview data. Detailed 5- to 9-year sexual histories were obtained on the event history calendars, including patterns of sexual activity progression and triggers for unintended sexual intercourse. Discussions of protective and risky sexual decision making were stimulated by adolescents' self-report of sexual risk behavior in their own words and reflective responses on the event history calendar. Both the adolescents and the interviewers thought the calendars encouraged recall and discussion of sexual risk behavior.     

Vitamin D deficiency in Egyptian mothers and their neonates and possible related factors

Abstract

Objective: To correlate vitamin D level in Egyptian mothers with that of their newborns, and examine risk factors related to maternal vitamin D deficiency.

Methods: A cross-sectional study was carried out at the university teaching hospital in Cairo, Egypt. Serum 25(OH) D levels were measured by enzyme-linked immunosorbent assay in 135 pregnant women at ≥37 weeks’ gestation immediately before delivery and in cord blood of their newborns.

Results: The levels of serum 25(OH) D were 32.6?±?21.4?ng/ml in mothers and 16.7?±?10?ng/ml in their newborns. Maternal vitamin D level was strongly correlated with that of the newborns (r?=?0.7, p?<?0.0001). Maternal vitamin D deficiency/insufficiency and neonatal vitamin D deficiency/insufficiency were encountered in (40%, 28.9% and 60%, 32.6% respectively). Maternal vitamin D levels showed significant correlations with maternal body mass index (BMI; r?=??0.201, p?=?0.021), gestational age at delivery (r?=?0.315, p?≤?0.0001), fish consumption (r?=?0.185, p?=?0.032), educational level (r?=?0.29, p?=?0.001), and skin exposure (r?=?0.247, p?=?0.004).

Conclusion: Maternal vitamin D levels strongly correlate with neonatal levels. Maternal vitamin D deficiency is a real problem in Egypt; this is generally related to high BMI, low fish consumption, low educational level, and limited skin exposure.     

Prevalence and risk factors associated with the patency of ductus arteriosus in premature neonates: a prospective observational study from Iran

Background: Patent ductus arteriosus (PDA) is a common problem in the preterm infants. The frequency of PDA varies with the time of study, and the characteristics of the population included in the trial.

Aims and objective: To determine the prevalence and prenatal risk factor associated with PDA.

Methods and material: This prospective cross-sectional observational study was carried out on neonates who had gestational age below 37 weeks during the period of February 2014 to September 2014. Echocardiography was done at 4–7 days of postnatal age. The association between prenatal risk factors of the infants and the PDA was studied.

Results: From a total population of 200 enrolled infants 22.5% had PDA. The mean gestational age and birth weight were 32.1?±?2.65 (weeks) and 1741?±?622.85 (g), respectively. Maternal antepartum hemorrhage, respiratory distress syndrome (RDS), need for surfactant, birth weights, female gender, gestational age, Apgar scores at 1 and 5?min of the infants were found to be associated with the prevalence of PDA.

Conclusion: Several prenatal factors make preterm newborns susceptible to PDA. These risk factors should be identified as soon as possible for early commencement of PDA management.     

Evaluation of risk factors can help to predict preterm delivery within 7 days in women hospitalized for threatened preterm labour

Objective: The ability to predict birth within 7 days of enrolment in women hospitalized for threatened preterm labour is essential for a proper decision to introduce corticosteroids for the treatment.

Method: The study included 622 women hospitalized due threatened preterm labour. Eighteen risk factors were analysed. The predictive value for accumulation of studied risk factors was assessed using receiver operating characteristic (ROC) curve analysis and dimension-based models of assessment methods: (i) forward stepwise selection (conditional), (ii) forward stepwise selection (Wald) and (iii) backward stepwise elimination (conditional).

Results: The accumulation of five and above risk factors gives specificity and positive predictive value (PPV) of diagnosis preterm delivery within 7 days of enrolment approaching 100% (99 and 98, respectively). The predictive value for studied risk factors enabled establishing the following order for risk factors significance: (i) cigarette smoking before pregnancy; (ii) low socioeconomic status; (iii) frequent contractions during pregnancy; (iv) bleeding during pregnancy; (v) urinary tract infections.

Conclusion: In women hospitalized for threatened preterm labour, the accumulation of five risk factors of preterm delivery predicts preterm delivery within 7 days of enrolment. That makes easier decision to introduce corticosteroids for the treatment.     

Venous thromboembolism during pregnancy and the post-partum period: incidence and risk factors in a large Victorian health service

BACKGROUND: There is a strong recommendation for post-partum thromboprophylaxis following emergency caesarean sections, particularly in overweight women, and following prolonged labour. AIMS: To analyse the incidence and epidemiological factors associated with antepartum and post-partum venous thromboembolism in a large Victorian health service. METHODS: A retrospective study of all 6987 women delivering at Ballarat Health Services between March 1999 and June 2006. Case notes of women with confirmed venous thromboembolism during this period were subjected to detailed analysis. The data were analysed for possible risk factors, the timing of thromboembolism in relation to the pregnancy and any correlation with thromboprophylaxis, if administered. Results: The rate of venous thromboembolism was 1.14 per 1000 deliveries, with risk factors of age > 30 (100%), obesity (75%), previous history of thromboembolism (62.5%) and caesarean section (37.5%). Majority of cases were diagnosed in first trimester (62.5%), and in the right lower limb (75%). None of the patients had been given thromboprophylaxis. CONCLUSION: While the incidence and risk factors were similar to those generally quoted, a much higher incidence was found in early pregnancy, and in the right lower limb. The importance of meticulous screening for risk factors in early pregnancy cannot be overemphasised.     

子宫内膜癌流行病学及发病因素

子宫内膜癌是女性生殖道三大恶性肿瘤之一,在欧美国家其发病率已占妇科恶性肿瘤的第一位。近年来,包括我国在内的许多发展中国家经济高速发展,人们生活习惯及饮食结构西方化,肥胖人群增多,以及非正规的激素替代治疗等多种因素导致内膜癌发生率明显上升,成为严重威胁发展中国家女性健康的生殖道恶性肿瘤。内膜癌的高危因素包括单纯雌激素的长期刺激、肥胖、糖尿病、高血压、不孕和绝经延迟等。     

Neonatal clavicle fracture in cesarean delivery: incidence and risk factors

Background: Neonatal clavicle fracture in cesarean delivery is rare and has not been extensively studied.

Methods: We performed a retrospective review of cesarean deliveries with neonatal clavicle fracture during a 12-year period. Maternal and neonatal factors as well as surgical factors related to cesarean delivery for the fracture were determined and compared to the control group to analyze their significance.

Results: Among a total 89?367 deliveries during the study period, 36 286 babies were born via cesarean section. Nineteen cases of clavicle fractures in cesarean section were identified (0.05% of total live births via cesarean section). In the analysis of maternal and neonatal risk factors, birthweight, birthweight ≥?4000 g and maternal age were significantly associated with clavicle fracture in cesarean section. However, clavicle fractures were not correlated with the selected surgical factors such as indication for cesarean section, skin incision to delivery time and incision type of skin and uterus. Logistic regression analysis showed that birthweight was the major risk factor for clavicle fracture.

Conclusion: Clavicle fractures complicated 0.05% of cesarean deliveries. The main risk factor related to a clavicle fracture in cesarean section was the birthweight of an infant. As reported in previous studies associated with vaginal delivery, clavicle fracture is considered to be an unavoidable event and may not be eliminated, even in cesarean delivery.     

Prevalence and risk factors of severe obstetric haemorrhage

Objective  To determine the prevalence, causes, risk factors and acute maternal complications of severe obstetric haemorrhage.
Design  Population-based registry study.
Population  All women giving birth (307 415) from 1 January 1999 to 30 April 2004 registered in the Medical Birth Registry of Norway. Information about socio-economic risk factors was obtained from Statistics Norway.
Methods  Cross-tabulation was used to study prevalence, causes and acute maternal complications of severe obstetric haemorrhage. Associations of severe obstetric haemorrhage with demographic, medical and obstetric risk factors were estimated using multiple logistic regression models.
Main outcome measure  Severe obstetric haemorrhage (blood loss of > 1500 ml or blood transfusion).
Results  Severe obstetric haemorrhage was identified in 3501 women (1.1%). Uterine atony, retained placenta and trauma were identified causes in 30, 18 and 13.9% of women, respectively. The demographic factors of a maternal age of ≥30 years and South-East Asian ethnicity were significantly associated with an increased risk of haemorrhage. The risk was lower in women of Middle Eastern ethnicity, more than three and two times higher for emergency caesarean delivery and elective caesarean than for vaginal birth, respectively, and substantially higher for multiple pregnancies, von Willebrand's disease and anaemia (haemoglobin <9 g/dl) during pregnancy. Admissions to an intensive care unit, postpartum sepsis, hysterectomy, acute renal failure and maternal deaths were significantly more common among women with severe haemorrhage.
Conclusion  The high prevalence of severe obstetric haemorrhage indicates the need to review labour management procedures. Demographic and medical risk factors can be managed with extra vigilance.     

子痫前期复发危险因素分析

Objective?The purpose of this study was to investigate the related risk factors of recurrent preeclampsia. Methods?Medical documents of 115 women who had second singleton pregnancy with the previous pregnancy complicated with preeclampsia were retrospectively analyzed from January 2010 to December 2020. These women were divided into two groups, 71 with preeclampsia and 44 without preeclampsia in the subsequent pregnancy. Data was analyzed using univariate analysis and multivariate logistic regression. Results?① Univariate analysis showed that the pre-pregnancy blood pressure, body mass index(BMI), delivered gestational weeks, NICU, birth weight, maternal serum ALB/CR/LDH have an effect on the recurrence of preeclampsia(P<0.05). ② The diagnostic gestational age and pre-existing chronic hypertension of previous pregnancy may have an effect on the recurrence of preeclampsia(P<0.05).③ After adjusting for confounding factors, the recurrence of preeclampsia was found to be influenced by the level of systolic blood pressure before the subsequent pregnancy (OR=1.135, 95%CI 1.067~1.205, P=0.000). Conclusion?The level of systolic blood pressure before the subsequent pregnancy is an independent risk factor for the recurrence of preeclampsia.     

Obstetrician-gynecologists' knowledge of preterm birth frequency and risk factors

Objectives. To assess obstetrician-gynecologists' knowledge of preterm birth, including prevalence, risk factors, and utility of various tests in predicting increased risk.

Methods. A questionnaire was mailed to 1193 members of the American College of Obstetricians and Gynecologists.

Results. The response rate was 59%. The majority of respondents were familiar with basic preterm birth prevalence rates. However, 21% underestimated the proportion of women with presumptive preterm labor in whom preterm birth will not occur. The majority (55%) overestimated the proportion of preterm births accounted for by multiples. Twelve percent indicated bed rest as a proven method for improving newborn outcome. Respondents were fairly accurate as to which factors produce the biggest increased risk of spontaneous preterm labor or rupture of membranes; however, they tended to overestimate the risk associated with smoking, hypertension, and non-gestational diabetes. They tended to underestimate, or were unsure of, the predictive value of positive fetal fibronectin (fFN) test results or short cervical length.

Conclusions. Obstetrician-gynecologists' basic knowledge concerning preterm birth prevalence and risk factors was adequate. However, they tended to overestimate the risk associated with various maternal factors and underestimate the predictive value of various test results.     

Prenatal and perinatal risk factors of schizophrenia

Schizophrenia could be considered the most severe of all psychiatric disorders. It shows a heterogeneous clinical picture and presents an etiopathogenesis that is not cleared sufficiently. Even if the etiopathogenesis remains a puzzle, there is a scientific consensus that it is an expression of interaction between genotype and environmental factors. In the present article, following a study of literature and the accumulated evidence, the role of prenatal and perinatal factors in the development of schizophrenia will be revised and synthesized. We think that better knowledge of the risk factors could be helpful not only for better comprehension of the pathogenesis but especially to optimize interventions for prevention of the disorder.     

死胎病因及管理

死胎的主要原因包括妊娠前母体疾病,如糖尿病,以及妊娠期并发症,如产前出血、妊娠期肝内胆汁淤积症、胎儿生长受限、单绒毛膜双胎、感染等。脐动脉彩色超声多普勒有助于预测死胎病因。小剂量阿司匹林（60～80 mg）有助于预防高危妊娠孕妇发生子痫前期及其他不良围生期结局。死胎尸检、胎盘病理检查和胎母出血检测等是死胎病因检查的基本手段。     

Prenatal and postnatal factors increase risk of severe ROP

Abstract

To determine that slower weight premature twins have more risk to develop severe retinopathy of prematurity (ROP) than the higher weight twins. We know that the lower weight twins had less optimal intra-uterine environments than their higher weight twins. We screened 94 consecutive premature twins for ROP. We compared the lower weight twins (n?=?47) against their higher weight twins (n?=?47). The risk of severe ROP (ROP stage 3 or greater) was significantly higher in the lower weight twin group (p?<?0.006). In the same way, in the lower weight twin group the non-perfused area of the temporal retinal artery was higher than that of the other group (an average of 1.2 diameters of the optic nerve head), in the 4–6 postnatal weeks (p?<?0.004). The lower weight twin group have an increased risk of severe ROP associated with bacteremia (p?=?0.045), or a weight gain less than 7?g per day in the 4–6 postnatal weeks (p?=?0.013) or a supplementary postnatal oxygen >4 days (p?=?0.007) compared to the higher weight twin group. We confirm Dr. Lee's work that less optimal prenatal factors, in preterm twins, increase the risk of severe ROP.     

Association between internal cervical os stenosis and other female infertility risk factors

Introduction

Cervical factor infertility accounts for approximately 5% of all female infertility risk factors, and may occur congenitally or acquired. Endometriosis and polyp were recognized as the common findings in women with stenosis of the external cervical os in a few studies.

产后出血危险因素及高危评分系统临床价值研究

目的 探讨发生产后出血的危险因素,以及建立产后出血高危评分系统和风险预测方程的临床应用价值。方法 选择2008年12月至2009年12月在福建省妇幼保健院进行系统产前检查并住院分娩的212例产后出血患者作为病例组,采用1∶2病例对照研究方法选择同期住院分娩未发生产后出血的424例产妇作为对照组;采用单因素分析筛选产后出血高危因素。在全国产后出血防治协作组拟定“产后出血预测评分表”（简称“评分表”）基础上,用筛选出的高危因素建立较全面的“产后出血高危评分系统”（简称“评分系统”）。通过受试者工作特性（receiver–operating characteristics,ROC）曲线下面积（AUC）评价并比较评分表和评分系统工作效能。结果 产后出血发生率为3.07%,其中严重产后出血发生率为15.56%。产后出血危险因素有孕妇年龄、产次、人工流产史、孕早期体重指数（BMI）、产前宫底高度、双胎或多胎妊娠、产前血小板计数（PLT）、前置胎盘、妊娠期高血压疾病、妊娠合并子宫肌瘤、胎儿腹围、羊水过多、分娩方式、子宫切口延裂、产道裂伤、第一产程异常、第三产程延长、胎盘粘连或植入、新生儿体重。用评分系统评分,若总评分≥6分或产前评分≥4分者发生产后出血危险性明显增加。评分表预测产后出血的ROC曲线AUC为0.657,评分系统评估产后出血的AUC为0.805。产后出血风险预测方程为：Z=1-1/［1+exp(-3.216+0.482×产前评分+0.452×产时产后评分)］或Z=1-1/［1+exp(-3.187+0.469×总评分)］;严重产后出血风险预测方程为：Z=1-1/［1+exp(-3.715+0.146×总评分)］。结论　产后出血发生与孕妇及胎儿因素、妊娠并发症及合并症、产程等均密切相关。评分系统总评分≥6分者或产前评分≥4分者应纳入产后出血重点监护范围。评分系统与评分表相比有较强预测产后出血的效能。     

Current controversies regarding pain assessment in neonates

Although over 40 methods of pain assessment in infants are available for use in clinical practice, unrecognized and under-treated pain remains one of the most commonly reported problems within the Neonatal Intensive Care Units. A number of factors have been found to account for differences in the robustness of the pain response in neonates of varying gestational ages. Discrepancies between behavioral and physiological pain indicators have also been reported. With newer technologies, there is an opportunity not only to verify infant pain perception, but these tools may allow an identification of which of the observed indicators are most sensitive in particular clinical situations. The current controversies regarding pain assessment in preterm and term infants are reviewed to define the most important issues and to develop a dialogue for future directions.