Antenatal Complications Research Articles

Mothers and their children\u2019s health (MATCH): a study protocol for a population\u2010based longitudinal cohort

BackgroundThe quality of prenatal care is critical for the prevention of adverse pregnancy outcomes. However, according to the World Health Organization (WHO), only 64 % of women worldwide have access to over four sessions of prenatal care throughout their pregnancy. Thus, studies that address factors affecting maternal and child health status before and after pregnancy are of immense importance. The primary aim of the mothers and their children’s health (MATCH) cohort study is to evaluate the effect of nutrition, sleep quality, and lifestyle on maternal and neonatal outcomes.MethodsA prospective cohort of > 2500 pregnant women in the first trimester (before 12 weeks’ gestation) will be recruited at Arash Women’s Hospital in Tehran, Iran between February 2020 and August 2021. All eligible pregnant women will be followed from their first trimester of pregnancy until delivery at four time points and assessed through a series of in-person visits with interviewer-administered questionnaires and telephone interviews. Detailed data will be collected on maternal demographics, lifestyle, medical history, reproductive history, obstetric history, dietary intake, sleep pattern, blood specimens, and anthropometric measurements, alongside paternal demographics, lifestyle, and family history. The outcomes will include antenatal, peripartum, and postnatal maternal complications and infant growth and neurodevelopment.DiscussionThe results of the MATCH cohort study will support the development of contextual interventions that can enhance antenatal, peripartum, and postnatal status, neonatal outcomes, and longevity mother and child.

Disparities between US Hispanic and non-Hispanic women in obesity-related perinatal outcomes: a prospective cohort study

Background Mortality figures and national health surveillance data have demonstrated that Hispanics have a 24% lower risk of all-cause mortality compared to their non-Hispanic counterparts despite increased rates of obesity and related illnesses. Objective The aim of this study is to evaluate if this paradox exists for obesity-related perinatal outcomes in otherwise low-risk Hispanic women. Materials and methods A prospective cohort study of low-risk women across all BMI classes with a singleton, non-anomalous term pregnancy admitted in active labor or undergoing induction of labor between May 2014 and April 2017. All demographic, obstetric, and neonatal outcomes were recorded, and the body mass index (BMI) closest to delivery was used for analysis. Data including composites of adverse maternal and neonatal outcomes were compared across BMI classes and between individuals of Hispanic and non-Hispanic ethnicity. Women with antenatal complications, prior cesarean delivery, and cesarean for non-reassuring fetal status were excluded. Results Of the 11,369 women who met inclusion criteria, 6303 (55%) were Hispanic. Eight percent of Hispanic women were normal weight (BMI: 18.5–24.9), 34% were overweight (BMI: 25–29.9), and 58% were obese (BMI > 30). Fourteen percent of non-Hispanic women were normal weight, 42% were overweight, and 44% were obese. The majority (65%) of women were multiparous. Rate of induction and birthweight increased across BMI for Hispanic and non-Hispanic groups, however the route of delivery was not significantly different (p = .22, 0.16, respectively). Although the association between BMI and composite perinatal complications did not differ by BMI class and ethnicity, the newborns of non-Hispanic women were more likely to be admitted to the neonatal intensive care unit with increasing maternal weight class (<0.001), even after adjusting for age, parity, marital status, prenatal visits, current tobacco use, type of labor, mode of delivery, and birthweight. Conclusion There were no demonstrable differences in composite adverse maternal or neonatal outcomes between Hispanic and non-Hispanic obese women. However, newborns of non-Hispanic obese women were more likely to be transferred to the neonatal intensive care unit with increasing maternal BMI.

PLACENTA PREVIA AND PLACENTA ACCRETA SPECTRUM (PAS) DISORDER: INCIDENCE, RISK FACTOR AND FETOMATERNAL OUTCOME IN A TERTIARY CARE CENTER

Introduction: Placenta Previa is characterised by Placental implantation into the lower uterine segment covering whole or part of the cervix . It complicates 0.4% of pregnancy at term The average incidence is 0.3% or 1 case per 300 to 400 deliveries. The presence of placenta previa can also increase a woman's risk for placenta accreta spectrum (PAS). This spectrum of conditions includes placenta accreta, increta, and percreta. Uncontrolled postpartum hemorrhage from placenta previa or PAS may necessitate a blood transfusion, hysterectomy thus leaving the patient infertile, admission to the ICU, or even death. Material and method: Study was conducted in department of obstetrics &amp; gynecology , swaroop rani hospital, Allahabad for 1 year . A total of 102 pregnant women presenting to antenatal OPD or admitted in IPD with history of antepartum hemorrhage and conrmed case of PP or MAP in Ultrasonography were selected. The follow up till the fetomaternal outcome was done and risk factors were evaluated for 102 cases. Result: Out of the total 2342 deliveries in one year 95 patients had PP and the incidence was 4.04% and 7 patients had morbidily adherent Placenta which accounts to an incidence of 0.29%. Previous LSCS, Multiparity, increase maternal age, Dialatation and curettage were risk factors in both Placenta Previa and Morbidily Adherent Placenta. Antenatal complication were antepartum hemmorrhage , Anemia, preterm labor. Emergency LSCS is more common mode of delivery in cases of Placenta previa. Caesarean hysterectomy were done in 3.2% cases of Placenta Previa and all cases of Morbidily adherent placenta . Most common perinatal complications in both groups were prematurity and low birth weight. Conclusion: Now a days Placenta previa and Morbidily adherent placenta are very common. Incidence increases as the rate of cesaerean section or abdominal surgery were increases.Earlydiagnosis and pre plan mode of delivery will decrease the risk of prematurity and low birth weight.

Antenatal Complications in Grand Multipara Presented at Tertiary Care Hospital

Background: Grand multiparity considered as a risk factor of obstetrics because of the recorded complications linked to the condition. Grand multiparity typically considered as the distinctive reason for the raised, maternal and fetal morbidity and mortality because of expanded incidence of adverse outcome during pregnancy and birth. Objective: To determine frequency of antenatal complications in grand multipara. Study Design: Cross-sectional study. Settings: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi Pakistan. Duration: Study duration was six months from March 2016 September 2016. Methodology: Total 212 patients were included in this study. Anemia was taken as Hb of 11g/dl, PIH was taken as BP of &gt;140/90mmHg after 20 weeks of gestation with or without proteinuria on two or more occasion 6 hours apart and placenta previa was confirmed via ultrasonography. All the information was collected via study proforma. Results: Patients mean age was 34.90±3.51 years. Most of the patients 96.7% had parity 5-9. Anemia was found 69.8% and pregnancy induced hypertension was 22.2%, while placenta previa was found to be 18.9%. Antenatal complications including anemia, pregnancy induced hypertension and placenta previa were found to be statistically insignificant according to age, parity and BMI, (p-&gt;0.05). Conclusion: Most common antenatal complication in this study was anemia followed by hypertension and placenta previa. Grand multiparity is at a greater risk of antenatal complications.

RELATIONSHIP BETWEEN THE DELAY IN MAKING A TIMELY DECISION TO SEEK MEDICAL ASSISTANCE AND PERINATAL MORTALITY IN LURAMBI AND BUTERE SUB-COUNTIES, KAKAMEGA COUNTY, KENYA

Purpose: To determine the relationship between the delays in making a timely decision to seek medical assistance and perinatal mortality in Lurambi and Butere sub-counties, Kakamega County, Kenya.&#x0D; Methodology: A community based retrospective cross-sectional research design was adopted using mixed methods for data collection. A total of 520 respondents were randomly selected from 40 out 830 villages of Lurambi and Butere sub-counties using multistage cluster sampling. The respondents were interviewed from November 2017 to March 2018. Data entry and analysis was done using SPSS Version 21 software. Descriptive and inferential statistical analyses were used. Bivariate and multivariate logistic regressions were applied and adjusted odds ratio was used to determine the strength of association. A p-value of ≤ 0.05 was considered as statistically significant.&#x0D; Findings: Education level (p&lt;0.02) and employment status (p&lt;0.03) of mothers influenced perinatal mortality. Wrong action taken during an experience of antenatal complication (AOR= 0.6; 95% CI: 0.1 – 0.9; p = 0.03), emergency unpreparedness (AOR=0.1; 95%CI: 0.04-0.42; p=0.0007) and, lack of recognition of newborn danger signs (AOR=01; 95%CI: 01-0.4; p&lt;0.0001) were significantly associated with perinatal mortality. Birth preparedness and complication readiness during pregnancy and childbirth, based on the study findings reduce delay in obtaining care. Strengthening maternal education and social support system along the continuum of care during pregnancy, delivery and post-natal periods is paramount to ensure newborn survival.&#x0D; Unique Contribution to Theory, Practice, and Policy: Unique factors are that apart from medical interventions, strengthening maternal education and social support system along the continuum of care during pregnancy, delivery and post-natal periods is paramount to ensure newborn survival in Lurambi and Butere sub counties. Interventions to promote informed decisions regarding maternal and newborn care with a strong social support system are critical. These results contribute to maternal and newborn health care practice and policy change that if implemented could result in a reduction of perinatal mortalities.

Maternal medicine in the COVID era.

The coronavirus disease-19 (COVID-19) pandemic has directly and indirectly impacted pregnant women with co-morbidities or antenatal medical complications, through vulnerability to the severe effects of COVID-19 and service reconfiguration. Women with diabetes or hypertension in pregnancy are at higher risk of admission to intensive care, need for invasive ventilation and death from COVID-19. Suggested service modifications specific to maternal medicine services include home measurement of blood glucose or blood pressure, the use of risk calculators, adaptations to screening criteria for gestational diabetes and monitoring of obstetric cholestasis. Neither the added risk of COVID-19 on pregnant women with medical comorbidities nor the impact of maternal medicine service modifications has yet been established.

Characteristics associated with uncomplicated pregnancies in women with obesity: a population-based cohort study

BackgroundApproximately one in five pregnant women have obesity. Obesity is associated with an increased risk of antenatal, intrapartum, and perinatal complications, but many women with obesity have uncomplicated pregnancies. At a time where maternity services are advocating for women to make informed choices, knowledge of the chance of having an uncomplicated (healthy) pregnancy is essential. The objective of this study was to calculate the rate of uncomplicated pregnancy in women with obesity and evaluate factors associated with this outcome.MethodsThis prospective cohort study was conducted using the Ontario birth registry dataset in Canada (703,115 women, April 2012–March 2017). The rate of uncomplicated or complicated composite pregnancy outcomes (hypertensive disorders of pregnancy, gestational diabetes, preterm birth, neonate small- or large- for gestational age at birth, congenital anomaly, fetal death, antepartum bleeding or preterm prelabour membrane rupture) were calculated for women with and without obesity. Associations between uncomplicated pregnancy and maternal characteristics were explored in a population of women with obesity but without other pre-existing co-morbidities (e.g., essential hypertension) or obstetric risks identified in the first trimester (e.g., multiple pregnancy), using log binomial regression analysis.ResultsOf the studied Ontario maternity population (body mass index not missing) 17·7% (n = 117,236) were obese. Of these 20·6% had pre-existing co-morbidities or early obstetric complicating factors. Amongst women with obesity but without early complicating factors, 58·2% (n = 54,191) experienced pregnancy without complication; this is in comparison to 72·7% of women of healthy weight and no early complicating factors. Women with obesity and no early pregnancy complicating factors are more likely to have an uncomplicated pregnancy if they are multiparous, younger, more affluent, of White or Black ethnicity, of lower weight, with normal placental-associated plasma protein-A and/or spontaneously conceived pregnancies.ConclusionsThe study demonstrates that over half of women with obesity but no other pre-existing medical or early obstetric complicating factors, proceed through pregnancy without adverse obstetric complication. Care in lower-risk settings can be considered as their outcomes appear similar to those reported for low-risk nulliparous women. Further research and predictive tools are needed to inform stratification of women with obesity.

Autoimmune Hemolytic Anaemias in Pregnancy: Experience in a Tertiary Care Hospital in South India.

Autoimmune hemolytic anaemia is very rare and there is limited data regarding their pregnancy outcomes. Hence we aimed to study the maternal and perinatal outcomes in pregnancies with autoimmune hemolytic anaemias (AIHA). A retrospective descriptive study of pregnant women with AIHA, who delivered at SJMCH between January 2011 and January 2016 was carried out. Their antenatal and labour records were reviewed and demographic details noted.The primary outcome measures studied were-the prevalence of AIHA, gestational age at delivery, antepartum, intrapartum and postpartum complications, mode of delivery and requirement of transfusion of blood and blood products. The secondary outcome measures studied included neonatal outcomes such as low birth weight, intrauterine growth restriction and need for intensive care. The data is presented as descriptive statistics, including means and percentage. The prevalence of AIHA was (18/12,420) 0.14%. The mean gestational age at delivery was 34weeks; 100%, 77% and 50% had antenatal, intra partum or postpartum complications, respectively. 44% had preeclampsia, 38% intrauterine growth restriction and 16% preterm labour. 83% required additional drugs for treatment of AIHA.72% had vaginal delivery; 28% had caesarean delivery; 33% were transfused antenatally and 22% postnatally; 50% of the babies were preterm and required intensive care, 66% had low birth weight. There was no maternal mortality. Multidisciplinary approach, early diagnosis and detection of autoimmune hemolytic anaemia and complications, good antenatal care, judicious transfusions and delivery at tertiary care centre are the keys to successful outcomes.

The Challenge of Identifying Causal Pathways Leading to Cerebral Palsy.

Cerebral palsy (CP) is a heterogeneous disorder relating to permanent motor disabilities, neuroimaging findings, subtypes, associated impairments, and etiologies. Although the exact etiology of CP is often impossible to establish, several antenatal, perinatal, and postnatal risk factors have been identified. The birth prevalence of CP has been stable at ∼2 per 1000 for several decades.1 However, recent studies reveal a decreasing trend in prevalence in some high-income countries.2–4 This decrease has not been ascribed to new specific preventive interventions but to general improvements in antenatal, obstetric, and neonatal care.In this issue of Pediatrics, Strøm et al5 report that offspring of mothers with a wide range of chronic maternal conditions have an increased risk of developing CP. With a robust data set, including >1 million live-born children recorded in Norwegian health registries, they found that several autoimmune conditions had twofold to threefold increased adjusted relative risks (aRRs) of developing CP. The highest aRRs were observed for diabetes type 2 (aRR: 3.2), lupus erythematosus (aRR: 2.7), and diabetes type 1 (aRR: 2.2) as compared with mothers without these conditions.The study reveals both strengths and limitations of large population-based registry studies. A major strength of such studies is that they have the potential to identify associations between rare exposures and rare outcomes and generate hypotheses for further etiologic and treatment studies. In contrast, researchers using large population-based registries have limited access to detailed information necessary to study mechanisms in more detail.In many studies, researchers have proposed that a causal pathway or an effect of multiple overlapping risk factors may lead to CP. This includes antenatal disorders and complications (70%–80% of children with CP) and perinatal and postnatal events.6–8 As the number of risk factors increases, the risk of developing CP increases.8,9 Strøm et al5 found the aRR of CP to be 3.4 in pregnancies in which the mothers had ≥2 chronic conditions as opposed to mothers with no chronic condition. Yet, as the authors state, the absolute risk of CP associated with ≥1 chronic maternal condition is low. Among 1000 pregnant women with any chronic and/or autoimmune disorder, >990 will deliver an infant who will not be diagnosed with CP. This low absolute risk is important to keep in mind when discussing with women who have a chronic and/or autoimmune disorder and are planning to become or already are pregnant and their partner.The authors underscore that the observed associations may not reflect a causal relationship and that they lack information on disease activity, duration, and treatment. Thus, the study cannot give clues to any specific preventive treatment. However, if these disorders are part of a causal pathway, optimal treatment might reduce the risk of CP. It is well documented that optimal control of diabetes types 1 and 2 at conception or during pregnancy reduces the risk of congenital malformations and complications at delivery.10–12 Both congenital malformations and complications at delivery are associated with CP.13,14 It is reasonable to speculate that optimal disease control of other autoimmune disorders could also prevent a few cases. Even so, a potential reduction in children with CP due to optimized care of these rare disorders would hardly affect the birth prevalence of CP. Still, as the Royal College of Obstetricians and Gynaecologists in the United Kingdom states, “each baby counts.”15The findings of this study may point to biological pathways, as discussed by the authors. The increased risk associated with autoimmune disorders could initiate further research into inflammatory mechanisms and the role of the placenta, the latter being probably the most important, but at the same time the least explored, organ in the etiology of CP. However, the path from the findings in the study by Strøm et al5 to “biological pathways for which interventions could be possible” is likely to be long.

Prevalence and determinants of asphyxia neonatorum among live births at Debre Tabor General Hospital, North Central Ethiopia: a cross-sectional study.

More than one third of the neonatal deaths at Neonatal Intensive Care Unit of Debre Tabor General Hospital (DTGH) are attributable to birth asphyxia. Most of these neonates are referred from maternity ward of the hospital. However, there is no recent evidence on the prevalence and specific determinants of birth asphyxia at DTGH. Besides, public health importance of factors like birth spacing weren't addressed in the prior studies. A cross sectional study was conducted on a sample of 240 newborns at delivery ward. The collected data were cleaned, coded and entered into Epi -data version 4.2 and exported to Stata version 14. Binary logistic regression model was considered and statistical significance was declared at P< 0.05 using adjusted odds ratio. The prevalence of asphyxia neonatorum was 6.7 % based on the fifth minute APGAR score. From multi-variable logistic regression analysis, antenatal obstetric complications (AOR = 2.63, 95% CI: 3.75, 14.29), fetal malpresentation (AOR = 3.17, 95% CI: 1.21, 15.20), premature rupture of fetal membranes (AOR = 6.56, 95% CI: 3.48, 18.12) and meconium stained amniotic fluid (AOR = 2.73, 95% CI: 1.76, 14.59) were significant predictors. The prevalence of fifth minute asphyxia neonatorum was relatively low. Fortunately, its predictors are modifiable. Thus, we can mitigate the problem even with our limited resources such as enhancing the existing efforts of antenatal and intra-partum care, which could help early detection and management of any obstetric and neonatal health abnormality."

MATERNAL OBESITY AND OBSTETRIC OUTCOME IN PREGNANT WOMEN ATTENDING PNS SHIFA KARACHI

Objective: To evaluate the impact of obesity on maternal and neonatal outcome.&#x0D; Study Design: Comparative cross sectional study.&#x0D; Place and Duration of Study: Department of Gynaecology and Obstetrics, Pakistan Naval Ship, Shifa HospitalKarachi, from Nov 2016 to Oct 2017.&#x0D; Methodology: All singleton pregnant women of normal prepregnancy body mass index (BMI) and obese women having ≥30 body mass index, delivering newborn at 28-42 weeks of gestation were included. Comparison of antenatal complications and neonatal outcomes was done among both groups.&#x0D; Results: Obese women significantly developed gestational hypertension (OR=7.4 95% CI, 4.84-11.4), preeclampsia (OR=2.22 95% CI, 1.36-3.6), gestational diabetes mellitus (OR=5.2; 95% CI, 3.57-7.58), labor induction (OR= 2.79 95% CI, 2.03-3.84), failed induction of labor (OR = 5.3 95% CI, 8.05-29.38), cesarean delivery (OR=1.89 95% CI, 1.41-2.5), large for gestational age newborn (OR=3.97 95% CI, 2.87-5.50). But there was no statistically significant difference in small for gestational age newborn (OR=0.91 95% CI, 0.42-1.98), new born with APGAR score ≤7 after 5 min after delivery (OR=2.168 95% CI, 0.97-4.82) among obese and normal weight pregnant women.&#x0D; Conclusion: There is increased risk of gestational hypertension, preeclampsia, gestational diabetes, failed induction of labor, dystocia, cesarean delivery and large for gestational age newborns in obese women.Keywords: , , , , ,

Congenital eyelid imbrication syndrome in a neonate: A rare case

A full-term newborn was examined after lower segmental cesarean section. There were no antenatal complications. Clinically, there was overlapping of upper lids over lower eyelids when the baby was crying, but reduced when the baby was asleep. The upper eyelids became normal within 2 days of delivery without any treatment. We report one such case.

STUDY OF MATERNAL BMI AT TERM PREGNANCY AND PREGNANCY OUTCOME

Background: The health and quality of life of a pregnant women and her baby is determined by the nutritional status. The risks of extremes of maternal nutritional status and the related pregnancy complications is a growing problem. Maternal surveillance can be done better with the knowledge of maternal BMI and it helps in the prevention of complications. Aim: To determine the association between maternal BMI at term pregnancy and its antenatal maternal complications, labour and neonatal complications and to evaluate the risk of developing adverse maternal and foetal outcomes in women with extremes of BMI. Study design: Prospective observational study. Materials And Methods: 1000 antenatal women with singleton live pregnancies within 37-42 weeks of gestational age attending ANOPD or ELR were included to study the effect of maternal BMI at term pregnancy and pregnancy outcomes. Results: Obese women had the highest incidence and highest risk of developing antenatal complications like GDM (7.6%) (p=0.02), PIH (17.6%) (p&lt;0.0001), preeclampsia (12.8%) (p&lt;0.01) and labour outcomes such as instrumental vaginal deliveries (9.3%) (p&lt;0.05), LSCS (52.3%) (p&lt;0.0001) and early puerperal outcomes such as PPH (18.1%) (p=0.0002) and delayed wound healing (10.4%) (p=0.0006). Obese women also had the highest incidence and highest risk of neonatal outcomes such as LGA babies (12%) (p=0.0002) and NICU admission (11.9%) (p=0.01). Underweight women had the highest incidence and highest risk of anaemia (57.3%) (p&lt;0.0001) and delivering SGA babies (21%) (p&lt;0.0001). Conclusion: The present study establishes the adverse maternal and neonatal outcomes associated with the extremes of maternal BMI. This study emphasizes the importance of the nutritional status and health of mothers which helps to reduce the adverse outcomes.

Maternal and infant morbidity following birth before 27 weeks of gestation: a single centre study

Delivery at extreme preterm gestational ages (GA) <;27 weeks is challenging with limited evidence often focused only on neonatal outcomes. We reviewed management and short term maternal, fetal and neonatal outcomes of births for 132 women (22 + 0 to 26 + 6 weeks’ GA) with a live fetus at admission to hospital and in labour or at planned emergency Caesarean section: 103 singleton and 29 (53 live fetuses) twin gestations. Thirty women (23%) had pre-existing medical problems, 110 (83%) had antenatal complications; only 17 (13%) women experienced neither. Major maternal labour and delivery complications affected 35 women (27%). 151 fetuses (97%) were exposed to antenatal steroids, 24 (15%) to tocolysis and 70 (45%) to magnesium sulphate. Delivery complications affected 11 fetuses, with 12 labour or delivery room deaths; survival to discharge was 75% (117/156), increasing with GA: 25% (1/4), 75% (18/24), 69% (29/42), 73% (33/45) and 88% (36/41) at 22, 23, 24, 25 and 26 weeks GA respectively (p = 0.024). No statistically important impact was seen from twin status, maternal illness or obstetric management. Even in a specialist perinatal unit antenatal and postnatal maternal complications are common in extreme preterm births, emphasising the need to include maternal as well as neonatal outcomes.

Role of Ambulatory Blood Pressure Monitoring in Predicting Adverse Maternofetal Events in Pregnancy

Abstract Aims To correlate the relationship between the ambulatory blood pressure parameters and the occurrence of the antenatal and postnatal adverse maternofetal events in pregnancy. Methods Observational study designed for 50 pregnant patients who had an appointment to the obstetrics with abnormal blood pressure (BP) measurements and for whom ambulatory blood pressure monitoring (ABPM) was studied between January 2019 and June 2019. Data about age, personal history, obstetrics, family, body mass index (BMI), weight gain in pregnancy, values of blood pressure in the appointment, values recorded in ABPM, delivery and newborn, pregnancy and postpartum events, and follow-up of woman and child. Data were analyzed using descriptive and inferential statistics with Minitab 17.0 for Windows. Results Patients demographic data, clinical history, and laboratory results, including the ABPM parameters, were compiled. Antenatal complications occurred in 22 patients (44%), and postpartum complications were found in 41 patients (82%) whose ABPM values were deranged. Antenatal complications were studied using the binary logistic regression analysis for calculating the role each factor played in the development of hypertension. In the sample studied, mean age was 24.980 with a standard deviation of 4.876 (p = 0.003; minimum age of 19 years and maximum age of 38 years), mean weight of patient was 63.71 with a standard deviation of 63.71 (p = 0.001), mean gravida was 1.780 with a standard deviation of 0.910 (p = 0.034), mean gestation weeks at presentation was 33.000 weeks with a standard deviation of 4.086 (p = 0.041), mean birth weight was 2.226 with a standard deviation of 0.797 (p = 0.000), mean maximum diastole was 109.22 with a standard deviation of 16.53 (p = 0.002), mean day maximum systole was 187.2 with a standard deviation of 203.5 (p = 0.009), mean day minimum diastole was 63.50 with a standard deviation of 12.99 (p = 0.013), all of which had statistical significance. It is found that the nighttime diastolic blood pressure (DBP) and daytime maximum systolic blood pressure (SBP) were the best predictors of adverse events. Among antenatal complications (ANC), the most common complication is intrauterine growth restriction (IUGR), noted in (n = 19, 86.36%) preterm delivery (n = 17, 77.27%) among the 17 babies who were delivered preterm; 12 (70.5%) needed neonatal intensive care unit (NICU) care of which 4 (25%) babies died because of prematurity; intrauterine death (IUD) was noted in 7 (31.81%) patients and eclampsia was seen in 5 (22.72%). Nondippers proðle had a worse survival rate at follow-up until delivery compared with those with a dipper proðle. Postnatal complications were seen in 41 patients; among them, 13 patients (31.7%) had abnormal fundus examination, 15 patients (36.58%) required usage of antihypertensive beyond first postpartum, 9 patients (21.95%) required blood transfusion for severe bleeding in the form of postpartum hemorrhage. Binary logistic regression for systolic dippers versus nondippers shows statistical significance in age (p = 0.023), weight (p = 0.038), and para (p = 0.045) (Table 3). Binary logistic regression for diastolic dippers versus nondippers shows statistical significance in age (p = 0.039), weight (p = 0.020), birth weight (p = 0.010), maximum heart rate (p = 0.043), and ANC (p = 0.007) Adverse events occurred most commonly in nondippers. Systole nondippers is noted in (n = 41, 82%). Dippers is noted in (n = 9, 18%), Diastole nondippers is noted in (n = 39, 78%) Dippers is noted in (n = 11, 22%). Conclusion ABPM recorded blood pressure is very precise. ABPM is the advised method for both diagnostic and therapeutic monitoring of hypertensive pregnancy diseases, mainly in situations like whitecoat hypertension, masked hypertension, nocturnal hypertension, and nondipping profile. In patients with high-risk pregnancy, elderly primigravida, and precious pregnancy, who have a high-risk of developing pregnancy-induced hypertension (PIH) and related complications, early use of ABPM predicts adverse maternofetal events, which when intervened at an earlier date can prevent antenatal and postnatal complications.

Does knowledge of danger signs influence use of maternal health services among rural women? Findings from Babati Rural district, Northern Tanzania

Introduction: increasing knowledge on obstetric danger signs (DS) among pregnant women and their fhmilies is one of the interventions targeted to reduce maternal and newborn mortality. It is expected that knowledge in DS will lead to early care seeking once complications occur among women or newborns. Health care providers are required to educate women on DS of obstetric emergency during pregnancy, delivery and immediate-post-delivery. This study aimed to determine the level of knowledge on danger signs among rural women and its effect on antenatal care visits, birth preparedness and complication readiness (BPCR) and on use of skilled birth attendance (SBA) during childbirth.

Ultrasonographic placental thickness versus fetal outcome: A prospective study in Southern India.

Background:Variations in placental thickness are associated with increased perinatal morbidity and mortality. However, only very few studies have been established on the correlation between placental thickness with birth outcomes. This study correlated placental thickness in 2nd and 3rd trimesters with neonatal outcome, maternal weight gain, and body mass index (BMI).Methods:A total of 116 patients aged between 20 to 50 years with singleton pregnancy and regular menstrual history (and sure about their last menstrual period) were included. Placental thickness was measured at 24 and 36 weeks by ultrasound and was divided into three groups: Group A (normal placenta), Group B (thin placenta), and Group C (thick placenta); and correlated with neonatal outcome, maternal weight gain, and BMI.Results: Out of the 116 pregnant women, 55 (47.4%) were primigravida and 61 (52.6%) were multigravida. Six patients (3.6%) delivered pre-term before 36 weeks. In the 2nd and 3rd trimesters, most cases had normal placental thickness (Group A; 93.1% and 92.7%), followed by thin placenta (Group B; 5.2% and 7.3%) and thick placenta (Group C; 1.7% and 0), respectively. Two patients with thin placenta had neonatal death. A significant positive correlation was found between birth weight and placental thickness (at 24 weeks; 0.516r, P<0.00001 and at 36 weeks; 0.669r, P<0.00001) and maternal weight gain and birth weight (0.563r, P<0.00001).Conclusion:Placental thickness on ultrasonography demonstrated well the correlation between birth weight in 2nd and 3rd trimesters and increased incidence of antenatal and postpartum complications resulting from thin placenta.

Influence of Maternal Infection and Pregnancy Complications on Cord Blood Telomere Length.

Background Exposure to suboptimal intrauterine environment might induce structural and functional changes that can affect neonatal health. Telomere length as an important indicator of cellular health has been associated with increased risk for disease development. Objectives This study was aimed to examine the independent and combined effects of maternal, obstetric, and foetal factors on cord blood telomere length (TL). Methods Pregnant women at the gestational age of 20th to 24th week who attended the antenatal clinic of a major local hospital in Hong Kong were recruited. Participants were asked to complete a questionnaire on demographics, health-related quality of life, and history of risk behaviors. Medical history including pregnancy complications and neonatal outcomes was obtained from electronic medical records of both mother and neonate. Umbilical cord blood was collected at delivery for TL determination. Results A total of 753 pregnant women (average age: 32.18 ± 4.51 years) were recruited. The prevalence of maternal infection, anaemia, and hypertension during pregnancy was 30.8%, 30.0%, and 6.0%, respectively. The adjusted regression model displayed that maternal infection was negatively associated with cord blood TL (β = −0.18, p = 0.026). This association became even stronger in the presence of antenatal anaemia, hypertension, delivery complications, or neonatal jaundice (β = −0.25 to −0.45). Conclusions This study consolidates evidence on the impact of adverse intrauterine environment at the cellular level. Maternal infection was significantly associated with shorter cord blood TL in a unique manner such that its presence may critically determine the susceptibility of telomere to other factors.

Maternal and Neonatal Outcome of Teenage Pregnancy at Al-Galaa Maternity Teaching Hospital, Cairo, Egypt

Backgrounds: Teenage pregnancies are generally considered as a high-risk however, sufficient data is lacking in the area, Cairo Egypt. We attempted to determine whether teenage pregnancies show poorer outcomes than adult-age pregnancies. Objectives: Finding out the prevalence of teenage pregnancy and its maternal and fetal outcome in comparison. Subjects and methods: A retrospective analytical case-control study was conducted on patients who had attended for delivery at Al-Galaa Maternity Teaching Hospital during the period of one year from March 2015 to February 2016. A total of included 538 patients aged 16 - 19 years as study group and adult age group: included 609 patients aged 25 - 29 years as the control group. The only primigravid was enrolled. The study records were retrieved for review. Comparisons were made between the two groups regarding maternal demographics, socioeconomic status, medical disorders, major antenatal complications, the outcome of labor, mode of delivery, and perinatal complications. Results: The prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value Conclusions: Teenager primigravid women should be considered as a high-risk pregnancy and thus require special medical attention to avoid adverse maternal and neonatal outcomes.

Birth Outcomes of Women with Obesity Enrolled for Care at Freestanding Birth Centers in the United States

IntroductionCurrent US guidelines for the care of women with obesity generalize obesity‐related risks to all women regardless of overall health status and assume that birth will occur in hospitals. Perinatal outcomes for women with obesity in US freestanding birth centers need documentation.MethodsPregnancies recorded in the American Association of Birth Centers Perinatal Data Registry were analyzed (n = 4,455) to form 2 groups of primiparous women (n = 964; 1:1 matching of women with normal body mass indices [BMIs] and women with obese BMIs [>30]), using propensity score matching to address the imbalance of potential confounders. Groups were compared on a range of outcomes. Differences between groups were evaluated using χ2 test for categorical variables and Student's t test for continuous variables. Paired t test and McNemar's test evaluated the differences among the matched pairs.ResultsThe majority of women with obese BMIs experienced uncomplicated perinatal courses and vaginal births. There were no significant differences in antenatal complications, proportion of prolonged pregnancy, prolonged first and second stage labor, rupture of membranes longer than 24 hours, postpartum hemorrhage, or newborn outcomes between women with obese BMIs and normal BMIs. Among all women with intrapartum referrals or transfers (25.3%), the primary indications were prolonged first stage or second stage (55.4%), inadequate pain relief (14.8%), client choice or psychological issue (7.0%), and meconium (5.3%). Primiparous women with obesity who started labor at a birth center had a 30.7% transfer rate and an 11.1% cesarean birth rate.DiscussionWomen with obese BMIs without medical comorbidity can receive safe and effective midwifery care at freestanding birth centers while anticipating a low risk for cesarean birth. The risks of potential, obesity‐related perinatal complications should be discussed with women when choosing place of birth; however, pregnancy complicated by obesity must be viewed holistically, not simply through the lens of obesity.