Maternity Center Research Articles

Long-term evolution of prepubertal-onset anogenital lichen sclerosus: A 35-year retrospective and cross-sectional study from a single tertiary care maternal and pediatric center

BackgroundAnogenital lichen sclerosus (ALS) in children may persist after puberty with potential clinical repercussions. ObjectiveThe purpose of this study was to evaluate post pubertal evolution of girls with ALS diagnosed in the prepubertal period based on physical examination, the persistence of functional symptoms and the effect on quality of life. MethodsWe retrospectively reviewed 65 cases of girls with prepubertal-onset ALS. Onset, signs/symptoms, photos, evolution and treatment were collected from the medical records. Subsequently, 30 of these 65 patients were assessed for persistence of signs/symptoms by physical examination and/or standardized questionnaire. ResultsSigns of active disease after puberty based on physical examination were present in 92% (N=23) of examined patients. A high proportion of cases with persistent ALS after puberty were asymptomatic (47%, N=14). LimitationsThis is a single center retrospective study with a limited number of patients. Half of our original cohort could not be reached or declined a follow-up visit. ConclusionPrepubertal lichen sclerosus is a chronic condition that can be asymptomatic after puberty despite continued disease activity. We recommend long-term follow-up of patients with prepubertal ALS to prevent associated morbidity.

The association between outdoor artificial light at night exposure and antenatal depression and anxiety symptoms: A retrospective cohort study in China

BackgroundOutdoor artificial light at night (ALAN) has emerged as a significant source of environmental pollution, however its association with antenatal depression and anxiety symptoms has not been explored before. MethodsThis study was based on a cohort study conducted at the Maternal and Child Health Care Center in Ma’anshan City, Anhui Province, China, which ultimately included 1047 pregnant women. Depression and anxiety symptoms were evaluated utilizing the self-administered Patient Health Questionnaire (PHQ-9) and the 7-item Generalized Anxiety Scale (GAD-7), respectively. Exposure levels to outdoor ALAN were calculated utilizing satellite data and the participants’ usual addresses. Logistic regression and restricted cubic spline were used to assess the association between exposure to outdoor ALAN and depression and anxiety symptoms in pregnant women. ResultsAfter adjusting for confounding factors, high ALAN exposure during the pre-pregnancy period (ORdepression = 3.16, 95% CI: 1.14∼8.75; ORanxiety = 3.09, 95% CI: 1.51∼6.28) and first trimester (ORdepression = 2.90, 95% CI: 1.13∼7.45; ORanxiety = 3.11, 95% CI: 1.55∼6.25) were associated with increased risks of antenatal depression and anxiety symptoms. Restricted cubic spline analyses showed the above associations were not nonlinear. ConclusionOur study is the first to propose that exposure to high levels of outdoor ALAN three months before pregnancy and during the first trimester of pregnancy is a risk factor for antenatal depression and anxiety symptoms.

Association of Resolved Low-Lying Placentation With Risk of Postpartum Hemorrhage

OBJECTIVE: To evaluate whether individuals who have a placenta previa or low-lying placenta that resolves before delivery are at increased risk of postpartum hemorrhage and postpartum hemorrhage–related morbidity. METHODS: This was a prospective, multicenter, 1:3 matched cohort study of pregnant individuals with singleton gestations diagnosed with low placentation by transvaginal scan at 19 to 23 weeks of gestation between January 2021 and December 2023 at nine academic maternity centers (exposed participants). Unexposed participants were those with a normally located placenta, matched in a 1:3 ratio according to parity. Resolution of low placentation was diagnosed when placenta was at 20 mm or more from the internal os. Individuals with fetal anomalies, hematologic disorders, therapeutic anticoagulation, placenta accreta spectrum disorder, vasa previa, persistent low placentation at birth, and delivery at a nonenrolling center were excluded. Primary outcome was postpartum hemorrhage of 1,000 mL or more. Secondary outcomes included postpartum hemorrhage of 1,500 mL or more, use of second-line uterotonic drugs, blood transfusions, additional procedures to control bleeding, intensive care unit admission, and hospital stay for more than 7 days. Multivariable logistic regression adjusted for confounders was used to estimate independent associations with outcomes. RESULTS: The study population included 182 exposed and 589 unexposed participants. Individuals with resolved low placentation had higher rates of smoking (P=.024), prior dilation and curettage (P=.012), posterior placenta (P<.001), and induction of labor (P=.038). Multivariate logistic regression analysis adjusted for confounders showed that exposed people had higher odds of postpartum hemorrhage of 1,000 mL or more (13.2% vs 4.1%, adjusted odds ratio [aOR] 3.1) compared with unexposed people and of use of second-line uterotonic drugs (28.0% vs 12.4%, aOR 2.69) and tranexamic acid (16.5% vs 7.5%, aOR 2.19), as well as hospital stay longer than 7 days (11.5% vs 3.4%, aOR 2.63). CONCLUSION: Individuals with resolved low placentation are at increased risk of postpartum hemorrhage and related complications compared with those who always had a normally located placenta.

Ambiance as a Key for a Better Birth Experience.

This research provides insights into childbirth as a sensitive experience, from the perspective of its user, "woman in labour," as well as from the perspective of the event itself, "the childbirth," and the birth space, with its spatial and ambiantal configurations. By adopting an in-situ approach, we conducted a spatial and ambiantal characterization of two childbirth different contexts; Tunis and Grenoble. Along this work, we used various methods such as ethnographic observation and semistructured interviews with mothers and midwives, when following visits to the birth spaces in Grenoble. Our experimental protocol was refined by introducing the capture of emotions, notably through the analysis of electrodermal activity variation, for the case of the Maternity and Neonatology Center in Tunis. In correlation with observations and interviews, the analysis of electrodermal activity reveals the mother's emotional state. Subsequently, we undertook a transposition and synthesis of significant ambiantal situations encountered in the birth space in Grenoble and Tunis, during labour phase of childbirth. Six ambiantal situations-types are identified and distributed across two dimensions: luminous and kinesthetic. The results of this research are extremely useful to guide the choices in design of birth space while at the same time considering the well-being of woman in labour. We will end with an ambiantal project that proposes interventions on spatial quality by introducing an ambiantal dimension to the birth space.

Factors Affecting the Accessibility of Maternal Healthcare Facilities in Punjab Province, Pakistan

The study was conducted to identify the hidden factors that influence maternal health services in the Punjab region of Pakistan. The study was conducted in Punjab province, Pakistan. A multi stage sampling technique was used to cover the large area. The area was separated into three stages. In the first stage, one division of Gujranwala out of nine divisions was selected through a random sampling technique. In the second stage, two districts were selected Sialkot and Gujranwala through a random sampling technique. In the third stage, four hundred respondents were selected 200 from each district through a convenient sampling technique. The findings of the research demonstrate that most of the respondents were living in rural areas. The majority of the respondents were high school pass and the respondent’s husband's education was intermediate level. Most of the respondent’s total household monthly income was 20001-30000. The majority of the respondents have less awareness about pregnancy problems and respondents faced complications during pregnancy. Most of the mothers faced difficult access to maternal health care services and had a long distance to health care center from home while most of the respondents hardly had access to transport. The majority of the respondents could not afford any maternal health care services and were waiting long hours for checkup sat the maternal health centers. The majority of the respondents adopted a traditional method and they delivered the baby at home and most of the respondents agreed that patriarchy impacts maternal health care services. It is recommended that the government ensure basic education, particularly in rural areas of Punjab, Pakistan

Contribution of Pelvic Ultrasonography in Perimenopausal Abnormal Uterine Bleeding

Background: About 70% of gynecological consultations for women in perimenopause are due to metrorrhagia. In most cases, they are only the witness of hormonal disturbances resulting from a luteal deficiency. Transvaginal ultrasound is the first innocuous and available additional examination that is requested as part of an etiological assessment. Objective: Our study aims to evaluate the contribution of ultrasonography in perimenopausal metrorrhagia and investigate possible clinical-ultrasound correlation. Methods: This analytical descriptive study was carried out on 50 treated for perimenopausal metrorrhagia in the emergency department of the Tunis Maternity and Neonatology Center for four months (November 1, 2017, to February 28, 2018). We included in our study patients who were not yet postmenopausal who were ≥ 45 years of age, and who sought care for breakthrough bleeding. All patients in our study initially underwent endovaginal ultrasonography, sometimes coupled with suprapubic ultrasonography. Results: The mean age of our patients was 46.3 years. Pelvic ultrasonography revealed an enlarged uterus in 16 patients (32%), with 14 of them having fibromatous uteri measuring between 3 to 10 centimeters. The findings indicate no significant correlation between ultrasound results and bleeding abundance (P = 0.321), pelvic pain (P = 0.108), and general condition (P = 0.437). Conclusion: Endovaginal pelvic ultrasonography is a quick, painless test and is the first test to be done first in an emergency department with perimenopausal vaginal bleeding. The correlation between clinical and ultrasound findings is highly random, making it impossible to assume a well-- coded diagnostic and therapeutic presumption.

Factors associated with intrafamily violence in pregnant women in a Peruvian mother-child center.

Introduction: Domestic violence in pregnant women is considered a serious public health problem that affects the well-being of the mother and child. Objective: To determine the factors associated with intrafamily violence in pregnant women at the Tablada de Lurín Maternal and Child Center during the period 2021-2022. Methods: Analytical cross-sectional study. The clinical histories of a first level health center were used. The main variable was domestic violence; the independent variables were demographic and social characteristics, number of children and previous illness. Results: Domestic violence occurred in 15.63%. In the first simple regression analysis, it was found that pregnant women with more than 4 children, with a confidence interval of 2.44, presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children. In the second multiple regression analysis, it was observed that pregnant women with more than 4 children presented a higher frequency of suffering intrafamily violence compared to pregnant women who had less than or equal to 2 children. Conclusions: It was found that pregnant women who suffered family violence represented 15.6%. Pregnant women with more than 4 children were 239% more likely to suffer domestic violence than women with fewer than 2 children, regardless of maternal age, being married or single, having higher education or having a previous illness.

Midwifery service managers’ readiness for prevention of obstetric violence in Nigeria: A community readiness model

Obstetric violence is a public health problem that needs to be prevented at all levels to improve maternal and newborn health outcomes. The midwifery service managers, as custodians of patient care in maternity centres are in a prime position to develop and implement effective obstetric violence prevention interventions. This study explored the midwifery service managers' level of readiness for the prevention of Obstetric Violence in three maternity centres at three separate hospitals in Oyo State, Nigeria. Data was collected from six midwifery service managers as midwifery community leaders, using the adapted Community Readiness Model as a data collection tool. The Community Readiness Model scoring guide was used to score the six dimensions of community readiness. In addition, a thematic analysis was used to analyze the qualitative data from their views on each of the six dimensions of the Community Readiness Model. The findings revealed an overall level of readiness for the prevention of obstetric violence among midwifery service managers was at level five which is the preparatory level. This means that the community has a modest readiness for Obstetric violence prevention, and it would be easier to develop sustainable prevention interventions for obstetric violence. Understanding the midwifery service managers’ level of readiness for the prevention of obstetric violence is important for governments and other stakeholders intending to develop obstetric violence prevention interventions that are contextually appropriate and acceptable to communities.

Comparison of fresh and frozen-thawed embryo transfer cycles in patients with low oocyte retrieval.

To explore the choice of embryo transfer schemes for patients with low oocyte retrieval (≤ 3 oocytes). A retrospective analysis was conducted on patients with oocyte yields ≤ 3 undergoing in vitro fertilization and embryo transfer (IVF-ET) and frozen embryo transfer (FET) at the Maternity & Child Care Center of Qinhuangdao Reproductive Medicine Department from January 2018 to December 2022. The data included 202 fresh cycles, with 104 cycles in Group-A and 98 cycles in Group-B. Additionally, 87 cycles involved the transfer of frozen embryos from fresh cycles that could not be transplanted for various reasons, with 31 cycles in Group-C and 56 cycles in Group-D. General patient information, embryo transfer details, and clinical pregnancy outcomes in both fresh and frozen cycles were statistically analyzed. No significant differences were observed between Groups A and C in age, anti-Müllerian hormone (AMH), basal follicle-stimulating hormone (bFSH), body mass index (BMI), duration of infertility, the proportion of patients with diminished ovarian reserve (DOR), oocyte retrieval count, usable embryo count, or the number of transplanted embryos (all p> 0.05). Advanced age was a risk factor for a decreased pregnancy rate, and FET significantly increased the pregnancy rate (p< 0.05, respectively). For patients under 35 years old with low oocyte retrieval, it is recommended to freeze all embryos when available and then proceed with FET. For patients aged 35 and above, without reducing the pregnancy rate, fresh embryo transfer is recommended to minimize treatment cycle frequency and economic expenses.

Mistreatment in healthcare: peripartum experience in a Tunisian maternity

BackgroundMistreatment in healthcare is defined by the set of behaviors, acts, and omissions committed by the healthcare providers on patients. Pregnant women can be exposed to this behavior during pregnancy, childbirth, and the postpartum period. It can have several aspects and affects the women's mental health, social and professional life, and also their newborns and families. ObjectiveThis study was made to estimate the frequency of mistreatment during the peripartum period in a Tunisian maternity unit, determine its impact on the parturient and her entourage, and draw up recommendations for the prevention of this public health problem. Study DesignWe conducted a cross-sectional survey in Department C of the Tunis Maternity and Neonatology Center from July 2022 to September 30, 2022. Our questionnaire encompassed verbal and physical abuse, patient information, consent, unprofessional conduct, poor communication, and discrimination. ResultsThis study included 400 patients. The average age was 29.3+–5.65. Single women represented 12.3% of the cases. Seventy-five percent of women reported having been victims of at least one type of violence during childbirth. Verbal abuse was the most frequent type observed. Eighty-two percent of women reported verbal abuse, while 23.25% underwent physical violence. After the delivery, 391 women (97.8%) stated that the delivery was a source of anxiety and that they were not ready to repeat the experience. Six of them were followed up in psychiatry. Mistreatment was expressed by a lack of information and/or respect for consent, unprofessional conduct, or poor communication between the caregiver and the patient. ConclusionThis study emphasizes the significance of including women in decision-making processes regarding their care. Establishing systematic approaches for providing information and obtaining consent is crucial, ensuring a dynamic approach that promotes women's freedom of choice.

Effect of a lower dose of intrathecal morphine on postoperative opioid consumption following cesarean delivery at a Texas level IV maternal care center

Background We hypothesized that patients who received a lower dose of intrathecal morphine (ITM) would have higher postoperative opioid consumption following cesarean delivery. Methods Patients who had cesarean deliveries from February 15, 2022, through February 14, 2024 at Baylor Scott & White Medical Center – Temple with single injection spinal or combined spinal epidural anesthesia who did not have labor epidural anesthesia were included. Morphine milligram equivalent (MME) opioid consumption in the first 24 postoperative hours was recorded along with patient demographic, physical, and clinical characteristics. Results A total of 535 and 502 patients received 0.2 and 0.15 mg ITM, respectively. Patients who received 0.15 mg ITM had higher rates of depression, scheduled cesarean deliveries, and acetaminophen administration compared to patients who received 0.2 mg ITM. Patients who received 0.2 mg ITM and 0.15 mg ITM had median (interquartile range) 24-hour MME consumption of 10.0 mg (0–30.0 mg) and 10.0 mg (0–40.0 mg), respectively (P = 0.97). Discussion MME consumption for 24 hours following cesarean delivery was similar between patients who received 0.2 and 0.15 mg ITM.

Dynamic Indicators of the Pulmonology Department of the National Center of Maternity and Child Health care for 2021-2023 Years

The article presents the materials of the reporting data on the therapeutic and diagnostic activities of the Department of pulmonology over the past 3-5 years. A comparative analysis of the department's work before and after the pandemic was carried out. The reasons for the increase in hospitalization in the Department of pulmonology over the past 3 years.

Invasive Micropapillary Carcinoma of the Breast: Comparison of Clinical, Epidemiological, Anatomopathological and Therapeutic Features with Infiltrating Carcinoma of Non-Specific Type

Invasive micropapillary carcinoma (IMCC) is a rare histological subtype of invasive breast cancer, its frequency ranges from 1.0 to 8.4% of all breast cancer cases. It is identified as a particularly aggressive tumor since frequent invasion of vessels, skin and lymph nodes is often reported. The aim of the work is to describe and compare the epidemiological, clinical, anatomopathological and molecular aspects of CMPI compared to CINS. Compare the overall survival of the two groups in order to identify the prognostic factors for CMPI. This is a retrospective, descriptive and analytical study spread over 6 years from January 2015 to December 2020, involving all cases of CMPI and CINS of the breast collected at the Obstetrics and Gynecology department of the Maternity and Neonatology Center of Monastir. The frequency found was 5.5% for CMPI and 72.69% for CINS. In our series we found the average age to be more advanced in CINS compared to CMPI without having a statistically significant difference (p=0.49). CMPI tends to be slightly larger than CINS with an average size of 3.7 compared to 3 for CINS. The right breast was the predominant tumor site for the 2 types of cancer p=0.71. CMPI presents a higher frequency of locoregional ADP and vascular emboli with p=0.001. Distant metastases were more frequent in CINS but without having a statistically significant difference. The overall survival of CMPI is 76% versus 86.4%. % of CINS. CMPI represents a particular variety of breast carcinomas; in this study we tried to dissect its different epidemiological, clinical, radiological and therapeutic characteristics which were largely in agreement with the literature.

Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning–based random forest approach

BackgroundQuality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality.MethodsThis study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3–5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results.ResultsThe score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver.ConclusionsThe proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.

The vaginal metabolomics profile with features of polycystic ovary syndrome: a pilot investigation in China.

Polycystic ovary syndrome (PCOS) is the most common metabolic disorder and reproductive endocrine disease, posing an elevated risk to women of reproductive age. Although metabolism differences in serum, amniotic fluid and urine have been documented in PCOS, there remains a paucity of evidence for vaginal fluid. This study aimed to identify the metabolic characteristics and potential biomarkers of PCOS in Chinese women of reproductive age. We involved ten newly diagnosed PCOS women who attended gynecology at Zhongda Hospital and matched them with ten healthy controls who conducted health check-up programs at Gulou Maternal and Child Health Center in Nanjing, China from January 1st, 2019 to July 31st, 2020. Non-targeted metabolomics based on ultra-high-performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) was applied to differentially screen vaginal metabolites between PCOS group and healthy controls. Principal component analysis (PCA), orthogonal partial least-squares discriminant analysis (OPLS-DA) and enrichment analysis were used to observe differences, search for potential biomarkers and enrich related pathways. Among the 20 participants, a total of 195 different metabolites were detected between PCOS group and healthy control group. PCOS and control groups were effectively separated by vaginal fluid. Lipids and lipid-like molecules constituted the majority of differential metabolites. Notably, dopamine exhibited an increased trend in PCOS group and emerged as the most significant differential metabolite, suggesting its potential as a biomarker for identifying PCOS. The application of UHPLC-MS/MS based vaginal metabolomics methods showed significant differences between PCOS and non-PCOS healthy control groups, especially linoleic acid metabolism disorder. Most differential metabolites were enriched in pathways associated with linoleic acid metabolism, phenylalanine metabolism, tyrosine metabolism, nicotinate and nicotinamide metabolism or arachidonic acid metabolism. In this pilot investigation, significant metabolomics differences could be obtained between PCOS and healthy control groups. For PCOS women of reproductive age, vaginal metabolism is a more economical, convenient and harmless alternative to provide careful personalized health diagnosis and potential targets for therapeutic intervention.

Epidemiology of congenital malformations in Tunisian liveborns: a retrospective study

Objective: To identify the various congenital malformations in liveborns in the neonatology service within the center of maternity and neonatology of Tunis (CMNT). Methods: This is a retrospective study of liveborns with congenital malformations hospitalized during one year from 1rst January to 31 December 2016. Results: The profile of malformations was dominated by polymalformations (22.29%), followed by chromosomal aberrations (21.14%), cardiovascular malformations (16.00%), and system nervous malformations (11.43%). Comparisons of liveborns and parental characteristics between all congenital malformations subtypes have shown significant differences in liveborns sex, consanguinity, and maternal age. Comparisons between malformed newborns and malformed fetuses have shown significant differences in consanguinity, rhesus type, maternal origin and parity. Conclusion: It seems important to set a careful surveillance of pregnancies at risk of developing congenital anomalies, systematic supplementation of vitamins and folic acid, and a national registry of congenital malformations. Keywords: Congenital malformations; liveborns; risk factors; prevention; Tunisia.

Neonatal birthweight prediction using two- and three-dimensional estimated fetal weight among borderline small fetuses.

This study aimed (1) to determine the degree of correlation between 2D and 3D estimated fetal weight (EFW) and neonatal birth weight (BW) among borderline small fetuses and (2) to compare the accuracy and precision of 2D and 3D EFW in BW prediction. A retrospective cohort study evaluated fetuses who had an ultrasound performed between January 2017 and September 2021 at a tertiary maternal center. All singleton pregnancies with 3D EFW within 4 weeks of delivery were included. Fetuses with known structural or genetic abnormalities were excluded. Pearson's correlation coefficients were determined for both 2D and 3D EFW to BW then compared using Williams' test and Fisher r to z transformation, where applicable. Mean percent difference and standard deviation were used to assess the accuracy and precision, respectively, of 2D and 3D EFWs in BW prediction. Two hundred forty-eight pregnancies were included. Ultrasound studies were performed with a median interval of 2 weeks (IQR 1, 3) between ultrasound and delivery. Both 2D and 3D estimated fetal weights showed a significant correlation with birth weight (r = 0.74 and r = 0.73, respectively), indicating similar accuracy between the two techniques. Two-dimensional and three-dimensional EFWs performed similarly in the prediction of BW in borderline small fetuses.

Relationship of Serum Nesfatin-1 and Insulin-Like Growth Factor-1 Levels with Adverse Pregnancy Outcomes in Patients with Polycystic Ovary Syndrome.

To investigate the relationship between serum nesfatin-1 and insulin-like growth factor-1 (IGF-1) levels and adverse pregnancy outcomes (APOs) in patients with polycystic ovary syndrome (PCOS). Observational study. Place and Duration of the Study: The study was performed from June 2021 to 2023 in the General Gynaecology section at the Maternity & Child Care Center of Qinhuangdao, Hebei, China. A total of 120 pregnant women with PCOS were divided into the control and study groups. The control group consisted of 70 pregnant women who successfully delivered healthy newborns, whereas the study group included 50 pregnant women who experienced APOs. The serum nesfatin-1 and IGF-1 levels in both groups were measured upon admission. The potential influencing factors of APOs in pregnant women with PCOS and the predictive value of serum nesfatin-1 and IGF-1 for APOs were analysed. Serum nesfatin-1 and IGF-1 levels were significantly higher in the study group than in the control group (p <0.05). Multivariate analysis revealed that testosterone ≥45μg/L, body mass index ≥25kg/m², waist-hip ratio ≥0.80, gestational diabetes mellitus, nesfatin-1, and IGF-1 were independent risk factors of APOs in patients with PCOS. The AUC for IGF-1 plus nesfatin-1 in predicting APOs in pregnant women with PCOS was 0.900 (95% CI: 0.845, 0.955). Elevated serum nesfatin-1 and IGF-1 levels are associated with pregnancy outcomes of patients with PCOS. Polycystic ovary syndrome, Nesfatin-1, Insulin-like growth factor-1, Adverse pregnancy outcome.

Obstetric psychoprophylaxis and duration of the active phase dilation period: A relational study

Objective: To identify the correlation between obstetric psychoprophylaxis and the duration of the active phase dilation period in pregnant women at the Centro Materno Infantil Daniel Alcides Carrión, Lima – 2019. Materials and methods: Non-experimental cross-sectional study. a documentary review was carried out and was complemented with the application of two data collection forms as an instrument, considering as variables the clinical history, age, number of pregnancies, number of prenatal care, gestational age at the first obstetric psychoprophylaxis session and the number of psychoprophylaxis sessions recorded. Results: The study included 165 medical records of pregnant women whose deliveries were attended at the daniel alcides carrión maternal and child center in lima during 2019, from which it was found that 69.09 % of the pregnant women ranged from 18 to 29 years of age; 77. 58 % of them were multiparous, 69 % showed more than 3 prenatal care, 91 % started their first obstetric psychoprophylaxis session between 28 to 37 weeks, 55.76 % had 4 to 6 obstetric psychoprophylaxis sessions and 68 % had a duration of up to 6 hours in the dilation period – active phase. Conclusions: Obstetric psychoprophylaxis has shown a significant level of incidence with respect to the duration of the active phase dilation period, demonstrating the benefit obtained by the pregnant woman during labor.

Identifying risk factors for urologic complications in placenta accreta spectrum surgical management.

To describe urologic complications associated with the surgical management of placenta accreta spectrum and determine their risk factors. A retrospective study was conducted on all patients diagnosed with abnormal invasive placentation who underwent surgery and delivered between 2002 and 2023 at a single expert maternity centre. Intra-operative and post-operative complications were described, with a special focus on urologic intra-operative injuries, including vesical or ureteral injuries. Univariate and multivariate analyses were performed to determine risk factors of intra-operative urologic injuries associated with placenta accreta spectrum surgical management. Additionally, using the Clavien-Dindo classification, the effects of intra-operative urologic injury and ureteral stent placement on post-operative outcome were evaluated. A total of 216 patients were included, of which 47 (21.48%) had an intra-operative bladder and/or ureteral injury. Placenta percreta was associated with a higher rate of intra-operative urologic injury than placenta accreta (72.34% vs. 6.38%, p < 0.001). Multivariate analyses showed that patients who had placenta percreta and bladder invasion or emergency hysterectomy were associated with more intra-operative urologic injuries (OR = 8.07, 95% CI [2.44-26.75] and OR = 3.87, 95% CI [1.09-13.72], respectively). Patients with intra-operative urologic injuries had significantly more severe post-operative complications, which corresponds to a Clavien-Dindo score of 3 or more, at 90 days (21.28% vs. 5.92%, p = 0.004). Surgical management of placenta accreta spectrum is associated with significant urologic morbidity, with a major impact on post-operative outcomes. Urologic complications seem to be correlated with the depth of invasion and the emergency of the hysterectomy.