Obstetric Clinic Research Articles

Correlation between biometeorological forecast and the incidence of obstetric admissions in perinatal center during five years: A retrospective study of one center

Background and purpose: The aim of this study was to correlate obstetric admissions at a tertiary perinatal center with biometeorological forecast and weather conditions. Materials and methods: This retrospective study was conducted at the Department of Gynaecology and Obstetrics Clinical Hospital “Sveti Duh” over five years, from January 1, 2014 to December 31, 2018. The hospital’s emergency data was used for record of obstetric admissions on each day. The selected days were sorted in 4 groups based on biometeorological forecast. Results: In the observed period, there were a total of 18,072 obstetric admissions. There were 216 days with fifteen or more admissions. The results showed no significant difference between obstetric admission based on the biometeorological forecast one day before or three days before. Most hospitalization were on days with a favorable biometeorological forecast in the observed period, 68 days with more than fifteen admissions per day. The day before, the biometeorological forecast was mostly favorable or relatively favorable. Conclusion: Our retrospective single-center study did not show a significant difference between obstetric hospital admissions depending on biometeorological conditions, but the higher number of admissions during days with a favorable forecast is definitely the basis for future studies with larger dataset.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

Evaluation of thalamus echogenicity via ultrasonography as a marker of fetal lung maturity

Background: Fetal lung immaturity is a major problem in the management of elective birth with respect to predicting the development of infant respiratory distress syndrome (IRDS) in the neonate after birth.Aim and Objectives: The aim of this study was to evaluate the validity of measuring fetal thalamic echogenicity by ultrasound as a marker of fetal lung maturity.Subjects and Methods: This was a prospective observational study that was being carried out on 80 pregnant patients. They were recruited from Obstetrics and Gynaecology clinics at Tanta University Hospitals during the period of research from March 2021 till the end of the study.Results: There was statistically significant difference between RDS group and those without RDS regarding thalamic echogenicity, 1 and 5- min APGAR score, NICU admission and neonatal mortality.Conclusion: Evaluation of echogenic thalamus by ultrasound at the level of the BPD is of value, and can be considered as a new marker of fetal lung maturity; however, further studies are required to strengthen such idea.

The Effectiveness Yoga-Based Mindfulness on Quality of Life in Pregnant Women

Background and Objectives: Pregnancy is considered a sensitive period in women's life, which is associated with many physical and psychological changes, and each person deals with it differently. Countless studies have confirmed the relationship between stress and anxiety during pregnancy and the mental and physical health of the child. The effectiveness of yoga –based mindfulness on quality of life in pregnant women. Methods and Materials: The present study was semi-experimental design with pre-test and post-test with control group. The statistical population of this study included all pregnant women referred to Iranian maternal health midwifery clinic in 1401, 30 of these subjects, were selected and randomly assigned (Each has equal chance of being elected) to two groups. Both groups were pre-test and post-test before and after the intervention. The experimental group received 16 sessions of 75 minutes (weekly 3 sessions) under yoga practice. Data collection tools include demographic characteristics and Short form 36 (SF-36) quality of life questionnaire. The collected data were analyzed by covariance analysis using spss-24. Results: The findings showed that the effectiveness of yoga-based mindfulness treatment had a greater impact on quality of life (P=0/002، F=5/969) in pregnant women. Conclusion: Therefore, it can be concluded that yoga can be used as a convenient, affordable and low-cost treatment for improving the quality of life of pregnant women.

Evaluation of the effects of raloxifene treatment on uterus in asymptomatic postmenoposal patients by transvaginal Doppler ultrasonography

Aims: To evaluate the effects of raloxifene treatment on uterus in asymptomatic postmenopausal patients by Doppler transvaginal ultrasonography (TvUS). Methods: Randomized controlled prospective study, 57 healthy postmenopausal asymptomatic patients, aged 45-60, who applied Okmeydanı Training and Research Hospital Obstetrics and Gynecology Outpatient Clinic between 2003-2004. Four patients were excluded from the study because they did not apply the treatment regularly. All of the patients were in natural menopause. They had not received any hormone replacement therapy before. Their body mass index (BMI) was below 30 kg/m2 and had no systemic diseases. The patients were divided into two groups as those who received raloxifene (n: 27) and those who did not (n: 26). Raloxifene was given 60 mg/day for 6 months. In all patients enrolled in the study, endometrial and uterine volume, pulsatility (PI) and resistance indices (RI) were evaluated by TvUS Doppler. Endometrial biopsies (EB) were obtained with pipelle at 0 and 6 months. Results: There was no significant difference in terms of age, height, weight and BMI (p<0.05). Parity, menopause time and endometrial thickness were similar (p<0.05). EB results were similar (p<0.05). Uterine volumes at month 0 and 6 were similar (p<0.05). PI and RI were found to be similar in the right and left arteries at baseline (p<0.05). While PI and RI on the right side were similar at 6 months, left uterine artery PI was found to be significantly higher in the treated group. Left uterine artery RI was similar. Conclusion: Raloxifene treatment neither did stimulate the endometrium, nor increased the uterine volume or uterine blood flow. It did not have any stimulating effect on the uterine tissue.

Participation in the CenteringPregnancy Program and Pregnancy-Induced Hypertension

CenteringPregnancy emphasizes nutrition, learning, and peer support through a group meeting format in contrast to the standard of prenatal care (SPNC) that maximizes a pregnant patient's time with their provider.We hypothesized that the program may yield a reduced risk of pregnancy-induced hypertension (PIH).In this observational study, we examined the effect of the CenteringPregnancy program versus SPNC on PIH. In 2021, birth certificate data were linked to hospital discharge records of women who delivered in obstetric clinics in the Midlands of South Carolina between 2015 and 2019. Logistic regression models were used to estimate the association between CenteringPregnancy participation (n=547) and any PIH and specific PIH diagnoses (gestational hypertension/unspecified hypertension, mild pre-eclampsia, and severe pre-eclampsia/eclampsia). Propensity score techniques (e.g., inverse probability of treatment weighting [IPTW]) were used to adjust for self-selection into the program versus SPNC. CenteringPregnancy participants had higher odds of developing any PIH under all specifications (OR1.48, 95% CI, 1.15, 1.92) and specifically, gestational hypertension/unspecified hypertension (OR 1.76, 95% CI, 1.28, 2.42) than those in SPNC. However, CenteringPregnancy participants did not experience significant higher odds of mild pre-eclampsia (OR 1.06, 95% CI, 0.65, 1.78) and severe pre-eclampsia/eclampsia (OR 1.21, 95% CI, 0.78, 1.89) compared to SPNC. Participation in CenteringPregnancy, compared to SPNC, was associated with higher odds of PIH, particularly gestational hypertension. Additional research is warranted to definitely rule out selection bias and identify contributing factor(s) that increased PIH despite efforts to improve pregnancy-related health outcomes among CenteringPregnancy participants.

Reproducibility and usability assessment of the novel Fine Birth device for threatened preterm labor diagnosis

Preterm delivery is considered the leading cause of mortality worldwide in children under five. Forty-five million pregnant women are hospitalized yearly for Threatened Preterm Labor (TPTL). However, only 50% of TPTLs end in delivery before the estimated date, classifying the rest as false TPTL. The ability of current diagnostic methods to predict TPTL is low (low positive predictive value), ranging between 8-30%. This highlights the need for a solution that accurately detects and differentiates between false and real TPTLs in women who attend obstetric clinics and hospital emergency departments with delivery symptoms. This is a pilot study aiming at first, to assess the reproducibility and usability of a novel medical device, the Fine Birth, aimed at accurately diagnosing TPTL through the objective quantification of pregnant women's cervical consistency. Secondarily, we aimed to evaluate the impact of training and the incorporation of a lateral micro camera on the device's reliability and usability outcomes. 77 singleton pregnant women were recruited during their follow-up visit to the obstetric and gynecological departments at five Spanish hospitals. Eligibility criteria were: pregnant women ≥ 18 years old, with a normal fetus and uncomplicated pregnancy, without prolapse of membranes, uterine anomalies, previous cervical surgery or latex allergy, and signing the informed written consent. Cervical tissue stiffness was assessed using the Fine Birth device, whose technology is based on the propagation of torsional waves through the studied tissue. Cervical consistency measurements were taken for each woman until obtaining two valid measurements by two different operators. The intra-observer and inter-observer reproducibility of the Fine Birth measurements was assessed using the Intraclass Correlation Coefficients (ICC) with a 95% confidence interval (CI) and the F-test p-value. The usability was evaluated based on clinicians' and participants' feedback. There was a good intra-observer reproducibility (ICC=0.88, 95% CI 0.84 to 0.95; F-test p-value < 0.05). Since the results obtained for the inter-observer reproducibility did not reach the desired acceptable values (ICC<0.75), a lateral micro camera was added to the Fine Birth intravaginal probe, and the operators involved in the clinical investigation received the corresponding training with the modified device. Analysis of 16 additional subjects demonstrated an excellent inter-observer reproducibility (ICC=0.93, 95% CI 0.78 to 0.97) and a clear improvement after the intervention (p<0.0001). The robust reproducibility and usability results obtained after the insertion of a lateral micro camera and the corresponding training make the Fine Birth a promising novel device to objectively quantify the patient's cervical consistency, diagnose TPTL and thus, predict the risk of spontaneous preterm birth. Further research is needed to demonstrate the clinical utility of the device.

Retrospective examination of endometrial sampling results in women with abnormal uterine bleeding

&lt;b&gt;Background: &lt;/b&gt;Abnormal uterine bleeding (AUB) is among the most significant and frequent causes of admission to the gynecology outpatient clinic. AUBs may manifest as the earliest sign of endometrial cancer. For the early detection and treatment of endometrial cancer, careful examination of AUBs is crucial.&lt;br /&gt; &lt;b&gt;Aim: &lt;/b&gt;The study was conducted to retrospectively evaluate the histopathological results of probe curettage materials applied to women who applied to the gynecology clinic for AUB and were hospitalized with the complaint of AUB.&lt;br /&gt; &lt;b&gt;Material and Methods: &lt;/b&gt;In the retrospective study planned between 2020 and 2021, all endometrial biopsies from 638 women with AUB reported to the gynecology clinic were reviewed and analyzed. The data were obtained from the archives of our hospital's gynecology and obstetrics clinic and pathology clinic.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; 638 cases were analyzed. The mean age of the patients was 47.94±9.53 years. Malignant pathology was detected in 20 cases (3.13%). Nineteen of these cases were seen in postmenopausal women. The most common pathology was found to be benign polyps at a rate of 19.91%. It was the most common benign pathology in women pre- and postmenopausal. Adenocarcinoma was detected in 13 (2.03%) postmenopausal cases while in only 1 (0.16%) of the premenopausal women.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Since more malignant pathologies are observed in postmenopausal women, women with asymptomatic or AUB complaints should be carefully monitored, and endometrial evaluation should not be skipped. Endometrial biopsies are valuable in the early detection of pre-cancerous and cancerous endometrial lesions, especially in postmenopausal women.

Barriers and facilitators to cord blood banking among pregnant women at a university obstetric clinic.

Cord blood (CB) is a cell source for hematopoietic stem cell transplantation. In 2019, the percentage of births with CB collected for banking was only 3% nationally and 0.05% in our state. To increase CB donations, we need to understand pregnant women's awareness and knowledge of, plus barriers and facilitators to, CB banking (CBB). We recruited 289 women in their third trimester from an academic obstetric clinic between October 2020 and May 2021. Women attending this clinic come from all parts of the state in addition to local city residents. After agreeing to participate, participants completed a survey using Research Electronic Data Capture (REDCap). Data were analyzed using SAS version 9.4. Exactly 58.9% of participants had heard of CBB, but only 26.53% understood its purpose; 10.03% indicated someone had discussed CBB with them, and 61.3% were undecided about it. The preferred source of information was the clinic provider (82.1%), followed by CB bank staff (36.8%). The requested mode for receiving information was face-to-face with their provider, including written materials. Income, education, and marital status did not have a significant influence on information preferences. Lack of knowledge continues to be a major barrier to CBB. Developing educational interventions based on womens' preferences may increase understanding of CBB. Study participants preferred that the healthcare provider deliver this information. This study was done in a primarily rural, southern state, while previous studies were in larger metropolitan areas, yet results are comparable.

Phylogenetic variants of Mycoplasma hominis from pregnant women and women presenting with infertility in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Background: Much controversies have been associated with the pathogenicity of Mycoplasma hominis but little has been done to unravel the mystery behind the different views. This study aimed at investigating the genetic variants abounding within M. hominis and the distribution of the virulent genes among the variants.&#x0D; Methodology: Twenty (20) M. hominis isolates from high vaginal swabs of women (11 from pregnant women and 9 from women presenting with infertility) attending the Obstetrics and Gynaecology clinics of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria, were sequenced using 16S rRNA universal gene target for the purpose of phylogenetic analysis and epidemiological typing. The isolates were also screened for the presence of M. hominis variable adherence antigen (vaa) and p120 virulent genes using primer constructs from the respective genes in a conventional PCR protocol.&#x0D; Results: Of the 20 M. hominis vaginal isolates, 4 phylogenetic strains were detected; strain MHS43 constituted 10/20 (50.0%) [2/9 (22.2%) from infertile women and 8/11 (72.7%) from pregnant women]; strain MHBS constituted 3/20 (15%) [3/9 (33.3%) from infertile women and 0/11 (0%) from pregnant women]; strain MHSWP2 constituted 4/20 (20.0%) [3/9 (33.3%) from infertile women and 1/11 (9.1%) from pregnant women]; while strain MHKC87 constituted 3/20 (15%) [1/9 (11.1%) from infertile women and 2/11 (18.2%) from pregnant women]. Each of vaa and p120 genes was detected in 14 of 20 isolates, while 6 isolates did not carry the genes. A 2-way ANOVA test showed that none of the genes was significantly associated with a particular strain (p=0.8641).&#x0D; Conclusions: The different views regarding the pathogenicity of M. hominis may be linked to the heterogeneity within the species and lack of omogeneity in the virulent genes as witnessed both in the intra species and intra strain levels.

Correlation Of Parameters Of Semen Analysis In Oligospermia In Infertility

Background: Various semen parameters including morphology, vitality, motility, maturation, pH, count, agglutination and biochemical parameters altogether determine the overall quality of semen. Common factors associated with oligospermia are diseases (genetic, infectious, hormonal and obstructive), smoking, environmental factors such as radiation, heavy metal poisoning, overheating of testicles. Objective: Semen analysis in infertile males of various age group with possible correlation of parameters in relation to oligospermia. Materials and methods: This cross-sectional descriptive observational study included 150 semen sample received from various infertility clinics, obstetric gynaecology clinics, In vitro fertilization centers, and from individuals with infertility problems. The study was conducted from July2021-February2022. Parameters studied included volume, liquefaction time, pH, count, motility, morphology, immature forms, agglutination, leucocytes, and fructose. Results: Out of 150 cases, majority belonged to the age group of 31-40years, mean age was 33.14 years. Seventy-three cases (48.7%) were normal, six (4%) showed azoospermia, 71 (47.3%) showed oligospermia. Parameters correlated positively with oligospermia are age (0.008 Pearson correlation, 0.946 p value, not significant), pH (0.194 Pearson correlation, 0.106 p value, not significant), liquefaction time (0.106 Pearson correlation, 0.378 p value, not significant). Parameters correlated negatively with oligospermia are volume (-0.58 Pearson correlation, 0.633 p value, not significant) and motility (-2.77 Pearson correlation, 0.19 p value, significant) Conclusion: The study showed a positive correlation of oligospermia with age, pH, liquefaction time and negative correlation with volume and motility. The study also showed a significant association between oligospermia and motility, morphology, agglutination and fructose.

Predictive Value of Sflt-1/Plgf Ratio for Occurrence of Preeclampsia in Singleton Pregnancies: A Retrospective Study

Introduction: Preeclampsia is multisystem disorder of pregnancy, characterized by endothelial and placental dysfunction. It is classified as an early onset (which occurs &lt; 34 weeks) and late onset (which occurs ≥ 34 weeks). There is an increase of level of antiangiogenic factor of soluble form similar to tyrosine kinase 1 (sFlt-1) and decrease of level of proangiogenic placental growth factor (PlGF) at preeclampsia. High ratio sFlt-1/PlGF is connected to occurrence of preeclampsia. Materials and Methods: There was a retrospective study of the Clinic for Gynecology and Obstetrics of the University Clinical Center of Republic of Srpska (KGA UKC RS), which was implemented in period January 1st, 2020 – December 31st, 2021 and which included 224 patients hospitalized at the Department of Perinatology for suspected preeclampsia development, from 26+0 weeks of gestation until birth. One of the key criteria for the inclusion of patients in the study is the use of the sFlt-1/PlGF ratio as a marker for the onset of preeclampsia, and the determination of protein values in 24-hour urine (biuret). The antenatal state of the fetus was also monitored by ultrasound measurement of the flow resistance ratio (Ri) through the middle cerebral artery and the umbilical artery (C/U), as well as the values of the newborn’s Apgar score in the first and fifth minute of life (AS 1 and 5). The patients included in the study were divided into two groups according to gestational age: group 1 (&lt;33+6 NG) and group 2 (≥34NG). For the purposes of the research, data from patient protocol books for the specified period, as well as corresponding data from the Clinical Information System (KIS), were used. Results: Calculated values for cut off 38 for group 1 are: NPV= 76.9%, PPV=72.0%, sensitivity=85.7%, specificity=58.8%, and for group 2 are: NPV= 89 ,1%, PPV=40.8%, sensitivity=72.1%, specificity=68.5%. For cut off 85, the calculated values for group 1 are: NPV= 82.4%, PPV=85.7%, sensitivity=85.7%, specificity=82.4%, and for group 2 they are: NPV= 84.9 %, PPV=70.4%, sensitivity=44.2%, specificity=94.4%. For cutt off 110, the calculated values for group 1 are: NPV= 77.8%, PPV=85%, sensitivity=81%, specificity=82.4%, and for group 2 they are: NPV= 83.5 %, PPV=72.7%, sensitivity=37.2%, specificity=95.8%. The measured value of protein in 24h urine (biuret) in comparison with the measured values of the sFlt-1/PlGF ratio have statistical significance for predicting the onset of preeclampsia. Statistical data processing obtained by examining the measured values of the sFlt-1/PlGF ratio and the antenatal and natal condition of the fetus (C/U and AS 1 and 5) showed statistical significance, except for C/U for group 2, where p=0.32. Conclusion: Determination of the sFlt-1/PlGF ratio as well as biuret and monitoring of the antenatal and postnatal state of the fetus significantly contributes to the timely diagnostic of preeclampsia, which impacts reducing the incidence of undesirable outcomes for the mother and the fetus.

Intimate partner violence during pregnancy – Prevalence and associations with women’s health: A cross-sectional study

ObjectiveIntimate partner violence (IPV) against women occurs in all settings. Exposure to intimate partner violence, especially during pregnancy, is associated with serious adverse health outcomes and is recognized as a global health issue. AimTo describe the prevalence of physical, psychological, and sexual intimate partner violence among pregnant women in Sweden during current pregnancy, and to investigate potential associations between exposure and sociodemographic characteristics and health. MethodsBetween October and December 2020, a cross-sectional survey study was conducted at 35 midwifery clinics in Stockholm, Sweden. ResultsThe questionnaire was answered by 3399 pregnant women. The results showed that 2.1% of the women reported exposure to intimate partner violence during pregnancy, with exposure to psychological violence being most common (1.8%), followed by exposure to physical violence (0.6%) and sexual violence (0.1%). Exposure to intimate partner violence was significantly associated with living situation and depressive symptoms, as well as education, country of birth, and employment status. ConclusionExposure to intimate partner violence occurs even during pregnancy and it is crucial to identify pregnant women exposed to intimate partner violence in order to inform clinical practice and to provide adequate support. More research is needed to develop screening instruments to detect violence against pregnant women.

Appropriate Delivery Timing in Fetuses with Fetal Growth Restriction to Reduce Neonatal Complications: A Case-Control Study in Romania.

(1) Background: The main challenge in cases of early onset fetal growth restriction is management (i.e., timing of delivery), trying to determine the optimal balance between the opposing risks of stillbirth and prematurity. The aim of this study is to determine the likelihood of neonatal complications depending on the time of birth based on Doppler parameters in fetuses with early onset fetal growth restriction; (2) Methods: A case-control study of 205 consecutive pregnant women diagnosed with early onset FGR was conducted at the Obstetrics Clinic of the Municipal Emergency Hospital in Timisoara, Romania; The case group included newborns who were delivered at the onset of umbilical arteries absent/reversed end-diastolic flow, and the control included infants delivered at the onset of reversed/absent ductus venosus A-wave. (3) Results: The overall neonatal mortality rate was 2.0%, and there was no significant statistical difference between the two study groups. In infants delivered up to 30 gestational weeks, grades III/IV intraventricular hemorrhage and bronchopulmonary dysplasia were statistically significantly more frequent in the control group. Moreover, univariate binomial logistic regression analysis on fetuses born under 30 gestational weeks shows that those included in the control group are 30 times more likely to develop bronchopulmonary dysplasia and 14 times more likely to develop intraventricular hemorrhage grades III/IV; (4) Conclusions: Infants delivered according to the occurrence of umbilical arteries absent/reversed end-diastolic flow are less likely to develop intraventricular hemorrhage grades III/IV and bronchopulmonary dysplasia.

Improving team-based care in basic emergency obstetric clinics: Using factor analysis to develop a brief teamwork tool for real-time feedback

Improving team-based care in basic emergency obstetric clinics: Using factor analysis to develop a brief teamwork tool for real-time feedback

Exploring the Link between Maternal Weight Gain During Pregnancy and LBW Incidence Amid COVID-19

The highest mortality cause in Indonesia is low birt weight (LBW). One of LBW causal factors is mothers’ lack of weight during pregnancy. Covid-19 pandemic affects all aspects including economy which economy which causes the unfulfilled nutrition needs in pregnant women. The objective of the study is to analyze the relation of mother’s weight rise during pregnancy and LBW incidents in the time of Covid-19 pandemic at Titik Kurniati private midwifery clinic. The study was a quantitative one with cross sectional design. The samples of the study were 64 samples taken by using quota sampling. The study used secondary data taken from medical and birth registration records. The data analysis used in the study was ficher exact. The study result showed p value of 0.002 and OR value was 16.44 (95% CI: 1.90-141.71). There is a significant relation of mother’s weight during pregnancy and LBW incidents in the time of Covid-19 pandemic period at Titik Kurniati private midwifery clinic. Mothers with abnormal body weight during pregnancy have 16 times higher risk to give birth in LBW condition compared with mothers with normal body weight during pregnancy.

Determination of the Readability Level of Consent Forms Used in the Gynecology and Obstetrics Clinic at Suleyman Demirel University.

Background This study aimed to evaluate the readability level of consent forms used for interventional procedures in the obstetrics and gynecology clinic and to determine the readability of the texts according to the education level of the patient. Methodology This study determined the readability of patient consent forms used before interventional procedures in the gynecology and obstetrics clinic at the Suleyman Demirel University Hospital, Isparta.The consent forms were divided into two main groups according to their use in obstetrics and gynecology procedures. The readability level of consent forms was assessed using two readability formulas developed by Ateşman and Bezirci-Yılmaz, which determine the readability level of Turkish texts in the literature. Results When the consent forms were analyzed according to Atesman's readability formula, they were found to be readable with more than 15 years of education at the undergraduate level, while according to Bezirci-Yılmaz's readability formula, they were found to be readable with 17 years of education at the postgraduate level. Conclusions Easy-to-read consent forms will ensure that patients are more informed about interventional procedures and participate more effectively in the treatment process. There is a need to develop readable consent forms suitable for the general education level.

Novel Metabolic Subtypes in Pregnant Women and Risk of Early Childhood Obesity in Offspring

The in utero metabolic milieu is associated with offspring adiposity. Standard definitions of maternal obesity (according to prepregnancy body mass index [BMI]) and gestational diabetes (GDM) may not be adequate to capture subtle yet important differences in the intrauterine environment that could be involved in programming. To identify maternal metabolic subgroups during pregnancy and to examine associations of subgroup classification with adiposity traits in their children. This cohort study included mother-offspring pairs in the Healthy Start prebirth cohort (enrollment: 2010-2014) recruited from University of Colorado Hospital obstetrics clinics in Aurora, Colorado. Follow-up of women and children is ongoing. Data were analyzed from March to December 2022. Metabolic subtypes of pregnant women ascertained by applying k-means clustering on 7 biomarkers and 2 biomarker indices measured at approximately 17 gestational weeks: glucose, insulin, Homeostatic Model Assessment for Insulin Resistance, total cholesterol, high-density lipoprotein cholesterol (HDL-C), triglycerides, free fatty acids (FFA), HDL-C:triglycerides ratio, and tumor necrosis factor α. Offspring birthweight z score and neonatal fat mass percentage (FM%). In childhood at approximately 5 years of age, offspring BMI percentile, FM%, BMI in the 95th percentile or higher, and FM% in the 95th percentile or higher. A total of 1325 pregnant women (mean [SD] age, 27.8 [6.2 years]; 322 [24.3%] Hispanic, 207 non-Hispanic Black [15.6%], and 713 [53.8%] non-Hispanic White), and 727 offspring with anthropometric data measured in childhood (mean [SD] age 4.81 [0.72] years, 48% female) were included. We identified the following 5 maternal metabolic subgroups: reference (438 participants), high HDL-C (355 participants), dyslipidemic-high triglycerides (182 participants), dyslipidemic-high FFA (234 participants), and insulin resistant (IR)-hyperglycemic (116 participants). Compared with the reference subgroup, women in the IR-hyperglycemic and dyslipidemic-high FFA subgroups had offspring with 4.27% (95% CI, 1.94-6.59) and 1.96% (95% CI, 0.45-3.47) greater FM% during childhood, respectively. There was a higher risk of high FM% among offspring of the IR-hyperglycemic (relative risk, 8.7; 95% CI, 2.7-27.8) and dyslipidemic-high FFA (relative risk, 3.4; 95% CI, 1.0-11.3) subgroups; this risk was of greater magnitude compared with prepregnancy obesity alone, GDM alone, or both conditions. In this cohort study, an unsupervised clustering approach revealed distinct metabolic subgroups of pregnant women. These subgroups exhibited differences in risk of offspring adiposity in early childhood. Such approaches have the potential to refine understanding of the in utero metabolic milieu, with utility for capturing variation in sociocultural, anthropometric, and biochemical risk factors for offspring adiposity.

Neurofibromatosis type 1 and pregnancy outcome: A case report

Background: Neurofibromatosis is a genetic disorder with high variability of clinical expression. Cutaneous manifestations such as café-au-lait spots, freckling patterns, and dermal neurofibromas, are the most distinguishable and common signs appearing in the vast majority of individuals with NF-1. Instances where a patient is both pregnant and affected with neurofibromatosis are less common and the information about the maternal-fetal outcomes are mainly from case reports in the literature. Case presentation: A 33-year-old multiparous pregnant patient affected by NF-1 presented to the Obstetrics and Gynecology Clinic in Prishtina in Kosovo in the 36th week of pregnancy. The patient displayed signs of NF-1 exemplified by the growth of existing neurofibromas and the development of new ones. In addition, the patient experienced a placental abruption which is a life-threatening obstetrical complication rarely reported in the literature as a complication associated with maternal NF-1. An emergent cesarean section was performed and a healthy neonate unaffected by NF-1 was born. Conclusions: Pregnant patients with NF-1 are prone to the worsening of NF-1 symptoms and obstetrical complications. Increased antenatal care for these patients is recommended to ensure the well-being of the mother and fetus.

Efficacy of supervised pelvic floor muscle training with a home-based biofeedback device for urinary incontinence in postpartum women: protocol for a multicentre randomised controlled trial

IntroductionSupervised pelvic floor muscle training (PFMT) of at least 3 months duration has been strongly recommended as a first-line treatment for women with stress urinary incontinence (SUI) or SUI-predominant mixed...