Birth Complications Research Articles

Innovative Entrepreneurship Education for Young People in Vietnam to Meet Current International Integration Requirements

Currently, the youth entrepreneurship movement in Vietnam is developing strongly and widely, the initial results of the movement have made an important contribution to the overall success of the country's renewal process. Taking place in the context of our country's increasing international integration with both opportunities and challenges intertwined, the youth entrepreneurship movement is also being profoundly affected and influenced, and many new problems arise from very difficult and complicated birth. Therefore, to help the movement develop quickly and sustainably and meet the requirements of the current international integration process, it is necessary to continue to further promote entrepreneurship education for Vietnamese youth promptly and comprehensively towards modernity and innovation.

Unmet need for family planning among married women in Zambia: lessons from the 2018 Demographic and Health Survey

BackgroundUnmet need for family planning among married women is still a public health concern in sub-Saharan Africa. In Zambia, one in every five married women had an unmet need for family planning in 2018. Unmet need for family planning has the potential to increase the number of unintended pregnancies and unsafe abortions. These factors can increase the proportion of women of child bearing age, who are at high risk of birth complications. This study was therefore conducted to understand the determinants of unmet need for family planning among married women in Zambia based on recent cross-sectional data.MethodsThe study analysed data extracted from the Zambia Demographic and Health Survey, which was a representative cross-sectional survey conducted in 2018. The analysis was done on a sample of 7598 currently married women aged 15–49 years. Multivariate logistic regression was used to examine determinants of unmet need for family planning in Zambia. The analyses was weighted to account for complex sample design.ResultsPrevalence of unmet need for family planning is still high in Zambia at 20%. Women in the age groups 25–34 and 35–49 were less likely to have total unmet need for family planning (AOR = 0.61; 95% CI 0.47, 0.78) and (AOR = 0.63; 95% CI 0.45, 0.86) respectively, compared with those aged 15–24 years. Age of a woman, parity, household wealth and exposure to media-based family planning messages were found to be significantly associated with unmet need for family planning among married women.ConclusionThere were significant differences in unmet need for family planning based on a woman's age, number of children ever born, wealth level, and exposure to media-based family planning messaging. Improving access to family planning messages and addressing underlying structural factors that improve the wealth status, particularly among young women, may help to reduce unmet need for family planning in Zambia.

Early life programming of nonalcoholic fatty liver disease in children

BackgroundResearch is beginning to implicate early life characteristics in the development of pediatric nonalcoholic fatty liver disease, however the relationship with perinatal characteristics is poorly understood. AimsWe evaluated the association between perinatal characteristics and nonalcoholic fatty liver disease in childhood. Study designNested case-control study. Subjects5104 children born in Quebec, Canada between 2006 and 2019. Exposures included maternal diabetes, obesity, prematurity, and other birth complications. Outcome measuresThe outcome was nonalcoholic fatty liver disease diagnosed in hospital before 14 years of age. We calculated adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between birth characteristics and nonalcoholic fatty liver disease. ResultsA total of 104 children with nonalcoholic fatty liver disease were included. Gestational diabetes (OR 2.17, 95% CI 1.15–4.10), preexisting diabetes (OR 5.75, 95% CI 2.67–12.4), and maternal obesity (OR 3.06, 95% CI 1.71–5.45) were associated with childhood nonalcoholic fatty liver disease. Prematurity (OR 1.93, 95% CI 1.06–3.54) and neonatal intensive care unit admission (OR 2.18, 95% CI 1.10–4.33) were also associated with nonalcoholic fatty liver disease. However, there was no association with low birthweight, small-for-gestational age birth, and macrosomia. ConclusionsMaternal metabolic disorders and prematurity may initiate processes early in life that lead to the development of nonalcoholic fatty liver disease in childhood.

Comparison of wavelet‐based decomposition and empirical mode decomposition of electrohysterogram signals for preterm birth classification

Signal decomposition is a computational technique that dissects a signal into its constituent components, providing supplementary information. In this study, the capability of two common signal decomposition techniques, including wavelet-based and empirical mode decomposition, on preterm birth classification was investigated. Ten time-domain features were extracted from the constituent components of electrohysterogram (EHG) signals, including EHG subbands and EHG intrinsic mode functions, and employed for preterm birth classification. Preterm birth classification and anticipation are crucial tasks that can help reduce preterm birth complications. The computational results show that the preterm birth classification obtained using wavelet-based decomposition is superior. This, therefore, implies that EHG subbands decomposed through wavelet-based decomposition provide more applicable information for preterm birth classification. Furthermore, an accuracy of 0.9776 and a specificity of 0.9978, the best performance on preterm birth classification among state-of-the-art signal processing techniques, were obtained using the time-domain features of EHG subbands.

Episiotomy in Southern Brazil: prevalence, trend, and associated factors.

ABSTRACTOBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil.METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure.RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80).CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.

Monocytes and macrophages in pregnancy: The good, the bad, and the ugly.

A successful human pregnancy requires precisely timed adaptations by the maternal immune system to support fetal growth while simultaneously protecting mother and fetus against microbial challenges. The first trimester of pregnancy is characterized by a robust increase in innate immune activity that promotes successful implantation of the blastocyst and placental development. Moreover, early pregnancy is also a state of increased vulnerability to vertically transmitted pathogens notably, human immunodeficiency virus (HIV), Zika virus (ZIKV), SARS-CoV-2, and Listeria monocytogenes. As gestation progresses, the second trimester is marked by the establishment of an immunosuppressive environment that promotes fetal tolerance and growth while preventing preterm birth, spontaneous abortion, and other gestational complications. Finally, the period leading up to labor and parturition is characterized by the reinstatement of an inflammatory milieu triggering childbirth. These dynamic waves of carefully orchestrated changes have been dubbed the "immune clock of pregnancy." Monocytes in maternal circulation and tissue-resident macrophages at the maternal-fetal interface play a critical role in this delicate balance. This review will summarize the current data describing the longitudinal changes in the phenotype and function of monocyte and macrophage populations in healthy and complicated pregnancies.

Term induction of labour in nulliparous women: When to draw the line?

ObjectiveThere exists uncertainty surrounding the most effective and efficient means of inducing labour, particularly in the setting of an unfavourable cervix. This study aims to determine the merit of repeating dinoprostone administration when a single application has failed to render the cervix favourable for amniotomy.Study designRetrospective analysis of a consecutive cohort of nulliparous women who underwent term induction of labour in a tertiary referral centre in Ireland was conducted over a 12- month period (December 2019 to January 2021). The time-interval from dinoprostone administration to delivery and the incidence of complicated birth, associated with single and sequential dinoprostone dosing, were determined. Comparisons were made using the Chi-square test and logistic regression adjusting for gestational age delivery.Results586 nulliparous women underwent term induction of labour during the study period. Administration of a single dose of dinoprostone or amniotomy alone were associated with the greatest prospect of an uncomplicated vaginal birth when compared to sequential dinoprostone dosing. Nonetheless, just one in four nulliparous women undergoing induction of labour experienced an unassisted and uncomplicated vaginal birth. The median [interquartile range] for time interval from induction to delivery or decision for caesarean delivery was 0.4 [0.3–0.6] days in those who underwent amniotomy alone, compared to 1.1 [0.7–1.5] days, 1.8 [1.4–2.2] days and 2.2 [2.0–2.6] days for those with 1, 2 or 3 doses of dinoprostone, respectively (p < 0.001 between all groups; Figure 1)ConclusionThese contemporaneous data indicate that in circumstances where more than a single dose of dinoprostone is required for cervical priming in a nulliparous woman, the incidence of an uncomplicated vaginal delivery decreased from more than half of women to less than one third. Over one third of women who were administered either a single dose of dinoprostone or more than one dose experienced an emergency intrapartum Caesarean delivery or a complicated vaginal birth. These findings are relevant to nulliparous women undergoing induction of labour in the setting of an unfavourable cervix and should be incorporated into shared decision-making consultations, particularly when repeat administration of dinoprostone is being considered.

Modern aspects of patology in puberty period

The woman’s health and its integral component – reproductive health – are largely determined by the conditions of her development in the womb, during the neonatal period, childhood, and adolescence. The article provides an analysis of modern research on the relationship of reproductive dysfunction since its inception, where there is a clear tendency to increase the number of patients with puberty pathology. The low level of somatic and reproductive health before pregnancy causes a high frequency of complicated births, leading to a deterioration in the development of subsequent generations. The woman’s reproductive system is the most dynamic biological object, which is extremely sensitive to adverse external and internal factors by the emergence of new adaptive reactions that acquire, under certain conditions, the properties of the pathological process. At the same time, many issues of the pathogenesis of fertility disorders have not been fully studied and remain controversial. Accordingly, not only the development of informative methods for assessing the state of the reproductive system, but also the problem of restoring reproductive health are becoming increasingly important. In such conditions, to improve the indicators of female reproductive health at all stages of its formation, it is necessary to improve and optimize the provision of gynecological and obstetric care.

Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion.

Polycystic ovary syndrome (PCOS) is associated with a higher risk for pregnancy and birth complications according to the specific features associated with PCOS. The features include obesity before and during pregnancy, hyperandrogenism, insulin resistance, infertility, cardiometabolic risk factors, and poor mental health. PCOS is not often recognized as a risk factor for poor pregnancy and birth outcomes in pregnancy care guidelines, while its associated features are. Pregnancy‐related risk profile should ideally be assessed for modifiable risk factors (e.g., lifestyle and weight management) at preconception in women with PCOS. Hyperglycaemia should be screened using a 75‐g oral glucose tolerance test at preconception or within the first 20 weeks of pregnancy if it has not been performed at preconception and should be repeated at 24–28 weeks of pregnancy. In the absence of evidence of benefit for strategies specific to women with PCOS, the international evidence‐based guidelines for the assessment and management of PCOS recommend screening, optimizing, and monitoring risk profile in women with PCOS (at preconception, during and postpregnancy) consistent with the recommendations for the general population. Recommended factors include blood glucose, weight, blood pressure, smoking, alcohol, diet, exercise, sleep and mental health, emotional, and sexual health among women with PCOS. The guidelines recommend Metformin in addition to lifestyle for assisting with weight management and improving cardiometabolic risk factors, particularly in those with overweight or obesity. Letrozole is considered the first‐line pharmacological treatment for anovulatory infertility in PCOS. Individualized approach should be considered in the management of pregnancy in PCOS.

Advancements in neonatology through quality improvement.

In the past 3 decades, quality improvement methodology has often been employed in medicine to improve patient outcomes. Neonatal medicine has seen an increase in publications using improvement science to ensure the application of potentially better practices to decrease complications and increase survival without major disability. This article reviews quality improvement studies that have impacted neonatal mortality and morbidity, as well as specific disease processes including bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. Using improvement science, studies have substantially reduced neonatal mortality and the major complications of preterm birth.

Male Hypogonadism Significantly Increases the Risk of Perinatal Birth Complications: Retrospective Analysis of US Claims Data

ABSTRACT Introduction Hypogonadism is common in men with male factor infertility and hormone therapies may improve semen parameters and pregnancy rates in affected men. However, compared to paternal factors such as advanced age, male infertility or obesity, it is uncertain whether hypogonadism itself impacts perinatal birth outcomes and complications. Objective This study evaluates the association between male hypogonadism and perinatal birth complications in the United States. Methods We performed a retrospective analysis of the IBM MarketScan™ Commercial Claims and Encounters database between 2011-2017. We identified birth records using birth or pregnancy-related major diagnostic categories associated with persons age 0. Fathers were considered to be adult (&amp;gt; 18) male individuals with the same family identifier as the neonates listed as either the primary insurance beneficiary or spouse. Birth records were excluded if there was no family identifier or the father was unable to be linked. For each birth, we recorded whether they were preterm, diagnosed as low birth weight, or diagnosed with birth defects. For the fathers linked with each birth record, we determined paternal age, hypogonadism status, geographic region, and other associated comorbidities. Births were stratified based on whether the father had hypogonadism or not and we performed univariate tests for variation. Additionally, we conducted a multivariate logistic model of birth complication (preterm, low weight, or growth defect) against father's age, hypogonadism status, and paternal comorbidities. Results Between 2011 and 2017, paternal hypogonadism was found in 3.97% of fathers among 468,546 birth records. In contrast, no paternal hypogonadism was found in 96.03% of fathers among 468,546 birth records. Overall, our study reveals that paternal hypogonadism is positively associated with perinatal birth complications (odds ratio (OR) 1.10; 95% CI: 1.06, 1.13). Additionally, low birth weight was found in 46, 96% of birth among 196,607 birth records with paternal hypogonadism, follow by preterm birth with 7.64% of birth among 26,886 birth records with paternal hypogonadism. Conclusions Male hypogonadism was associated with a statistically significant increase in perinatal birth complications. However, these results should be interpreted with caution because patients with male hypogonadism are also likely to have male infertility. For hypogonadism to be considered as a separate risk factor for perinatal birth complications further investigation will be needed. Disclosure No

Mesenchymal Stromal Cell-Derived Extracellular Vesicles for Neonatal Lung Disease: Tiny Particles, Major Promise, Rigorous Requirements for Clinical Translation

Extreme preterm birth disrupts late lung development and puts newborns at risk of developing chronic lung disease, known as bronchopulmonary dysplasia (BPD). BPD can be associated with life-long complications, and currently no effective treatment is available. Cell therapies are entering the clinics to curb complications of extreme preterm birth with several clinical trials testing the feasibility, safety and efficacy of mesenchymal stromal cells (MSCs). The therapeutic effect of MSCs is contained in their secretome, and nanosized membranous structures released by the MSCs, known as extracellular vesicles (EVs), have been shown to be the therapeutic vectors. Driven by this discovery, the efficacy of EV-based therapy is currently being explored in models of BPD. EVs derived from MSCs, contain a rich cargo of anti-inflammatory and pro-angiogenic molecules, making them suitable candidates to treat multifactorial diseases such as BPD. Here, we review the state-of-the-art of preclinical studies involving MSC-derived EVs in models of BPD and highlight technical and regulatory challenges that need to be addressed before clinical translation. In addition, we aim at increasing awareness regarding the importance of rigorous reporting of experimental details of EV experiments and to increase the outreach of the current established guidelines amongst researchers in the BPD field.

Preterm Birth, Exasperation to the South Asian Countries

When a child is born before 37 weeks or 259 days of pregnancy, it is termed as preterm birth. Pre-term birth is prevalent in both developed and developing country. However, difference lies in their survival. In lower and middle income countries, most preterm babies die due to lack of even simple interventions. India ranks top in the world for deaths due to complications of preterm birth. Similarly, other South Asian countries, Pakistan, Bangladesh, Afghanistan and Nepal rank 3rd, 6th, 9th and 20th in the same. The aim of this review paper is to provide a landscape analysis on the burden of pre-term birth and challenges in the context of South Asian region. Databases such as PubMed, Scopus and Google Scholar were searched from 2000 to 2020 and 27 articles are included in the study. It was found that pre-term birth causes huge burden in the form of morbidity, mortality as well as socio economic losses. Preterm birth was associated with increased sepsis, cardiovascular disease, respiratory illness, hypothermia, neurological and gastrointestinal complications. South Asian countries have distinct challenges in eliminating or reducing preterm births which are: poor quality health surveillance data, inadequate trained health workforce, insufficient finance and funding, service delivery and other methodological challenges. Ending pre-term birth is important as it is directly related to Sustainable Development Goal 3. Therefore, there should be increase in priority given to increase financing, quality data gathering, adopting innovative measures as well as joint efforts of all the sectors to control the pre-term birth.

Pregnant women with bipolar disorder who have a history of childhood maltreatment: Intergenerational effects of trauma on fetal neurodevelopment and birth outcomes.

Intergenerational transmission of trauma occurs when the effects of childhood maltreatment (CM) influence the next generation's development and health; prenatal programming via maternal mood symptoms is a potential pathway. CM is a risk factor for bipolar disorder which is present in 1.8% of pregnant women. Mood symptoms are likely to increase during pregnancy, particularly for those with a history of CM. We examined whether there was evidence for intergenerational transmission of trauma in utero in this population, and whether maternal mood was a transmission pathway. CM and maternal mood were self-reported by N=82 pregnant women in treatment for bipolar disorder. Fetal heart rate variability (FHRV) was measured at 24, 30, and 36 weeks' gestation. Gestational age at birth and birth weight were obtained from medical charts. A cluster analysis yielded two groups, Symptom+ (18.29%) and Euthymic (81.71%), who differed on severe mood symptoms (p < 0.001) but not on medication use. The Symptom+ group had more CM exposures (p < 0.001), a trend of lower FHRV (p=0.077), and greater birth complications (33.3% vs. 6.07% born preterm p < 0.01). Maternal prenatal mood mediated the association between maternal CM and birth weight in both sexes and at trend level for gestational age at birth in females. This is the first study to identify intergenerational effects of maternal CM prior to postnatal influences in a sample of pregnant women with bipolar disorder. These findings underscore the potential enduring impact of CM for women with severe psychiatric illness and their children.

Outcome of Vaginal Birth after Caesarean Section at a Tertiary Health Facility, Southern Nigeria

Background: Caesarean section rate has been on the increase in the past few years. Previous caesarean sections are a major indication for caesarean sections. The risks associated with repeat caesarean sections have brought about the need to adopt vaginal birth after caesarean section (VBAC) as the preferred mode of delivery in a previously scarred uterus. Aims and Objectives: To determine the pregnancy outcome and complications of vaginal birth after caesarean section at the University of Port Harcourt Teaching Hospital. Materials and Methods: This was a retrospective descriptive study of 121 women with one previous caesarean section who presented at the labour ward of the University of Port Harcourt Teaching Hospital between January 1, 2010, and December 31, 2019. Data was obtained from the case notes, ward, and theatre registers, encoded into a spreadsheet, and analyzed using SPSS 22.0. The results are presented as means, rates and proportions. Associations between variables were assessed using students t-test and Pearson’s correlation. Statistical significance was considered at P&lt;0.05. Results: There were 20,661 deliveries during the period under review. Of these, 175 had vaginal birth after caesarean section (VBAC). However, only 121 case notes were available for analysis. About one third, 44 (36.36%) of the women had previous successful VBAC and 5 (4.13%) had augmentation of labour. Perineal laceration was the most common complication 38 (31.4%). Majority of the babies 103 (85%) had APGAR scores &gt; 7 in the first minute, while 10 (8.55%) were admitted in the Special Care Baby Unit. Maternal age, socioeconomic status, gestational age at delivery and birth weight were not significantly associated with the outcome of VBAC. Conclusion: Vaginal Birth after Caesarean Section is safe and should be recommended in carefully selected women with previous caesarean section, to reduce the morbidities associated with repeat caesarean sections.

Knowledge, Attitude, and Practice using the Kangaroo Method Care in Maternal with Low Birth Weight Babies

Newborn mortality is still quite high in the world, including Indonesia, one of which is caused by complications of premature birth. Kangaroo Method Care (KMC) is one way to keep the newborn’s body temperature warm by making direct contact between the baby’s skin and the mother’s skin. The purpose of this study was to analyze the relationship between knowledge, attitude, and practice of Kangaroo Care Method for mothers with low birth weight (LBW) infants. This study is a quantitative study with a cross-sectional approach. Respondents in this study were mothers who had LBW after treatment from the Regional General Hospital (RSUD) Koja, North Jakarta who were domiciled in Koja, Tanjung Priok, and Cilincing Districts, North Jakarta, amounting to 50 people. Data was collected using questionnaires and observations, and analyzed using the Spearman Correlation statistical test. Based on the results of the study, the average score of mother’s knowledge about Kangaroo Care Method was 21.76 (SD 1.06); the average score of the mother’s attitude towards the Kangaroo Care Method is 26.74 (SD 0.80); and the average duration of practice for Kangaroo Care Method is 2.92 hours/day (SD 0.90). Based on the results of observations, it was found that most of the LBW mothers had practiced Kangaroo Method Care by holding the right position from Kangaroo Method Care. Based on the Spearman Correlation statistical test, it was found that there was a relationship between knowledge, attitude, and practice of the Kangaroo Care Method in LBW mothers.

INCU Analyzer for Infant Incubator Based on Android Application Using Bluetooth Communication to Improve Calibration Monitoring

Worldwide, over 4 million babies die within a month of birth each year. Of these, 3.9 million are in developing countries. A proportion approximately 25% of these deaths are due to complications of premature birth, most commonly inadequate thermoregulation, water loss, and neonatal jaundice. An infant incubator provides stable temperature, relative humidity, and airflow values. A periodical calibration should be applied on infant incubator to monitor the functionality. The study aims to develop a calibration device that measures temperature, humidity, airflow, and noise in the baby incubator based on an Android application with Bluetooth communication to improve the calibration monitoring process. This is to achieve a better performance of the conventional INCU analyzer. The contribution of this research is that the values of the temperature, humidity, airflow, and noise can be displayed on both devices, the INCU analyzer machine, and mobile phone; thus, the user can monitor the measurement activities wirelessly. Furthermore, the statistical calculation for all measurements can be saved on a mobile phone device. The main design consists of temperature sensor LM35, humidity sensor DHT22, airflow sensor MPX5010DP, an analog signal conditioning circuit, an Arduino Mega microcontroller, Bluetooth module HC05, and Android mobile phone. The resulting design was compared to the standard or calibrator INCU analyzer machine (Fluke Biomedical INCU II). This study found that the smallest error is -1.72%°C, -0.106 % RH, -1.727% dB, and &lt;0.1% m/s for temperature, humidity, noise, and airflow parameters, respectively. After the evaluation process, this device can be used as an INCU analyzer to calibrate the infant incubator.

Health disparities, COVID-19, and maternal and childbirth outcomes: a meta-epidemiological study of equity reporting in systematic reviews

Background Pregnant women with COVID-19 are at increased risk for adverse maternal and pregnancy outcomes, and birth complications. Given the health outcome disparities among pregnant women of racial and ethnic minorities and the reliance of medical practice on systematic reviews and meta-analyses (SRMAs)—as they are the apical component in the hierarchy of evidence in medical research—the primary objective of the study is to examine the inclusion of the equity reporting in SRMAs focused on pregnancy outcomes and COVID-19 using PROGRESS-Plus equity framework. PROGRESS represents equity measures of Place, Race, Occupation, Gender, Religion, Education, Social capital, and Socio-economic status. Methods We conducted a systematic search of three databases to identify SRMAs related to maternal and pregnancy outcomes related to COVID-19. We extracted whether SRMAs reported or analyzed PROGRESS-Plus components among other study characteristics. Results Nearly 85% of SRMAs did not include any equity items to account for racial or geographic disparities. Reporting of race was absent from 95% of the studies. Place was the most common PROGRESS item and maternal age was the most common PROGRESS-Plus item reported overall. Conclusion When research is performed and reported in a way that fails to address disparities, the downstream repercussions may include medical care in the form of new protocol-driven hospital management, pharmacologic interventions, and other treatment options that mirror this absence in reporting. The absence of adequate reporting widens gaps in health outcomes among at-risk groups, such as pregnant women of racial and ethnic minorities.

Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications \u2014 a cross-sectional study

The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged ≥ 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage ≥ 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann–Whitney U-test, chi-square test or Fisher’s exact test, and Spearman’s rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.

Role of lactoferrin in preventing preterm birth and pregnancy complications: a systematic review and meta-analysis.

The aim of this systematic review was to report the role of lactoferrin supplementation for the prevention of preterm birth (PTB) in women at risk. PubMed and Embase databases were searched. Inclusion criteria were studies exploring maternal and perinatal outcomes in women at high-risk for preterm birth receiving compared to those not receiving lactoferrin during pregnancy. The primary outcome was preterm PTB<37 weeks; the secondary outcomes were gestational age at birth, PTB<34 and 28 weeks, preterm premature rupture of the membranes (PPROM), chorioamnionitis and admission to Neonatal Intensive Care Unit. Random effect meta-analyses were used to analyze the data. Six studies (333 pregnancies) were included. Overall, women taking lactoferrin had a lower risk of PTB<37 weeks of gestation with an OR of 0.43 (95% CI: 0.2-0.9). Likewise, gestational age at delivery was higher in women-taking compared to those not-taking lactoferrin (MD=0.46 weeks, SD=0.17, P=0.006). The other included studies explored the role of lactoferrin in affecting the inflammatory profile in the amniotic fluid of women undergoing invasive test, without reporting its actual role in preventing PTB. Prophylactic administration of lactoferrin can reduce the risk of PTB in women at risk. Further large and adequately powered randomized trial are needed in order to elucidate the actual role of lactoferrin in reducing the risk of preterm birth and in affecting perinatal outcomes in women at risk.