Birth Complications Research Articles

The vascular phenotype of BPD: new basic science insights-new precision medicine approaches.

Bronchopulmonary dysplasia (BPD) is the most common complication of preterm birth. Up to 1/3 of children with BPD develop pulmonary hypertension (PH). PH increases mortality, the risk of adverse neurodevelopmental outcome and lacks effective treatment. Current vasodilator therapies address symptoms, but not the underlying arrested vascular development. Recent insights into placental biology and novel technological advances enabling the study of normal and impaired lung development at the single cell level support the concept of a vascular phenotype of BPD. Dysregulation of growth factor pathways results in depletion and dysfunction of putative distal pulmonary endothelial progenitor cells including Cap1, Cap2, and endothelial colony-forming cells (ECFCs), a subset of vascular progenitor cells with self-renewal and de novo angiogenic capacity. Preclinical data demonstrate effectiveness of ECFCs and ECFC-derived particles including extracellular vesicles (EVs) in promoting lung vascular growth and reversing PH, but the mechanism is unknown. The lack of engraftment suggests a paracrine mode of action mediated by EVs that contain miRNA. Aberrant miRNA signaling contributes to arrested pulmonary vascular development, hence using EV- and miRNA-based therapies is a promising strategy to prevent the development of BPD-PH. More needs to be learned about disrupted pathways, timing of intervention, and mode of delivery. IMPACT: Single-cell RNA sequencing studies provide new in-depth view of developmental endothelial depletion underlying BPD-PH. Aberrant miRNA expression is a major cause of arrested pulmonary development. EV- and miRNA-based therapies are very promising therapeutic strategies to improve prognosis in BPD-PH.

The Combined Effect of STEMB and Immunomodulatory Substance in the Blood Profile of Cows at the 15th Day Post-Partum.

The objective is to determine the morphological and biochemical blood parameters of cows at the 15th day postpartum with the separate and combined use of an Embryonic Stimulator (STEMB) and an immunomodulator (Immunopharm). In all studies, there were three experimental groups. For the first experimental group, the STEMB solution was administered to Holstein cows at 30 days before delivery, injected thrice subcutaneously at 7 days’ intervals and at a dosage of 0.075 ml/kg of body weight. The second experimental group was administered with the immunomodulator thrice intramuscularly at 7 days’ intervals and at a dosage of 6 ml per cow, starting 30 days prior to delivery. Finally, the third experimental group of cows were administered the drugs STEMB and Immunopharm combined while using the same dosage (0.075 ml/kg and 6 ml/cow respectively) and scheme (Thrice, 7 days’ interval, starting at 30 days before deliver) as the two other groups. It was found that the combined use of STEMB and Immunopharm improved the blood cell composition; increased amount of monocytes, segmented neutrophils, hemoglobin, total protein, alpha-globulins, immunoglobulins (A, M, G) and also reduced the indicators of ALT and AST enzymes to the threshold level. It has been demonstrated that the combined use of STEMB and Immunopharm are optimal for the prevention of birth and postpartum complications as well as providing an improvement in the blood cell composition.

Frozen embryo transfer in the menstrual cycle after moderate-severe ovarian hyperstimulation syndrome: a retrospective analysis

BackgroundOvarian hyperstimulation syndrome (OHSS) is a rare but serious complication of controlled ovarian stimulation. Frozen-embryo transfer (ET) is prompted to be performed in the next menstrual cycles after cancellation of fresh-ET after occurrence of OHSS. However, effects of frozen-ET in the second menstrual cycle have never been investigated. Therefore, this study aimed to assess this in the menstrual cycle after OHSS.MethodsThe OHSS group included 342 women with moderate-severe OHSS who underwent the first frozen-ET in the second menstrual cycle in the First Affiliated Hospital of Anhui Medical University from June 2018 to September 2019. A total of 342 women without OHSS who received frozen-ET in the second menstrual cycle were selected as control group matched by age, body mass index, fertility history, ovulation induction scheme. Uni- and multi-variable conditional logistic regression was used to estimate the association between moderate-severe OHSS and pregnancy outcomes.ResultsThere were no significant differences in maternal outcomes (miscarriage, preterm birth and pregnancy complications including gestational diabetes mellitus, pregnancy-induced hypertension, placenta previa, premature rupture of membranes and postpartum hemorrhage) and in neonatal outcome (birth-weight and body length, neonatal congenital diseases and other complications) between the two groups in either uni- or multi-variable models.ConclusionsFrozen-ET in the menstrual cycle after OHSS has similar maternal and neonatal outcomes as in women without OHSS. This study indicates that frozen-ET could be performed in the second menstrual cycle in women who recovered from moderate-severe OHSS.

Prematurity-associated wheeze: current knowledge and opportunities for further investigation.

Prematurity-associated wheeze is a common complication of preterm birth, with significant impact on the health and healthcare utilization of former preterm infants. This wheezing phenotype remains poorly understood and difficult to predict. This review will discuss the current state of the literature on prematurity-associated wheeze. We will discuss etiology and pathophysiology, and offer two conceptual models for the pathogenesis of this complex condition. This review will also identify current methods of ascertainment, and discuss the strengths and limitations of each. We will explore research-backed approaches to prevention and management, and finally suggest both pre-clinical and clinical avenues for investigation. An in-depth understanding of prematurity-associated wheeze will aid clinicians in its diagnosis and management, and inspire scientists to pursue much-needed further study into causes and prevention of this common and impactful condition. IMPACT: There is no recent, concise review on the current state of research on prematurity-associated wheeze, which is a rapidly evolving area of study. This article highlights causal models of wheeze, methods of ascertainment, management strategies for the clinician, and opportunities for further research for the physician scientist.

Early Pregnancy Examination Education as an Effort for Delivery Complications

Antenatal care is defined as health services provided to pregnant women by family members or midwives during the entire pregnancy. Care during pregnancy is important for the proper growth and development of the baby. Prenatal care helps reduce or prevent adverse outcomes during pregnancy. Poor antenatal care causes low birth weight babies, premature babies, neonatal deaths, birth complications etc. It is also effective in reducing maternal morbidity that occurs due to poor health, an unhygienic environment, poor nutrition and lack of medical facilities. Maternal Mortality Rate (MMR) is the number of maternal deaths that occur during pregnancy, childbirth, postpartum caused by emergency complications, either directly or indirectly . Factors that cause maternal death can be broadly grouped into direct and indirect causes. One of the efforts to accelerate the reduction of maternal and newborn mortality is through increasing access and quality of antenatal care, delivery assistance, prevention of complications and family planning by midwives, better known as the Childbirth Planning and Complications Prevention Program (P4K) programmed by the Indonesian Ministry of Health. The method of this community service is the counseling method in the form of direct presentation of lecture material to pregnant women and distributing questionnaires to assess the level of knowledge of mothers related to early pregnancy checks in an effort to prevent childbirth complications that occur in pregnant women. The importance of disseminating information related to antenatal care for the prevention of complications during delivery is very important for pregnant women to reduce maternal and infant mortality.

A decrease in endometrial thickness before embryo transfer is not associated with preterm birth and placenta-mediated pregnancy complications

Research questionDoes a decrease in endometrial thickness (compaction ≥10%) before embryo transfer prognosticate the risk for preterm birth and placenta-mediated pregnancy complications among IVF pregnancies? DesignRetrospective cohort study at a large private fertility practice. Patients with a singleton live birth after a fresh or frozen embryo transfer between 2016 and 2019 were included. The primary outcome was preterm birth (delivery before 37 weeks gestational age). Secondary outcomes included gestational hypertension, pre-eclampsia, intrauterine growth restriction and placental abruption. ResultsOf the 252 patients that met the study criteria, 122 (48%) demonstrated endometrial compaction (≥10%) and 130 (52%) did not. Age, body mass index (BMI), parity, history of preterm birth or history of pre-existing maternal conditions between the compaction and no-compaction groups were not significantly different. The overall prevalence of placenta-mediated complications across all participants was 25% (n = 62). The number of preterm births between the compaction and no-compaction groups (13% and 6%, respectively, P = 0.09) as well as the prevalence of placenta-mediated complications (29.5% and 20%, respectively, P = 0.08) were not significantly different. Findings for the primary outcome (preterm birth) persisted even after adjustment for potential confounding variables, including maternal age, parity, BMI, embryo score and type of embryo transfer (fresh versus frozen) (adjusted OR 1.86, 95% CI 0.64 to 5.38). ConclusionsEndometrial compaction (or decrease in endometrial thickness) before embryo transfer is not associated with preterm birth or placenta-mediated pregnancy complications.

The impact of preconception counselling on maternal and fetal outcomes in women with chronic medical conditions: A systematic review

BackgroundBeyond diabetes mellitus little data reports outcomes of women with chronic medical conditions who have received pre-conception counselling (PCC). This study aimed to perform a systematic review of the literature to evaluate evidence regarding the impact of PCC on maternal and fetal outcomes in women with chronic medical conditions aside from diabetes mellitus. MethodsA systematic review was conducted in accordance with PRISMA. PubMed, Cochrane, Ovid Medline and Web of Science were searched. Two reviewers screened abstracts and full texts. Inclusion criteria included studies relating to chronic medical disorders of interest published between database inception and 21st May 2022, reporting outcomes relating to disease activity and perinatal outcomes. ResultsThe search yielded 11,814 results of which six met criteria for inclusion. Two papers describe the demographics of women more likely to receive PCC which included younger age, shorter disease duration, nulliparity, IVF pregnancy and higher education/job security. Two reported the effects of PCC on women's behaviour with improvements demonstrated in correct medication adherence, folic acid intake and smoking cessation. Five studies reported outcomes related to disease activity; those receiving PCC were more likely to have quiescent disease during pregnancy. Improvements in pregnancy outcomes were described including reduced rates of small for gestational age, low birth weight, preterm birth, congenital abnormality and obstetric complications. DiscussionA paucity of data exists relating to pregnancy outcomes in women with chronic medical conditions receiving PCC. Reported outcomes are favorable, supporting the routine inclusion of PCC in preparation for pregnancy in such patients.

Skilled birth attendant utilization trends, determinant and inequality gaps in Ethiopia

BackgroundGlobally over half a million women die every year from potentially preventable and treatable pregnancy and childbirth complications; of which 99% occur in low-and middle-income countries (LMICs). The utilization of skilled birth attendants can timely identify treatable birth complications and save lives. However, utilization of services remained low in LMICs. This study aimed to examine the trends in the utilization of skilled birth attendants and the inequality gaps in Ethiopia using data from the Demographic and Health Surveys.MethodsWe used data from five rounds of Ethiopian Demographic and Health Surveys conducted in the period 2000–2019. Respondents were women in the reproductive age group who had a live birth within five years preceding the surveys. We used the concentration curve and concentration index to identify the inequalities using the World Health Organization recommended Health Equity Analysis Toolkit software. We did a logistic regression analysis to examine factors associated with skilled birth attendant utilization using STATA version 14.0.ResultThe skilled birth attendant coverage trend showed an increment from 5.7% in 2005 to 49.8% in 2019. The inequality gaps within the wealth, residence and education categories also showed a reduction over time. The odds of utilizing SBA were higher among those having primary, secondary, and above education status [AOR = 1.61 95%CI (1.33, 1.95)], being in the upper wealth quintile [AOR = 3.46 95%CI (1.8, 4.31)] and living in urban areas [AOR = 3.53 95%CI (1.88, 6.64)].ConclusionThe skilled birth attendant coverage trend showed a steady increase from 2005 to 2019 but if we continue with the current pace, it will be difficult to achieve the national target. The inequality gaps in household wealth status and residency area remain high. Efforts like strengthening the health system and engaging multisectoral agents need to be given priority to further reach the poorest and those living in rural areas to achieve national and international targets.

Training for breech deliveries with the mother in an upright position: An innovative adaptation of a simulation model

BackgroundDelivery of a breech baby with the mother in an upright position or on all fours has gained a renewed interest. In these positions, the obstetrician or midwife needs to learn new landmarks and maneuvers. A realistic simulation model would be a valuable adjunct for breech on all fours teaching programs. Material and methodsThis article describes the simulation model and training program we have developed to train an interprofessional team to assist breech births when the mother is on all fours. A questionnaire was used to evaluate the realism of the adapted mannequin and the impact of training on the confidence level of the participants. ResultsOn a Likert scale of 1 to 5, 92% of participants agreed or strongly agreed that the adapted mannequin used was realistic for training obstetric maneuvers for complicated breech births. After training, their confidence level supporting a breech birth in an upright position rose from an average of 2.5 to 5.7 on a scale of 1 to 10. ConclusionLearning the skills for breech deliveries on all fours is made possible by targeted training with this adapted simulation model.

Defining Anaemia across the Lifecycle in Healthy Reference Populations: An Analysis for Guideline Development

Background Detection of anaemia is critical for clinical medicine and public health in high and low income settings, but anaemia definitions are uncertain, causing discordance across different laboratories and guidelines. Current WHO anaemia definitions, set in 1968 using limited data, reflect the 5th centile of the haemoglobin distribution in apparently healthy populations. WHO is now reviewing these definitions. Haemoglobin concentration is sensitive to iron and other nutrient deficiencies, inflammation, renal impairment, and genetic conditions, and thus conservative criteria to obtain a healthy reference population is crucial in estimating the 5th centile. To support WHO definitions, this study estimated the 5th centile for haemoglobin in healthy reference populations derived from a secondary analysis of large cohorts. Methods We identified data sources from which sufficient clinical and laboratory data were available to identify an apparently healthy reference sample. These comprised the National Health and Nutrition Examination Survey (NHANES, USA, 8 survey years); Health Survey for England (HSE, England, 4 survey years); the Australian Health Survey (AHS), comprising 2 separate surveys: National Health Survey (NHS, Australia) and National Nutrition and Physical Activity Survey (NNPAS, Australia); TARGetKids! (prospective longitudinal cohort of children, Canada); BRISC (trial of oral iron in infants, Bangladesh); Generation R (prospective cohort of pregnant women, Netherlands). Markers or iron status and inflammation were available in all surveys, with exclusions for ferritin<15ug/L (or <12ug/L in children <5 years), or C-Reactive Protein (CRP) >5mg/L. Where possible, exclusions were applied based on renal function, folate, and active B12. Clinical data from all surveys (except Generation R) excluded individuals with pre-existing health conditions, use of medication (other than contraception), recent illness or hospital admission. In the pregnant Generation R group, those with pregnancy complications were excluded. In all groups, current smokers and those who consumed excess alcohol were excluded. Adults with BMI <18.5 or >30kg/m2 were excluded; children were excluded if growth z-scores were <-2 or >+2. In children <24months, those with birth complications or prematurity were excluded. Thresholds were defined in adult men (18-65 years), adult non-pregnant women (18-65 years), pregnant women (18-45 years, by trimester), and children (6-23 months, 24-59 months, 5-11 years, 12-17 years). Discrete 2.5th and 5th centiles were estimated along with two-sided 90% confidence intervals for each data set and estimates were combined across all data sources using a fixed-effect meta-analysis approach. Results In non pregnant adult men and women (total n=57,896 individuals), exclusions resulted in an apparently healthy group of 15-20% of each survey (less where survey years were missing required biochemistry). A broad range of self-reported ethnicities/ancestries were represented. For example in healthy adults: NHANES 17-33% of participants identified as White; HSE >90% identified as White; AHS 50-60% reported European ancestry. 5th centiles of the distribution of haemoglobin values in the derived reference samples were obtained (see Figure 1 for example in non-pregnant women). Pooled estimates for each sample are shown in Table 1. The results generally align with current WHO thresholds, other than adult men, where a 5th centile of 135.1g/L (90% CI 134.4-135.7) is above the WHO threshold of 130g/L, and in children 6-23 months where the 5th centile of 104.5g/L (90% CI 103.6-105.4) is lower than the current value of 110g/L. Our data support the current threshold in non-pregnant adult women of 120g/L. Sensitivity analyses suggest persons of Black race or ethnicity may have 5th centiles lower than values of White persons (predominantly within the US surveys), but presence of haemoglobinopathy as well as other contributing factors cannot be excluded. Conclusion In this analysis using stringent criteria to define healthy reference group at low risk of iron/ other nutrient deficiency, or inflammation, we have estimated statistical thresholds to define anaemia across the lifecycle. These data contribute to WHO guideline development, and provide a platform for harmonisation of thresholds across different laboratories and clinical guidelines. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Impact of Creating Awareness About Birth Preparedness and Complications Readiness Amongst Pregnant Women of Remote Communities with Extreme Poverty and Access Problems

Background: Although antenatal care sets in road to safety of mother and baby, birth affects pregnancy outcome most. Birth preparedness, complications readiness (BPCR) during pregnancy become essential, especially for rural women who have scarce health services, resources and access problems. Objectives: Community based study was carried out to know about impact of creating BPCR awareness to rural, tribal pregnant women. Material and methods: Study was conducted in 100 villages, randomly divided into 50 studies and 50 controls. Minimum 10 from each village, 15 to 39 years old, 1040 pregnant women, became study subjects. BPCR awareness was tried with maximum 5 sessions. Some women had only one session, because of inclusion from mid pregnancy, research assistant’s fixed visits, women’s availability. Ten randomly included women from each village in control set of villages, with no BPCR sessions, 1000 became study subjects. Pregnancy outcome was collected in study, as well as control villages. Results: Of 115 women who could have only one session, 45.2% found session useful, 16.5% of them had home births, 40.9% at Subcentre, 5.2% District hospital, 11.3% Referral hospital, 96.5% had live births, 3.5% stillbirths, 6.3% neonatal deaths occurred. Of 475 women who had 2-3 sessions, 77.1% found sessions useful, 3.6% had HBs, 42.3% at SC, 35.8% primary health centre, 30 (6.3%) DH, 12% RH, with 100% LBs, 1.1% NNDs. Of 450 women who had 4-5 sessions, 84.9% said sessions were very useful, 0.7% had HBs, 42.7% at SC, 38% PHC, 6.4% DH, 12.2% at RH, no SB, 1.6% NNDs. Of 1000 women who were not given BPCR awareness sessions, 40.4% had HB, 32.4% SC, 19.2% PHC, 2.8% DH, 5.2% RH, 92.7% had LBs, 7.3 SBs, 11.3% NNDs, no maternal death. Conclusion: BPCR awareness helped increase facility births, improved neonatal outcome, especially with more sessions.

Impact of COVID-19 pandemic on births: A university hospital experience

Background/Aim: Many studies have focused on assessing the effects of coronavirus 2019 (COVID-19) on the general population, but insufficient data concerning the impact on vulnerable populations, such as pregnant women, are available. The aim of this study was to compare the results of births before and during the pandemic in terms of maternal and newborn health and to determine the effect of the pandemic on such births. Methods: The population of this descriptive, retrospective cohort study consisted of women who gave birth in Sivas Cumhuriyet University Hospital Gynecology and Obstetrics Clinic between 01.03.2019–31.08.2019 and 01.03.2020–31.08.2020. No sample selection was made. As birth characteristics, the total and average number of births per month, the week of birth, whether there was a preterm birth, and the mode of delivery were evaluated. Age, number of pregnancies and births were evaluated as maternal characteristics. The birth weight and height of the newborn, number of babies with low birth weight, presence of stillbirth, Apgar 0 and 5 minute scores, and birth complications were evaluated as birth outcomes. Countable data were expressed as numbers and percentages and measurement data as mean, standard deviation, and minimum and maximum values. Inter-period means were compared with the t-test, nominal data were compared with the chi-squared test, and P &lt; 0.05 was considered significant. Results: It was observed that a 22.1% increase in the number of births during the pandemic period (n = 685) occurred when compared with the pre-pandemic period (n = 561). The difference in the increase in the number of births in both periods was not statistically significant (P = 0.153). The birth patterns, gender of the newborns, and the birth rates, including low birth weights, were similar during both periods. Gravidity and parity averages and minimum–maximum values were similar in both periods. When the weeks of gestation at birth were compared, it was observed that births occurred in the months before the pandemic, on average, during earlier gestational weeks. The number of births with fetal anomalies and stillbirths were compared, and it was found that the number of cases seen in both periods were similar. Conclusion: In this study, the characteristics and results of the pre-pandemic and pandemic periods were found to be similar.

Abstract 11961: Ductus Arteriosus Oxygen Response is Mediated by Mitochondrial Subunit NDUFS2

Introduction: The ductus arteriosus (DA) is a fetal vessel connecting the pulmonary artery (PA) and aorta, diverting oxygenated blood away from the developing lungs to the systemic circulation. The DA rapidly constricts in response to the increase in arterial oxygen (O 2 ) following the first breath. Failure of the DA to close in response to O 2 results in persistent ductus arteriosus, one of the most common complications of preterm birth. Mitochondria are known to play an important role in the O 2 response of DA smooth muscle cells (DASMC), however the mechanism is not fully understood. A subunit of mitochondrial Complex I, NDUFS2 (NADH:ubiquinone oxidoreductase core subunit 2) mediates the O 2 response of other specialized O 2 sensing tissues (PA and carotid body); we assess whether NDUFS2 also plays a role in DA O 2 sensing. Methods: DASMC were isolated from male term (29 days gestation) fetal New Zealand white rabbits. Cell lines were purified via fluorescence activated cell sorting, excluding CD90 + and CD31 + cells (fibroblasts and endothelial cells, respectively). Smooth muscle cell purity was confirmed using flow cytometry for α-smooth muscle actin (α-SMA). Primary cultures were 97.65% ± 0.65% CD90 - CD31 - , and were 100% α-SMA + post-sorting. We measured the O 2 responsiveness of DASMC using confocal microscopy, measuring changes in intracellular calcium with Cal-520AM. Cells were cultured in hypoxia (2.5% O 2 , pO 2 = 41 mmHg), with O 2 -induced increase in calcium relative to hypoxic baseline serving as a surrogate for constriction. DASMC were treated for 48 hours with 30 pmol siRNA and 90 pmol Lipofectamine® RNAiMAX to knockdown gene expression of NDUFS2 or a negative control. Knockdown was confirmed using qPCR. Results &amp; Conclusions: There was a 14.7% (±2.6%, n=33, p&lt;0.0001) increase in intracellular calcium relative to hypoxic baseline in siNC-treated cells. O 2 response was obliterated when treated with siNDUFS2 (0.7% ± 2.1%, n=29, p=0.798), with a 90.9% ± 1.89% knockdown of NDUFS2 mRNA expression. These data suggest a critical role for the mitochondrial electron transport chain, specifically NDUFS2, in DA oxygen responsiveness. While further functional studies will be required, our findings suggest a novel potential therapeutic target to modulate DA patency.

Analysis of risk factors related to extremely and very preterm birth: a retrospective study

Background:Preterm birth is one of the main causes of perinatal morbidity and mortality and imposes a heavy burden on families and society. The aim of this study was to identify risk factors and analyze birth conditions and complications of newborns born at < 32 gestational weeks for extremely preterm (EP) and very preterm (VP) birth in the clinic to further extend the gestational period.Methods:We performed a retrospective cohort study and collected data from 1598 pregnant women and 1660 premature newborns (excluding 229 premature babies who died due to severe illness and abandonment) admitted to the Obstetrics and Gynecology Hospital Affiliated with Nanjing Medical University in China from 2016 to 2020. We compared women’s and newborns’ characteristics by t-tests and Chi-square tests for continuous and categorical variables, respectively. Multivariable logistic regression was performed to estimate the effects of risk factors on EP and VP birth.Results:We identified 3 independent risk factors for EP birth: cervical incompetency (P < 0.001); multiple pregnancy (P < 0.01), primipara (P < 0.001). Additionally, we identified 4 independent risk factors for VP birth: gestational diabetes mellitus (GDM) (P < 0.05), preterm premature rupture of membrane (PPROM) (P < 0.01), fetal intrauterine distress (P < 0.001), and hypertensive disorder complicating pregnancy (HDCP) (P < 0.001). In addition, pairwise comparisons revealed statistically significant differences in the incidence rates of neonatal pneumonia, bronchopulmonary dysplasia (BPD) and sepsis between the 28–28 + 6 and 29–29 + 6 weeks of gestation groups (P < 0.05). Compared with 28–28 + 6 weeks of gestation, neonatal complications were significantly more common at < 26 weeks of gestation (P < 0.05). The incidence rates of neonatal intracranial hemorrhage(NICH), patent ductus arteriosus(PDA), patent foramen ovale(PFO), pneumonia, BPD and sepsis were significantly higher in the 26–26 + 6 and 27–27 + 6 gestational weeks than in the 28–28 + 6 gestational weeks (P < 0.05).Conclusion:PPROM, is the most common risk factor for EP and VP birth, and cervical insufficiency, multiple pregnancy, and primipara are independent risk factors for EP birth. Therefore, during pregnancy, attention should be devoted to the risk factors for PPROM, and reproductive tract infection should be actively prevented to reduce the occurrence of PPROM. Identifying the risk factors for cervical insufficiency, actively intervening before pregnancy, and cervical cervix ligation may be considered to reduce the occurrence of EP labor. For iatrogenic preterm birth, the advantages and disadvantages should be carefully weighed, and the gestational period should be extended beyond 28 weeks to enhance the safety of the mother and child and to improve the outcomes of preterm birth.

The Influence of Exercise, Lifestyle Behavior Components, and Physical Fitness on Maternal Weight Gain, Postpartum Weight Retention, and Excessive Gestational Weight Gain.

This study examines (a)the influence of exercise, lifestyle behavior components (sedentary time, physical activity, and sleep and dietary patterns), and physical fitness on maternal weight gain, postpartum weight retention, and excessive gestational weight gain and (b)whether exercise protects against the adverse effects of impaired metabolism and nonoptimal body composition related to excessive gestational weight gain. Subjects were assigned to either a supervised concurrent (aerobic + resistance) exercise program followed 3days/week (n = 47) or a control group (n = 54). Sedentary time, physical activity, sleep and dietary patterns (assessed by accelerometry and questionnaires), muscle strength (handgrip test), and cardiorespiratory fitness (Bruce test) were determined at gestational Weeks 16 and 33 (early-middle and late pregnancy, respectively), and at 6 weeks postpartum. Weight gain and weight retention were calculated using recorded weights at prepregnancy, early-middle, and late pregnancy, and at 6weeks postpartum. Birth complications, maternal postpartum body composition, cardiometabolic, and inflammatory markers in maternal and umbilical cord arterial and venous blood, and in colostrum, and mature milk were also recorded. The exercise intervention reduced late weight gain (B = -2.7, SE = 0.83, p = .003) and weight retention (B = -2.85, SE = 1.3, p = .03), independent of any lifestyle behavior component or physical fitness, but did not prevent excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration were associated with a smaller mean weight gain and lower excessive weight gain values (p < .05). Among the participants who experienced excessive weight gain, those who were exercisers had a lower body mass index and systemic tumor necrosis factor-alpha concentration, lower umbilical cord venous tumor necrosis factor-alpha and arterial interferon gamma levels, higher cord arterial interleukin-10 levels, and improved placental function compared with controls (p < .05). In summary, exercise may help optimize gestational weight gain and weight retention, and may attenuate the impaired phenotype related to excessive weight gain. Increasing cardiorespiratory fitness, muscle strength, and sleep duration might help to prevent excessive weight gain during pregnancy.

Exploring the psychosocial challenges faced by pregnant teenagers in Ditsobotla subdistrict.

Pregnant teenagers usually experience psychosocial challenges such as a great amount of stress when they have to deal with an unwanted pregnancy, unpreparedness for parenthood and a lack of income as well as labour and birth complications. These are further complicated by the stigma from their families, friends and community. Unaddressed psychosocial challenges during teenage pregnancy can adversely affect the health outcomes of both mother and the child. This study explores and describes the psychosocial challenges faced by pregnant teenagers in the Ditsobotla subdistrict. The study was conducted in three health centres in the Ditsobotla subdistrict. A qualitative-exploratory-descriptive and contextual research design was used. Non-probability purposive and convenience sampling techniques were used to select the participants. Semistructured individual interviews through WhatsApp video calls were used to collect data, which were analysed using conventional content analysis. Three themes emerged from the findings of the study, namely psychological challenges, social challenges and suggestions to address psychosocial challenges faced by pregnant teenagers. The findings established that pregnant teenagers in the Ditsobotla subdistrict are faced with psychosocial challenges which negatively impact their psychological health and social life. Suggestions made in this study have the potential to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict if implemented. The findings of this study provide important information that may be used to improve the psychosocial well-being of pregnant teenagers in the Ditsobotla subdistrict.

New WHO recommendations for the care of preterm or low birthweight infants have the potential to transform maternal and newborn health-care delivery

The incidence of preterm birth (gestational age <37 weeks) worldwide was 15·2 million in 2019, occurring in 11% of livebirths. 1 Cao G Liu J Liu M Global, regional, and national incidence and mortality of neonatal preterm birth, 1990-2019. JAMA Pediatr. 2022; 176: 787-796 Crossref PubMed Scopus (6) Google Scholar , 2 Our World in DataNumber of births and deaths per year, world. https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100Date: 2022 Date accessed: November 7, 2022 Google Scholar In 2015, an estimated 20·5 million livebirths globally were low birthweight (LBW; weight <2500g at birth). 3 Blencowe H Krasevec J de Onis M et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health. 2019; 7: e849-e860 Summary Full Text Full Text PDF PubMed Scopus (322) Google Scholar The survival, health, growth, and neurodevelopment of preterm and LBW infants lags behind that of full-term infants and special care is needed for these vulnerable infants. 4 Escobar GJ McCormick MC Zupancic JA et al. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006; 91: F238-F244 Crossref PubMed Scopus (119) Google Scholar , 5 Wang ML Dorer DJ Fleming MP Catlin EA Clinical outcomes of near-term infants. Pediatrics. 2004; 114: 372-376 Crossref PubMed Scopus (535) Google Scholar Preterm and LBW infants are susceptible to impaired respiration, difficulty feeding, growth failure, poor body temperature regulation, and infection. 4 Escobar GJ McCormick MC Zupancic JA et al. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006; 91: F238-F244 Crossref PubMed Scopus (119) Google Scholar , 5 Wang ML Dorer DJ Fleming MP Catlin EA Clinical outcomes of near-term infants. Pediatrics. 2004; 114: 372-376 Crossref PubMed Scopus (535) Google Scholar Globally, preterm birth accounts for 36·1% of neonatal deaths and 17·7% of deaths among children younger than 5 years. 6 Perin J Mulick A Yeung D et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022; 6: 106-115 Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar Complications of preterm birth are the leading cause of death in children before their fifth birthday. An estimated 0·94 million deaths worldwide were due to preterm birth in 2019. 6 Perin J Mulick A Yeung D et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health. 2022; 6: 106-115 Summary Full Text Full Text PDF PubMed Scopus (52) Google Scholar

Factors associated with institutional delivery among mothers who gave birth within 1 year prior to the study at Gilgelbelles town, Northwest Ethiopia: a mixed-methods study

ObjectivesThis study aimed to assess factors associated with institutional delivery among mothers who had delivered within 1 year prior to the study at Gilgelbelles town, Northwest, Ethiopia.DesignA community-based mixed-methods study...

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Australian fertility preservation guidelines for people with cancer 2022: review and recommendations.

Penyuluhan Kesehatan Meningkatkan Pengetahuan Tentang Manfaat Prenatal Gentle Yoga Pada Ibu Hamil

Prenatal gentle yoga is one type of modification of hatha yoga that is adapted to the condition of pregnant women. Yoga is a movement of the body with the harmonization of mind and soul. One of the yoga exercises intended for pregnant women is the Pranayama Position. Regular yoga practice during pregnancy can increase fetal weight and reduce preterm birth and childbirth complications. This community service aims to increase the knowledge of pregnant women about the benefits of prenatal gentle yoga. Existing problems are solved through community outreach activities through three stages, namely preparation, implementation and evaluation. The preparatory stage involves taking initial data and coordinating with the Puskesmas to plan the process of implementing counseling with a theme according to the needs of pregnant women, then the implementation stage begins with and introduces yourself, explains the aims and objectives of the counseling and distributes questionnaires to measure the knowledge of pregnant women before being given counseling. The evaluation phase consisted of discussion and question and answer as well as distributing questionnaires after health education. This activity was carried out on June 2, 2022 at the Bajeng Health Center which was attended by 21 pregnant women. The conclusion is that there are differences in knowledge before and after giving health education about the benefits of prenatal gentle yoga.