Early Pregnancy Complications Research Articles

Category ‐ Early Pregnancy Complications and Gynaecology

Category ‐ Early Pregnancy Complications and Gynaecology

012 Dysmenorrhea

“Dysmenorrhea”, of which the literal meaning from Ancient Greek, is “difficult menstrual flow”, is characterized by 24–48 h lasting lower abdominal cramps requiring medication or limiting normal activities, starting with menses or within few hours before or after their onset, correlated with ovulatory cycles and with duration and amount of menstrual flow. Nausea, vomiting, headache, dizziness, fatigue and other associated symptoms are often present. By definition, primary dysmenorrhea (PD) occurs with no pelvic pathology affecting 90% adolescents with dysmenorrhea. Secondary dysmenorrhea (SD) is associated with pelvic diseases, is present in 10% cases, being caused mostly by endometriosis and obstructive genital anomalies but also by PID, STDs, early pregnancy complications, adenomyosis, pelvic adhesions, cervical stenosis and other clinical pictures. Typically, PD arises 2 – 3 years after menarche, with onset of ovulatory cycles and may be diagnosed by meaningful history, focused on menstruation, and negative physical exam. Laboratory testing, imaging (US and MRI), hysteroscopy, laparoscopy are needed when SD is suspected. Several treatments exist. Non-medicinal approach includes exercise, acupuncture, topic heat, herbal preparations, magnetic devices, with some effectiveness but further studies are needed. Complementary and alternative medicine (Vitamins, Magnesium, fish oil, Chinese food) may be useful but need stronger evidence. NSAIDs, administered from the onset of bleeding at proper dosage for no longer than 2 – 3 days are first line treatment. Combined EPs, with different preparations and ways of administration, are suggested in sexually active girls and if NSAIDs are ineffective. Levonorgestrel Intra Uterine System (LNG IUS) lowers menstrual pain, now being advisable also in teens. Subdermal Etonorgestrel implant is effective too. In teens Depot medoxyprogesteronacetate rises concerns about bone mass. Because of bone demineralization, GnRH analogues are not allowed in under 16; in later ages an add-back estrogen and progesterone treatment is suggested. If medical treatments fail, laparoscopy is mandatory and not to be postponed: to diagnose and treat endometriosis and to remove functioning non-communicating uterine horns. Obstructive septa of genital anomalies must be removed. Careful follow-up recommended.

124 Is there any impact of age on psychological well-being when facing early pregnancy problems?

Background: Threatened miscarriage is one of the most common early pregnancy complication. About 20% of women may end up with miscarriage. Women may face a significant social and psychological morbidity. Objective: This study investigated if age of pregnant women would affect their psychological well-being on facing the early pregnancy problems. Method: All Chinese women attending the early pregnancy assessment clinic for early pregnancy problem of abdominal pain and vaginal bleeding were recruited. Exclusion criteria included women requested for termination of pregnancy or referred for suspected ectopic pregnancy. Informed consent was obtained. Demographic data, pain and bleeding severity were collected. They were invited to fill in questionnaire before the consultation, including the Chinese versions of 12-item General Health Questionnaire (GHQ-12), Beck Depression Inventory (BDI), Spielberger’s State Anxiety Inventory (STAI), and Fatigue Scale (FS). After that, gynecological examination and transvaginal ultrasound scan were performed by qualified gynecologists. Diagnosis of first trimester miscarriage, unknown viability and viable pregnancy was made. Women would be further follow-up in 1–2 weeks if the first diagnosis was unknown viability to determine the viability.Comparison was made between women who were aged ≤ 20 years (Group A) and aged ≥ 21 years old (Group B). Results: In all, 18 women were aged ≤ 20 years. Significantly more women aged ≤ 20 years were nulliparous and smoker. More of them also reported bleeding symptoms. Overall, the mean scores of GHQ12, BDI, STAI and FS questionnaires were 4.0 ± 3.1 (range 0–12), 9.2 ± 6.9 (range 0–55), 54.3 ± 10.7 (range 21–80), 2.4 ± 0.5 (1–4) respectively. There was no significant difference in all the GHQ-12, BDI, STAI and FS scores. Conclusion: There was no significant difference on psychological well-being between women aged ≤ 20 years or ≥ 21 years when facing the early pregnancy problems. Table 1 Table 1Demographics and scores of different questionnaires on psychological well-being. AllN = 1271 Group A (n = 18) Group B (n = 1253) P-value Nulliparity 750 (59.0%) 15 (83.3%) 735 (58.7%) 0.035 Smoking 177 (13.9%) 8 (44.4%) 169 (13.5%) 0.002 Presence of bleeding 1002 (78.8%) 8 (44.4%) 994 (79.3%) <0.001 Presence of abdominal pain 866 (68.1%) 14 (77.8%) 852 (68.0%) 0.38 GHQ-12 4.0 ± 3.1 4.1 ± 2.7 4.0 ± 3.2 0.92 BDI 9.2 ± 6.9 10.9 ± 9.2 9.2 ± 6.9 0.28 STAI 54.3 ± 10.7 52.8 ± 9.2 54.3 ± 10.7 0.56 FS 2.4 ± 0.5 2.3 ± 0.5 2.4 ± 0.5 0.39 Outcome of pregnancy - Viable pregnancy 1111 (87.4%) 17 (94.4%) 1094 (87.3%) 0.72 -Miscarriage 160 (12.6%) 1 (5.6%) 159 (12.7%) Open table in a new tab

An observational cohort study of health outcomes and costs associated with early pregnancy assessment units in the UK

BackgroundThe objective of this study was to assess the impact of consultant presence, volume of patients seen and weekend opening on the health and cost-related outcomes associated with different Early Pregnancy Assessment Unit (EPAU) configurations.MethodsThis was an observational study with a prospective cohort design. Six thousand six hundred six pregnant women (16 years of age and over) attending EPAUs because of suspected early pregnancy complications were recruited from 44 EPAUs across the UK. The main outcome measures were quality of life, costs, and anxiety.ResultsCosts, quality of life and anxiety scores were similar across configurations with little evidence to suggest an impact of consultant presence, weekend opening or volume of patients seen. Mean overall costs varied from £92 (95% CI £85 - £98) for a diagnosis of normally developing pregnancy to £1793 (95% CI £1346 - £2240) for a molar pregnancy. EQ-5D-5L score increased from 0.85 (95% CI 0.84–0.86) at baseline to 0.91 (95% CI 0.90–0.92) at 4 weeks for the 573 women who completed questionnaires at both time points, largely due to improvements in the pain/discomfort and anxiety/depression dimensions. 78% of women reported a decrease in their anxiety score immediately following their EPAU appointment.ConclusionsEPAU configuration, as specified in this study, had limited impact on any of the outcomes examined. However, it is clear that care provided in the EPAU has a positive overall effect on women’s health and emotional wellbeing, with significant improvements in EQ-5D and anxiety shown following an EPAU visit.

Proteome-defined changes in cellular pathways for decidua and trophoblast tissues associated with location and viability of early-stage pregnancy

BackgroundIn early pregnancy, differentiating between a normal intrauterine pregnancy (IUP) and abnormal gestations including early pregnancy loss (EPL) or ectopic pregnancy (EP) is a major clinical challenge when ultrasound is not yet diagnostic. Clinical treatments for these outcomes are drastically different making early, accurate diagnosis imperative. Hence, a greater understanding of the biological mechanisms involved in these early pregnancy complications could lead to new molecular diagnostics.MethodsTrophoblast and endometrial tissue was collected from consenting women having an IUP (n = 4), EPL (n = 4), or EP (n = 2). Samples were analyzed by LC–MS/MS followed by a label-free proteomics analysis in an exploratory study. For each tissue type, pairwise comparisons of different pregnancy outcomes (EPL vs. IUP and EP vs. IUP) were performed, and protein changes having a fold change ≥ 3 and a Student’s t-test p-value ≤ 0.05 were defined as significant. Pathway and network classification tools were used to group significantly changing proteins based on their functional similarities.ResultsA total of 4792 and 4757 proteins were identified in decidua and trophoblast proteomes. For decidua, 125 protein levels (2.6% of the proteome) were significantly different between EP and IUP, whereas EPL and IUP decidua were more similar with only 68 (1.4%) differences. For trophoblasts, there were 66 (1.4%) differences between EPL and IUP. However, the largest group of 344 differences (7.2%) was observed between EP and IUP trophoblasts. In both tissues, proteins associated with ECM remodeling, cell adhesion and metabolic pathways showed decreases in EP specimens compared with IUP and EPL. In trophoblasts, EP showed elevation of inflammatory and immune response pathways.ConclusionsOverall, differences between an EP and IUP are greater than the changes observed when comparing ongoing IUP and nonviable intrauterine pregnancies (EPL) in both decidua and trophoblast proteomes. Furthermore, differences between EP and IUP were much higher in the trophoblast than in the decidua. This observation is true for the total number of protein changes as well as the extent of changes in upstream regulators and related pathways. This suggests that biomarkers and mechanisms of trophoblast function may be the best predictors of early pregnancy location and viability.

Hubungan Pengetahuan, Frekuensi ANC, dan Usia Ibu dengan Deteksi Dini Bahaya Kehamilan Pada Ibu Hamil Trimester III

World Health Organization (WHO) estimates 800 women die every day due to complication in pregnancy and birth process, around 99% from all maternal deaths happened in developing countries. Around 80% maternal deaths caused because of the increasing of complication during pregnancy, labor, and after labor. The method used in this study was analytic survey with cross sectional approach. The statistical test was chi-square test. The population of this study was all third trimester pregnant women in Keramasan Public Health Center Working Area Palembang from January to June 2021 which was estimated to be 116 pregnant women and the sample was 54 respondents. The univariate analysis showed that of 54 respondents studied, there was 29 respondents (53,7%) did early detections of the dangers of pregnancy, whose with good knowledge was 28 respondents (51,9%), whose with standards ANC frequency was 24 respondents (44,4%), and whose with low-risk maternal age was 18 respondents (33,3%). The result showed that there was significant relationship between knowledge and early detections of the dangers of pregnancy p.value 0,015 &lt; α = 0,05, there was significant relationship between ANC frequency and early detections of the dangers of pregnancy p.value = 0,047 &lt; α = 0,05, and there was significant relationship between maternal age and early detections of the dangers of pregnancy p.value = 0,026 &lt; α = 0,05. The results of this study are expected to be useful as references for increasing the number of pregnant women want to do routine pregnancy check-ups as an effort to detect early pregnancy complications that exist in pregnant women.

Progesterone for the prevention of threatened miscarriage

Miscarriage, defined as the loss of a pregnancy before 24 weeks of gestation, is the most common complication of early pregnancy, affecting approximately 15% of clinically recognized pregnancies. The steroid hormone progesterone is essential for the maintenance of pregnancy, and progesterone deficiency is associated with miscarriage. Two important clinical risk factors for miscarriage are a history of previous miscarriages and vaginal bleeding in early pregnancy. Progesterone supplementation has therefore been attempted to prevent miscarriages in asymptomatic women with a history of miscarriages and in women who have started to bleed in early pregnancy. The latest evidence from high quality clinical trial research has shown that vaginal micronized progesterone treatment of women with the dual risk factors of early pregnancy bleeding and a history of one or more previous miscarriages increases the likelihood of a successful live birth (relative rate 1.08, 95% CI 1.02 to 1.15, high-certainty evidence). This treatment has also been shown to be cost-effective, leading to the National Institute for Health and Care Excellence committee for the guideline ‘Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126)’ updating their guidance to recommend the use of vaginal micronized progesterone to treat women with the dual risk factors of a history of one or more previous miscarriages and early pregnancy bleeding. This change in practice has the potential to prevent up to 8,450 miscarriages a year in the UK.

Inequalities in Birth Weight in Relation to Maternal Factors: A Population-Based Study of 3,813,757 Live Births.

Background: Despite numerous studies of women having children later in life, evidence of the relationship between maternal factors and newborn outcomes in Central and Eastern European countries is limited. This study aimed to examine the association between maternal age, biological determinants, including parity and sex of the newborn, demographic and social background, and birth weight in 3.8 million singleton live births in Poland. Methods: The effect of maternal age on birth weight (in grams and Z-scores) adjusted for confounders was assessed using Generalized Linear Models. Results: The mean (±SD) birth weights of neonates born to primiparous women and multiparous women were 3356.3 ± 524.9 g and 3422.7 ± 538.6 g, respectively, which corresponded to a Z-score of −0.07 ± 0.96 and 0.14 ± 1.00, respectively (p ≤ 0.001). After controlling for biological, demographic, and social factors, a significant decrease in birth weight was found for primiparous women of the age group ≥30 years and multiparous women aged ≥35 years compared to the age group of 25–29 years. The lowest neonatal birth weight was observed in the case of women aged ≥45 years. Confounders did not affect birth weight Z-scores among primiparous women, whereas among multiparous women, together with educational factors, they reversed Z-scores from positive to negative values. The lower birth weight of neonates was overall associated with lower maternal education. Conclusions: Regardless of parity, advanced maternal age is strongly associated with a decreased neonatal birth weight, implying complications in early pregnancy and the antenatal period as well as obstetric complications. Counseling to support women’s family planning decisions and improving women’s education during their reproductive age may help to alleviate unfavorable newborn outcomes.

The risk of miscarriage following surgical treatment of heterotopic extrauterine pregnancies.

STUDY QUESTIONWhat is the risk of loss of a live normally sited (eutopic) pregnancy following surgical treatment of the concomitant extrauterine ectopic pregnancy?SUMMARY ANSWERIn women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine ectopic pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy.WHAT IS KNOWN ALREADYPrevious studies have indicated that surgical treatment of the concomitant ectopic pregnancy in women with live eutopic pregnancies could be associated with an increased risk of miscarriage. The findings of our study did not confirm that.STUDY DESIGN, SIZE, DURATIONA retrospective observational case–control study of 52 women diagnosed with live eutopic and concomitant extrauterine pregnancies matched to 156 women with live normally sited singleton pregnancies. The study was carried out in three London early pregnancy units (EPUs) covering a 20-year period between April 2000 and November 2019.PARTICIPANTS/MATERIALS, SETTING, METHODSAll women attended EPUs because of suspected early pregnancy complications. The diagnosis of heterotopic pregnancy was made on ultrasound scan and women were subsequently offered surgical or expectant management.There were three controls per each case who were randomly selected from our clinical database and were matched for maternal age, mode of conception and gestational age at presentation.MAIN RESULTS AND THE ROLE OF CHANCEIn the study group 49/52 (94%) women had surgery and 3/52 (6%) were managed expectantly. There were 9/52 (17%, 95% CI 8.2–30.3) miscarriages <12 weeks’ gestation and 9/49 (18%, 95% CI 8.7–32) miscarriages in those treated surgically. In the control group, there were 28/156 (18%, 95% CI 12.2–24.8) miscarriages <12 weeks’ gestation, which was not significantly different from heterotopic pregnancies who were treated surgically [odds ratio (OR) 1.03 95% CI 0.44–2.36]. There was a further second trimester miscarriage in the study group and one in the control group. The live birth rate in the study group was 41/51 (80%, 95% CI 66.9–90.2) and 38/48 (79%, 95% CI 65–89.5) for those who were treated surgically. These results were similar to 127/156 (81%, 95% CI 74.4–87.2) live births in the control group (OR 0.87, 95% CI 0.39–1.94).LIMITATIONS, REASONS FOR CAUTIONThis study is retrospective, and the number of patients is relatively small, which reflects the rarity of heterotopic pregnancies. Heterotopic pregnancies without a known outcome were excluded from analysis.WIDER IMPLICATIONS OF THE FINDINGSThis study demonstrates that in women diagnosed with heterotopic pregnancies, minimally invasive surgery to treat the extrauterine pregnancy does not increase the risk of miscarriage of the concomitant live eutopic pregnancy. This finding will be helpful to women and their clinicians when discussing the options for treating heterotopic pregnancies.STUDY FUNDING/COMPETING INTEREST(S)This work did not receive any funding. None of the authors has any conflict of interest to declare.TRIAL REGISTRATION NUMBERResearch Registry: researchregistry6430.

IS THERE A RELATIONSHIP BETWEEN COMPLICATIONS OF EARLY PREGNANCY AND BIOMETEOROLOGICAL FORECAST?

The aim of our study was to connect the possible complications of early pregnancy (miscarriage and symptomatic ectopic pregnancy) up to the 12th week of gestation with biometeorological conditions while assuming a greater number of incidents with an unfavorable biometeorological forecast. We performed a retrospective observational study using medical data of a single medical center of Department of Gynecology and Obstetrics, Sveti Duh University Hospital and meteorological data from the Croatian Meteorological and Hydrometeorological Service in Zagreb. We tracked the number of visits to the gynecology and obstetrics emergency unit on a daily basis during 2017. Days with five or more visits were selected and underwent further analysis, during which the number of miscarriages and symptomatic ectopic pregnancies was noted. The information from the biometeorological forecast was then extracted and added to the database. Our results did not show a statistically significant difference between the groups determined by biometeorological forecast in the number of spontaneous abortions or ectopic pregnancy. Also, statistically significant results did not follow the expected trend of the increasing number of complications related to worse biometeorological forecast, or vice versa, a decreased number of complications with better forecast. Our single-center retrospective analysis of emergency unit visits related to weather conditions did not show a connection between the complications of early pregnancy and biometeorological conditions. However, different results could emerge in future studies. Considering the large and high-quality database collected for this study, efforts in researching the connection between other gynecologic pathologies and weather conditions will be feasible.

Prevalence of deep and ovarian endometriosis in early pregnancy: ultrasound diagnostic study

To assess the prevalence and morphological appearance of deep endometriosis and ovarian endometrioma using pelvic ultrasound examination in women attending for an early pregnancy assessment. This was a prospective observational study set within a dedicated early pregnancy unit. The study included 1341 consecutive women who attended for an early pregnancy assessment for reassurance or because of suspected early pregnancy complications. All women underwent a transvaginal scan to assess the location and viability of their pregnancy. In addition, a detailed examination of pelvic organs was carried out to detect the presence of endometriosis and other gynecological abnormalities. Data analysis was performed using logistic regression and multivariable analysis. The prevalence of deep endometriosis and/or ovarian endometrioma in women attending our early pregnancy unit was 4.9% (95% CI, 3.8-6.2%). In 33/66 (50.0% (95% CI, 37.9-62.1%)) women with endometriosis, this was a new diagnosis that was made during their early pregnancy scan. On multivariable analysis, the presence of endometriosis was strongly associated with a history of subfertility (odds ratio (OR), 3.15 (95% CI, 1.63-6.07)) and presence of a congenital uterine anomaly (OR, 5.69 (95% CI, 2.17-14.9)) and uterine fibroids (OR, 2.37 (95% CI, 1.31-4.28)). Morphological changes typical of decidualization were seen in 11/33 (33.3% (95% CI, 17.2-49.4%)) women with ovarian endometrioma and 18/57 (31.6% (95% CI, 19.5-43.7%)) women with deep endometriotic nodules. Deep endometriosis and ovarian endometrioma were present in a significant proportion of women attending for early pregnancy assessment. The prevalence varied depending on a history of subfertility, and therefore is likely to differ significantly among populations, depending on their characteristics. Ultrasound is a useful tool for the detection of endometriosis in early pregnancy and the identification of women who may benefit from specialist antenatal care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Ischemia-Modified Albumin (IMA) levels in ectopic pregnancy and early pregnancy loss.

IMA is a novel marker to consider in ischemic conditions. The initial stages of pregnancy represent a physiological ischemic status. IMA levels may be changed when there is suspicion of early pregnancy complications because of increased oxidative stress. We aimed to determine and compare IMA values in cases of ectopic and healthy pregnancies as well as early pregnancy loss. This prospective case control study population (n = 91) consisted of early pregnancy loss (n = 28), ectopic pregnancy (n = 28), and an intracavitary early healthy pregnancy (n = 35). The serum IMA levels were compared in these groups. Demographic parameters were similar and there was no significant difference between the three groups in terms of serum IMA concentrations. We suggested that IMA cannot be used clinically for the diagnosis and follow up of early pregnancy complications during the first five to six gestational weeks.

Intestinal dysbiosis during pregnancy: the norm or pathology?

BACKGROUND: An interest in the study of intestinal microflora has grown among scientists in recent years. This is due to the active development of molecular genetic techniques. The obvious importance of gut microbiota for pregnancy has been established in some scientific works; however, the number of studies devoted to this issue is small.&#x0D; AIM: This study was aimed to assess the qualitative and quantitative composition of the intestinal microflora in pregnant women.&#x0D; MATERIALS AND METHODS: The study involved 200 women aged 18 to 43 years in pregnancy from six to 22 weeks. A qualitative and quantitative analysis of the intestinal and vaginal microbiota was performed by real-time PCR.&#x0D; RESULTS: Intestinal dysbacteriosis was detected in 100% of the examined pregnant women. Grade I was detected in 64.5% (n = 129), grade II in 26.5% (n = 53), and grade III in 9% (n = 18) of cases. A decrease in the concentrations of resident bacteria was noted in all pregnant women; in addition, in women with moderate and severe dysbacteriosis, opportunistic microorganisms (Clostridium difficile, Enterobacter spp., Streptococcus spp., and Campylobacter spp.) were detected in quantities exceeding the formally permissible values. The analysis of the course of pregnancies showed that grade I and grade II intestinal dysbacteriosis is a risk factor for early pregnancy complications (OR = 0.2, p = 0.00), thus confirming the role of intestinal microbiocenosis in miscarriage.&#x0D; CONCLUSIONS: Pregnancy is a predisposing factor for changes in the intestinal microflora, as evidenced by the detection of intestinal dysbiosis in 100% of pregnant women in the main and control study groups. Considering that the majority of women with a normal pregnancy were diagnosed with grade I intestinal dysbiosis, it can be assumed that this degree of dysbiosis is the norm of pregnancy. Thus, the identification of moderate or severe intestinal dysbiosis should be associated with complications of early pregnancy.

Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: Findings from the VESPA Study.

ObjectiveTo determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DesignProspective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes”.Setting44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.Participants6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.ExposuresPlanned and actual senior clinician presence, unit size, and weekend opening.Main outcome measuresUnplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.Results205/6397 (3.2%; 95% CI 2.8–3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.ConclusionsInvolvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

The role of galectins in obstetrics with particular emphasis on premature preterm rupture of membranes.

Premature rupture of membranes (pPROM) affects about 4% of pregnancies and remains the main cause of preterm delivery (PTD). We currently lack a method for screening patients at high risk of pPROM as well as causal treatment for this yet not fully understood pathology of pregnancy. Promising, potential markers are proteins from a family of lectins-galectins. To date, 13 subtypes have been identified in humans. Particular galectins inhibit the mother's immune response to the fetus, thus enabling the maintenance of pregnancy and delivering at term. So far, the role of some galectins has been proven in relation to early pregnancy complications, hypertension and preeclampsia, fetal growth disturbances (including fetuses small for gestational age, fetal growth restriction and macrosomia) and even in physiological processes which occur during healthy pregnancy. In reference to pPROM galectins seem to be linked to pathomechanisms leading to weakening of the structure of membranes and in result their rupture. Examination of galectins appears to be crucial for understanding certain pathologies of pregnancy and gives hope for the effective identification of risk groups and future causal treatment.

Pregnancies lost and found: a quality improvement project to increase follow-up for early pregnancy complications

Pregnancy of unknown location (PUL) and medically managed ectopic pregnancy (EP) require longitudinal surveillance to avoid adverse outcomes; however, patients with PUL/EP in the United States (U.S.) are often unable to adhere to recommended treatment plans. This quality improvement (QI) project sought to improve PUL/EP follow-up using a three-pronged intervention: standardised recall procedures, direct patient-provider communication and electronic medical record (EMR) documentation templates and tracking. We compared patients with PUL/EP managed before and after the QI project. Our primary outcome was completion of PUL/EP clinical care. Demographics, initial diagnoses and adverse outcomes were similar between 87 pre-QI and 81 post-QI patients. Significantly more patients completed PUL/EP clinical care post-QI (80.2 vs. 65.5% p = .03). Post-QI, more providers contacted patients at standard intervals (100 vs. 57.1%, p < .0001), and EMR documentation was improved (100 vs. 69.0%, p < .001). Simple changes to PUL/EP management improved completion of clinical care and compliance with standardised recall and documentation. IMPACT STATEMENT What is already known on this subject? Pregnancy of unknown location (PUL) and medically managed ectopic pregnancy (EP) require longitudinal surveillance to avoid adverse outcomes; however, patients with PUL/EP in the United States (U.S.) are often unable to adhere to recommended treatment plans. What do the results of this study add? By standardising recall procedures, ensuring direct communication between patients and providers using a dedicated cell phone, and integrating case tracking and documentation into the electronic medical record (EMR), this quality improvement (QI) project improved completion of clinical follow-up for patients with PUL/EP (overall, 80.2 vs. 65.5% pre-QI, p=.03) and for the subgroup with medically managed EP not requiring surgery (76.5 vs. 36.4% pre-QI, p= .05). We also improved providers’ compliance with standardised recall procedures and EMR documentation post-QI (p < .0001). There was no difference in the number of attempts to contact patients, or in the number of surveillance blood draws actually performed. Post-QI, survey responses indicated that patients were easily able to contact their provider and understood the importance of follow-up processes. What are the implications of these findings for clinical practice and/or research? Early pregnancy care providers can utilise simple strategies to improve follow-up of patients with PUL and medically managed EP, without increasing burdens to their health systems. Patients’ favourable experiences with this management support its implementation.

P02 Doctor, I just don't feel alright

P02 Doctor, I just don't feel alright

VP31.12: Trends in fetal ultrasound referrals and case severity throughout the first and second waves of the COVID‐19 pandemic

To determine the combined and differential impact of individual waves of the COVID-19 pandemic on fetal ultrasound referral patterns and antenatal case severity. This was a cross-sectional study evaluating temporal trends in fetal ultrasound referral patterns and case severity at a regional fetal assessment unit. Fetal assessment scans performed during the first and second ‘waves’ of the pandemic (March to May 2020 and November to March 2021) were compared head-to-head and to baseline pre-COVID-19 patterns. Clinic lists and stored ultrasound reports were reviewed to collate maternal demographics and medical history, referral details, daily scan volumes, ultrasound findings, and level of case severity, in order to compare outcomes across the pandemic. 9,451 fetal ultrasounds were performed during the first and second waves of the pandemic, and represent a significant reduction from baseline volumes in the unit (p = 0.008). In the first wave, there was a significant decrease in referrals for early pregnancy complications, genetic ultrasounds, and diabetes surveillance (p < 0.01): there were also fewer referrals from rural communities and general practitioners. The second-wave of the pandemic represented a further decline in referrals from remote locations, but less disruption in number of scans for maternal medical complications. The level of high-acuity cases increased significantly throughout the pandemic compared to baseline (4.9% vs 3.3%; p = 0.0031), but was higher in the first as compared to the second-waves. Also, there was an almost 10% increase in the relative proportion of stillbirths diagnosed during the pandemic, although the absolute numbers remain small. Fetal ultrasound volumes decreased and case severity increased throughout the pandemic, as well as an increase in stillbirths. Enhanced understanding of the impact of access to prenatal care and utilisation of services on the direct and indirect risks for pregnant women is critical for improving care and outcomes during future pandemic planning.

The impact of early pregnancy complications on completed family size-A nationwide, registry-based cohort study with 40 years of data.

The impact of early pregnancy complications on completed family size is unknown. Here, we hypothesize that early pregnancy complications and adverse outcomes may influence family size. In this nationwide, registry-based study we included all 458475 women born 1957-1972 who lived in Denmark from age 20-45years with at least one registered pregnancy. The main outcome of the study was number of children per woman by age 45, estimated using a Generalized Linear Mixed Model. Exposures were: (a) total number of pregnancy losses experienced (0, 1, 2, ≥3); (b) highest number of consecutive pregnancy losses (0, 1, 2, ≥3); (c) sex of firstborn child; (d) outcome of first pregnancy (live birth, stillbirth, pregnancy loss, ectopic pregnancy, or molar pregnancy). Number of live births was negatively influenced by maternal age and adverse first pregnancy outcomes, especially ectopic pregnancies. A 30-year-old woman with a first ectopic pregnancy was expected to have 1.16 children (95% CI 1.11-1.22) compared with 1.95 children (95% CI 1.86-2.03) with a first live birth. Three or more consecutive losses also decreased number of live births significantly: 1.57 (95% CI 1.50-1.65) compared with 1.92 (95% CI 1.84-2.0) with only live births. The total number of pregnancy losses had no effect before the age of 35years. Sex of firstborn had no effect. Previous pregnancy history has a significant effect on number of children per woman, which is important at both individual and societal levels. Pathophysiological research of adverse pregnancy outcomes should be an urgent priority as the causes remain poorly understood.

Womens experience of Manual Vacuum Aspiration: An Irish perspective

ObjectiveManual Vacuum Aspiration (MVA) is a well-established management option for early pregnancy loss or early termination of pregnancy. MVA is performed as out-patient surgical procedure using local anaesthetic whereby aspiration of uterine contents is achieved through use of a hand-held negative pressure syringe. Ireland’s first MVA service was established at the Rotunda Hospital Dublin in April 2020,. The purpose of this study was to gather feedback from women who had undergone MVA in the unit. Study designProspective mixed methods study of women attending for uterine aspiration under local anaesthetic from July to October 2020 in the unit. Consenting women were contacted one week following MVA via telephone. The survey conducted consisted of structured closed questions along with open-ended questions, to assess womens satisfaction in relation to all aspects of the MVA service. ResultsNineteen women took part in the study, a response rate of 86.4%. Participants reported feeling well informed prior to attending for MVA. Prior to the procedure, pain expectation scores were high but actual reported pain scores were much lower. Although some participants did find MVA uncomfortable, the fact the procedure was very quick and the side effects so minimal generally negated this. The location and set up of the clinic scored highly among participants as did the staff of the clinic. Overall satisfaction with the MVA service was high with 84.2% of participants reporting they would opt again for MVA in the future. ConclusionsWomen living in Ireland are interested and agreeable with having Manual Vacuum Aspiration as an available option for management of early pregnancy complications. Consideration should be given to expansion of MVA services nationally.