Death In Pregnant Women Research Articles

Identifying Pregnant Patients With Suspected Intimate Partner Violence.

Intimate partner violence (IPV) is the leading cause of death in pregnant women. Although it can be difficult to identify patients experiencing IPV, injuries to the head, neck, or face due to an assault are known to correlate with intentional injury. The objective of this study is to assess the contemporary burden of IPV in pregnancy and describe the patient characteristics. The National Inpatient Sample was queried for all pregnant women between January 2016 and December 2019. Patients were divided into two groups: suspected IPV (SIPV) and no-SIPV groups. We defined SIPV as any pregnant patient with an identified head, neck, or face injuries categorized as intentional assault. Multivariable logistic regression analysis was performed to assess the association between SIPV and variables of interest. A total of 28,540 pregnant patients presented with traumatic injuries with 530 (.02%) identified as SIPV. Suspected IPV patients were younger (25 vs 27 years, P = .012), more likely to be of Black race (46% vs 28%, P = .002), more likely to be in the lowest income quartile (51% vs 38%, P = .031), less likely to have private insurance (12% vs 34%, P < .001), and have higher rates of substance use disorder (35% vs 18%, P < .001). Black race and history of substance use disorder were associated with increased odds of SIPV-related injuries (odds ratio [OR]: 2.01, interquartile range [IQR]: 1.27-3.16, P = .003 and OR: 2.30, IQR 1.54-3.43, P < .001, respectively). Our results suggest that there are significant racial and socioeconomic disparities in potential risk for IPV during pregnancy.

Factors Associated with Pulmonary Edema among Severe Pre-Eclamptic Women: A Case Control Study

Background: Pre-eclampsia remains an important cause of hypertensive acute pulmonary edema in pregnancy. Acute pulmonary edema, which signifies severe disease, is a leading cause of death in pregnant women with pre-eclampsia and a frequent cause of admission to intensive care unit. Objective: To examine pulmonary edema’s prevalence and associated factors among severe pre-eclamptic pregnant women. Materials and Methods: The present study was an analytic retrospective case-control study. Five hundred fifty-eight gestational-age pregnant women diagnosed with pre-eclampsia with severe features according to the ACOG 2013 guidelines delivered at Pattani Provincial Hospital between July 2021 and April 2023 were enrolled by retrospective review the hospital records. Four hundred severe pre-eclamptic women met the inclusion criteria. Fifty-one pregnant women with severe pre-eclampsia who developed pulmonary edema were included as cases, and 204 severe pre-eclamptic women who did not develop pulmonary edema were included in cases for a ratio of 1 to 4. The statistical analyses involved the two groups. Multiple logistic regression analysis, odd ratio, and 95% confidence interval (CI) were performed. Results: Among severe pre-eclamptic pregnant women, the associated factors for severe preeclamptic women decreased 69% (95% CI 0.1 to 0.9) with nulliparous, decreased 88% (95% CI 0.0 to 1.1) with the first blood pressure level of more than 180/120 mmHg, decreased 98% (95% CI 0.0 to 0.1) with epigastric pain as presenting symptoms. However, the associated factors for pulmonary edema increased 2.04 (95% CI 1.0 to 4.0) times with the number of antenatal care visits of less than eight times and increased 2.79 (95% CI 1.4 to 5.6) times with gestational diabetes mellitus. Conclusion: The prevalence of pulmonary edema among severe pre-eclamptic women was 12.75%. The factors associated with pulmonary edema among severe pre-eclamptic women included gestational diabetes mellitus and poor antenatal care of less than eight visits.

Pendidikan Kesehatan Sebagai Upaya Pencegahan Terjadinya Intrauterine Fetal Death (IUFD) Pada Ibu Hamil

Introduction: Intrauterine Fetal mortality (IUFD) is defined as fetal mortality after 20 weeks of gestation and is divided into two types: early IUFD and late IUFD. If the fetal death happens before 24 weeks of gestation, it is considered early IUFD; if the fetal death occurs beyond 24 weeks of gestation, it is considered late IUFD. Objective: Aims to expand awareness and increase knowledge of pregnant women regarding the incidence of Intrauterine Fetal Death (IUFD) in order to prevent and reduce the prevalence of Intrauterine Fetal Death (IUFD) in pregnant women Method: The method used is a qualitative approach by providing education in the form of health education to pregnant women at the Banjarsari Community Health Center, Ciamis Regency on 17 November 2023 who have met the inclusion and exclusion criteria with a total of 6 participants. The parameters used in measuring knowledge use the interview method and giving questionnaires. Result: The results showed that all participants did not know about Intrauterine Fetal Death (IUFD) in pregnant women. Meanwhile, after implementing health education regarding Intrauterine Fetal Death (IUFD), all participants knew about the health problem of Intrauterine Fetal Death (IUFD) Conclusion: The end of the implementation of the health education initiative on Intrauterine Fetal Death went smoothly, as expected. This health education is useful and beneficial for pregnant women in the Banjarsari Community Health Center area. This is proven by the participants' interest and active participation in this health education, as well as increasing knowledge about Intrauterine Fetal Death in pregnant women before and after the education.

Factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units.

to evaluate the factors associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil. this ecological study was conducted using secondary data from Brazilian pregnant women with COVID-19 hospitalized in Intensive Care Units between March 2020 and March 2022. Univariate analysis and logistic regression were employed. out of 3,547 pregnant women with COVID-19 hospitalized in Intensive Care Units, 811 died (22.8%). It was found that lack of COVID-19 vaccination (OR: 2.73; 95% CI: 1.83; 4.04), dyspnea (OR: 1.73; 95% CI: 1.17; 2.56), obesity (OR: 1.51; 95% CI: 1.05; 2.17), chronic cardiovascular disease (OR: 1.65; 95% CI: 1.14; 2.38), and non-white race/color (OR: 1.29; 95% CI: 1.00; 1.66) were independently and significantly associated with death. it is concluded that vaccination status, presence of comorbidities, and clinical and ethnic-racial characteristics are associated with COVID-19 death in pregnant women hospitalized in Intensive Care Units in Brazil.

Factors associated with hospitalizations and deaths of pregnant women from Paraná due to COVID-19: a cross-sectional study

RESUMO Objetivo: Analisar os fatores associados à hospitalização em enfermaria e unidade de terapia intensiva (UTI), e ao óbito pela COVID-19 em gestantes com caso confirmado. Métodos: Pesquisa observacional, transversal, realizada com dados de gestantes com caso confirmado para COVID-19 provenientes do Sistema de Informação de Vigilância Epidemiológica da Gripe e do Sistema Estadual Notifica COVID-19, do Paraná. Investigou-se a associação entre variáveis independentes e dependentes (hospitalização em enfermaria e UTI, e óbito) pelo modelo de regressão de Poisson com variância robusta. Resultados: 4.719 gestantes compuseram a população do estudo; 9,6 e 5,1% foram hospitalizadas em enfermaria e UTI, respectivamente; 1,9% evoluíram para óbito. Houve associação entre a idade materna avançada e internação em enfermaria (RP=1,36; IC95% 1,10–1,62) e UTI (RP=2,25; IC95% 1,78–2,71), e óbito (RP=3,22; IC95% 2,30–4,15). Verificou-se associação entre o terceiro trimestre gestacional e hospitalização em enfermaria (RP=5,06; IC95% 2,82–7,30) e UTI (RP=6,03; IC95% 3,67–8,39) e óbito (RP=13,56; IC95% 2,90–24,23). O segundo trimestre associou-se à internação em UTI (RP=2,67; IC95% 1,36–3,99). Gestantes com cardiopatia apresentaram maior frequência de hospitalização em enfermaria (RP=2,24; IC95% 1,43–3,05) e UTI (RP=2,66; IC95% 1,46–3,87). A obesidade foi associada à admissão em UTI (RP=3,79; IC95% 2,71–4,86) e ao óbito (RP=5,62; IC95% 2,41–8,83). Conclusão: A idade materna avançada, o final do período gestacional e comorbidades foram fatores associados a quadros graves de COVID-19.

The Adverse Outcomes of Chorioamnionitis on the Pregnant Female and Their Fetus

Introduction: Chorioamnionitis is an intra-amniotic infection caused by an ascending polymicrobial bacterial infection. Triple I (intrauterine inflammation or infection or both) is also proposed to replace chorioamnionitis due to its imprecise definition and variable clinical manifestations. Intraamniotic infection is characterized by inflammation of the amniotic fluid, placenta, fetus, fetal membranes, or decidua. Maternal fever, uterine tenderness, maternal tachycardia, fetal tachycardia, and purulent fluid coming from the cervical os (the cervical opening can be external, near the vagina, or internal, near the uterus) are the key clinical findings that are crucial for the diagnosis of clinical chorioamnionitis. Clinically, intra-amnionitic infections have been linked to severe morbidity and death in pregnant women, fetuses, and newborns. Method: A systematic search of PubMed, Embase, LitCovid, MedRxiv, BioRxiv, Google Scholar, EBSCO MEDLINE, CINAHL and Scopus electronic database was done using key words like Chorioamnionitis, adverse complication in pregnancy to mother and her fetus associated with intrauterine infection, Intraamniotic inflammation and triple I. Studies have been included from January 2015 to December 2022. Result: Chorioamnionitis is most typically caused by ascending infection and is frequently linked with premature membrane rupture. Chorioamnionitis is typically caused by a polymicrobial infection, with Ureaplasma urealyticum, Mycoplasma hominis, and Gram-negative anaerobes being common pathogens. Antimicrobial drugs, antipyretics, rapid treatment, and supportive care are the mainstays of management. Conclusion: Overall, this review provides a better understanding of Chorioamnionitis and its potential impact on public health. By shedding light on this emerging disease, we hope to contribute to ongoing efforts to prevent and treat of this serious disorder. Keywords: Chorioamnionitis, Intrauterine Infection, Pregnancy, adverse complication, Triple I, Intraamniotic Inflammation

The Relationship between Handling Midwifery Complications and Health Services (K4) with Maternal Mortality Hypertension in East Java

Background: One of the dangers of midwifery or pregnancy is the mortality of pregnant women with hypertension. By managing midwifery difficulties and health services for pregnant women, efforts may be made to prevent and manage the mortality of pregnant women with hypertension (K4). The management of midwifery difficulties and prenatal care services (K4) reduced in East Java Province in 2021. Objectives: The purpose of this study was to map out the disease's spread and explain how maternal mortality is related to hypertension and its causes. Methods: In 38 East Javan regions and cities, maternal mortality was examined. In order to assess the secondary data from the East Java Health Profile in 2019–2021, this study used the Pearson correlation test. Furthermore, SPSS applications were used to analyze the data. Results: There was a relationship between maternal mortality with hypertension in 2021 and the coverage of midwifery complications (p = 0.000), as well as between the coverage of prenatal care services (K4) and the death of pregnant women with hypertension in 2021 (p = 0.000). Conclusion: The treatment of midwifery problems and the availability of prenatal care services (K4) were factors in the deaths of pregnant women with hypertension. A program of interventional actions that must be carried out while paying more attention to pregnant women's health, particularly for those with hypertension, was required.

Application of Mamdani’s Fuzzy Inference System in the Diagnosis of Pre-eclampsia

Pre-eclampsia is the second of the top three causes of death in pregnant women after bleeding and followed by infection. By knowing the risk factors, early detection of pre-eclampsia in pregnant womenneeds to be done so that later it can be treated more quickly to prevent further complications. This studyaims to design a practical application of a decision-making system for the diagnosis of pre-eclampsia inpregnant women using the Fuzzy Inference System (FIS) method so it can be used efficiently and effectively for the early diagnosis of pre-eclampsia. The method used in data analysis is the FIS Mamdanimethod with defuzzification using the centroid method. The designed system considers blood pressureand proteinuria as input variables and pre-eclampsia status as output variables. The research resultsshow that the system has 7.27% of Mean Absolute Percentage Error (MAPE) value and when comparing the final diagnosis of the system and expert diagnoses (doctors) from 20 patients at two hospitals, itwas found that the system diagnosis was 100% in accordance with the expert diagnoses.

Prediction of neonatal death in pregnant women in an intensive care unit: Application of machine learning models

IntroductionNeonatal mortality remains a critical concern, particularly in developing countries. The advent of machine learning offers a promising avenue for predicting the survival of at-risk neonates. Further research is required to effectively deploy this approach within distinct clinical contexts. Objective: This study aimed to assess the applicability of machine learning models in predicting neonatal mortality, drawing from maternal and clinical characteristics of pregnant women within an intensive care unit (ICU). MethodsConducted as an observational cross-sectional study, the research enrolled pregnant women receiving care in a level III national hospital's ICU in Peru. Detailed data encompassing maternal diagnosis, maternal characteristics, obstetric characteristics, and newborn outcomes (survival or demise) were meticulously collected. Employing machine learning, predictive models were developed for neonatal mortality. Estimations of beta coefficients in the training dataset informed the model application to the validation dataset. ResultsA cohort of 280 pregnant women in the ICU were included in this study. The Gradient Boosting approach was selected following rigorous experimentation with diverse model types due to its superior F1-score, ROC curve performance, computational efficiency, and learning rate. The final model incorporated variables deemed pertinent to its efficacy, including gestational age, eclampsia, kidney infection, maternal age, previous placenta complications accompanied by hemorrhage, severe preeclampsia, number of prenatal checkups, and history of miscarriages. By incorporating optimized hyperparameter values, the model exhibited an impressive area under the curve (AUC) of 0.98 (95 % CI: 0.95–1), along with a sensitivity of 0.98 (95 % CI: 0.94–1) and specificity of 0.98 (95 % CI: 0.93–1). ConclusionThe findings underscore the utility of machine learning models, specifically Gradient Boosting, in foreseeing neonatal mortality among pregnant women admitted to the ICU, even when confronted with maternal morbidities. This insight can enhance clinical decision-making and ultimately reduce neonatal mortality rates.

Maternal outcomes of pregnant patients after trauma: a retrospective study of the Trauma Registry of England and Wales.

Trauma accounts for 20% of deaths in pregnant women. Injury characterisation and outcome in pregnant women following trauma is poorly described. To understand and inform optimum care of this key injury population, a study was conducted using the Trauma Audit Research Network (TARN) database. In total, 341 pregnant and 26,774 non-pregnant female patients aged 15 to 46 years were identified for comparison from the TARN database. Mortality, cross-sectional imaging, blood product administration and EQ-5D scores were compared between the two groups. Mechanism of injury, Injury Severity Score (ISS) and mortality rate before and after the creation of regional trauma networks were reported for pregnant patients. Pregnancy was recorded in 1.3% (341/27,115) of included patients, with the most common cause of injury being road traffic collisions. A reduction in crude maternal mortality was observed over the course of the study period (7.3% to 2.9%). Baseline mean EQ-5D (0.47) and EQ-VAS (54.08) improved to 0.81 (p < 0.001) and 85.75 (p = 0.001), respectively, at 6 months following injury. The incidence of trauma in pregnancy is small and mortality in injured pregnant women decreased over the study period. Pregnant patients have significantly improved patient-reported outcome measures 6 months after injury although this is limited in impact because of poor response rates and outcome reporting. Construction and validation of tools aiding in outcome reporting will help considerably in understanding further gains in the care of pregnant women.

The Influence of Health Education Using Media Booklets About the Importance of Hemoglobin Levels to Increase Knowledge of Pregnant Women in the Work Area of the Ngemplak Public Health Center

&lt;p&gt;&lt;em&gt;Hemoglobin is a component of red blood cells or erythrocytes which functions to bind oxygen and deliver it to all the body's tissue cells. One of the health problems that develop in pregnant women is low hemoglobin (Hb) levels. Anemia is the main cause of morbidity and death in pregnant women. Anemia during pregnancy is defined as a hemoglobin level lower than 10 g/dl. Knowledge of pregnant women about anemia is one of the factors that play a role in the incidence of iron deficiency anemia in pregnant women. The purpose of this study was to determine the effect of health education using booklet media about the importance of hemoglobin levels to increase knowledge in pregnant women on knowledge before and after being given health education. This type of research is a quantitative study with a pre-experimental design through one group pre-post test design. The population of this study were all pregnant women in the first, second, and third trimesters. The research sample is 60 samples with purposive sampling technique. Data collection used a knowledge questionnaire about the importance of hemoglobin levels which had been tested for validity with a result of 0.444 and reliability with a result of 0.890 by researchers. The results of the research were carried out by the Kolmogrov-Smirnov normality test first, then the Wilcoxon Signed Rank Test was carried out. Based on the research results, it was obtained the results of hypothesis testing with a significance value of p-value 0.000 &amp;lt;0.05 so it can be concluded that there is an effect of health education using booklet media about the importance of hemoglobin levels to increase knowledge in pregnant women.&lt;/em&gt;&lt;/p&gt;&lt;strong&gt;&lt;em&gt;Keywords:&lt;/em&gt;&lt;/strong&gt; &lt;strong&gt;&lt;em&gt;Hemoglobin Level, Anemia in Pregnancy, Health education, Knowledge, Booklet&lt;/em&gt;&lt;/strong&gt;

STUDI LITERATURE PENGETAHUAN IBU TENTANG PENCEGAHAN DAN PENANGANAN ANEMIA PADA MASA KEHAMILAN

Mother's knowledge is one of the factors that stimulate or stimulate the realization of a health behavior. it is expected that mothers have good behavior in order to reduce the risk of anemia during pregnancy. This study aims to determine the level of knowledge of mothers about the prevention and management of anemia during pregnancy. The research method uses a descriptive method by using literature studies in articles/journals that discuss maternal knowledge about the prevention and treatment of anemia during pregnancy. The results obtained from several journals that have been reviewed are the majority of pregnant women who have low knowledge about anemia due to maternal age, occupation, and education. The conclusion of the researcher is that knowledge of pregnant women is one of the important factors to reduce the risk of anemia during pregnancy. healthy behavior and can reduce the risk of death in pregnant women and fetuses

Higher β cell death in pregnant women, measured by DNA methylation patterns of cell-free DNA, compared to new-onset type 1 and type 2 diabetes subjects: a cross-sectional study

Diabetes is a metabolic disorder of glucose homeostasis in which β cell destruction occurs silently and is detected mainly when symptoms appear. In the last few years, it has emerged a great interest in developing markers capable of detecting pancreatic β cell death focused on improving early diagnosis and getting a better treatment response, mainly in type 1 diabetes. But other types of diabetes would also benefit from early detection of β cell death. Differentially methylated circulating DNA is being studied as minimally invasive biomarker of cell death. We aimed to explore whether the unmethylated/methylated ratio of the insulin and amylin genes might be a good biomarker of β cell death in different types of diabetes. A lower index ∆Ct indicates a higher rate of β-cell death. Plasma samples from subjects without diabetes, pregnant women, pregnant with gestational diabetes (GDM), type 1 diabetes and type 2 diabetes were analyzed. A qPCR reaction with specific primers for both methylated and unmethylated fragments of insulin and amylin genes were carried out. Pregnant women, GDM and non- GDM, showed a higher β-cell death for both markers (∆INS = 3.8 ± 2.1 and ∆Amylin = 8.5 ± 3.6), whereas T1D presented lower rate (∆INS = 6.2 ± 2.1 and ∆Amylin = 10.7 ± 2.9) comparable to healthy subjects. The insulin methylation index was associated with the newborn birth weight (r = 0.46; p = 0.033) and with insulin resistance (r = -0.533; p = 0.027) in the GDM group. The higher rate of β-cell death was observed in pregnant women independently of their metabolic status. These indexes could be a good indicator of β cell death in processes caused by defects on insulin secretion, insulin action, or both.

Clinical Characteristics and Outcomes of Pregnant Women with Covid-19 in Gadjah Mada Academic Hospital

Introduction: This study aimed to determine the characteristics of pregnant women diagnosed withCovid-19 and hospitalized at the Gadjah Mada University Academic Hospital.Methods: The method in this study is a descriptive research method to illustrate a situation objectivelyand without intervention. All pregnant women who seek treatment and are included in the Gadjah MadaUniversity Academic Hospital study are diagnosed with Covid-19 by RT-PCR.Results: The object of this study were 210 pregnant female patients diagnosed with Covid-19 untilAugust 2021. The third trimester dominated the gestational age, and most of them had no symptoms(asymptomatic). The most dominant symptom was cough. Most of the patients came with referrals fromthe puskesmas on the grounds of pregnancy complaints. Most of them are puskesmas referrals withseven days of treatment in the hospital. Most of the delivery of pregnant women with Covid-19 was byabdominal delivery.Conclusion: The clinical characteristics and outcomes of pregnant women with Covid-19 whounderwent treatment varied. Most of them went home from treatment due to improved conditions orhad given birth and continued to self-isolate at home. Nevertheless, it remains a concern that Covid-19is undoubtedly one of the factors that can cause death in pregnant women.

The Inter-Trimester Variation and Prognostic Value of Creatinine, Cystatin C and Uric Acid in Preeclamptic Patients: A Retrospective Study

Background: This study aimed to evaluate the clinical significance of maternal serum creatinine, cystatin C, and uric acid levels in relation to fetal death in pregnant women with preeclampsia. Methods: This retrospective study evaluated 708 women with preeclampsia, and 738 healthy pregnant women were selected as control. Medical records were reviewed to collect obstetric, neonatal, and biochemical data, including creatinine, cystatin C, and uric acid concentrations. Results: Maternal serum creatinine, cystatin C, and uric acid concentrations were significantly higher in the preeclamptic group than in the control (p &lt; 0.05). Preeclamptic women in the fetal death group had significantly higher creatinine levels during their second and third trimesters, and higher uric acid concentrations throughout the pregnancy compared to the fetal survival group. Preeclamptic patients were divided into four groups based on quartiles of uric acid levels. The overall fetal survival rate in patients with upper-quartile uric acid concentrations was significantly lower than those with low uric acid levels during pregnancy. Multivariate logistic regression analysis revealed that uric acid concentration was a significant risk factor for fetal death in the first and second trimesters in the preeclamptic group (p &lt; 0.05). Conclusions: In pregnant women with preeclampsia, fetal death was associated with upper-quartile uric acid concentrations in the first and second trimesters. Uric acid levels can be an indicator of fetal death in the early and middle stage of pregnancy.

OUTCOME OF MONKEYPOX INFECTION IN GRAVIDA: A LITERATURE REVIEW

Monkeypox is a smallpox-like disease which is an important globally emerging infectious disease caused by the monkeypox virus. WHO declared monkeypox a public health emergency on 23 July 2022. Most research on monkeypox infection in humans has not included pregnant people. However, previous studies in pregnancy on the outcome of infection with smallpox viruses belonging to the Poxviridae family have reported high mortality rates. This literature review aims to determine the effects of monkey pox on pregnancy. Methods: Writing literature reviews is done by searching the Pubmed, Sciencedirect, Web of Science, and Scopus databases. A literature search was carried out using the keywords "outcome", "monkeypox", and "pregnancy". Searches using these keywords are limited to 2014 – 2023 (the last 10 years) and then screening according to inclusion and exclusion criteria. Results: A total of three included literature were reviewed using a qualitative descriptive method. The three literatures reinforce each other&#x0D; by finding signs and symptoms of monkeypox in neonates, besides that there are also pregnant women who experience miscarriages. However, there is one literature which states that there is no monkeypox transmission from pregnant women with monkeypox to neonates. Conclusion: The findings from this literature review indicate that the impact of monkeypox on pregnancy is closely associated with a high risk of miscarriage, intrauterine fetal death, vertical transmission, and complaints in pregnant women due to monkeypox infection. Health workers are advised to be more alert to monkeypox cases in pregnancy due to the relatively high risk of fetal death in pregnant women in endemic areas and during monkeypox epidemics.

Administration of Nitrates After Spontaneous Delivery in Rheumatic Heart Disease

Introduction: Heart disease is one of the most common causes of maternal death. The incidence has increased since women with congenital and acquired heart disease reached fertile age. The circulation system changes during pregnancy which are induced by changes in the progesterone. The changes in progesterone levels increase heart work and cause death in pregnant women. Objective: This report aims to elaborate on the administration of nitrates as the management of labor in rheumatic heart disease (RHD). Case Report: A 27-year-old woman complained of shortness of breath and wanted to give birth. The patient was 38 weeks pregnant and had a history of heart disease. Antero-posterior chest radiography examination showed pulmonary edema and cardiomegaly. The patient was examined using echocardiography before spontaneous labor and was diagnosed as pregnant with rheumatic heart disease. As an emergency management, the patient was given painless spontaneous labor. The patient was given nitrates on the first day after delivery as a treatment for progesterone withdrawal syndrome in this case. After the delivery process was completed, the patient was admitted to the Intensive Care Unit (ICU). Discussion: Progesterone hormone produced by the corpus luteum and the placenta until the eighth week of pregnancy and before delivery, respectively, can reduce systemic vascular resistance. Progesterone hormone increase causes peripheral vasodilation by affecting the function of endothelial nitric oxide synthase (eNOS) and nitrite oxide (NO) production. Conclusion: A pregnant woman with rheumatic heart disease can be given exogenous nitrate. Administration of exogenous nitrates in this patient successfully prevent the reduction of peripheral vascular resistance and postpartum hemodynamic instability because it can replace the reduction in nitric oxide caused by progesterone withdrawal.

Congenital malformations among offspring of women with type 1 diabetes who use insulin pumps: a prospective cohort study.

Continuous subcutaneous insulin infusion by insulin pump is often superior in improving glycaemic control compared with conventional multiple daily insulin injection (MDI). However, whether pump treatment leads to improved pregnancy outcomes in terms of congenital malformations and perinatal death remains unknown. The present aim was to evaluate the risk of malformations and perinatal and neonatal death in pregnant women with type 1 diabetes treated with pump or MDI. We performed a secondary analysis of a prospective multinational cohort of 2088 pregnant women with type 1 diabetes in a real-world setting who were treated by pump (n=750) or MDI (n=1338). ORs for offspring with congenital malformations or perinatal or neonatal death were calculated using crude data and by logistic regression on propensity score-matched data. At enrolment (gestational week 8; 95% CI 4, 14), pump users had a higher educational level (university degree: 37.3% vs 25.1%; p<0.001) and better glycaemic control (mean HbA1c: 51±10 mmol/mol [6.8±0.9%] vs 54±14 mmol/mol [7.1±1.3%], p<0.001) compared with MDI users. Moreover, a greater proportion of pump users had an HbA1c level below 75 mmol/mol (9%) (97.6% vs 91.9%, p<0.001), and more often reported taking folic acid supplementation (86.3% vs 74.8%; p<0.001) compared with MDI users. All clinically important potential confounders were balanced after propensity score matching, and HbA1c remained lower in pump users. The proportion of fetuses with at least one malformation was 13.5% in pump users vs 11.2% in MDI users (crude OR 1.23; 95% CI 0.94, 1.61; p=0.13; propensity score-matched (adjusted) OR 1.11; 95% CI 0.81, 1.52; p=0.52). The proportion of fetuses with at least one major malformation was 2.8% in pump users vs 3.1% in MDI users (crude OR 0.89; 95% CI 0.52, 1.51; p=0.66; adjusted OR 0.78; 95% CI 0.42, 1.45; p=0.43), and the proportions of fetuses carrying one or more minor malformations (but no major malformations) were 10.7% vs 8.1% (crude OR 1.36; 95% CI 1.00, 1.84; p=0.05; adjusted OR 1.23; 95% CI 0.87, 1.75; p=0.25). The proportions of perinatal and neonatal death were 1.6% vs 1.3% (crude OR 1.23; 95% CI 0.57, 2.67; p=0.59; adjusted OR 2.02; 95% CI 0.69, 5.93; p=0.20) and 0.3% vs 0.3% (n=2 vs n=4, p=not applicable), respectively. Insulin pump treatment was not associated with a lower risk of congenital malformations, despite better glycaemic control in early pregnancy compared with MDI. Further studies exploring the efficacy and safety of pump treatment during pregnancy are needed.

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study.

To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

Preeclampsia and Its Associated Risk Factors: A Case-control Study in Qazvin Province

Background: Preeclampsia is one of the common disorders in pregnancy. It is characterized by hypertension and proteinuria in the second half of pregnancy. It is also one of the three main causes of death in pregnant women. Objective: This study investigated the risk factors of preeclampsia in women referred to Kowsar Hospital in Qazvin Province, Iran. Methods: In this case-control study, after reviewing 7855 cases of pregnant women referred to Kowsar Hospital in 2016, 171 hospitalized patients with severe preeclampsia were put in the case group, and 171 patients with delivery problems were in the control group. Then, we compared the collected data about risk factors, such as a history of preeclampsia, hypertension, smoking, diabetes mellitus, infertility, twin, and body mass index, in both groups. Results: The Mean±SD age of the pregnant women with preeclampsia was 31.19±6.42 years with an interquartile interval of 26-35 years. History of preeclampsia (P=0.02), hypertension (P=0.001), and body mass index (P=0.001) were significantly higher in the preeclampsia group than in the control group. Also, there was no significant relationship between a history of diabetes mellitus, infertility, or twin with preeclampsia (P&lt;0.05). Conclusion: This study showed that the risk factors of a history of preeclampsia, hypertension, and body mass index significantly differed between the case and control groups.