Disease In Pregnant Women Research Articles

Tu2082 Ultrasound As a Primary Imaging Modality for Follow Up of Croh?s Disease in Pregnant Women: Initial Results

Tu2082 Ultrasound As a Primary Imaging Modality for Follow Up of Croh?s Disease in Pregnant Women: Initial Results

THE RESEARCH OF AWARENESS OF MEDICAL PERSONNEL REGARDING ORAL PATHOLOGY PREVENTION DURING PREGNANCY

During the pregnancy period woman repeatedly seeks medical aid and consults different medical specialists. Meanwhile, there is no continuity for dynamic monitoring of pregnant woman’s health. The level of knowledge of medical personnel concerning prevention of main dental diseases must be high enough, as the influence on manageable risk factors is under their responsibilities. However, this level is confirmed neither in Russian, nor in the foreign literature. Aim - study of awareness of medical personnel who monitor pregnant women on the issues concerning prevention of dental caries and periodontal diseases. Data and methods. A survey was conducted among 127 medical doctors of different specialities (obstetrician-gynecologists, dentists, pediatricians), working for state budgetary public health organizations of Samara. Results. The study highlighted a low level of primary health care doctors’ awareness on preventive measures for the main dental diseases of pregnant women (absence of motivation for dental diseases prevention and oral hygiene, inadequate knowledge about fluoride importance for caries prevention, exaggeration of the influence of non-manageable risk factors (heredity, ecological environment) on dental pathology development, a high level of reliance on information from the mass media about preventive measures in dentistry). Conclusion. It is necessary to improve the level of knowledge of doctors who monitor pregnant women. It can be achieved by the increase of doctors’ awareness (organization of lectures and seminars, development and production of visual aids for doctors of different specialities and mid-level medical staff).

Increase in Reported Prevalence of Microcephaly in Infants Born to Women Living in Areas with Confirmed Zika Virus Transmission During the First Trimester of Pregnancy - Brazil, 2015.

Widespread transmission of Zika virus by Aedes mosquitoes has been recognized in Brazil since late 2014, and in October 2015, an increase in the number of reported cases of microcephaly was reported to the Brazil Ministry of Health.* By January 2016, a total of 3,530 suspected microcephaly cases had been reported, many of which occurred in infants born to women who lived in or had visited areas where Zika virus transmission was occurring. Microcephaly surveillance was enhanced in late 2015 by implementing a more sensitive case definition. Based on the peak number of reported cases of microcephaly, and assuming an average estimated pregnancy duration of 38 weeks in Brazil (1), the first trimester of pregnancy coincided with reports of cases of febrile rash illness compatible with Zika virus disease in pregnant women in Bahia, Paraíba, and Pernambuco states, supporting an association between Zika virus infection during early pregnancy and the occurrence of microcephaly. Pregnant women in areas where Zika virus transmission is occurring should take steps to avoid mosquito bites. Additional studies are needed to further elucidate the relationship between Zika virus infection in pregnancy and microcephaly.

ARRHYTHMIAS IN PREGNANT WOMEN — SIGNIFICANCE OF THE PROBLEM AND ITS SOLUTIONS

The paper presents an analysis of a total of 5650 labor and delivery records of women in maternity departments of the city of Rostovon-Don for 2010-2014. Mean age was 28,26 years. We found out that cardiovascular diseases occurred in 25.58% of cases. There was a significant increase in the prevalence of cardiovascular diseases in pregnant women during 2010-2014. Arrhythmias were indicated typically of all the cases of cardiovascular diseases during pregnancy in 31,7%. Pregnant women with arrhythmias were assessed for concomitant diseases. We also outlined the main principles of patients’ medical attention according to current National Guidelines.

Alta incidência da infecção urogenital por Chlamydia trachomatis em mulheres parturientes de Belém, Estado do Pará, Brasil

RESUMO INTRODUCAO: A infeccao sexual por Chlamydia trachomatis e a infeccao bacteriana sexualmente transmissivel mais prevalente do mundo. E assintomatica em ate 80% dos casos e esta associada a doenca inflamatoria pelvica, infertilidade tubaria, parto prematuro, aborto, gravidez ectopica, doenca respiratoria no recem-nascido e mortalidade neonatal. OBJETIVO: Verificar a incidencia e os fatores associados a infeccao urogenital de C. trachomatis em parturientes de uma maternidade publica de referencia em Belem, Estado do Para, Brasil, entre o periodo de 21 de novembro a 8 de dezembro de 2011. MATERIAIS E METODOS: As participantes do estudo assinaram um Termo de Consentimento Livre e Esclarecido e responderam um questionario padronizado. A deteccao de C. trachomatis foi realizada atraves do sistema COBAS Amplicor CT/NG (Roche Molecular Systems, Branchburg, NJ, EUA), seguindo as recomendacoes do fabricante. Na analise estatistica, foi utilizado o programa BioEstat v5.0 e o teste Odds ratio foi empregado para a analise das variaveis. O p ≤ 0,05 foi considerado estatisticamente significativo, com intervalo de confianca de 95%. RESULTADOS: A incidencia da infeccao urogenital por C. trachomatis foi de 18% (22/122); a infeccao esteve significantemente associada as parturientes de idade igual ou inferior a 25 anos (p = 0,014) e as que nao realizaram o pre-natal (p = 0,0029). CONCLUSAO: A alta incidencia de C. trachomatis em parturientes de uma grande maternidade mostra a necessidade da elaboracao de politicas de saude voltadas para as estrategias de triagem e prevencao das infeccoes sexualmente transmissiveis em gravidas e em neonatos na Regiao Amazonica brasileira.

P161. Ultrasound as a primary imaging modality for follow-up of Crohn’s disease in pregnant women: initial results

P161. Ultrasound as a primary imaging modality for follow-up of Crohn’s disease in pregnant women: initial results

Molecular Characterization of Streptococcus agalactiae Isolates From Pregnant and Non-Pregnant Women at Yazd University Hospital, Iran.

Background:Streptococcus agalactiae (Group B streptococcus, GBS) that colonize the vaginas of pregnant women may occasionally cause neonatal infections. It is one of the most common causes of sepsis and meningitis in neonates and of invasive diseases in pregnant women. It can also cause infectious disease among immunocompromised individuals. The distribution of capsular serotypes and genotypes varies over time and by geographic era. The serotyping and genotyping data of GBS in Iranian pregnant and non-pregnant women seems very limited.Objectives:The aim of this study was to investigate the GBS ‎molecular capsular serotype ‎and genotype distribution of pregnant and non-pregnant carrier ‎women at Yazd university hospital, in Iran.‎Patients and Methods:In this cross-sectional study, a total of 100 GBS strains isolated from 237 pregnant and 413 non-pregnant women were investigated for molecular capsular serotypes and surface protein genes using the multiplex PCR assay. The Chi-square method was used for statistical analysis.Results:Out of 650 samples, 100 (15.4%) were identified as GBS, with a predominance of capsular serotypes III (50%) [III-1 (49), III-3 (1)], followed by II (25%), Ia (12%), V (11%), and Ib (2%), which was similar with another study conducted in Tehran, Iran, but they had no serotype Ia in their report. The surface protein antigen genes distribution was rib (53%), epsilon (38%), alp2/3 (6%), and alpha-c (3%).Conclusions:The determination of serotype and surface proteins of GBS strains distribution would ‎be ‎relevant ‎for the future possible formulation of a GBS vaccine.

ACG Clinical Guideline: Liver Disease and Pregnancy.

Consultation for liver disease in pregnant women is a common and oftentimes vexing clinical consultation for the gastroenterologist. The challenge lies in the need to consider the safety of both the expectant mother and the unborn fetus in the clinical management decisions. This practice guideline provides an evidence-based approach to common diagnostic and treatment challenges of liver disease in pregnant women.

Current approach for urinary system stone disease in pregnant women

Urinary system stones can be classified according to size, location, X-ray characteristics, aetiology of formation, composition, and risk of recurrence. Especially urolithiasis during pregnancy is a diagnostic and therapeutic challenge. In most cases, it becomes symptomatic in the second or third trimester. Diagnostic options in pregnant women are limited due to the possible teratogenic, carcinogenic, and mutagenic risk of foetal radiation exposure. Clinical management of a pregnant urolithiasis patient is complex and demands close collaboration between patient, obstetrician and urologist. We would like to review current diagnosis and treatment modalities of stone disease of pregnant woman.

Prevalence and factors associated with anemia in pregnant women attending the General Hospital in Douala

IntroductionL’anémie est un problème de santé publique, prédominant chez les enfants et les femmes en âge de procréer. L’objectif de l’étude était de déterminer la prévalence et les facteurs associés à l’anémie chez les femmes enceintes à l’Hôpital Général de Douala.MéthodesIl s’agissait d’une étude transversale qui s’est déroulée de juillet 2012 à juillet 2013. Toutes les femmes enceintes consentantes se présentant pour consultation prénatale et ayant réalisées une numération formule sanguine (NFS) étaient incluses. Les caractéristiques sociodémographiques, les antécédents obstétricaux et les résultats de la NFS étaient enregistrés sur une fiche technique pré-testée. L’anémie était définie selon les critères de l’OMS. Après quelques statistiques descriptives, nous avons effectué une analyse bivariée à l’aide du test de Chi 2 et la probabilité exacte de Fisher pour rechercher les facteurs associés à l’anémie. Une valeur de p< 0,05 était considérée significative.RésultatsAu total 415 gestantes ont été recrutées. La prévalence de l’anémie était de 39,8%. L’âge moyen était de 29,89±4,835ans. Le taux moyen d’hémoglobine était de 10,93±1,23.L’anémie normochrome normocytaire (53,3%) était prédominante. L’anémie était sévère dans 2,4% des cas. L’anémie en grossesse était significativement associée aux antécédents de pathologies chroniques (P=0,02) et d’anémie gravidique antérieure (P=0,003). L’anémie était plus observée au 3ème trimestre (P=0,04) et l’allaitement maternel était protecteur (P=0,02).ConclusionLa prévalence de l’anémie chez la femme enceinte reste élevée. Un accent doit être mis sur une meilleureprise en charge des pathologies chroniques chez les gestantes et sur leur suivi en post natal afin de corriger l’anémie avant la grossesse ultérieure.

Anticoagulation in pregnancy and puerperium: With a focus on the benefits and risks of the applications of vitamin K antagonists on the prevention of mechanical heart valves thrombosis

Introduction: The current number of women in the reproductive phase (from 15 to 45 years) in Europe is estimated at about 105 million, with about 5 million children annually born in average. About 1% of pregnancies among women in Europe are complicated by heart disease, the risk of cardiovascular disease in pregnant women being further increased by the fact that ever older women are giving birth. Methods: Preparing this paper is based on a systematic PubMed search of existing professional databases and accessible medical journals and textbooks dealing with this subject matter. Topic: Being certainly drugs with the best anticoagulant effect in situations of high risk for thrombosis, especially in patients with mechanical prosthetic heart valves during pregnancy, vitamin K antagonists (VKA) on the other hand also entail a well-known dose-related risk of embryo toxicity, genotoxicity, and hemorrhage in the fetus and in the mother. The choice of appropriate anticoagulant depends on the stage of pregnancy. In accordance with the North-American guidelines (American College of Chest Physicians - ACCP) for women already on oral vitamin K antagonists actively trying to conceive frequent pregnancy tests, and substitution of VKA with heparin drugs when pregnant are recommended rather than VKA replacement with low molecular weight heparin (Low Molecular Weight Heparin - LMWH) when planning a pregnancy. Heparin derivatives have no embryo toxic and fetotoxic characteristic effects of VKA but they are less effective at preventing valve thrombosis, due to which they have recently been superseded by improved techniques for monitoring effects of heparin, with a mentioned made that low molecular weight heparin used in high therapeutic doses requires obligatory (on a weekly basis) monitoring of anti-factor Xa coagulation activities. Conclusion: Adequate anticoagulant therapy during pregnancy requires an analysis of risk factors for thrombosis, hemorrhage risk, consideration of comorbidities in pregnant women, especially renal function, especially taking into account the gestational age. Though it must be admitted that there is no absolutely safe anticoagulant therapy during pregnancy, a choice of the safest option regarding the stated risks for the mother and the child is of paramount importance.

Influences of Oral Health Behaviors, Depression and Stress on Periodontal Disease in Pregnant Women

The purpose of this study was to identify the influences of oral health behaviors, depression, and stress on periodontal disease in pregnant women. The participants in this study were 129 pregnant women. Data were collected using questionnaires which included individual characteristics, oral health care behaviors, the Center for Epidemiological Studies-Depression scale (CES-D), a global measure of perceived stress, and pregnancy stress. A dentist measured periodontal probing depth and classified stages of periodontal disease according to the Community Periodontal Index (CPI). Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression. Periodontal disease had significant correlations with oral health care behaviors (r=-.56, p<.001), perceived stress (r=.44 p<.001), pregnancy stress (r=.37 p<.001), diet (r=-.33, p<.001) and depression (r=.18 p=.046). Factors influencing periodontal disease for these pregnant women were being in the 2nd (β=.27, p<.001) or 3rd trimester (β=.45, p<.001), having a pregnancy induced disease (β=.20, p=.002), performing higher oral health behaviors (β=-.30, p<.001), and having higher perceived stress (β=.17, p=.028). The explanation power of this regression model was 61.6% (F=15.52, p<.001). The findings of this study indicated that periodic assessment of periodontal disease is essential for pregnant women who are in 2nd or 3rd trimester and have pregnancy induced diseases. Enhancing oral health care behaviors and reducing perceived stress are indicated as effective strategies to reduce periodontal disease in pregnant women.

Validity of Self-Reported Periodontal Disease Questionnaire among Pregnant Women.

As part of the Kumamoto RAINBOW Project, a multifaceted implementation of the prevention of premature labor, we investigated pregnant women's oral health status and assessed the validity of a self-reported periodontal disease questionnaire. We examined the oral health status of pregnant women and asked them for subjective descriptions of symptoms of periodontitis both in the first and the second half of their pregnancy in Kumamoto Prefecture from August 2012 to January 2014. The Community Periodontal Index (CPI) was used to assess the periodontal condition, and women having periodontal pockets with depths of ≥4 mm were catecogorized as having periodontitis. The results were the scores of the self-questionnaire for periodontal disease prepared by the Japan Dental Association. Of the 9,527 pregnant women who received periodontal check- ups during the first half of pregnancy, 32 percent were diagnosed as having periodontitis. The self-questionnaire had a sensitivity of 51.2% and a specificity of 62.9% for pregnant women to predict their periodontal disease. Then, we evaluated the importance of each question by logistic regression analysis and extracted the useful items. An increased sensitivity (79.9%) was obtained with the best of the modified questionnaire. To our knowledge, this is the first report of the evaluation of the usefulness of the self-reported periodontal disease questionnaire for pregnant women. The current self-questonnaire used for the general adult population was less sensitive for pregnant women. Our modified questionnaire showed an improved sensitivity for diagnosing periodontitis, but its specificity remained low. A specialized self-questionnaire for periodontal disease in pregnant women should be designed.

Safety and feasibility of laparoscopic cholecystectomy during pregnancy

Background/aim Symptomatic biliary diseases in pregnant women remain a great challenge to surgeons. The present study aimed to evaluate the safety and feasibility of laparoscopic cholecystectomy (LC) during pregnancy. Patients and methods This prospective, observational study was conducted on 27 pregnant women with a mean age of 27.3 ± 4.1 (range 21–36) years who presented with symptomatic gallbladder diseases (stones or cholecystitis) and underwent LC. Gestational age, operative time, and maternal and fetal outcomes were noted. Results The mean operative time was 58.7 (range 32–78.5) min. Conversion to open cholecystectomy occurred only in one patient with acute cholecystitis due to the presence of severe adhesions (3.7%). No intraoperative or postoperative complications were observed, except for mild wound infection in only one patient (3.7%) and mild uterine contractions in two patients (7.4%). All patients went on to deliver at full term with no abortion or preterm labor. Conclusion Pregnant women with repeated attacks of biliary colic and/or cholecystitis after failure of conservative treatment can undergo LC easily and safely without hazardous effects on either mothers or fetuses, especially in the second trimester.

Risk factors associated with Chagas disease in pregnant women in Santander, a highly endemic Colombian area.

ObjectiveTo determine the prevalence and risk factors associated with Chagas disease in pregnant women in an endemic area of Santander, Colombia.MethodsCross‐sectional study included 23 municipalities of Santander, Colombia. Serological IFAT and ELISA tests were undertaken to detect IgG anti‐ Trypanosoma cruzi. A questionnaire was conducted for assessing the risk factors of each participant. Newborns were evaluated at birth and followed up to 1 year of age to determine congenital infection.ResultsAn overall prevalence of 3.2% (95% CI 2.4–4.2) among 1518 pregnant women was detected. Prevalences by provinces were as follows: Guanentina: 6.0% (95% CI 4.1–8.5), García Rovira: 2.9% (95% CI: 1.5–4.8) and Comunera: 0.4% (0.4–2.3). The main risk factors identified were age >32 years old (OR: 2.1; 95% CI: 1.1–3.9); currently having a thatched roof (OR: 11.8; CI95% 2.2–63.2) and a thatched roof during childhood (OR: 3.0; 95% CI: 1.4–6.6); having below primary school education level (OR: 4.6; 95% CI: 2.2–9.5); and a history of a close contact with the vector (triatomine bugs) at least once during their lifetime (OR: 6.9; 95% CI: 3.7–12.9). No congenital cases were detected by parasitological or serological techniques.ConclusionsPrevalence of Chagas disease in pregnant women is a potential source of infection in this Colombian endemic area. The main risk factors associated with seropositivity were related to conditions favouring the contact with the vector. The results show that it is necessary to continue an active surveillance in order to offer diagnosis and treatment to mothers and their newborns in addition to screening to pregnant women from endemic areas.

Fecal Calprotectin: A Biomarker and Predictor of Disease Activity During Pregnancy in Women with IBD

Introduction: Active inflammatory bowel disease (IBD) during pregnancy is associated with adverse maternal and fetal outcomes, and therefore requires early optimization of therapy. Women with inflammatory bowel disease (IBD) often have gastrointestinal symptoms during pregnancy, but it is often difficult to differentiate between pregnancy symptoms and active IBD. Fecal calprotectin (FCP) is a noninvasive biomarker of intestinal inflammation used to guide the management of IBD. Whether FCP can be used as a biomarker to identify active disease in pregnant women with IBD who have symptoms is not well understood. The objectives of this study were to determine if FCP is elevated during pregnancy in women with IBD who 1) have active disease or 2) who flare within 3 months of the FCP measurment. Methods: Women with IBD (18 to 45 yrs) were followed pre-conception (PC) and at each trimester of pregnancy (T[n]) in the Preconception and Pregnancy in IBD clinic. Women completed the modified Harvey Bradshaw Index (mHBI) for Crohn's disease and the partial Mayo (pMayo) for ulcerative colitis. Women with mHBI > 5 or pMayo > 2 were identified as having clinically active disease. FCP was determined from the first morning stool sample from each visit using the Quantum Blue High Range Reader. We compared the FCP of the women who 1) had active disease vs inactive disease at each study visit, and 2) who flared within 3 months vs who do not flare within 3 months of the FCP measurement. Results: Of the 60 patients enrolled in the clinic, 9 women with Crohn's disease, and 13 women with ulcerative colitis provided stool samples over 27 visits. FCP was elevated in women with active disease compared to women with inactive disease at each clinic visit (Figure 1). FCP was also elevated in women who flared within 3 months (Figure 2). These findings were mainly seen among women with UC.Figure 1Figure 2Conclusion: Fecal calprotectin is elevated before and during pregnancy in women with active IBD, and in women who will flare within 3 months of FCP measurement. FCP has a potential to be used as a noninvasive biomarker of disease activity during pregnancy in women with IBD - in order to confirm disease activity or to identify those at risk of flaring, so that clincians can optimize the management of IBD preconception and during pregnancy, and thus improve maternal and fetal outcomes.

Cost-effectiveness analysis of universal screening for thyroid disease in pregnant women in Spain

Objective To assess the cost-effectiveness of universal screening for thyroid disease in pregnant women in Spain as compared to high risk screening and no screening. Methodology A decision-analytic model comparing the incremental cost per quality-adjusted life year (QALY) of universal screening versus high risk screening and versus no screening. was used for the pregnancy and postpartum period. Probabilities from randomized controlled trials were considered for adverse obstetrical outcomes. A Markov model was used to assess the lifetime period after the first postpartum year and account for development of overt hypothyroidism. The main assumptions in the model and use of resources were assessed by local clinical experts. The analysis considered direct healthcare costs only. Results Universal screening gained .011 QALYs over high risk screening and .014 QALYS over no screening. Total direct costs per patient were €5,786 for universal screening, €5,791 for high risk screening, and €5,781 for no screening. Universal screening was dominant compared to risk-based screening and a very cost-effective alternative as compared to no screening. Use of universal screening instead of high risk screening would result in €2,653,854 annual savings for the Spanish National Health System. Conclusions Universal screening for thyroid disease in pregnant women in the first trimester is dominant in Spain as compared to risk-based screening, and is cost-effective as compared to no screening (incremental cost-effectiveness ratio of €374 per QALY). Moreover, it allows diagnosing and treating cases of clinical and subclinical hypothyroidism that may not be detected when only high-risk women are screened.

Lumbalgia durante el embarazo. Abordaje multidisciplinar

After explaining that low back pain is considered the most common pregnancy complication, its pathogenesis, risk factors and the clinical characteristics of the very painful symptoms of this condition are described. As for its approach, it is stressed that it must be multidisciplinary, introducing very important preventive measures, including proper postural hygiene. For its treatment, the methods may be based on non-surgical or pharmacological interventions of a conservative non-invasive nature. Thus, physiotherapy, osteopathic manipulation, multimodal intervention (exercise and education), exercises performed in water environment, acupuncture, etc., have proven to be effective. Finally, it is emphasised that given the significant impact on their quality of life, different health professionals must be proactive and treat the lumbar disease in pregnant women.

Enfermedad hipertensiva del embarazo. I. Riesgo Materno

Se presenta un estudio de Cohortes de 418 pacientes con EHE (Enfermedad Hipertensiva del embarazo) atendidas en el Hospital General Base Cayetano Heredia entre Enero 1980 a Junio 1982. Aplicando los parámetros diagnósticos de EHE. 191 (45.7%) tuvieron diagnóstico confirmado y 227 (54 .3 %) diagnóstico clínico o preventivo de enfermedad. Se corrobora la mayor incidencia de la enfermedad en gestantes menores de 25 años a predominio de primigestas, resaltándose la importancia del control prenatal para disminuir la morbi-mortalidad materna. La EHE se asocia con elevados índices de cesárea (28.7%) y es causa importante de morbilidad puerperal (por anemia e infecciones) con una elevada tasa de mortalidad materna (237 0/000).

ANALYSIS OF PREGNANCY COURSE, DELIVERY AND POSTNATAL PERIOD IN WOMEN WITH INTRACRANIAL HEMORRHAGE OF DIFFERENT ETIOLOGY

Intracranial hemorrhage is one of the leading non-obstetric causes of maternal mortality and morbidity. The relevance of the problem is determined on one side by serious complications for mother and fetus, on the other side, by unpredictable course and prognosis of cerebrovascular disease in pregnant women. The condition is complicated by development the symptoms that occur in patients both with cerebral pathology and with preeclampsia / eclampsia, HELLP-syndrome