Women Of Gestational Age Research Articles

Prediction of the ideal gestational weight gain for reducing the risk of macrosomia/large for gestational age in women with gestational diabetes mellitus in northern Taiwan

BackgroundAppropriate weight gain reduces the risk of fetal macrosomia and large for gestational age (LGA) in women with gestational diabetes mellitus (GDM), especially in the second and third trimester. This study aims to identify the optimal weight g–ain for such women across several pre-pregnancy body mass index (BMI) categories to lower the risk of macrosomia and LGA. MethodsThis retrospective cohort study enrolled women with GDM in north Taiwan who delivered between January 2012 and July 2022. BMI cut-offs were based on Chinese-specific guidelines and used to classify the participants as underweight (<18.5 kg/m2), normal weight (18.5–24.0 kg/m2), overweight (24.0–28.0 kg/m2), or obese (>28 kg/m2). Receiver operator curve analysis was used to determine the optimum GWG cut-off ranges to predict macrosomia / LGA, and uni- and multivariate analyses were used to analyze risk factors. In addition, a multivariable model predicting macrosomia and LGA in infants was developed. ResultsA total of 963 participants was included in our analysis. Optimal mean weekly rates of GWG in the second and third trimesters were 0.43 kg/week and 0.61 kg/week, respectively, in the underweight and normal weight group, and 0.33 kg/week and 0.32 kg/week, respectively, in the overweight and obesity group. ConclusionThe 2009 IOM guidelines, offering weight gain recommendations for pregnant women, appear to be applicable to Asian women diagnosed with GDM. This indicates that it is essential for such women to maintain an adequate total GWG throughout pregnancy. Physicians should address GWG using the IOM guidelines and trigger intervention when it is required to reduce macrosomia and LGA occurrence.

External validation of models to estimate gestational age in the second and third trimester using ultrasound: A prospective multicentre observational study.

Accurate assessment of gestational age (GA) is important at both individual and population levels. The most accurate way to estimate GA in women who book late in pregnancy is unknown. The aim of this study was to externally validate the accuracy of equations for GA estimation in late pregnancy and to identify the best equation for estimating GA in women who do not receive an ultrasound scan until the second or third trimester. This was a prospective, observational cross-sectional study. 57 prenatal care centres, France. Women with a singleton pregnancy and a previous 11-14-week dating scan that gave the observed GA were recruited over an 8-week period. They underwent a standardised ultrasound examination at one time point during the pregnancy (15-43 weeks), measuring 12 foetal biometric parameters that have previously been identified as useful for GA estimation. A total of 189 equations that estimate GA based on foetal biometry were examined and compared with GA estimation based on foetal CRL. Comparisons between the observed GA and the estimated GA were made using R2, calibration slope and intercept. RMSE, mean difference and 95% range of error were also calculated. A total of 2741 pregnant women were examined. After exclusions, 2339 participants were included. In the 20 best performing equations, the intercept ranged from -0.22 to 0.30, the calibration slope from 0.96 to 1.03 and the RSME from 0.67 to 0.87. Overall, multiparameter models outperformed single-parameter models. Both the 95% range of error and mean difference increased with gestation. Commonly used models based on measurement of the head circumference alone were not amongst the best performing models and were associated with higher 95% error and mean difference. We provide strong evidence that GA-specific equations based on multiparameter models should be used to estimate GA in late pregnancy. However, as all methods of GA assessment in late pregnancy are associated with large prediction intervals, efforts to improve access to early antenatal ultrasound must remain a priority. The proposal for this study and the corresponding methodological review was registered on PROSPERO international register of systematic reviews (registration number: CRD4201913776).

Utilizing latent connectivity among mediators in high‐dimensional mediation analysis

Mediation analysis intends to unveil the underlying relationship between an outcome variable and an exposure variable through one or more intermediate variables called mediators. In recent decades, research on mediation analysis has been focusing on multivariate mediation models, where the number of mediating variables is possibly of high dimension. This paper concerns high‐dimensional mediation analysis and proposes a three‐step algorithm that extracts and utilizes inter‐connectivity among candidate mediators. More specifically, the proposed methodology starts with a screening procedure to reduce the dimensionality of the initial set of candidate mediators, followed by a penalized regression model that incorporates both parameter‐ and group‐wise regularization, and ends with fitting a multivariate mediation model and identifying active mediating variables through a joint significance test. To showcase the performance of the proposed algorithm, we conducted two simulation studies in high‐dimensional and ultra‐high‐dimensional settings, respectively. Furthermore, we demonstrate the practical applications of the proposal using a real data set that uncovers the possible impact of environmental toxicants on women's gestational age at delivery through 61 biomarkers that belong to 7 biological pathways.

Determination of Gestational Age using Crown-Rump Length and its Associated Maternal Correlates in Igbos Living in Nnewi: An Ultrasound Study.

Purpose: The objective was to determine the accuracy of gestational age measured by CRL in fetuses of black women and also to identify the maternal factors affecting this accuracy in determining the gestational age by CRL measurement in fetuses of black women.&#x0D; Methodology: This prospective cross-sectional study was conducted in Life and Trinity Specialist hospitals both in Nnewi, South-East, Nigeria. The gestational ages of the fetuses by CRL were determined using Siemens 2D ultrasound scan within 14 weeks and the accuracy compared with the gestational ages obtained from the Last Menstrual Period (LMP). Factors affecting the accuracy of CRL in determining the gestational age in women like the maternal heights and ages were measured. The ultrasound scan was done by a consultant in the department of Obstetrics. Analysis was done using SPSS Package version [20]. Regression analysis was used to compare dependent ad independent variables. Paired t-test was carried out on gestation period by LMP and gestation period by CRL to know if the mean difference between the gestation period by LMP and gestation period by CRL is significant. Multiple correlation analysis was used to ascertain the degree of relationship between maternal weight and age and gestational age by LMP and CRL.&#x0D; Findings: The result showed that two hundred and sixty-­five women met the inclusion criteria but two were lost to follow up and two hundred and sixty-three were used finally for analysis. The accuracy of ultrasound scan in estimating the gestational age using CRL is within one week in majority of the cases. Maternal height, weight and age are poorly correlated to age of the fetus using the CRL. The fetuses of black women showed a marginal increase in length at gestational age below eight weeks but afterwards this difference is not pronounced. In conclusion, the accuracy of CRL in determining the gestational age is within one week in majority of cases. The maternal height and age are poorly correlated to the CRL of the fetus and thus to the gestational age.&#x0D; Unique Contributor to Theory, Policy and Practice: Ultrasound scan incorporated with growth chart for fetuses of white women can be equally used to ascertain the gestational ages of fetuses of black women with insignificant difference

Twist-1 Stimulates the Malignant Behaviors of Hydatidiform Mole via the PI3K/AKT Pathway.

Hydatidiform mole (HM) is a common pregnancy disease among women of gestational age. Twist-related protein 1 (Twist-1) is involved in the development of various tumors, but its role in HM is poorly defined. This study aimed to explore Twist-1 expression and its biological function in HM cells. Twist-1 expression in HM was detected by immunohistochemistry and quantitative real-time polymerase chain reaction (qRT-PCR). The effects of silencing Twist-1 on choriocarcinoma (CCA) cell proliferation were detected by cell counting kit-8 (CCK-8) and clone formation assays. CCA cell migration and invasion were detected through transwell assay. Western blot was used to detect epithelial-mesenchymal transition (EMT) and the expression of phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) pathway-related proteins. Twist-1 expression was upregulated in HM tissues (p < 0.001) and CCA cells (p < 0.01). Twist-1 silencing inhibited proliferation of BeWo and JAR cells (p < 0.01, p < 0.05) as shown by CCK-8 assay (p < 0.01) and clone formation assays (p < 0.01, p < 0.05). Twist-1 silencing inhibited the migration (p < 0.01) and invasion activity (p < 0.01, p < 0.05) of BeWo and JAR cells. Western blot results showed that Twist-1 silencing promoted E-cadherin (p < 0.01) expression, and inhibited N-cadherin (p < 0.01, p < 0.05) and vimentin (p < 0.01, p < 0.05) expression in BeWo and JAR cells. Twist-1 downregulation decreased protein levels of p-PI3K (p < 0.01) and p-AKT (p < 0.01, p < 0.05) in BeWo and JAR cells. Silencing Twist-1 inhibits the malignant behavior of CCA cells, which may play a part by inhibiting the EMT process and the PI3K/AKT pathway.

Early Detection of Preeclampsia Through Urine Protein Examination as a Means of Maternal Emergency Prevention

A decrease in urine albumin levels in pregnant women, which can be checked through urine protein examination, is an indicator used to determine whether a pregnant woman is experiencing preeclampsia. Preeclampsia has become a cause of increasing morbidity and mortality rates which affects both mothers and newborns. This research aimed to early detect the preeclampsia through urine protein examination and see the correlation between the characteristics of the research subjects and urine protein. Used a descriptive design with a correlational design, the urine protein from 36 pregnant women was examined in their second and third trimesters of pregnancy. Next, univariate analysis was carried out and Spearman Correlation test was used in bivariate analysis for abnormally distributed ordinal data while the Contingency Coefficient Correlation test was carried out for data that used abnormally distributed nominal scale. Based on the bivariate analysis, the variables of age, education, employment, and obstetric history obtained a significant value of p value&gt;0,05, showed no correlation with urine protein. Contrarily, the blood pressure variable had a significant value of p 0,049 &lt; 0,05. Pregnant women in gestational age of &gt;20 weeks with high blood pressure must examine the urine protein immediately to early detect preeclampsia and prevent maternal emergencies.

Investigation of the relationship between changes in maternal coagulation profile in the first trimester and the risk of developing preeclampsia

Normal pregnancy is a hypercoagulable state with an increase in coagulation factor levels and a decrease in natural anticoagulation. However, a higher hypercoagulable state with prolonged activated partial thromboplastin time (APTT), prothrombin time (PT), increased D-dimer, and mean platelet volume is seen in women with preeclampsia at the time of onset. In addition, endothelial dysfunction occurs before the clinical symptoms of preeclampsia. Therefore, we undertook this study to investigate the coagulation profile in the first trimester in women who developed preeclampsia later. A total of 853 pregnant women with singleton births at the Obstetrics and Gynecology Hospital of Fudan University between January 2021 and December 2021 were included in this case-control study. In the comparison with the controls (n = 531), the mean value of D-dimer, APTT, thrombin time (TT), antithrombin (AT)), and fibrin degradation products (FDP) was significantly lower in preeclamptic women at the time of diagnosis (n = 322). The changes in the coagulation profile were not associated with the severity or the time of onset. The reduced values of D-dimer, AT, and FDP, and increased values of TT were also observed in the first trimester in women who developed preeclampsia later and were not associated with the severity, or the time of onset of preeclampsia. After adjusting for maternal age and BMI, the values of D-dimer and AT in the first trimester were correlated to the risk of developing preeclampsia. Our findings suggest that there is an abnormal maternal response to the hemostatic system in early gestational age in women who developed preeclampsia later and measuring the coagulation profile could be an additional predictive marker of preeclampsia.

Quantitative strain elastography of the uterine cervix assessed by the GE Voluson E10 system in combination with a force-measuring device

Objective During pregnancy, the stiffness of the cervical tissue decreases long before the cervical length decreases. Therefore, several approaches have been proposed in order to ensure a more objective assessment of cervical stiffness than that achieved by digital evaluation. Strain elastography has shown promising results. This technique is based on an ultrasound assessment of the tissue deformation that occurs when the examiner applies pressure on the tissue with the ultrasound probe. However, the results are only semi-quantitative as they depend on the unmeasured force used by the examiner. We, therefore, hypothesized that a force-measuring device applied to the handle of the ultrasound probe may render the technique quantitative. With this approach, the stiffness is the force (measured by the device) divided by the compression (measured by the elastography platform). One perspective is the early identification of women at risk of preterm birth in whom cervical stiffness may decrease long before cervical shortening. Another perspective is cervical evaluation when planning labor induction. In this feasibility study, we aimed to evaluate how quantitative strain elastography performs when a commercially available strain elastography platform (by which the algorithm is unavailable) is combined with a custom-made, force-measuring device. We studied how the assessments were associated with the gestational age in women with uncomplicated pregnancies and how they were associated with cervical dilatation time from 4 to 10 cm in women undergoing labor induction. Methods In the analysis, we included quantitative strain elastography assessments from 47 women with uncomplicated singleton pregnancies, with gestational age between 12+0 and 40+0, and from 27 singleton term-pregnant women undergoing labor induction. The force-measuring device was mounted on the handle of a transvaginal probe. The strain values (i.e. the compression of the cervical tissue) were obtained by the elastography software of the ultrasound scanner (GE Voluson E10). The region of interest was placed within the central part of the anterior cervical lip. Based on the force data and strain values, we calculated the outcomes cervical elastography indexGE (CEIGE ) and the cervical strength indexGE (CEIGE x cervical length: CSIGE ). Results The average CEIGE was 0.24 N at week 12 and 0.15 N at week 30–34. For CSIGE these figures were 8.2 and 4.7 N mm, respectively (p = 0.002). Among women undergoing labor induction, the CEIGE was associated with a cervical dilatation time (4–10 cm) beyond 7 h. For nulliparous women, this area under the ROC curve was 0.94. Conclusion Quantitative strain elastography may constitute a tool for the evaluation of a uterine cervix with normal length in women at risk of preterm birth and in women undergoing labor induction. The performance of this tool deserves evaluation in larger clinical trials.

Surgical Pathology During Pregnancy: Acute Cholecystitis, A Common Problem

Introduction: If left untreated, acute cholecystitis, a common illness that can develop during pregnancy, can cause major consequences for both the mother and fetus. It might be difficult to diagnose acute cholecystitis during pregnancy since its symptoms can resemble those of other abdominal disorders. For the first time in the history of the United States, the first time in the history of the United States. The production of gallstones and consequent inflammation are thought to be caused by hormonal changes, altered gallbladder function, and reduced gallbladder motility, which are all factors in the pathophysiology of acute cholecystitis during pregnancy. The clinical history, symptoms, physical examination, and diagnostic procedures, such as abdominal ultrasonography and assessment of bilirubin and liver enzyme levels, are used to make the diagnosis of acute cholecystitis during pregnancy. The severity of the symptoms and the woman's gestational age determine how to treat acute cholecystitis during pregnancy. Cholecystectomy, a laparoscopic procedure to remove the gallbladder, is typically the most successful therapy for acute cholecystitis during pregnancy. Yet, because of the physiological and structural changes in the pregnant woman's body, surgery may be more difficult. As a result, each patient's therapy should be customized, and the risks and benefits of surgery should be carefully weighed. The prognosis of acute cholecystitis during pregnancy is favourable if appropriately detected and treated. Pregnant women should be aware of symptoms and seek medical assistance right away if they think they may have acute cholecystitis. Most pregnant women may have a safe pregnancy and birth with prompt diagnosis and treatment.

Molecular and Serological Epidemiology of Herpes Simplex Virus Type 1 and 2 in Pregnant Women of Gorgan City, North East of Iran.

As one of the most widespread sexually transmitted infections, Herpes Simplex Virus (HSVs) globally account for 60-95% of persistent infections in adults. This infection is prevalent in women of gestational age and is likely to be transmitted from the infected mother to her neonate. Additionally, it gives rise to devastating complications in neonates. This study was designed to estimate the molecular and serological prevalence of HSV-1 and 2 in pregnant women of Gorgan city, North East of Iran. Vaginal secretions and blood specimens of 315 pregnant women referred to an educational hospital in the North east of Iran were tested for HSV-1 and HSV-2 using multiplex PCR and ELISA assays. Chi-Square test was utilized to evaluate the association of qualitative variables and the level of significance was set at p≤0.05. Moreover, statistical analysis was performed using SPSS V.19.0. HSV-1 and HSV-2 DNA was detected in 5.7% and 8.3% of participants, respectively. Given the serological analyses of total HSV-1 and HSV-2 antibodies, 92.7% (239/315) of patients were IgG positive and 5.4% (17/315) were IgM positive. The rate of HSV-1 and 2 in the present study was lower than that reported by World Health Organization (WHO). This study emphasizes the conduction of further investigations on HSVs since these viruses are probably playing significant role in sexually transmitted infections.

Analysis of Poor Perinatal Outcome During COVID-19 Pandemic Lockdown: A Cross Sectional Study

Fear of hospitalization in addition to uncertainties about appropriate treatment at the beginning of COVID -19 pandemic may have affected the health and outcome of pregnant women. Lack of transportation closed out -patient services, and lack of employment has directly linked to poor maternal and perinatal outcomes during nationwide lockdown. This study was aimed to find out the poor perinatal outcome during the first COVID-19 pandemic lockdown at BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal. This was a descriptive cross-sectional study conducted in BPKIHS from 24th March 2020 to 23rd July 2020 during the first COVID- 19 lockdown for the duration of 4 months. The data were collected between 1st February to 15th February 2021 from the hospital records. Convenience sampling was done. Data analysis was done by SPSS version 24. Poor perinatal outcomes: perinatal death, preterm delivery, intrauterine growth restriction, newborn admission, and different reasons for admission were analyzed using descriptive statistics. There were a total of 2685 obstetric admissions and 2442 deliveries during the study period of 4 months. Mean age and gestational age of women with poor perinatal outcome were 27.16 ± 6.02 years and 36.38± 4.54 weeks respectively. The perinatal death rate was 26.2 per 1000 births. 128 newborns required neonatal admission and prematurity was the most common cause. The prevalence of poor perinatal outcome was like other studies done in similar settings. However, larger, comparative studies are needed to identify a definite association of COVID 19 pandemic lockdown with poor perinatal outcomes.

Accuracy of Trans-Cerebellar Diameter and Placental Thickness in Third Trimesteric Pregnant Women for Calculation of Gestational Age: A Cross Sectional Study

Background: Accurate determination of gestational age has become important for deciding the appropriate time for termination of the pregnancy as well as to monitor the fetal growth during the entire period of pregnancy. Objective: The aim of the study was to assess whether the trans-cerebellar diameter, placental thickness or combining both of them is more accurate for assessment of gestational age in the 3rd trimester of pregnancy. Patients and Methods: This is a cross sectional study conducted at outpatient Clinic and Obstetric ward, Ain Shams University Maternity Hospital, over a period of six months from March 2019 to September 2019. One hundred pregnant women were recruited according to inclusion criteria either from outpatient clinic or were admitted in obstetric ward Ain Shams Maternity Hospital to find out the most accurate fetal biometric measurement in the third trimester either trans-cerebellar diameter placental thickness or both compared to reliable LMP (last menstrual period) dates confirmed by crown rump length (CRL) in the first trimester. Results: Trans-cerebellar diameter mean ± SD was 46.0 ± 3.5 with range 38.2 - 51.7. The mean of placental thickness was 39.6 ± 7.1 with range 22.8 - 54.3. Placental thickness had highest determination (0.813) for last menstrual period followed by trans-cerebellar diameter (0.802). Combining trans-cerebellar diameter and placental thickness increased determination (0.902) for last menstrual period. Conclusion: Combined use of trans-cerebellar diameter and placental thickness in the third trimester of pregnancy is a reliable indicator for gestational age in women whose last menstrual period is unreliable or unknown, but placental thickness had higher accuracy than trans-cerebellar diameter.

Determinants of Small for Gestational Age in Women With Type 2 Diabetes in Pregnancy: Who Should Receive Metformin?

In the MiTy (Metformin in Women With Type 2 Diabetes in Pregnancy) randomized trial of metformin versus placebo added to insulin, we found numerous benefits with metformin but identified an increased proportion of infants who were small for gestational age (SGA). We aimed to determine the predictors of SGA in order to individualize care. Using logistic regression, we assessed baseline maternal characteristics as predictors of SGA. We compared maternal/neonatal outcomes in SGA metformin and placebo groups using the t, χ2, or Fisher exact test, as appropriate. Among the 502 mothers, 460 infants were eligible for this study. There were 30 infants with SGA in the metformin group (12.9%) and 15 in the placebo group (6.6%) (P = 0.026). Among SGA infants, those in the metformin group were delivered significantly later than those in the placebo group (37.2 vs. 35.3 weeks; P = 0.038). In adjusted analyses, presence of a comorbidity (chronic hypertension and/or nephropathy) (odds ratio [OR] 3.05; 95% CI 1.58-5.81) and metformin use (OR 2.26; 95% CI 1.19-4.74) were predictive of SGA. The absolute risk of SGA was much higher in women receiving metformin with comorbidity compared with women receiving metformin without comorbidity (25.0% vs. 9.8%). In this study, we observed a high percentage of SGA births among women with type 2 diabetes and chronic hypertension and/or nephropathy who were treated with metformin. Therefore, with the aim of reducing SGA, it is reasonable to be cautious in our use of metformin in those with type 2 diabetes and chronic hypertension or nephropathy in pregnancy.

Burden of Placenta Previa as a Cause of Postpartum Hysterectomy at a Tertiary Care Hospital

Objective: To find the frequency of placenta previa in females undergoing hysterectomy during cesarean delivery at term. Material and methods: This Cross sectional study was conducted at Department of Obstetrics &amp; Gynecology, Lady Willingdon Hospital, Lahore for 6 months. Total 90 females who will fulfill selection criteria were enrolled in the study from operation theatre. Informed consent was obtained. Demographic features was obtained. Then females undergone cesarean section and planned hysterectomy. All surgeries were done by researcher herself. The location of placenta was noted ultrasound before cesarean and placenta previa was labeled if present. Location of placenta previa was also confirmed during cesarean section. Results: There were total 90 patients in our study among them the mean age was 36.61±4.31 years. There were 60(66.7%) women who underwent caesarean section previously. There were 12(13.3%) women with placenta previa. Frequency of placenta previa in different age groups was 41.7% in 30-34 years, 25% in 35-39 and 33.3% in women whose age was &gt;40 years. (p- value=0.71). No statistically significant association was seen between gestational age of women and placenta previa. i.e. (p-value-0.106) Gestational age 37-38: 25% (3/12) &amp; Gestational age 39-40: 75% (9/12). Statistically significant association was seen between parity status of women and placenta previa. i.e. (p-value-0.000) Parity-1: 0(0%), Parity-2: 0(0%), Parity-3:5(41.7%) and Parity-4:7(58.3%). No statistically significant association was seen between previous cesarean section of women and placenta previa. i.e. (p-value-0.366) No previous CS: 25% (3/12), One previous CS: 33.3% (4/12), Two previous CS: 16.7% (2/12) &amp; Three previous CS: 25% (3/12). Conclusion: High frequency of placenta previa was noted in our study among females undergoing postpartum hysterectomy. Keeping in mind the results of this study it can be concluded that the placenta previa being a risk factor for emergency obstetrics hysterectomy should be identified and screened antenatally to improve disease prognosis to achieve desired clinical outcomes. Key words: Placenta previa, Hysterectomy, Cesarean delivery, Term delivery

The Effects of Letrozole and Metformin Combined with Targeted Nursing Care on Ovarian Function, LH, and FSH in Infertile Patients with Polycystic Ovary Syndrome

Background Polycystic ovary syndrome (PCOS) is a common gynecological endocrine disorder in women of gestational age and the most common cause of female infertility. This study aimed to investigate the effect of letrozole and metformin combined with targeted nursing on ovarian function, LH, and FSH in infertile patients with PCOS. Methods A total of 72 infertile patients with PCOS were divided into the control group and combined group. The control group was given metformin tablets combined with targeted nursing therapy. The combined group was treated with letrozole on the basis of the control group. Ovarian function, LH, and FSH were compared between the two groups before and after treatment. Results After treatment, the total effective rate (94.44%) of the combined group was significantly higher than that of the control group (80.56%). After treatment, the levels of HbA1c, FINS, HOMA-IR, TG, and TC in the two groups were lower than those before treatment, and the HDL-C level was higher than that before treatment. The full-term delivery rate, ovulation rate, and normal menstrual rate in the combined group were higher than those in the control group. After treatment, the LH level in the combined group was lower than that in the control group, and the FSH level was higher than that in the control group. After 1 month, 3 months, and 5 months of treatment, RI, PI, and ovarian volume were decreased, and the endometrial thickness was increased in both groups. Also, after 5 months of treatment, the RI, PI, and ovarian volume in the combined group were significantly lower than those in the control group, and the endometrial thickness was significantly higher than that in the control group. There was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusion The combination of letrozole and metformin with targeted nursing in the treatment of infertility patients with PCOS has better clinical effect and high safety. It can improve endometrial receptivity and ovarian reserve function and regulate LH and FSH levels.

Frequency of Abruptio Placenta in Women With Pregnancy-Induced Hypertension.

Background: Bleeding that takes place after premature separation of the normally situated placenta, usually after 20 weeks of pregnancy, is known as abruptio placenta. Factors increasing chances of abruptio placenta are advanced age pregnancy, parity, smoking, pregnancy-induced hypertension, pre-eclampsia, and previous incidence of abruptio. The objective of the study was to find the frequency of abruptio placenta in women with pregnancy-induced hypertension.Methods: This descriptive prospective study was conducted in the Department of Obstetrics and Gynaecology, Jinnah Postgraduate Medical Centre, Karachi, from January to July, 2021. Women of gestational age above 20 weeks were included. Patients with blood pressure ≥140/90mmHg were considered as having pregnancy-induced hypertension. Early separation of the normally placed placental from the uterine wall was defined as placental abruption with clinical signs of painful vaginal bleeding (concealed or revealed), uterine contractions, and non-reassuring fetal heart rate. Descriptive statistics were calculated. Stratification was done and the post-stratification chi-square test was applied. P-value ≤ 0.05 was taken as significant.Results: A total of 205 patients were included in the study. The mean age was 24.26±2.92 years. The mean gestational age was 30.82±3.22 weeks. The mean parity was 2.59±0.80 children. Mean systolic blood pressure was 148.48±5.99 mmHg and mean diastolic blood pressure was 94.85±3.05 mmHg. Bleeding was reported in 110 (53.7%) cases. Lower abdominal tenderness in 125 (60.5%) cases. Fetal heart rate was normal in 16.6% of the cases. Abruptio placenta was observed in 29 (14.1%) patients.Conclusion:Abruptio placenta is a life-threatening condition that occurs during pregnancy that can result in both maternal and fetal morbidity and mortality. Adequate and urgent intervention can result in a favourable outcome.

English

BACKGROUND Gestational diabetes mellitus (GDM) is a major health problem arising due to insulin resistance in pregnant women. It is associated with multiple maternal complications which may cause end organ failure, complicated labour and delivery and thereby increasing the maternal morbidity and mortality. The foetus is also at risk for problems beginning from in utero and extending into the neonatal period and adult life. We wanted to correlate first trimester HbA1c values with the subsequent development of gestational diabetes mellitus and identify if glycosylated haemoglobin can be used as an adjunct with other screening methods. METHODS It is a prospective cohort study. This study was conducted from August 2015 to August 2017. All women of gestational age 6 to 12 weeks who came to Sri Ramachandra University outpatient department were taken for this study. Informed consent was obtained and a detailed history taking was done as per proforma. Along with routine antenatal investigations, Glycosylated haemoglobin (HbA1c) was also done. Oral Glucose Tolerance Test was to be performed at 24 - 28 weeks as per the World Health Organisation –with 75gm criteria and the results were tabulated and analysed to know the significance of Glycosylated haemoglobin (HbA1c) in the outcome of gestational diabetes mellitus. Further a fasting and postprandial blood sugar was done in the 3rd trimester for all patients as a secondary screening tool for gestational diabetes mellitus. Secondary outcomes of obstetric and neonatal complications were also studied. RESULTS In the present study a total of 323 patients were screened for HbA1c during the first trimester and followed till delivery. Only 21.9 % developed gestational diabetes mellitus. Elevated Glycosylated haemoglobin (HbA1c) value of 5.7 - 6.4 % was seen in 5.9 %. CONCLUSIONS Most of the patients with elevated Glycosylated Haemoglobin in the first trimester had high chance of developing gestational diabetes mellitus. Glycosylated haemoglobin is indeed a simple way of screening, but its solitary use remains controversial and hence could possibly be tried as an adjunct with other screening methods. KEY WORDS Glycosylated Haemoglobin, Gestational Diabetes Mellitus, Glycaemic Control, Maternal and Foetal Morbidity and Mortality

Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal- retrospective cross sectional study

BackgroundThe maternal mortality ratio is a significant public health indicator that reflects the quality of health care services. The prevalence is still high in developing countries than in the developed countries.This study aimed to determine the MMR and identify the various risk factors and causes of maternal mortality.MethodsThis is a retrospective study conducted in a tertiary care center in Eastern Nepal from 16th July 2015 to 15th July 2020. The maternal mortality ratio was calculated per 100,000 live-births over five year’s study period. The causes of death, delays of maternal mortality and, different sociodemographic profiles were analyzed using descriptive statistics.ResultsThere was a total of 55,667 deliveries conducted during the study period. The calculated maternal mortality ratio is 129.34 per 100,000 live-births in the year 2015 to 2020. The mean age and gestational age of women with maternal deaths were 24.69 ± 5.99 years and 36.15 ± 4.38 weeks of gestation. Obstetric hemorrhage, hypertensive disorder of pregnancy and sepsis were the leading causes of maternal death. The prime contributory factors were delay in seeking health care and reaching health care facility (type I delay:40.9%).ConclusionsDespite the availability of comprehensive emergency obstetric care at our center, maternal mortality is still high and almost 75% of deaths were avoidable. The leading contributory factors of maternal mortality are delay in seeking care and delayed referral from other health facilities. The avoidable causes of maternal mortality are preventable through combined safe motherhood strategies, prompt referral, active management of labor and, puerperium.

Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: a mixed-method study

Background: Prepartum depression is common among pregnant women and has not been studied much in low and middle-income countries. Evidence shows that mental illnesses are prevalent in urban than in rural areas. The study objective was to determine the magnitude of prepartum depression, risk factors, and real-life experiences of depression among pregnant women. Method: A mixed-method cross-sectional study was conducted. It included 262 pregnant women attending antenatal clinics in two public health facilities in urban low-income settlement Nairobi, Kenya. Edinburgh Postnatal Depression Scale (EPDS) with cut-off &gt;13 was used to classify clinical depressive illness. Further, a focus group discussion was conducted with 20 women identified with depression. Univariable analysis with Odd's Ratio was used to test associations. Variables with a p&lt;0.05 in multivariable regression were considered significant. Result: Out of the 262 women, 33.6% were found to have clinical depression as indicated by EPDS score of &gt;13. Women's gestational age was statistically significantly associated with prepartum depression [OR 4.27 (95% C.I. 2.08 - 8.79), p &lt; 0.001]. Income level ≤ 5000 KES was statistically significantly associated with prepartum depression [OR 3.64 (95% C.I.1.25 -10.60), p=0.018]. Further, thematic analysis of qualitative indicated that poverty, lack of social support, domestic violence, and unfriendly health care were major contributors to prepartum depression. Conclusion: Significant numbers of pregnant women were found to experience depression. This prevalence rate indicates a high disease burden of women who live with depression, which is not diagnosed because screening of depression is not done in primary health care centers. This study calls for a need and consideration for screening for perinatal depression in primary health care facilities, mainly in resource-poor areas. Interventions targeting means of resolving conflicts in families are highly needed. Such steps would help achieve key sustainable development goals where maternal and child health remains key priority.

Correlation Analysis Between MTHFR C677T Polymorphism and Uterine Fibroids: A Retrospective Cohort Study.

BackgroundUterine fibroids(UF) are the most common benign tumors in women, with high incidence and unknown causes. We aimed to explore the correlation between Methylenetetra-hydrofolate reductase (MTHFR) C677T polymorphism and UF.MethodsThis is a retrospective cohort study. Data were collected from 2411 women detected for MTHFR C677T polymorphism in the Fifth Affiliated Hospital of Sun Yat-sen University from 2018 to 2020. B-ultrasound (BU) and the first page of medical records were used to analyze whether they had ever been diagnosed with UF. The collected data were analyzed. Using the chi-square test and regression analysis to explore the correlation, and the risk factors was screened by multifactor logistic regression analysis.ResultsA total of 2411 pregnant women were in the MTHFR C677T polymorphism detection. Among them, 226(9.37%) were diagnosed as UF by BU or clinical diagnosis. The allele and genotype of MTHFR C677T were significantly different between the case and control group (p<0.05), and the distribution of the allele was following Hardy-Weinberg (H-W) equilibrium. Comparing with the wild-type (C/C), the mutant group (C/T+T/T) was more likely to form UF(OR,1.43;OR95%CI,1.07-1.89). After adjusting for confoundings, the heterozygous mutant (C/T) was more susceptible to UF than the wild-type (aOR,1.41;aOR95%CI,1.41-1.91). In the case group, BMI, gravidity and parity were not associated with the size and number of UF and the MTHFR C677T polymorphism (p>0.05). However, older maternal age was associated with the incidence of UF, especially the multiple UF (p<0.05).ConclusionOur results found that MTHFR C677T polymorphism was associated with UF occurrence for the first time. This could imply that it may increase the risk of forming UF in women of gestational age.