Good Pregnancy Outcome Research Articles

Role of pharmacist's counseling on folate compliance

Background: Pregnant women's compliance with a regimen of folate supplementation is an important factor in decreasing incidence of neural tube defects (NTDs). Because effective medication counseling can be used to enhance women's compliance with folate intake, pharmacists can help ensure good pregnancy outcomes by improving women's compliance through such counseling. Objectives: To determine the effect of medication counseling delivered by pharmacists on compliance among pregnant women in Tabuk, Saudi Arabia. Materials and Methods: A cross-sectional analytical study was conducted of 360 pregnant women who attended antenatal care clinics at primary health-care centers in 2018. A well-designed questionnaire was used for data collection. The data were analyzed using descriptive statistics and the Chi-squared test. Results: About half of the study participants began consuming folic acid after becoming pregnant (55.8%) and only 28.6% reported preconceptional intake. The most common reason for noncompliance was forgetfulness (64.40%). Almost two-thirds of women knew the importance of taking folate in pregnancy to prevent NTDs (64.2%). Their main sources of knowledge about folic acid were doctors (35.8%) and pharmacists (25%). A significant association was found between regular folate intake and pharmacist counseling as a source of folate information. Conclusion: Almost half of pregnant women complied with their folate supplementation regimen. However, lower preconceptional intake was observed. Participants' level of awareness of the importance of folic acid supplementation for pregnant women, though adequate, was not sufficient to ensure good pregnancy outcomes. Pharmacists were identified as a valuable source of information about folic acid, with their provision of medication counseling significantly associated with regularity of folate intake.

GnRH agonist versus HCG triggering in different IVF/ICSI cycles of same patients: a retrospective study

The aim of this study was to assess Gonadotropin Releasing Hormone agonist (GnRHa) trigger results of fresh in vitro fertilisation (IVF), Intracytoplasmic Sperm Injection (ICSI) cycles in high-responder patients. Thirty-six high-responder patients, undergoing GnRH antagonist protocol combined with GnRHa trigger for final oocyte maturation, were included. All cycles were autologous fresh transfer cycles. Fifteen of 36 patients had previous IVF/ICSI cycles triggered with human chorionic gonadotropin (hCG) and both cycles of these patients were compared. The mean fertilisation rate, blastocyst development and clinical pregnancy rates were 67%, 44.4% and 44.4%, respectively. The hCG and GnRHa trigger cycles of the same patients were compared as two groups (n: 15). 2PN oocyte counts were significantly higher in agonist trigger cycles (p .048). There were no differences in terms of M2 oocyte count and fertilisation rate. The blastocyst formation and clinical pregnancy rates for hCG and GnRHa trigger cycles were 33.3–66.7% and 13.3–46.7%, respectively. These results were found to be 2-fold and 3.5-fold higher, but not statistically significant. GnRHa trigger in combination with LPS is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.IMPACT STATEMENTWhat is already known on this subject? Gonadotrophin releasing hormone agonist (GnRHa) trigger is effective in the induction of oocyte maturation and prevention of Ovarian Hyperstimulation Syndrome (OHSS) on IVF cycles using antagonist protocol.What do the results of this study add? The main strength of this study is the comparison of different triggers in different cycles of the same patients. GnRHa trigger in combination with Luteal Phase Support (LPS) is a good option for final oocyte maturation due to its good pregnancy outcomes and virtually eliminating OHSS risks.What are the implications of these findings for clinical practice and/or further research? We suppose that GnRHa trigger combined with modified LPS is clinically more successful than Human Chorionic Gonadotropin (hCG) in regard to OHSS prevention and reproductive outcomes on fresh IVF/ICSI cycles. More extensive studies are needed to draw firm conclusions.

Fertility and disease outcomes in patients with chronic myeloid leukemia

目的报道服用酪氨酸激酶抑制剂（TKI）的男性慢性髓性白血病（CML）患者配偶和女性妊娠期诊断CML患者的生育和疾病结局。方法将1998年7月至2018年2月确诊并服用TKI治疗的男性CML患者及2009年10月至2018年2月期间妊娠期诊断CML的女性患者纳入研究。采用收集病历资料、问卷调查和门诊及电话随访方式收集患者疾病和生育相关信息。结果共收集服用TKI期间配偶妊娠的49例男性CML患者数据，其配偶初次受孕前，男性患者服用伊马替尼34例、尼洛替尼9例、达沙替尼6例，配偶受孕时，患者中位年龄为32（25～48）岁，TKI治疗时间为36（0.2～198）个月，除1例在仅获得完全血液学反应状态下为备孕而停药1年患者发生疾病进展外，其余48例男性患者均处于疾病稳定状态。所有男性患者的配偶共妊娠61次，生产55例婴儿，早产1例、生产低体重儿2例，其中1例合并尿道下裂，出生后行手术修复，其余均为足月健康婴儿。共收集18例女性妊娠期诊断CML的患者数据，2例自然流产，2例人工流产，14例分娩健康婴儿，未见先天畸形，确诊CML至开始TKI（伊马替尼15例，尼洛替尼3例）治疗时间为4（0.3～16）个月，中位随访45（7～114）个月，5年完全分子学反应、主要分子学反应、分子学反应4.5（MR4.5）获得率分别为88.9％、85.3％和35.1％，5年无失败生存、无进展生存和总生存率分别为64.2％、90.9％和90.9％，所有婴儿均正常发育。结论男性CML患者服用TKI对生育结局无不良影响，应避免盲目停药备孕。TKI时代，女性妊娠合并CML患者生育和疾病结局良好。

Does seronegative obstetric APS exist? "pro" and "cons".

Antiphospholipid Syndrome (APS) is the commonest treatable cause of recurrent miscarriage and pharmacological treatment of pregnant patients with antiphospholipid antibodies (aPL) should aim at preventing obstetric complications and maternal thrombotic events. Conventional treatment for patients with an established diagnosis of obstetric APS (OAPS), generally resulting in over 70-80% successful pregnancies. Since seropositive (SP)-APS and seronegative (SN)-APS patients had shown similar clinical profiles, patients with SN- OAPS, as well as SP-OAPS, should receive combined treatment in order to improve the pregnancy prognosis; indeed, current standard of care increased good pregnancy outcome in SN-APS, with similar effect to confirmed APS. The above data suggest that there are patients with the clinical manifestations of OAPS but persistently negative to conventional aPL that need to be identified to ensure adequate therapy and therefore a better prognosis. The clinical utility of non-criteria aPL in the diagnosis of SN-APS is still a matter of debate. In the last decade more and more studies have reported the presence of patients suffering from SN-APS in which non-conventional ("non-criteria") aPL might be present or antibodies may be detected using methodological approaches different from the traditional assays. To improve test standardization large prospective, multicenter, and multinational studies are needed. Therefore, when assessing a patient with clinical manifestations consistent with OAPS but aPL negative using the conventional available assays, the clinician should consider the possibility that the patient is affected with SN-APS.

CD83 is locally regulated and differentially expressed in disturbed murine pregnancy.

Alterations in the immunologic balance during pregnancy have been associated with poor pregnancy outcomes. The underlying mechanisms are complex and mouse models delivered valuable information on inflammatory imbalance in disturbed pregnancies and served as model to test potential anti-inflammatory therapies. CD83 is a transmembrane protein (mCD83) with a soluble form (sCD83) which possesses strong anti-inflammatory properties. During murine pregnancy, upregulated mCD83 expression induces sCD83 release after in vitro stimulation with LPS, phorbol myristate acetate (PMA) and ionomycin. The release mechanism of sCD83 and its control are yet to be elucidated. In this study, the expression of mCD83 and sCD83 has been extensively studied in the CBA/J × DBA/2J mouse model of pro-inflammatory-mediated pregnancy disturbances. mCD83 was higher expressed on splenic B cells, uterus-draining lymph nodes T cells and dendritic cells from mice with poor pregnancy outcome (PPOM) compared to mice with good pregnancy outcome (GPOM). PPOM, however, was accompanied by lower sCD83 serum levels. In vitro treatment of splenic B cells with progesterone led to a reduction of TIMP1 expression, mCD83 expression and sCD83 release, while TIMP1 treatment had a positive effect on sCD83 availability. These results suggest that tissue and matrix components are involved in the regulation of CD83 in murine pro-inflammatory pregnancies.

Multicenter research on tumor and pregnancy outcomes in patients with early-stage cervical cancer after fertility-sparing surgery.

ObjectiveTo investigate tumor and pregnancy outcomes after fertility-sparing surgery for cervical cancer.MethodsA total of 83 patients with cervical cancer who received fertility-sparing surgery at 10 gynecologic cancer research centers in Henan Province were enrolled from January 2010 to June 2016. Clinical data and follow-up results were collected. Of them, 78 had cervical squamous carcinoma and five had cervical adenocarcinoma. International Federation of Gynecology and Obstetrics (2009) staging showed that 26 patients had stage IA1, 11 had stage IA2, and 46 had stage IBI. Seventy-two patients underwent radical trachelectomy and retroperitoneal lymphadenectomy, whereas 11 underwent subradical trachelectomy and retroperitoneal lymphadenectomy. Moreover, 17 patients received one to two courses of preoperative neoadjuvant chemotherapy and five received two to four courses of postoperative chemotherapy. Eighty-three patients were followed up postoperatively (median follow-up duration, 36.2 months).ResultsWith regard to tumor outcomes, one (1.2%) patient showed recurrence following fertility-sparing surgery. In 69 patients with planned pregnancy after treatment, 54 had 58 pregnancies, including 42 full-term births and eight premature births. Seventy-nine patients were satisfied with their quality of life.ConclusionsRadical/subradical trachelectomy is safe and effective as fertility-sparing surgery for young patients with early cervical cancer, with good pregnancy outcomes.

Role of Beta HCG and AFP in Prediction of Hypertensive Disorder in Pregnancy in Second Trimester- A Hospital Based Prospective Study

Background: Pre-eclampsia is an important cause of maternal and neonatal complication and death. If hypertension in pregnancy is diagnosed at an early age, we can provide an efficient care to mother for good outcome of pregnancy. The aim of this study to evaluated the role of B-HCG and AFP as predictors of HDP. Methods: This prospective Investigation study was conducted on 100 pregnant women attending the antenatal clinic in Department of Obstetrics and Gynaecology, Jaipur. Estimation of serum β-HCG and AFP was done by ELISA technique. Then there finding were correlated with the value of serum β-HCG and AFP in second trimester to see whether there is any relation between levels of serum β- HCG and AFP in second trimester and development of HDP. Results: ‘Out of 100 women, 5 i.e. 5% were <20 years of age, maximum i.e. 62 (62%) were in 21-25 years of age group, 25 (25%) were in 26-30 years of age group and 8 (8%) were in 31-35 years age of group. Significantly higher mean S. β-HCG (mIU/ml) was observed in HDP group i.e. 13450.5±3420.8 as compared to 7732±2024 in normotensive group and a test of full model was statistically significant indicating that the predictors reliably distinguish between HDP group and normotensive group (Chi square 55.328, df 4, p<.001). Conclusion: We conclude from this study the measurement of serum β-HCG and AFP should be routinely done in second trimester of pregnancy, to predict the occurrence of HDP for better fetomaternal outcome.

Identification and evaluation of the microbiome in the female and male reproductive tracts.

The existence of an extensive microbiome in and on the human body has increasingly dominated the scientific literature during the last decade. A shift from culture-dependent to culture-independent identification of microbes has occurred since the emergence of next-generation sequencing (NGS) techniques, whole genome shotgun and metagenomic sequencing. These sequencing analyses have revealed the presence of a rich diversity of microbes in most exposed surfaces of the human body, such as throughout the reproductive tract. The results of microbiota analyses are influenced by the technical specifications of the applied methods of analyses. Therefore, it is difficult to correctly compare and interpret the results of different studies of the same anatomical niche. The aim of this narrative review is to provide an overview of the currently used techniques and the reported microbiota compositions in the different anatomical parts of the female and male reproductive tracts since the introduction of NGS in 2005. This is crucial to understand and determine the interactions and roles of the different microbes necessary for successful reproduction. A search in Embase, Medline Ovid, Web of science, Cochrane and Google scholar was conducted. The search was limited to English language and studies published between January 2005 and April 2018. Included articles needed to be original microbiome research related to the reproductive tracts. The review provides an extensive up-to-date overview of current microbiome research in the field of human reproductive medicine. The possibility of drawing general conclusions is limited due to diversity in the execution of analytical steps in microbiome research, such as local protocols, sampling methods, primers used, sequencing techniques and bioinformatic pipelines, making it difficult to compare and interpret results of the available studies. Although some microbiota are associated with reproductive success and a good pregnancy outcome, it is still unknown whether a causal link exists. More research is needed to further explore the possible clinical implications and therapeutic interventions. For the field of reproductive medicine, determination of what is a favourable reproductive tract microbiome will provide insight into the mechanisms of both unsuccessful and successful human reproduction. To increase pregnancy chances with live birth and to reduce reproduction-related health costs, future research could focus on postponing treatment or conception in case of the presence of unfavourable microbiota and on the development of therapeutic interventions, such as microbial therapeutics and lifestyle adaptations.

Lois Jovanovič, MD, MACE: Pioneer in the Field of Diabetes and Pregnancy and Beyond.

Lois Jovanovic is a name that has become synonymous with good pregnancy outcomes for women with type 1 diabetes. Having type 1 diabetes herself and experiencing the challenges it poses for the pregnant woman, Dr. Jovanovic devoted her career to helping women with diabetes prepare for pregnancy and experience successful outcomes. She always emphasized the importance of being in excellent metabolic balance before becoming pregnant and always told her patients that they were “not allowed to get pregnant until she gave them permission.” As newer insulin analogs became available, they were only approved for use outside of pregnancy. Dr. Jovanovic pioneered testing these analogs in pregnancy, proving that not only were they safe for pregnant women and their babies but resulted in improved diabetes control throughout the pregnancy. Dr. Jovanovic developed an algorithm for insulin use that she taught her patients so they could more easily manage their diabetes during the stress of pregnancy (1). She was very proud of how successful the outcome could be when a pregnancy was meticulously managed and for years kept a picture of each newborn whose mother she had worked with through the pregnancy. Dr. Jovanovic was passionate about her patients—more than one was overheard saying “Dr. Lois is the first diabetes doctor who really understood what I’m going through.” Others swore they are only mothers because of Dr. Lois; she was their devoted “cheerleader” (her term) as she kept in close touch with her moms throughout their pregnancies, including through daily faxed glucose diaries and phone calls. Dr. Jovanovic authored or coauthored numerous texts and monographs to help women and their physicians better understand the diabetic pregnancy. These included Diabetes & Pregnancy: What to Expect (2) and Gestational Diabetes: What to Expect (3), which the American Diabetes Association relied on for years along …

Effect of preconceptional DHEA treatment on in vitro fertilization outcome in poor ovarian respond women: study protocol for a randomized controlled trial

BackgroundWomen undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with poor ovarian respond (POR) always have very low clinical pregnancy rates. In previous data, dehydroepiandrosterone (DHEA) was suggested as a promising treatment and maybe has a good pregnancy outcome. But there is no sufficient evidence from randomized clinical trials evaluating the effect of DHEA preconceptional treatment on live birth in POR.MethodsThis trial is a multicenter active-placebo double-blind clinical trial (1:1 treatment ratio of active versus placebo). The infertile POR patients undergoing IVF or ICSI will be enrolled and randomly assigned to two parallel groups. Participants in these two groups will be given 4–12 weeks’ treatment of DHEA or placebo, respectively. The primary outcome is live birth rate.DiscussionThe results of this study will provide evidence for the effect of preconceptional DHEA treatment on IVF outcome in POR.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-15006909. Registered on November 9, 2015.

Pregnant mothers have limited knowledge and poor dietary diversity practices, but favorable attitude towards nutritional recommendations in rural Ethiopia: evidence from community-based study

BackgroundMothers’ nutrition is crucial for good pregnancy outcomes and in improving children’s nutritional status. The present study aimed to examine the level of knowledge and attitude towards maternal nutrition and dietary diversity practices among pregnant mothers in rural central Ethiopia.MethodsIn-depth analysis of data from a prospective study involving a total of 389 eligible pregnant women, enrolled during their second antenatal care (ANC) visit was conducted between August 2014 and March 2015. Study participants were selected by employing systematic sampling techniques. Dietary diversity practices were assessed by asking each individual pregnant woman to provide a single 24-h dietary recall. Simple frequencies and graphs were used to present the analyzed data and interpretations.ResultsVegetables were listed top as major sources of vitamin A (45.5%) and iron (23.8%). Nearly half (47%) of the mothers lacked awareness on balanced and diversified diets. Conversely, nearly three fourths (73.8%) and two thirds (66.8%) of them had favorable attitudes towards dietary diversity and early initiation of antenatal care follow up. With a median dietary diversity score of four, starchy staples (100%), legumes and nuts (89.2%) were major food groups consumed by almost all of the mothers included in the study.ConclusionThough pregnant mothers had limited knowledge and poor dietary diversity practices, they exhibited a relatively favorable attitude towards major nutritional recommendations. Use of antenatal care and its follow up as a point of entry for educating pregnant women and increasing nutrition knowledge and attitude is recommended.

Committee for Academic Affairs JSSHP Research Award 2018 Clinical Research Introducing tight systolic blood pressure control before 16 weeks’ gestation is associated with good pregnancy outcomes in patients with chronic hypertension

Committee for Academic Affairs JSSHP Research Award 2018 Clinical Research Introducing tight systolic blood pressure control before 16 weeks’ gestation is associated with good pregnancy outcomes in patients with chronic hypertension

Should Women with Sickle Cell Disease be Administered Prophylactic Transfusions to Avoid Complications during Pregnancy?

BACKGROUNDIncreasing numbers of women with sickle cell disease (SCD) are reaching reproductive age. There is an array of possible pregnancy outcomes that women with SCD may experience. Many have described adverse maternal and fetal outcomes in pregnant patients with SCD including increased risk of pre-eclampsia, infections, painful vaso-occlusive crises as well as increased risk of intrauterine growth restriction, pre-term delivery and pregnancy loss. Not all women with SCD have complicated pregnancies, however. Limited data are available to categorize the proportion of patients who have uncomplicated pregnancies and protective characteristics for good pregnancy outcomes. Identifying these features potentially informs practice and reduces exposure to blood products as red blood cell (RBC) transfusion is associated with an increased risk of alloimmunization, particularly in pregnancy. OBJECTIVETo determine the proportion and characteristics of pregnant patients with SCD who have uncomplicated pregnancies. METHODSWe retrospectively reviewed medical records of pregnant women with SCD from 1980 to 2018 at Mount Sinai Hospital, a university affiliated tertiary care centre in Toronto, Canada. We defined a pregnancy to be uncomplicated if the pregnancy was not associated with a hospitalization, RBC transfusion was not administered peripartum and/or the delivery was at term (37 or more weeks gestation). RESULTSA total of 179 pregnancies were included (Figure 1). Preliminary results show that 57% of pregnancies had hemoglobin SS disease. The median maternal age was 27 years (range 16-43 years) (n=179). Median hemoglobin concentration, platelet count and leukocyte count were 91g/L (n=141), 304 x 10(9)/L (n=140) and 11 x 10(9)/L (n=140), respectively. Hospital admission was required in 61% of pregnancies (n=171) and RBC transfusion in 49% of pregnancies (n=173). The median hemoglobin F level was 0.05 (range 0.01-0.87). Nineteen percent had coexisting alpha gene deletion (s). The median birth weight was 2863 grams (n=155). Analysis is ongoing to determine characteristics associated with the pre-defined pregnancy outcomes. CONCLUSIONSWomen with SCD frequently have adverse maternal and fetal outcomes with pregnancy. However, 39% of pregnancies with SCD in this study did not require hospitalization and 51% did not require RBC transfusion. Additional analysis will attempt to identify protective features so as not to expose all patients to RBC transfusion unless it is required. These initial results suggest that risk scores should be developed for pregnant patients with sickle cell disease to identify who may benefit from RBC transfusion. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Patients with multiple morphological abnormalities of the sperm flagella harbouring CFAP44 or CFAP43 mutations have a good pregnancy outcome following intracytoplasmic sperm injection.

Multiple morphological abnormalities of the sperm flagella (MMAF) are a rare type of male infertility. Mutations in DNAH1, CFAP43 and CFAP44 are the main aetiology of the disorder. Previously, good intracytoplasmic sperm injection (ICSI) outcomes were reported for MMAF patients with DNAH1 mutations. However, the ICSI prognosis for MMAF patients with CFAP43 or CFAP44 mutations was not known. We designed a retrospective cohort study. Molecular genetic testing identified six MMAF patients with biallelic CFAP44 (CFAP44+ group) or CFAP43 mutations and 12 patients with homozygous or compound heterozygous DNAH1 mutations (DNAH1+ group). A control group consisted of age-matched, non-MMAF men. For MMAF patients carrying CFAP44 mutations, the recorded rates of fertilisation, transferable embryos, pregnancy and delivery after ICSI were 76.47%, 88.46%, 50.0% and 50.0% respectively. The fertilisation rate was significantly higher in the CFAP44+ group than in the DNAH1+ group (76.47% vs. 54.5%, p=0.0196). There were no statistically significant differences in the rates of transferable embryos, implantation, clinical pregnancy and miscarriage between the CFAP44+ group and either the DNAH1+ group or the age-matched control group. Our results support a good ICSI prognosis for MMAF patients carrying CFAP44 or CFAP43 mutations.

Pregnancy outcome of autosomal aneuploidies other than common trisomies detected by noninvasive prenatal testing in routine clinical practice.

The objective of the study is to report the incidence and pregnancy outcome of autosomal aneuploidies other than common trisomies 21, 18, and 13 detected by noninvasive prenatal testing (NIPT) at a single center. Pregnant women undergoing NIPT from February 2015 to January 2018 in our center were offered expanded screening to include rare autosomal aneuploidies. Aneuploidies included extra copy chromosomes (most likely trisomies) and decreased copy chromosomes (most likely monosomies). The pregnancy outcomes of women consenting to the expanded NIPT screen were recorded. Expanded NIPT was performed in 15362 pregnancies. A total of 59 autosomal aneuploidies other than the 3 common trisomies were detected, with a positive screening rate of 0.38% (59/15362). The screen positive rate was higher in women aged above 35years than in those younger (0.44% vs 0.32%, P<.05). Of the screen positive results, 30.5% (18/59) were because of extra copies for chromosomes trisomy 7, 10.2% (6/59) for chromosome 22, and 8.5% (5/59) for chromosomes 8 and 16 respectively, while other choromosomes were less frequently involved. Decreased copy chromosomes were less common: 6.8% (4/59) for chromosomes 14 and 13. Mixed aneuploidies with increased copies for some chromosomes and decreased copies for others were also noted. Invasive prenatal diagnosis was performed in 61% (36/59) of the cases. Invasive test results and clinical follow-ups demonstrated that most (94.9%, 56/59) of the rare aneuploidies were false positives, probably resulting from confined placental mosaicism. Only 1 case (1.7%, 1/59) with NIPT report of extra copies of chromosome 7 and without ultrasound evidence of fetal abnormality was confirmed to be fetal mosaicism by microarray test. Uniparental disomy of whole chromosome 2 was identified by microarray analysis in 1 case with extra copy chromosome 2 detected by NIPT. Loss of heterozygocity of chromosome 7q11.23-q21.11 was detected in another case with extra copy chromosome 7. Fortunately, pregnancy outcomes of both cases were normal. Two fetal deaths attributed to severe fetal growth restriction were associated with extra copies of chromosome 16 at expanded NIPT. Autosomal aneuploidies other than trisomies 21, 18, and 13 are not uncommon in routine clinical NIPT practice. Extra copies of chromosomes in rare cases can be associated with uniparental disomy. Most rare aneuploidies at NIPT have good pregnancy outcomes. Thus, invasive testing should be used with caution for these aneuploidies in routine clinical practice.

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania

BackgroundCaesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management.MethodsAudit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored.ResultsDuring the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min).ConclusionsAlthough this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.

Giant Ovarian Mucinous Cystadenoma Complicating Term Pregnancy

Huge ovarian cyst are found in less than 1% of all ovarian cyst in pregnancy and are associated with poor feto-maternal outcome. A 28 years old G2P1 with history of normal vaginal delivery 3 years back was referred from local health post with complains of intermittent pain abdomen at 29 weeks. Her scan showed huge ovarian cyst of 18.9×17.6 cm with multiple thick septation. Woman was conservatively managed till term and elective surgery was planned however she presented in labour with breech presentation at 39 weeks and 4days. Emergency lower segment caesarian section along with left sided salpingo-oophorectomy was done along with delivery of 2.5 kg healthy female baby. Histopathology was suggestive of mucinous cystadenoma of ovary. Although antepartum removal of ovarian cyst has been recommended to ensure good pregnancy outcome, expectant management and timed intervention can be adopted for pregnancy with huge ovarian cysts. Keywords: mucinous cystadenoma; ovarian cyst; pregnancy.

Effectiveness of high-dose transvaginal progesterone supplementation for women who are undergoing a frozen-thawed embryo transfer.

PurposeTo evaluate the effectiveness of high‐dose progesterone supplementation for women who are undergoing a frozen‐thawed embryo transfer (FET).MethodsAmong the 2010 FET cycles that were included in the present study, 1188 were 1200 mg/d of vaginal progesterone, while 822 were 900 mg/d. The dose of progesterone that was used was decided by the treatment period and additional progesterone supplementation was used when the serum progesterone levels were <9 ng/mL on luteal day 5.ResultsThe clinical pregnancy rate was higher in the 1200 mg group than in the 900 mg group. The mean serum progesterone level on luteal day 5 in the 1200 mg and 900 mg groups was 12.6 ng/mL and 13.4 ng/mL, respectively. The rate of additional progesterone supplementation was higher in the 1200 mg group. A logistic regression analysis identified a younger age (≤37 years) and the use of 1200 mg progesterone as independent predictive factors for the clinical pregnancy outcome. The analysis of the infant outcomes revealed no significant difference in the distribution of birth ages and weights.ConclusionHigh‐dose transvaginal progesterone of 1200 mg/d as luteal support contributed to good pregnancy outcomes.

Allantoic cyst of the umbilical cord detected in the first trimester with good pregnancy outcome

Abstract Allantoic cysts of the umbilical cord are embryological remnants of either the allantois or the omphalomesenteric duct. These cysts represent a rare ultrasound finding especially in the first trimester. Allantoic cysts can be associated with fetal malformations and chromosomal aberrations or are characterised by spontaneous resolution and good pregnancy outcome. Here we present a rare case of umbilical cord cyst detected by ultrasound in the first trimester with later resolution and favourable pregnancy outcome.

Eating practices during pregnancy: perceptions of select Maasai women in Northern Tanzania

BackgroundGlobally, pregnant women are challenged to meet sufficient and necessary dietary intake in order to improve maternal and neonatal outcomes. These challenges are amplified in traditional communities, such as the Maasai, where the historical and cultural practices may further curtail, or impact on this dyad’s potential success. The research is intended to enhance understanding of Maasai women’s pregnancy and nutrition traditions as well as their beliefs.Method Interviews with 12 pregnant Maasai women, all originally from the (Ngorongoro Conservation Area Authority NCAA) area and have spent most or all of their adult lives in the NCAA, sought to answer two research questions: how do these women describe their current dietary pattern and what do they believe is the role of nutrition during pregnancy.ResultsInterpretive description methodology was used to reveal five themes: (1) Eating less food makes baby come easier, (2) Not producing food means more dependence, (3) Working hard harms my baby, (4) Knowing what is needed for a good pregnancy and (5) Preferring our traditional ways for pregnancy and birth.ConclusionsThere is an imperative to address nutrition throughout the perinatal period within the Maasai population and the women recognize how important nutrition is for them and their babies. Opportunities to incorporate cultural values and practices must be embedded in programmes/services to achieve success and sustainability. It is important for future prenatal programming with the Maasai in northern Tanzania and other vulnerable groups of pregnant women to build on the women’s knowledge of what leads to good pregnancy outcomes.