High-risk Obstetric Population Research Articles

Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Hospital in Peshawar

OBJECTIVES To examine demographic characteristics, diagnosis on admission, and clinical outcomes in terms of morbidity and mortality of all those obstetric patients who were shifted to the Intensive care unit. METHODOLOGY This retrospective study was conducted in Gynae Unit A, Medical and Surgical intensive care units of Khyber Teaching Hospital Peshawar from 1st January 2021 to 31st December 2022. All the obstetric patients admitted to medical or surgical intensive care units were included, i.e., pregnant women or women admitted within six weeks after delivery to medical or surgical ICUs. Data about the patient’s demographics, obstetric/medical history, diagnosis on admission, reason for shifting to Intensive care units, course and treatment, ICU course, length of stay, outcome, and maternal mortality were obtained.RESULTSThe ICU admission rate of obstetric patients in the study period was 0.7%. The age group of 26-30 years was most commonly seen in our study, where 35(40%) of our cases fell, followed by the 21-25 age group (19.5%).27(31%) of our patients were primigravidas and 60(69%) were multigravidas.21(24%) were antenatal,65(75%) were postnatal and 1(1%) was ectopic. Postpartum hemorrhage was the most common indication(24%) for which patients were referred to the intensive care unit, followed by Eclampsia in 15(17%) and placenta accreta in 13(15%). Causes of mortality for the ICU admissions were shock and ARDS in 1(7%) each, DIC in 5(33%), and Cardiac arrest in 8(53%) cases. Fifteen patients expired in the intensive care unit during the study period, making the mortality rate 17%. CONCLUSION Strengthening critical care is important for saving the high-risk obstetric population. A structured ICU with an interdisciplinary approach is necessary to reduce high-risk obstetric mortality.

283 A Prenatal lead screening and intervention program in a high risk obstetrical population

283 A Prenatal lead screening and intervention program in a high risk obstetrical population

Maternal cardiac disease and perinatal outcomes in a single tertiary care center

Objective Maternal mortality in the U.S. has increased, with a substantial contribution from maternal cardiac disease. As a result of improved childhood survival, more women with congenital heart disease are reaching reproductive age leading to a growing high-risk obstetric population. We sought to determine the obstetrical and neonatal outcomes of women with maternal cardiac disease, including acquired cardiovascular disease and congenital heart disease. Methods We studied a retrospective cohort study of women that delivered from 2008 to 2013 (N = 9026). Singleton pregnancies without preexisting conditions were established as the unexposed group for this study. Maternal and neonatal outcomes were compared between the unexposed group (N = 7277) and women exposed to maternal (acquired or congenital) cardiac disease (N = 139) as well as only congenital heart disease (N = 85). Statistical comparisons used univariate/multivariable logistic and linear regression analysis controlling for confounders with p < .05 and 95% confidence intervals indicating statistical significance. Results Pregnancies complicated by maternal cardiac disease were associated with increased odds of preterm birth (<34 weeks, <37 weeks), intrauterine growth restriction (IUGR), need for assisted vaginal delivery, maternal ICU admission, and prolonged maternal hospitalization (>7 d). Neonatal outcomes including small for gestational age and Apgar score <7 at 5 min were increased in the pregnancies complicated by maternal cardiac disease. When pregnancies complicated by congenital heart disease were analyzed as a sub-group of the cohort, the results were similar. There were increased odds of preterm birth (<37 weeks), early-term delivery, need for assisted vaginal delivery, and prolonged hospitalization. Neonatal outcomes were only significant for small for gestational age. Conclusion We observed that in a select cohort of pregnancies complicated by maternal cardiac diseases (acquired or congenital), there were significant increases of adverse perinatal outcomes. Therefore, a multidisciplinary approach including maternal-fetal medicine specialists, cardiologists, obstetric anesthesia, and dedicated ancillary support is imperative for optimal care of this high-risk obstetrics population.

Prevalence and Associated Factors of Postpartum Modern Contraceptive Uptake among Mothers Delivered at Mekelle Public Hospitals, Northern Ethiopia

Background Postpartum family planning has the potential to reduce maternal and child morbidity and mortality. A short birth interval of less than two years is associated with adverse health effects for the mother and baby and the society as a whole. Postpartum contraceptive uptake is one of the lowest in Ethiopia. Objectives The aim of this study was to determine the magnitude and associated factors of postpartum family planning acceptance in Mekelle public hospitals from 1 April to 31 July 2022. Methodology The cross-sectional study design was employed. Data were collected prospectively using an interviewer-administrated structured questionnaire. In both hospitals (i.e. Mekelle General Hospital and Ayder Comprehensive Specialised Hospital), 399 mothers were interviewed in their immediate postpartum period. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22. In addition to descriptive statistics, Pearson’s chi-square test was used for bivariate analysis of sociodemographic and reproductive health factors and postpartum family planning. Multiple logistic regression was used to explore factors associated with postpartum contraceptive use. Results The prevalence rate of family planning uptake in the immediate postpartum period was 17.8% (n=71). More than a third (n=152, 38.1%) of mothers in this study did not receive appropriate family planning. Slightly more than half (52.8%) intend to use contraceptives at 6 weeks postpartum. Compared to those who did not counseled, those who were counseled were ten times more likely to receive postpartum family planning (AOR=10.1, 95% CI: (3.911-26.375). Women who gave birth by cesarean delivery used family planning twice more than those who gave vaginally (AOR = 1.954, 95% CI: (1.072-2773). Conclusion Despite the high-risk obstetric population in teaching hospitals, a small proportion of women used family planning. Furthermore, many women did not receive appropriate counseling on postpartum family planning. Counseling was the most significant factor influencing postpartum modern contraception uptake. Because referral and teaching hospitals host a large number of high-risk mothers, immediate postpartum family planning uptake should be considered a very important element of care. Previous studies have reported that most women who planned to come for contraceptive uptake 6 weeks postpartum do not actually come. Therefore, timely (ie, periconceptional and antepartum) and appropriate counseling should be advocated to increase the immediate adoption of postpartum family planning. Key words: Postpartum family planning, counseling, contraception,

Maternal congenital heart disease and effects on neonatal outcomes: the other side of the dyad

As a result of improved childhood survival, more patients with congenital heart disease (CHD) are reaching reproductive age, leading to a growing high risk obstetric population. Though much knowledge has been gained in this cohort, less is known about their offspring compared to other cardiac populations. In this study, we sought to determine the fetal and neonatal outcomes from pregnancies complicated with maternal CHD in comparison to acquired heart disease.

Observational cohort study of perinatal outcomes of women with COVID-19

BackgroundUnderstanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia. MethodsWe performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated. ResultsWe enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery. ConclusionsWe did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.

Bringing postpartum care to the NICU-An opportunity to improve health in a high-risk obstetric population.

Bringing postpartum care to the NICU-An opportunity to improve health in a high-risk obstetric population.

Viscoelastic Testing in an Obstetric Population at High Risk of Hemorrhage.

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test used in trauma for goal-directed transfusion. However, there are limited data on baseline ROTEM parameters in the U.S. obstetric population. Obtaining baseline parameters is a first step in implementing a goal-directed massive transfusion protocol in obstetric hemorrhage. Our study aimed to establish pre- and postdelivery baseline parameters in a high-risk obstetric population and determine their association with postpartum hemorrhage (PPH). Prospective observational study of patients ≥34 weeks' gestation, at high risk of PPH, admitted for delivery. INTEM, EXTEM, FIBTEM, and APTEM assays were performed at the time of admission to labor and delivery and then 2 hours after delivery. Primary outcome was pre- and postdelivery ROTEM parameters among women without PPH. A sample size of 60 women was needed for >90% power to detect at least 50% correlation between pre- and postdelivery assuming a loss of 10% of participants to follow-up. Of 60 women in the study, 10 (17%) had PPH. Baseline characteristics were not different between those with or without PPH. Pre- and postdelivery ROTEM parameters were not significantly different except for APTEM. None of the patients who had PPH, compared with 4 (10%) of those who did not, had shortened clotting time and higher maximum clot firmness in postdelivery APTEM compared with EXTEM, a pattern suggestive of hyperfibrinolysis (p = 0.4). In this study, we describe baseline ROTEM parameters in women at high risk of PPH. The majority of patients did not have a ROTEM pattern that is suggestive of hyperfibrinolysis, for which tranexamic acid is thought to be beneficial. Based on our findings, previously established obstetric transfusion thresholds for goal-directed massive transfusion protocols are likely valid for the majority of the obstetric population regardless of the presence of comorbidities or pregnancy complications. · ROTEM parameters do not vary significantly before and after delivery.. · Most patients did not have a hyperfibrinolysis pattern, for which tranexamic acid is thought to be beneficial.. · Previous goal-directed obstetric transfusion thresholds are likely valid in most populations..

1332Endometriosis, assisted reproductive technology and adverse pregnancy outcomes: a population based data linkage study

Abstract Background Endometriosis is a chronic inflammatory disease characterised by endometrial tissue outside the uterus – pain and infertility are common symptoms. There is a paucity of data on the association between endometriosis and adverse pregnancy outcomes where the contribution of assisted reproductive technology (ART) use is also considered. This study will examine the association between endometriosis, with and without ART use, on adverse pregnancy outcomes. Methods Population data linkage study of all female NSW residents aged 15-45 years with a singleton birth in 2006-2015. Pregnancies were classified into 4 groups based on endometriosis diagnosis (yes/no) and ART use (yes/no). Multinomial logistic regression was used to estimate the odds of adverse pregnancy outcomes with 99% confidence intervals, adjusting for maternal and pregnancy factors. Outcomes assessed included placenta praevia, antepartum haemorrhage, planned birth (induction of labour or caesarean section) and preterm birth. Results Of 889,101 eligible pregnancies, women with endometriosis were more likely to be older while women who used ART were more likely to be nulliparous, birth in a private hospital and less likely to smoke. Adjusted odds ratios for selected study outcomes are outlined below. Conclusions Endometriosis is associated with increased odds of preterm birth, placenta praevia, antepartum haemorrhage and planned birth. In general, the odds of adverse pregnancy outcomes associated with endometriosis were further increased with ART use. Key messages These findings suggest that women with endometriosis, especially those who achieved pregnancy via ART use, represent a high risk obstetric population requiring appropriate surveillance and management.

707 Hepatitis C screening in a high risk obstetric population

The Society of Maternal-Fetal Medicine recommends screening for risk factors for Hepatitis C (HCV) in pregnancy. HCV testing is indicated for patients with identifiable risk factors. The objective of our study was to evaluate the adequacy of this testing methodology in a high risk patient population. This was a retrospective cohort study of 739 patients delivered at a tertiary care center from 2018-2019. The rate of HCV screening was determined by medical chart review for risk factors at initial prenatal visit: history of injected/intranasal drug use, long-term hemodialysis, percutaneous/parenteral exposures in an unregulated setting, blood transfusion/organ transplantation prior to 1992, incarceration, or sexually transmitted disease (STD). Patient charts were also evaluated for clinical risk factors: STD in pregnancy, elevated ALT level, and unexplained chronic liver disease. Analysis was performed to determine if those with identified risk factors were appropriately tested for HCV. All patients in the study were screened for at least one HCV risk factor, though none were fully screened for all of the above risk factors. The most frequently screened risk factors were: history of STD (n=726, 98.2%) and history of injected/intranasal drug use (n=715, 96.8%). The least frequently screened were: history of percutaneous/parenteral exposures (n=1, 0.1%) and history of incarceration (n=4, 0.5%). Overall, 327 (44.2%) of patients screened positive for risk factors, however only 9 (1.2%) were subsequently tested for HCV. Our study demonstrates that an insufficient number of pregnant women with identified risk factors were appropriately tested for HCV disease. More research is needed to determine if universal HCV screening during pregnancy should be considered.

The Role of Aspirin for Preeclampsia Prevention in Women with Diabetes.

A diagnosis of type I or type 2 diabetes confers heightened risk for virtually every obstetric and perinatal complication, with the incidence of superimposed preeclampsia representing a particularly high-risk scenario. Over the past three decades, studies have investigated the role of aspirin in preeclampsia prevention, yielding some promising results for certain at-risk groups, yet unconvincing evidence of benefit among women with pre-pregnancy diabetes. The purpose of this review is to present the current evidence base for aspirin use in pregnancy as a means of mitigating preeclampsia risk in the setting of pregestational type I or type 2 diabetes. Meta-analysis data examining low-dose aspirin for preeclampsia prevention in at-risk and low-risk women has demonstrated modest benefit, but subanalyses of cohorts with diabetes have failed to demonstrate a beneficial effect. Evidence is emerging that indicates a benefit only among women who initiate aspirin therapy prior to 16weeks' gestation, and uncertainty exists surrounding the effective dose. In light of equipoise surrounding the potential role of aspirin for prevention of preeclampsia in women with diabetes, current research is targeted at determining clinical efficacy of aspirin in this high-risk obstetric population.

Angiogenic factors sFlt-1 and PlGF in preeclampsia: Prediction of risk and prognosis in a high-risk obstetric population

ObjectivesDespite its simple definition, preeclampsia can have variable and atypical clinical presentations, an unpredictable course, and potential adverse maternal and fetal outcomes. No single test currently predicts risk or prognosis adequately. Scientific advances suggest that an angiogenic imbalance is involved in its pathophysiology. The objective of this study was to investigate the use of sFlt-1, PlGF, and their ratio in predicting preeclampsia. Materials and methodsIn a single-center prospective observational study, we measured the angiogenic markers sFlt-1 and PlGF and calculated the sFlt-1/PlGF ratio in patients at risk of preeclampsia at 20 to 37 weeks of gestation. The main outcomes were the occurrence of preeclampsia and the interval before its onset. ResultsOf the 67 at risk patients included, 8 (12%) developed preeclampsia. For a sFlt-1/PlGF ratio ≥85, the specificity was 93%. The ratio was significantly higher (ratio=104±30) in women with an onset time less than 5 weeks than in those with later preeclampsia (ratio=10±2), P<0.001. ConclusionIn a high-risk population, angiogenic markers appear to be an interesting aid in predicting the onset of preeclampsia with high specificity and in estimating time to onset. However, due to small number of cases of PE, more studies are needed before recommendations to use these markers in daily practice.

A Mobile Application for Monitoring and Management of Depressed Mood in a Vulnerable Pregnant Population.

This study tested whether a mood tracking and alert (MTA) mobile application (app) improved mental health care delivery in a high-risk obstetric population. Pregnant women with depressive symptomatology at <32 weeks gestation were followed for eight weeks after randomization to a control patient portal (PP) app alone or with the MTA app. The MTA app monitored activity, assessed mood, and alerted obstetric providers of signs of worsening mood. Seventy-two women enrolled (PP, N=24; MTA, N=48). MTA users had significantly more contacts addressing mental health, and as gestational age increased, they rated ability to manage their own health significantly better than women in the control group. Women who received telephone contact from a provider triggered by an MTA app alert were significantly more likely to receive a mental health specialist referral. A mobile MTA app improved service delivery and patient engagement among patients with perinatal depression symptoms.

Retrospective Cohort Study of Cervical Pessary Use in Women with Short Cervix at Risk of Preterm Delivery

ObjectiveA paucity of effective interventions exists for the prevention of preterm birth (PTB). Renewed interest has focused on cervical pessaries, which have the benefits of being inexpensive, nonsurgical, and easily inserted and removed. In this study, we aim to describe our experience with this device in a Canadian tertiary care centre. Primary outcomes were rates of spontaneous or iatrogenic PTB before 37, 34, and 28 weeks gestation in pregnancies complicated by short cervix treated with cervical pessary. MethodsThis was a retrospective cohort study of women with singleton, twin, and triplet pregnancies with pessary placement from August 2013 to March 2015 in the Urogynecology Clinic at the Lois Hole Hospital for Women in Edmonton, AB. Included women were deemed to be at high risk of PTB due to short cervix (≤25 mm) found on ultrasound. ResultsAmong 115 women included, pessaries were placed at a mean gestation of 25.3 weeks. Forty-nine singleton women (52.7%) delivered at term. Of these deliveries, 75% were spontaneous. Rates of PTB before 34 and 28 weeks gestation for all deliveries, respectively, were 37.4% and 10.4%. Removal data were available for 87.8% of patients, and the pessary remained in situ for a mean of 48 days. ConclusionIn this study's high-risk obstetrical population, the rates of preterm birth remained high. The effectiveness of pessary use, particularly when compared to other preventative strategies, remains a topic in need of further investigation. To our knowledge, this is the first study to contribute pessary data from a Canadian population.

Timing of delivery in a high-risk obstetric population: a clinical prediction model

BackgroundThe efficacy of antenatal corticosteroid treatment for women with threatened preterm birth depends on timely administration within 7 days before delivery. We modelled the probability of delivery within 7 days of admission to hospital among women presenting with threatened preterm birth, using routinely collected clinical characteristics.MethodsData from the Canadian Perinatal Network (CPN) were used, 2005–11, including women admitted to hospital with preterm labour, preterm pre-labour rupture of membranes, short cervix without contractions, or dilated cervix or prolapsed membranes without contractions at preterm gestation. Women with fetal anomaly, intrauterine fetal demise, twin-to-twin transfusion syndrome, and quadruplets were excluded. Logistic regression was undertaken to create a predictive model that was assessed for its calibration capacity, stratification ability, and classification accuracy (ROC curve).ResultsWe included 3012 women admitted at 24–28 weeks gestation, or readmitted at up to 34 weeks gestation, to 16 tertiary-care CPN hospitals. Of these, 1473 (48.9%) delivered within 7 days of admission. Significant predictors of early delivery included maternal age, parity, gestational age at admission, smoking, preterm labour, prolapsed membranes, preterm pre-labour rupture of membranes, and antepartum haemorrhage. The area under the ROC curve was 0.724 (95% CI 0.706–0.742).ConclusionWe propose a useful tool to improve prediction of delivery within 7 days after admission among women with threatened preterm birth. This information is important for optimal corticosteroid treatment.

Lithium exposure during pregnancy: outcomes for women who attended a specialist antenatal clinic

Introduction: Lithium treatment in pregnancy represents a significant dilemma for women and treating health professionals alike. The complexity of risk-benefit analysis is impacted by limited information.Methods: A cohort study of 33 women with severe mental illness, who were prescribed lithium at any time during the pregnancy, and gave birth between December 2007 and January 2015 at a specialist antenatal clinic in Western Australia. A descriptive comparison for women who continued lithium throughout pregnancy, and those who ceased on discovery of pregnancy was undertaken examining demographic, obstetric, neonatal and psychiatric variables.Results: Women who were prescribed lithium, irrespective of whether they continued or discontinued the medication represented a high risk group obstetrically, with high rates of smoking overall (33%) medical comorbidities (54%) and antenatal complications (88%). Preconception counseling occurred in 33% of the cohort but increased the likelihood of continuing lithium in pregnancy (p = .007). Compared to those who ceased lithium, women who remained on lithium through the pregnancy had increased rates of fetal ultrasound abnormalities such as abdominal circumference >90th % (p = .005). Psychiatric relapses through the antenatal and immediate postpartum period appeared to be due to a combination of factors.Discussion: Pregnant women with severe mood disorders treated with lithium are a vulnerable, high-risk obstetric population who would benefit from preconception counseling, regular antenatal care in a tertiary center, delivery with neonatal pediatric support and experienced psychiatric management.

Factors Influencing Medication Adherence in High Risk Pregnant Patients [6E

INTRODUCTION: Pregnant patients’ non-adherence with prescription medications is a challenging problem. The purpose of this study was to investigate factors influencing medication adherence in our urban high risk obstetric clinic. METHODS: This is a prospective cross-sectional study performed February through June 2016 at the Maternal Fetal Medicine clinic at UIC. Participants were ≥24 weeks, English-speaking adults, and taking ≥1 prescription medication. After obtaining consent, study participants were surveyed by questionnaire. Answers were entered into 3 adherence scoring scales: Morisky 8 medication adherence score (MMAS-8), medication adherence reasons scale (MARS), and rapid estimate of adult literacy. RESULTS: A total of 69 patients completed the questionnaire; 60% had unplanned pregnancies, and 45% had health literacy &lt; 8th grade level. Adherence scores were low in 42%, moderate in 38%, and high in 20% of participants. Pregnant women with low adherence score were significantly more likely to be on higher number of medications (p=0.044) and had trended towards missed prenatal visits (p=0.056). 31.9% had asthma, 52.2% had diabetes, 44.9% had hypertension, 11.6% had thyroid disorders, and 4.3% had seizure disorders. Patients with hypertension had higher non-adherence compared to all other categories (p=0.037), and more commonly used marijuana (p &lt; 0.001). Being employed, having a smartphone, dependents, and partner did not affect adherence scores. Women reporting forgetfulness, carelessness, medication side-effects, stopping medication when symptom free, travel, inconvenience, and difficulty calculating dose had low adherence scores. CONCLUSION: Understanding the reasons for medication non-adherence in an urban high risk obstetric population may allow providers to tailor motivational interviewing to improve individual adherence.

The relationship between maternal body composition in early pregnancy and foetal mid-thigh soft-tissue thickness in the third trimester in a high-risk obstetric population

Maternal obesity is an emerging challenge in contemporary obstetrics. To date there has been no study analysing the relationship between specific maternal body composition measurements and foetal soft-tissue measurements. The aim of this study was to determine whether measurement of maternal body composition at booking predicts foetal soft-tissue trajectories in the third trimester. We analysed the relationship between foetal thigh in the third trimester and both maternal BMI and body composition using the Tanita digital scales in the first trimester. Foetal subcutaneous thigh tissue measurements were obtained at intervals of 28, 32 and 36 weeks of gestation. A total of 160 women were identified. There was a direct correlation between MTST at 36 weeks and BMI (p = .002). There was a positive correlation between MTST at 36 weeks and leg fat mass (p = .13) and leg fat free mass (p = .013). There was a positive correlation between arm fat free mass and MTST at 36 weeks. We showed there is an association between maternal fat distribution and foetal subcutaneous thigh tissue measurements. MTST may be more useful in determining if a child is at risk of macrosomia.Impact statementPrevious studies have suggested that maternal obesity programmes intrauterine foetal adiposity and growth. The aim of this study was to examine the relationship in a high-risk obstetric population between measurements of maternal body composition in early pregnancy and the assessment of foetal adiposity in the third trimester using serial ultrasound measurements of mid-thigh soft-tissue thickness. BMI is only a surrogate measurement of fat and does not measure fat distribution. Our study shows the distribution of both maternal fat and fat-free mass in early pregnancy may be positively associated with foetal soft-tissue measurements in the third trimester. Maternal arthropometric measurements other than BMI may help predict babies at risk of macrosomia and neonatal adiposity.

Applications of and Barriers to Holistic Self-Care in a Low-Income, High-Risk Obstetric Population

ObjectiveWe examined 1) women's perceptions regarding self-care, 2) applications of self-care, and 3) barriers to practicing effective self-care. MethodsFour focus groups were conducted in a low-income, pregnant population. Focus group recruitment and discussions took place at a large medical center in a medically underserved area of central Georgia. Thirty-two adult pregnant women attending a high-risk obstetric clinic were included. Data related to holistic self-care were identified and grouped into one of three categories: women's valuations of self-care, applications of self-care, and barriers to self-care. The results were synthesized and compared to results from a study of postpartum women in which the same analytic framework for examining self-care practice was applied. ResultsAlthough women tended to understand the importance of self-care, they had difficulty practicing all forms of self-care on a regular basis owing to financial constraints, limited family support, health complications due to their high-risk obstetric status, external commitments, and childcare and household responsibilities. Applications of self-care were typically inexpensive and mainly required time rather than money. ConclusionsSocioeconomic status seems to influence the specific applications of and barriers to self-care. Health care providers should be aware of existing low-cost resources in the community that may assist prospective and new mothers in tending to their own emotional and physical needs. Providers should also discuss the importance of self-care with women during the perinatal period. Efforts should be made to educate school administrators regarding the impact of spontaneous requests for money for school activities, supplies, and field trips on the family budget.

Do women with recurrent miscarriage constitute a high-risk obstetric population?

The aim of this study was to examine if women with history of recurrent miscarriage have a higher risk of maternal and foetal complications in future pregnancies. This was a retrospective case control study that analysed data collected prospectively between 2001 and 2007 from 400 women with history of recurrent miscarriage who achieved pregnancies progressing beyond 24 weeks gestation compared to 39,860 deliveries from the general obstetric database within the same time period. Results showed that women with recurrent miscarriage had significantly increased odds of low Apgar scores at one (odds ratios (OR) 1.57, 95% CI 1.20–2.05) and five minutes (OR 2.0, 95% CI 1.23–3.27), small for gestational age (OR 1.96, 95% CI 1.12–3.43), preterm delivery (OR 1.64, 95% CI 1.22–2.19) and antepartum haemorrhage (OR 7.67, 95% CI 4.23–13.91). The risks were increased in the presence of a male foetus but no difference was observed between primary and secondary miscarriage patients. In conclusion, women with recurrent miscarriage have an increased risk of several maternal and foetal complications and therefore may require closer monitoring during the antenatal period particularly when pregnant with a male foetus.