High-risk Pregnancies Research Articles

Research Trends in Postpartum Post-Taumatic Stress Disorder Among High-Risk Pregnancies: A CiteSpace Bibliometric Analysis

Background: High-risk pregnancies are associated with increased complications that can jeopardize maternal and fetal health, leading to adverse outcomes such as intrauterine growth restriction and preterm labor. Postpartum psychiatric challenges, including postpartum depression and post-traumatic stress disorder (PTSD), often emerge due to hormonal shifts and physical trauma during childbirth. Previous research indicates that postpartum PTSD is more prevalent among high-risk pregnancy populations, yet the field lacks centralization. Methods: This study utilized CiteSpace software to analyze 175 relevant publications on postpartum PTSD in high-risk pregnancies retrieved from the Web of Science Core Collection (2004–2024). A systematic literature review, employing a Boolean search strategy, ensured comprehensive data collection. The analysis included citation patterns, keyword co-occurrence, and clustering to identify key trends and emerging research areas. Results: Findings revealed a marked increase in research output, particularly from 2019 onward, with the United States leading in publication volume and centrality. High-frequency keywords included "posttraumatic stress disorder," "postpartum depression," and "risk factors," indicating primary focus areas in this domain. Cluster analysis identified eight thematic areas, with significant attention on factors influencing PP-PTSD, clinical symptoms, and prevention strategies. Keyword emergence maps highlighted evolving interests, particularly the impact of adverse childhood experiences and traumatic childbirth. Conclusion: The study underscores the urgent need for targeted mental health interventions for women with high-risk pregnancies, as these populations are particularly susceptible to postpartum PTSD. Continued research into risk factors and the development of predictive models is essential for improving maternal mental health care, ensuring that interventions are tailored to the specific needs of this vulnerable group. Enhanced understanding of the interplay between maternal health and postpartum outcomes is critical for optimizing care strategies.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions. Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period.According to modifiedCoopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Perinatal outcomes in indian women with Antiphospholipid Antibody Syndrome (APS): Five year experience from a tertiary care centre

BackgroundAntiphospholipid Syndrome (APS) is a systemic autoimmune thrombophilic condition characterized by obstetric manifestations, including pregnancy loss, preeclampsia and fetal growth restriction. Early diagnosis and management are key to improve maternal and neonatal outcomes. ObjectiveThe aim of this study is to assess the perinatal outcomes in APS, the development of various adverse pregnancy outcomes (APO), and their association with specific antibody profiles. Material methodsThis observational study was carried out on booked cases of singleton pregnancy and diagnosed cases of primary APS in our High-Risk Pregnancy (HRP) clinic from January 2018 to December 2022 after approval from institutional ethics committee. Forty-three confirmed cases of primary APS were enrolled and started on low-dose aspirin and low-molecular-weight heparin (LMWH) as per the patient's body weight after confirmation of fetal heart activity radiologically until 36 weeks of gestation as a standard of care. ResultsForty patients (93 %) had obstetric APS, and three patients (7 %) had thrombotic APS. During the course of the current pregnancy, adverse pregnancy outcomes (APO) developed in 12 (30 %) out of 40 cases of obstetric APS and in all 3 patients with thrombotic APS. Preeclampsia was seen in 11 (25.5 %), FGR in 12 (27.9 %), and preterm birth in 7 (16.2 %) cases. Patients with an antibody profile showing the presence of Anti-β2 GP-I positivity and ACL positivity had fewer APOs (20 % and 29 %) in comparison to patients with a LA and triple positive antibody profile (55 % and 50 %). ConclusionTreatment of pregnant women with APS causes significant improvement in the live birth rate. The late pregnancy complications like preeclampsia, FGR, and premature birth, occurring despite treatment still remains a challenge and emphasizes the need for stringent antepartum surveillance and timely delivery.

“But I’m not a professional” − How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study

ObjectivesTelemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring. MethodsA qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation. ResultsFifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an ‘Empowering yet challenging responsibility’ as well as an ‘Extended patient-clinician partnership.’ There were pros and cons as to the influence of telemonitoring in everyday life; ‘Tele-comfort yet ambivalence’ and that it could be accompanied by annoying practical issues; ‘Accompanying remote issues.’ ConclusionsPerforming obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.

Advances in Thromboprophylaxis for High-Risk Pregnancies: A Comprehensive Review of Current Strategies and Emerging Approaches.

Thrombosis during pregnancy poses a significant clinical challenge due to its potential for severe maternal and fetal complications. The incidence of thromboembolic events in pregnant women is heightened by pregnancy-associated hypercoagulability, venous stasis, and endothelial changes, all of which contribute to an elevated risk. Effective thromboprophylaxis is essential to mitigate these risks and improve outcomes for both mother and child. This review provides a comprehensive evaluation of current thromboprophylaxis strategies, including pharmacologic interventions such as low-molecular-weight heparins (LMWHs) and unfractionated heparin (UFH) and nonpharmacologic measures like compression stockings and lifestyle modifications. Additionally, the review explores emerging approaches, including personalized medicine strategies, novel anticoagulants, and technology-enabled monitoring solutions. By integrating current evidence with emerging trends, this review aims to offer insights into optimizing thromboprophylaxis in high-risk pregnancies, ultimately contributing to improved clinical outcomes and guiding future research directions in this critical area of maternal healthcare.

Early third trimester maternal cardiac morphometry in high-risk pregnancies of placental insufficiency

Early third trimester maternal cardiac morphometry in high-risk pregnancies of placental insufficiency

Assessment of fertility and sexual dysfunction in women with systemic sclerosis: a narrative review of the literature.

The aim of this work is to review the existing literature regarding sexual and reproductive function of women affected by systemic sclerosis and to establish the impact of the disease on the gynaecological-obstetrical field. A systematic search has been conducted by means of PubMed, Cochrane, Google Scholar, until January 2024 by the keywords ''systemic sclerosis'', ''fertility'', "sexual dysfunction" and "pregnancy". Sexual dysfunction has been described in most of the studies. This could be related to dryness and dyspareunia, but also to the psychosocial impact of SSc on body and facial appearance, which impacts on social and sexual relationships. There is conflicting evidence regarding the influence of SSc and fertility. Before the 1980s pregnancies in these patients were rare. This could be linked to the satisfied reproductive desire before the onset of SSc, or to the fact that pregnancy was labelled as high-risk, leading to counsel against it in most patients. Recently, the evidence supporting infertility is conflicting. There is no certain theory on how the disease may interfere with reproductive function, but a possible linkage can be detected in a pro-inflammatory milieu which can impair the ovarian reserve. Women affected by SSc should be followed-up by a multidisciplinary team to prevent sexual dysfunction. Although there is no consensus on the impact of SSc on fertility, these patients should be provided with adequate pre-conceptional counselling and a strict follow-up in high-risk pregnancy units.

Finding Hope in the Neonatal Intensive Care Unit: Ben's Story.

The following essay is a personal story about a NICU experience in 1991 describing a high-risk pregnancy following uterine rupture. After 18 weeks of home and then in-patient monitoring, the infant was delivered by emergency cesarean section at 30 weeks' gestation. The story is written by a retired nurse, but is a first-hand parent narrative.

Management of a high-risk pregnancy associating autoimmune diseases, chronic hypertension, prediabetes and inherited thrombophilia

Management of a high-risk pregnancy associating autoimmune diseases, chronic hypertension, prediabetes and inherited thrombophilia

Early third trimester maternal cardiac function in high-risk pregnancies of placental disfunction

Early third trimester maternal cardiac function in high-risk pregnancies of placental disfunction

Plasma cell-free DNA as a monitoring tool for high-risk pregnancies associated with antiphospholipid syndrome

IntroductionDespite thromboprophylaxis, women with antiphospholipid syndrome (APS) face high-risk pregnancies due to proinflammatory and prothrombotic states. This highlights the need for new monitoring and prognostic tools. Recent insights into the pathophysiological role of neutrophil activation and extracellular trap (NET) formation in this syndrome led to the exploration of plasma cell-free DNA (cfDNA), a derivative of NETosis, as a promising biomarker. Materials and methodscfDNA was isolated and quantified from plasma samples of healthy pregnant women (control group, HC) and women with APS (APS group). We assessed the physiological variability of cfDNA across the three trimesters in HC. Levels of cfDNA were compared between APS and HC by gestational trimester. ROC curve analysis was performed to evaluate the efficacy of cfDNA levels for classifying APS patients. Furthermore, cfDNA levels in pregnant women with APS with obstetric complications were compared to those from uncomplicated pregnancies. ResultsAmong HC, cfDNA significantly increased in the third trimester compared to the first and second. Elevated cfDNA levels in APS compared to HC were observed in the first and second trimesters. First-trimester cfDNA levels demonstrated the highest classification ability to discriminate between APS and HC patients (AUC: 0.906). Among APS, those with complicated pregnancies (fetal growth restriction, preeclampsia, placenta accreta) exhibited significantly elevated cfDNA levels in the second trimester. ConclusionsElevated levels of cfDNA in pregnant women with APS, particularly among those with obstetric complications, supports further investigation into the potential of cfDNA as a valuable tool in the obstetric management of women with APS.

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

The primary health care environment and the performance of advanced antenatal care trained nurse-midwives in South Africa.

Transfer of learning in the workplace depends on various factors, one of which is the work environment. The aim of this study was to describe the interplay between the primary healthcare work environment, the performance of advanced antenatal care trained nurse-midwives, and birth outcomes. A cross-sectional, quantitative study was conducted in two purposely selected districts in South Africa. Document analyses were also completed. Statistical Analysis Software version 9.4 was used for descriptive statistical data analysis. The participating clinics, in the TM and LJ districts, both achieved ideal clinic status. The scores for the management of low- and high-risk pregnancies ranged between 86-89% and 87%, respectively. Babies born had Apgar scores of between 7-9 and 8-10 in 1 minute and 5 minutes after birth, respectively. Nurse-midwives scored low on interpreting assessment findings. Contrary to the Transfer of Learning Theory, nurse-midwives performed better in poorer work environments. The study suggests that the performance of advanced antenatal care trained nurse-midwives may not solely depend on a well-equipped work environment. Further studies should highlight the broader determinants of advanced antenatal care nurse-midwives services output.

Effectiveness of Poedji Rochjati Score Card (PRSC) for Detecting High Risk in Pregnant Woman at Tegalwaru Community health Center Purwakarta

Pregnancy, childbirth, postpartum, and infant care are natural physiological processes. However, there is a potential for a life-threatening situation to arise during this period, which can pose a risk to both the mother and the baby and, in severe cases, even lead to death. If we can effectively detect them, we can prevent maternal deaths. One tool to detect high-risk pregnant women is the Poedji Rochjati Score Card (PRSC). The aim of this research is to determine the effectiveness of the Poedji Rochjati Score Card (PRSC) for detecting high risk in pregnant women in the Purwakarta Community Health Center area, Purwakarta Regency. The study's research design was a retrospective cohort with secondary data. The Tegalwaru Community Health Center, Tegalwaru District, Purwakarta Regency hosted the research from December 2023 to January 2023. In 2022, all 920 pregnant women were included in this study. This study used total population techniques to sample. There were 617 respondents (67.1%) of low-risk pregnant women, 279 respondents (30.3%) with high-risk pregnancies, and 24 respondents (2.6%) with very high-risk pregnancies. Pregnant women with a score of 2 had 617 respondents (67.1%), 6 had 235 respondents (25.5%), 10 had 44 respondents (4.8%), 14 had 20 respondents (2.2%), and 18 had 4 respondents (0.4%). The Poedji Rochjati Score Card (PRSC) is effective for detecting high-risk pregnant women. Based on the results of the Chi Square test, the p value was <0.001. The Poedji Rochjati Score Card (PRSC) effectively identifies high-risk pregnancies, comprehensive care is still necessary for pregnancies without risk, as the risk of pregnancy can fluctuate throughout pregnancy and delivery.

Association between interpregnancy interval and adverse perinatal outcomes among subsequent twin pregnancies: a nationwide population-based study

BackgroundThe existing evidence on the association between interpregnancy interval (IPI) and pregnancy outcomes primarily focuses on singleton pregnancies, with limited research on twin pregnancies. ObjectiveThis study aimed to investigate the association between IPI and adverse perinatal outcomes in twin pregnancies. Study DesignThis population-based, retrospective cohort study analyzed data from the National Center for Health Statistics in the United States between 2016 and 2020. We included multiparous women aged 18 to 45 years with live-born twins without congenital anomalies, born between 26 and 42 weeks of gestation. Poisson regression models, adjusted for potential confounders, were used to evaluate the associations between IPI and adverse outcomes, including preterm birth (PTB) <36 weeks, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, neonatal composite morbidity, and infant death. Missing data on covariates were managed using multiple imputations. Dose-response analyses were performed using the restricted cubic splines (RCS) approach. Subgroup analyses were stratified by maternal age, parity, and combination of neonatal sex. Sensitivity analyses were conducted using complete data and excluding pregnancies with intervening events during the IPI. ResultsA total of 143,014 twin pregnancies were included in the analysis. Compared to the referent group (IPI of 18–23 months), an IPI of less than 6 months was associated with an increased risk of PTB<36 weeks (RR, 1.21; 95% confidence interval [95% CI]: 1.17–1.25), SGA (RR, 1.11; 95% CI: 1.03–1.18), neonatal composite morbidity (RR, 1.19; 95% CI: 1.12–1.27), NICU admission (RR, 1.18; 95% CI: 1.14–1.22), and infant death (RR, 1.29; 95% CI: 1.05–1.60). An IPI of 5 years or more was associated with an increased risk of PTB<36 weeks (RR, 1.18; 95% CI: 1.15–1.21), SGA (RR, 1.24; 95% CI: 1.18–1.30), neonatal composite morbidity (RR, 1.10; 95% CI: 1.05–1.15), and NICU admission (RR, 1.14; 95% CI: 1.11–1.17). The dose-response analyses showed that these outcomes had U-shaped or J-shaped associations with IPI. The associations between IPI and the outcomes slightly differed by advanced maternal age, parity, and combination of neonatal sex. The sensitivity analyses yielded similar results to the main findings. ConclusionExtreme IPI, less than 6 months or more than 5 years, was associated with adverse outcomes in twin pregnancies. IPI could be used as a predictor for risk stratification in high-risk twin pregnancies.

Retraction Note: Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebo-controlled trial.

Retraction Note: Progesterone effects on preterm birth in high-risk pregnancies: a randomized placebo-controlled trial.

Relationship between serum uric acid, nocturnal hypertension and risk for preeclampsia in high-risk pregnancies.

To analyze the possible association between serum uric acid (SUA) and nocturnal hypertension and to evaluate the ability of these variables (alone or in combination) to predict preeclampsia (PE) we conducted a historical cohort study in 532 high-risk pregnancies. Women were divided according to SUA values and nocturnal blood pressure (BP) into four groups: 1- normal SUA and nocturnal normotension; 2- high SUA and nocturnal normotension; 3- normal SUA and nocturnal hypertension and 4- high SUA and nocturnal hypertension. High SUA was defined by the top quartile values and nocturnal hypertension as BP ≥ 120/70 mmHg, using ambulatory blood pressure monitoring (ABPM), during nocturnal rest. Risks for PE were compared using logistic regression. SUA had a weak but significant correlation with daytime systolic ABPM (r = 0.11, p = 0.014), daytime diastolic ABPM (r = 0.13, p = 0.004), nighttime systolic ABPM (r = 0.16, p < 0.001) and nighttime diastolic ABPM (r = 0.18, p < 0.001). Also, all ABPM values were higher in women with high SUA. The absolute risk of PE increased through groups: 6.5%, 13.1%, 31.2%, and 47.9% for groups 1, 2, 3, and 4, respectively, p < 0.001. Compared with Group 1, Group 3 (OR 6.29 95%CI 3.41-11.60), but not Group 2 (OR 2.15 95%CI 0.88-5.24), had statistically significant higher risk for PE. Group 4 (women with both, high SUA and nocturnal hypertension) had the highest risk (OR 13.11 95%CI 6.69-25.70). Risks remained statistically significant after the adjustment for relevant variables. In conclusion, the combination of SUA > 4 mg/dL and nocturnal BP > 120/70 mmHg implies a very high risk to developed PE.

Pregnant women at high-risk for arterial hypertension: birth care and associated factors

This study aims to analyze the factors associated with high-risk pregnancies due to Arterial Hypertension, as well as childbirth assistance in a highly complex public maternity, linked to the Rede Cegonha. This is an observational, cross-sectional study carried out in a maternity located in Fortaleza, Ceará, Brazil. Of the 300 participants, most have low socioeconomic conditions, living in a situation of vulnerability. There was an association between the variables age and parity, with statistical significance (p = &lt;0.001), between education and first pregnancy (p = 0.002), between the age of the pregnant woman and the choice of motherhood (p = 0.03), as well as with the non-admission to the first maternity hospital that the pregnant woman sought care (p = 0.014). High-risk pregnant women, in a situation of social vulnerability, have access to prenatal care, even in the first trimester, but have difficulty accessing and wandering in search of childbirth assistance.

Safety and efficacy of motor imagery-based physical activity in high-risk pregnancy: A randomized controlled study.

This study aimed to investigate the acute effects of motor imagery-based physical activity on maternal well-being, maternal blood pressure, heart rate, oxygen saturation, fetal heart rate, and uterine contractions in women with high-risk pregnancies. This randomized controlled trial was conducted in Izmir Tepecik Education and Research Hospital from August 2023 to January 2024. Seventy-six women with high-risk pregnancies were randomized into two groups: a motor imagery group (n = 38, diaphragmatic-breathing exercise and motor imagery-based physical activity) and a control group (n = 38, diaphragmatic-breathing exercise). Maternal well-being was determined using the Numerical Rating Scale-11. Digital sphygmomanometry was used to measure maternal heart rate and blood pressure, pulse oximetry for oxygen saturation, and cardiotocography for fetal heart rate and uterine contractions. Assessments were performed pre-intervention, mid-intervention, and post-intervention. There were no significant differences in baseline characteristics between groups (P > 0.05). There was a significant main effect of time in terms of maternal well-being and maternal heart rate (P = 0.001 and P = 0.015). In addition, there was a significant main effect of the group on oxygen saturation (P = 0.025). The overall group-by-time interaction was significant for maternal well-beingm with an effect size of 0.05 (P = 0.041). The combination of diaphragmatic-breathing exercises and a motor imagery-based physical activity program in women with high-risk pregnancies was determined to have no adverse effects on the fetus, did not induce uterine contractions, and resulted in a significant improvement in maternal well-being and oxygen saturation. Thus, imagery-based physical activity can be used in high-risk pregnancies where physical activity and exercise are not recommended.

Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study.

The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction. We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes. We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors. Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system.