High-risk Pregnancies Research Articles

Pregnancy Outcomes in Patients with Prosthetic Heart Valves in Saudi Arabia

Background: Pregnancies in women with heart prostheses are high-risk pregnancies with increased maternal and fetal adverse outcomes. Advances in prosthetic heart valve design and anticoagulation have improved these outcomes over the past decades. Objectives: To study the pregnancy outcomes in pregnancies with heart prostheses and to compare these outcomes between mechanical and biosynthetic heart prostheses in Saudi patients. Methods: In this single centered retrospective study conducted at King Saud Medical City (KSUMC) between January 2011 and February 2020, we have reviewed all pregnant women’s heart prostheses. Fetal and maternal data were obtained, and outcomes were compared between pregnancies with mechanical heart prostheses and bioprostheses. Results: A total of 111 pregnancies were reviewed. A total of 51.4% of pregnancies had bioprostheses, 48.6% had mechanical prostheses, and 64.0% of participants were obese. The majority of the participants had a parity in the range of 2-9 (N=107, 96.4%). The most frequent type of rheumatic heart disease was mitral regurgitation (N=49, 44.1%), followed by mitral stenosis (N=32, 28.8%). There was no maternal mortality and no structural valve failure. There was a high rate of hospital admission in both groups, up to 55% of pregnancies. The rates of abortion, postpartum hemorrhage and transfusions were higher than those in general pregnancies; however, there was no difference in maternal and fetal complications between the two types of prostheses, i.e., bioprostheses and mechanical. Conclusion: Although women with prosthetic heart valves have higher rates of adverse outcomes, they generally tolerate pregnancy well. There was no difference in adverse outcomes between bioprosthetic and mechanical prostheses

A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy.

The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated. A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated. UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases). A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.

Prediction and prevention of preterm birth: Quality assessment and systematic review of clinical practice guidelines using the AGREE II framework.

Prediction of pregnancies at risk of preterm birth (PTB) may allow targeted prevention strategies. To assess quality of clinical practice guidelines (CPGs) and identify areas of agreement and contention in prediction and prevention of spontaneous PTB. We searched for CPGs regarding PTB prediction and prevention in asymptomatic singleton pregnancies without language restriction in January 2024. CPGs included were published between July 2017 and December 2023 and contained statements intended to direct clinical practice. CPG quality was assessed using the AGREE-II tool. Recommendations were extracted and grouped under domains of prediction and prevention, in general populations and high-risk groups. We included 37 CPGs from 20 organizations; all were of moderate or high quality overall. There was consensus in prediction of PTB by identification of risk factors and cervical length screening in high-risk pregnancies and prevention of PTB by universal screening and treatment for asymptomatic bacteriuria, screening and treatment for BV in high-risk pregnancies, and use of preventative progesterone and cerclage. Areas of contention or limited consensus were the role of PTB clinics, universal cervical length measurement, biomarkers and cervical pessaries. This review identified strengths and limitations of current PTB CPGs, and areas for future research.

Awareness of High-risk Pregnancy among Young Adults

A cross sectional study was conducted to find out level of awareness regarding high-risk pregnancy among young adults. The survey was carried out at random locations such as workplaces and colleges where both male and female literate population is most probably found. Using stratified random sampling technique, study subjects were selected (100) and completed the data collecting period over the course of academic year 2023-2024. The required information was collected through self-made questionnaire. The study findings showed that, in general, young individuals either had favourable awareness or were uncertain about many aspects of prenatal care. Majority of the respondent’s percent score were higher than 70% of highest possible mean score in reproductive fitness, chronic illness. Nutrition and weight management. The results also show statistically significant level of knowledge of prenatal risk factors.

The Impact of Epidural Analgesia on Cesarean Section Rates and Neonatal Outcomes: A Retrospective Cohort Study

This retrospective cohort study aimed to assess the frequency of emergency cesarean sections with epidural analgesia and its implications on Apgar scores and Neonatal Intensive Care Unit (NICU) admissions among patients at Tehran University of Medical Sciences Hospitals from 2017 to 2018. Data from 7170 patients were extracted from the hospital information system (HIS) through a consensus method. Descriptive statistics, cross-tabulation, and logistic regression analyses were conducted using Stata v17 software. Out of 9387 patients, 62.7% underwent cesarean sections, and 37.1% had normal vaginal deliveries. Epidural analgesia was administered to 127 patients, with 98.4% achieving successful normal vaginal delivery. Nulliparous women constituted 64.29% of those receiving epidural analgesia. Apgar scores at five and ten minutes were comparable between epidural and non-epidural groups. Emergency cesarean rates with epidural analgesia were low (1.6%). Findings align with previous research indicating no significant impact of epidural analgesia on Apgar scores. Nulliparous women predominated in the epidural group, consistent with pain pattern disparities. The study supports recent research showing epidural analgesia does not increase emergency cesarean rates, even in high-risk pregnancies. This study suggests that epidural analgesia does not significantly impact Apgar scores, NICU admissions, or emergency cesarean rates. While the comprehensive dataset enhances reliability, retrospective design limitations are acknowledged. Prospective studies exploring factors contributing to neonatal mortality and overall labor duration are recommended for more robust evidence.

Ultrasound Imaging based recognition of prenatal anomalies: A systematic clinical engineeringreview

Abstract For prenatal screening, ultrasound imaging allows for real-time observation of developing fetal anatomy. Understanding normal and aberrant forms through extensive fetal structural assessment enables for early detection and intervention. However, the reliability of anomaly diagnosis varies depending on operator expertise and device limits. First trimester scans in conjunction with circulating biochemical markers are critical in identifying high-risk pregnancies, but they also pose technical challenges. Recent engineering advancements in automated diagnosis, such as AI-based ultrasound image processing and multimodal data fusion, are developing to improve screening efficiency, accuracy, and consistency. Still, creating trust in these data-driven solutions is necessary for integration and acceptability in clinical settings. Transparency can be promoted by explainable AI (XAI) technologies that provide visual interpretations and illustrate the underlying diagnostic decision making process. An explanatory framework based on deep
learning is suggested to construct charts depicting anomaly screening results from ultrasound video feeds. AI modeling can then be applied to these charts to connect defects with probable deformations. Overall, engineering approaches that increase
imaging, automation, and interpretability hold enormous promise for altering traditional workflows and expanding diagnostic capabilities for better prenatal care.

Assessment of Second Trimester Genetic Amniocentesis: A Review of 6 Years of Experience at Sanpatong Hospital, A Mid-level Secondary Hospital Setting

OBJECTIVE This study aims to assess the indications, complications, and outcomes of second-trimester genetic amniocentesis performed at Sanpatong Hospital, Chiang Mai, Thailand. METHODS A cross-sectional descriptive study analyzed data collected from high-risk pregnant women who underwent second-trimester genetic amniocentesis at Sanpatong Hospital between October 1st, 2016 and September 30th, 2022. The data include indications for the procedure, complications, and pregnancy outcomes. RESULTS A study of 451 women with high-risk pregnancies who underwent amniocentesis found that the most common indications for second trimester genetic amniocentesis were advanced maternal age (49.4%) and a high-risk Quad test (49.4%). Abnormal chromosomes were detected in 3.1% of cases, with aneuploidy the most common type (2.1%), primarily trisomy 21 (1.3%). The overall aspiration success rate was 100%. The only complications related to the procedure were pelvic pain (0.6%) and placental hematoma (0.2%). There were no fetal losses within 30 days after amniocentesis. The culture failure rate was 1.1%. Pregnancy outcomes included preterm delivery (12.3%) and normal term delivery (87.7%). CONCLUSIONS Performing second trimester genetic amniocentesis at Sanpatong Hospital, a mid-level secondary hospital, over a six-year period resulted in no fetal losses.

Pancreatitis in pregnancy: The complex interplay with triglycerides and diabetes

Pancreatitis in pregnancy: The complex interplay with triglycerides and diabetes

Birth weight in high risk and normal pregnancy: a comparative study

Birth weight in high risk and normal pregnancy: a comparative study

Kartu Skor Poedji Rochyati in the Indonesian Maternal Referral System

Kartu Skor Poedji Rochyati in the Indonesian Maternal Referral System

Midwives’ attitudes towards the use of cardiotocography in Greece

Introduction: Cardiotocography was designed to monitor the condition of the fetus during childbirth, but is now widely used in the prenatal period and the test is especially important in high-risk pregnancies, as it can detect reduced fetal placental function in conditions such as preeclampsia, hypertension, Rhesus sensitization etc. Aim: The aim of the research is to evaluate and highlight the attitude of Midwives regarding the use of cardiotocography in Greece prenatally and during childbirth. Material and Method: Data were collected using a questionnaire that included questions about the attitude of midwives to the use of cardiotocography. The sample was random and the questionnaires were distributed electronically via google forms. Results: It was found that 82% of the respondents consider the existence of a cardiotocograph necessary in an emergency and 76.7% express a positive opinion regarding its use in general and during childbirth, 49% state that with cardiotocography during childbirth, the mother's anxiety increases but at the same time 50.5% believe that the cardiotocograph does not spoil the beauty of childbirth. Also, 71.8% of the respondents do not consider that their skills are undermined by the use of cardiotocography and 52.4% state that the caregivers are not distracted by the mother. In addition, 71.8% of the respondents do not consider that their skills are undermined by the use of cardiotocography and also 52.4% state that the caregivers are not distracted from the mother. In addition, 43.7% state that their own judgment outweighs the ECG results but in cases where the ECG gives false indications, 36.9% state that they do not trust their judgment. Finally, 61.6% believe that cardiotocography is often used unnecessarily. Conclusions: Midwives in Greece are positive about the use of cardiotocography prenatally and during childbirth and do not consider that their knowledge and skills are undermined through the examination, with the majority of respondents (82%) to consider the existence of a cardiotocograph necessary in an emergency.

Determinants of distress levels in high-risk pregnant women – cross-sectional study

Introduction and aim. Global and national care recommendations indicate that women with high-risk pregnancies should receive personalized and qualified care during this period. This study was conducted to determine the distress levels in high-risk pregnant women and affecting factors. Material and methods. The cross-sectional this study was conducted with total of 416 high-risk pregnant women who met the inclusion criteria in the obstetrics clinic of a training and research hospital. The study data were collected with data collection form and “Tilburg Pregnancy Distress Scale (TPDS).” Results. The mean TPDS total score of high-risk pregnant women was 18.25±6.85. It was found that planning pregnancy, gravida, and diagnosis of gestational hypertension, systemic diseases, and gestational diabetes in the present pregnancy was asso ciated with pregnancy-specific distress (p<0.05; β=0.291, β=0.158, β=0.272, β=0.137, β=0.116, respectively). Conclusion. It is advised that health professionals assess the distress levels of high-risk pregnant women and give personalized care during prenatal period.

THE RELATIONSHIP OF PREGNANT WOMEN'S CHARACTERISTICS TO KNOWLEDGE ABOUT HIGH-RISK PREGNANCY

Hight risk pregnancy is a condition that can affect the health of the mother and baby in the womb and this research aims to identify the relationship between characteristics of pregnant women and knowledge of high risk pregnancy. The research method was analytical observational with a cross sectional approach with 86 pregnant women respondents in Neglasari village, Majalaya district, bandung regency in May 2023. Data was collected using a questionnaire which was then analyzed using shi square. The results of the study showed that the highest frequency of lack of knowledge at age ≥ 35 years was 28 respondets (32,56%), the highest frequency of lack of knowledge with junior high school education was 24 respondents (27,9%), and the highest frequency of lack of knowledge with no work was as many as 39 respondents (27,9%) and the highest frequency of poor knowledge primiparous parity was 17 respondents (19,77%). The conclusion of the research is that there is a relationship between the characteristics of pregnant women and knowledge of high-risk pregnancies, so it is recommended to the Neglasari village head to increase socialization and helth education related to improving maternal health during pregnancy so that high-risk pregnancies can be prevented.

Effect of the Practice of Guided Imagery on the Perceived Stress Level in High-Risk Pregnancies

Objective: This research was conducted to identify the effect of the practice of Guided Imagery on the perceived stress level in high-risk pregnancies.
 Methods: The study was designed as a prospective, randomized, and single-blind study. The research was performed with the participation of a total of 128 women (64 in the experimental group, 64 in the control group) who had high-risk pregnancies between February-May, 2021. The data were evaluated with the Perceived Stress Scale.
 Results: The experimental group obtained a lower mean of post-test scores (26.36±5.96) from the Perceived Stress Scale than the control group (30.48±3.93), and this difference was statistically significant (p

Do demographic and obstetric characteristics affect fetal health locus of control among high-risk pregnancies? A Turkish sample

Objectives Fetal health locus of control has been indicated to effect how mothers approach their health beliefs and health-related decisions. The purpose of this study was to determine the fetal health locus of control (FHLC) level in high-risk pregnancies and to evaluate the factors affecting FHLC in high-risk pregnancies. Materials and methods The descriptive cross-sectional study was conducted with highrisk pregnant women. A total of 221 participants were included. Results and Discussion It was shown that The Internality Locus of Control was low and The Chance-Based Locus of Control was high in high-risk pregnant women. The current age of women and the age of their first pregnancy had a positively relationship with Powerful Others Locus of Control (FHLC-P). Although FHLC scores of multigravidas were higher than primiparous, no significant difference was found. Besides, there was a significantly higher FHLC-C score in women who did not change their exercise habits during pregnancy (p=0.008). Although the FHLC-I score was higher in women, who made changes in nutrition habits, it was determined that it was not significant. Conclusion The results of fetal health locus of control in high-risk pregnancies will lead to women who have high-risk pregnancies taking responsibility for adapting to the treatment process, taking into account the controls and making lifestyle changes, rather than leaving the situation to fate. Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 438-446

High-Risk Pregnancy Follow-Up: What the Childbirth Educator Needs to Know

Women with a high-risk pregnancy or birth often need additional follow-up care. This article provides a summary of the current recommendations for follow-up after a high-risk pregnancy. It is intended to be a quick read for the busy childbirth educator and includes a table that summarizes the recommendations.

ANALYSIS OF FACTORS AFFECTING THE LEVEL OF KNOWLEDGE OF WUS ABOUT HIGH RISK IN PREGNANCY

Background: Every pregnant woman has the potential for danger during pregnancy, childbirth, and postpartum. Until now, in all parts of the world, high-risk pregnancies are still a problem in health services, especially in developing countries. In Indonesia, the MMR decreased during the period 1991-2015 from 390 to 305 per 100,000 live births. However, this achievement is still far from the MDGs target of 102 per 100,000 live births. Until 2015 the target of the MDGs has not been achieved. While the target for the Sustainable Development Goals (SDGs), the MMR target is 70 per 100,000 live births in 2030. In relation to high-risk pregnancies, at the Kramatwatu Health Center there were 739 high-risk pregnancies found in 2021, while in the village of Pejaten, there are still many women of childbearing age who are pregnant or give birth at a risky age of 83. From these conditions, complications can result from high-risk pregnancies such as miscarriage, premature birth, genetic disorders and death. This can occur due to lack of knowledge about highrisk pregnancies. This research method is descriptive research with cross sectional or cross sectional design. This research was conducted in Pejaten Village, Kramatwatu Serang Banten. The research sample was taken by purposive sampling. Primary data collection was carried out using a questionnaire containing 25 questions filled out by respondents. In addition, the research output will be published in the Poltekkes journal (Jurnal of Applied Health). More than half (58.3%) of respondents still have less knowledge about high risk in pregnancy. Factors Age, education, occupation, history of pregnancy and sources of information related to the level of knowledge of wus about high risk in pregnancy. This research can help provide information to develop new strategies that are more appropriate in an effort to reduce high risk in pregnancy in the Kramatwatu Health Center area, especially in Pejaten village.

Doppler in High-Risk Pregnancy and Its Correlation With Feto-Maternal Outcomes: A Prospective Study

Doppler in High-Risk Pregnancy and Its Correlation With Feto-Maternal Outcomes: A Prospective Study

Machine Learning Prediction of Fetal Health Status from Cardiotocography Examination in Developing Healthcare Contexts

Reducing neonatal mortality is a critical global health objective, especially in resource-constrained developing countries. This study employs machine learning (ML) techniques to predict fetal health status based on cardiotocography (CTG) examination findings, utilizing a dataset from the Kaggle repository due to the limited comprehensive healthcare data available in developing nations. Features such as baseline fetal heart rate, uterine contractions, and waveform characteristics were extracted using the RFE wrapper feature engineering technique and scaled with a standard scaler. Six ML models—Logistic Regression (LR), Decision Tree (DT), Random Forest (RF), Gradient Boosting (GB), Categorical Boosting (CB), and Extended Gradient Boosting (XGB)—are trained via cross-validation and evaluated using performance metrics. The developed models were trained via cross-validation and evaluated using ML performance metrics. Eight out of the 21 features selected by GB returned their maximum Matthews Correlation Coefficient (MCC) score of 0.6255, while CB, with 20 of the 21 features, returned the maximum and highest MCC score of 0.6321. The study demonstrated the ability of ML models to predict fetal health conditions from CTG exam results, facilitating early identification of high-risk pregnancies and enabling prompt treatment to prevent severe neonatal outcomes.

Pregnancy outcomes for women with pre-existing renal disease and the role of a dedicated joint maternal medicine and renal clinic: A retrospective cohort study.

To reaffirm the value of a joint obstetric and renal clinic on obstetric outcomes in patients with high-risk pregnancies due to chronic kidney disease (CKD). This was a retrospective cohort study of patients who attended the clinic between 2005 and December 2021. The hospital is a regional tertiary unit for renal medicine and a maternal medicine hub. The data included all women with pre-existing renal conditions who were cared for in a dedicated renal and obstetric clinic. Datasets were extracted from hospital notes, the renal database, clinical data and maternity electronic health records. The data analyzed included pre-existing renal conditions, biochemical parameters related to the renal condition, pregnancy outcomes included miscarriages, gestation, mode of delivery, postpartum hemorrhage (PPH), loss, birth weight and neonatal admission. The results were as follows: Lupus nephritis: four term deliveries; three had pre-eclampsia; two PPH and two miscarriages. Four estimated glomerular filtration rates (eGFRs) returned to baseline levels within 12 months. With regard to IgA nephropathy there were five live births, four term deliveries, two pre-eclampsia (PE) and five cesarean sections (CS). All eGFRs returned to baseline within 12 months. With regard to patients with adult polycystic kidney disease (APKD), there were six live births, two had pre-eclampsia and there were five term vaginal deliveries. Patients with lupus nephritis, APKD, and IgA demonstrated a higher incidence of adverse pregnancy outcomes as compared with our local pregnant population. Our findings reflect those of larger studies and support the role of combined renal/obstetric clinics. More research and larger scale studies are needed into specific CKD conditions and their outcomes.