High-risk Pregnancies Research Articles

Testing for Hepatitis C During Pregnancy Among Persons With Medicaid and Commercial Insurance: Cohort Study.

The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy. We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing. Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing. Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3%) and 221,436 (18.3%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8%) and 187,819 (21.9%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2% to 13,971/52,330, 26.8%) and commercially insured patients (from 38,308/211,555, 18.1% to 39,152/139,972, 28%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed.

A-316 Suboptimal Compliance to Postpartum Glucose Monitoring in a High-risk Pregnancy Population - A Single Center Study

Abstract Background Gestational diabetes mellitus (GDM) is a predictive factor in developing type 2 diabetes mellitus (T2DM) in affected mothers and their offspring. Its prevalence is increasing proportionally with the obesity epidemic, affecting 10% of pregnant women and 50% of which are likely to develop T2DM. Current guidelines by the American Diabetes Association and the American College of Obstetricians and Gynecologists recommend screening at 4–12 weeks with a 2-hour postpartum glucose tolerance test (OGTT) in patients with a history of GDM. However, several studies have reported suboptimal test ordering and completion rates attributable to the busy postpartum period and provider role confusion between primary care physicians and obstetricians. Due to the complex maternal-fetal cases encountered at our institution, the aim of this study is to evaluate the ordering and test completion rates amongst care providers and patients to ensure compliance with stipulated guidelines. Method We conducted a retrospective audit of women diagnosed with GDM who delivered at our institution from Jan 2019–Oct 2022. We abstracted data from electronic health records. Gestational diabetes was defined by one or more of the following: abnormal 3hr OGTT or 1-hour OGTT of >/=200 mg/dL at >/= 24 weeks. We excluded patients with pre-existing diabetes defined by diagnosis code or by an abnormal 1st trimester 3hr GTT or HbA1C and patients who did not return for a postpartum visit. We compared the proportions of patients with postpartum glucose monitoring orders (glucose tolerance tests or Hemoglobin A1C) to those without orders. Factors such as race, GDM management, provider type and insurance carrier were assessed as potential barriers to non-compliance. Results We identified 356 patients who were diagnosed with GDM during the study period. Of these, 158 patients were excluded who had pre-existing diabetes or did not return for postpartum care. The mean (SD) maternal age was 33.2 (6.0) years. Seventy-four percent (147/198) of patients had a postpartum glucose tolerance test order (Group A), and 26% (51/198) had no laboratory order for glucose monitoring (Group B). The proportion of patients with a completed test order was 24% (35/147), of which four results were abnormal (indicated for diabetes or pre-diabetes). There was no difference in parity, ethnicity, insurance type, diabetes management and provider type between the two groups. Poor compliance was observed in patients with glucose tolerance laboratory orders, while patients with an HbA1c order were 100% compliant. Conclusion Overall, this report demonstrates poor patient compliance with postpartum glucose tolerance testing. Although HbA1C is not recommended for postpartum glucose monitoring, patients were more likely to complete this test.

Effects of Recreational Therapy and 3D Ultrasonography for High-Risk Pregnancies on Psychological Well-Being during Hospitalization and in the Puerperal Phase.

Hospitalization during pregnancy often produces psychosocial distress for pregnant women. In this study, 3D ultrasound and recreational therapy were compared to the standard treatment for their influence on depressive symptoms and anxiety. In this prospective one-year intervention study, women who were admitted to the hospital for any pregnancy complication, other than psychiatric, were included. A control group, with standard clinical treatment, and two intervention groups, both additionally receiving either 3D ultrasound or recreational therapy, were established. Psychological well-being was assessed at defined times by the PHQ-health-questionnaire. A total of 169/211 women were included: control group n = 79, 3D ultrasound group n = 43, and crochet group n = 83. A higher than estimated underlying depression was seen for all women on admission. The intervention groups showed less depression (p = 0.02762). No difference was seen between the intervention groups (p = 0.23029). Anxiety decreased throughout intervention, but not significantly. On admission, all women showed similar results of underlying depression, indicating that hospitalization itself already causes mild psychological stress. Both interventions decreased depressive symptoms. Intervention with either recreational therapy or 3D ultrasound can prevent the development of mild and major depression and decrease anxiety disorders, and therefore has a positive effect on well-being during hospitalization. These results emphasize the need to implement forms of interventions to improve the well-being of women, as this might improve pregnancy and neonatal outcome.

Evaluation of a telehealth program for high-risk pregnancy in a health service provider institution

IntroductioneHealth offers a solution to current challenges in maternal health. Telemonitoring can rethink antenatal care, achieving more personalized medicine, especially in high-obstetric risk conditions. A home care model mediated by the development of a mobile and web application that seeks support in clinical decision-making was created in our institution. The software architecture consists of an information system (HCIS, Health Care Information System), a database, an authentication server, and an interoperability bus. MethodsThe usability of the software by patients was assessed using the Information Systems Usability Questionnaire (CSUQ) version 3, as well as the satisfaction of the care model designed through a survey in a prospective observational study in 62 patients with a high-risk pregnancy. Participants were monitored in real-time through blood glucose, blood pressure, and weight measurements, and attended telemedicine appointments with an obstetrician from admission to six weeks postpartum. ResultsThe CSUQ results show a good acceptance of the use of the application by patients both in the global score and the different domains, Global, System utility (SYSUSE), Information Quality (INFOQUAL), and Interface quality (INTERQUAL). The satisfaction survey also shows good results in general and by domains. ConclusionThe findings of this study provide some suggestions for the implementation of a technological development and a care model from the patient’s perspective.

Pregnancy-Associated Plasma Protein-A: Its Significance as a Single Biomarker for Adverse Obstetric Outcomes

OBJECTIVES: Low levels of pregnancy-associated plasma protein-A in pregnant women linked to unhealthy placentation and a spectrum of maternal and fetal complications. Its assessment as a single biomarker has the potential to identify high-risk pregnancies. This prospective observational study was conducted to find a correlation between low pregnancy-associated plasma protein-A levels in the first trimester of pregnancy with various obstetric outcomes to establish if it can be used as a single biomarker for counseling couples. STUDY DESIGN: The study was conducted at Base Hospital, Delhi Cantt. Maternal serum pregnancy-associated plasma protein-A levels were assessed at 11 to 13+6 weeks of gestation, converted in multiples of the median and patients were followed till delivery. Maternal outcomes were recorded in terms of abortions, development of gestational hypertension, gestational diabetes, preeclampsia, placental abruption, fetal growth restriction, fetal demise, neonatal intensive care unit admission, etc., and analyzed to find an association with levels first trimester of pregnancy-associated plasma protein-A. RESULTS: Low pregnancy-associated plasma protein-A levels showed a statistically significant association with gestational hypertension, preeclampsia, abortion, fetal demise, and also for adverse neonatal outcomes like APGAR <5 at 1 min, fetal growth restriction, neonatal intensive care unit admission, and perinatal deaths. No significant association was observed for preterm delivery, gestational diabetes, and placental abruption. CONCLUSION: Serum pregnancy-associated plasma protein-A levels in the first trimester of pregnancy have the potential of being utilized as a validated marker for adverse pregnancy outcomes. Early identification of such pregnancies can help in optimizing feto-maternal outcomes through closer surveillance, timely intervention, and referral to tertiary care centers. Further research would help the fraternity in developing a prediction model.

Stroke vs. Preeclampsia: Dangerous Liaisons of Hypertension and Pregnancy.

Stroke during pregnancy and preeclampsia are two distinct but interrelated medical conditions, sharing a common denominator-blood control failure. Along with cardiovascular diseases, diabetes, dyslipidemia, and hypercoagulability, hypertension is undoubtedly a major risk factor associated with stroke. Even though men have higher age-specific stroke rates, women are facing higher life-long stroke risk, primarily due to longer life expectancy. Sex hormones, especially estrogen and testosterone, seem to play a key link in the chain of blood pressure control differences between the genders. Women affected with stroke are more susceptible to experience some atypical stroke manifestations, which might eventually lead to delayed diagnosis establishment, and result in higher morbidity and mortality rates in the population of women. Preeclampsia is a part of hypertensive disorder of pregnancy spectrum, and it is common knowledge that women with a positive history of preeclampsia are at increased stroke risk during their lifetime. Preeclampsia and stroke display similar pathophysiological patterns, including hypertension, endothelial dysfunction, dyslipidemia, hypercoagulability, and cerebral vasomotor reactivity abnormalities. High-risk pregnancies carrying the burden of hypertensive disorder of pregnancy have up to a six-fold higher chance of suffering from stroke. Resemblance shared between placental and cerebral vascular changes, adaptations, and sophisticated auto-regulatory mechanisms are not merely coincidental, but they reflect distinctive and complex cardiovascular performances occurring in the maternal circulatory system during pregnancy. Placental and cerebral malperfusion appears to be in the midline of both of these conditions; placental malperfusion eventually leads to preeclampsia, and cerebral to stoke. Suboptimal performances of the cardiovascular system are proposed as a primary cause of uteroplacental malperfusion. Placental dysfunction is therefore designated as a secondary condition, initiated by the primary disturbances of the cardiovascular system, rather than an immunological disorder associated with abnormal trophoblast invasion. In most cases, with properly and timely applied measures of prevention, stroke is predictable, and preeclampsia is a controllable condition. Understanding the differences between preeclampsia and stroke in pregnancy is vital for healthcare providers to enhance their clinical decision-making strategies, improve patient care, and promote positive maternal and pregnancy outcomes. Management approaches for preeclampsia and stroke require a multidisciplinary approach involving obstetricians, neurologists, and other healthcare professionals.

Adolescent Pregnancy Outcome in a District Hospital of Bangladesh

Background: Adolescent pregnancy is universally accepted as high risk pregnancy. Bangladesh has the highest (1 in 10) adolescent fertility rate in South Asia.
 Objective: The study was conducted to find out the common problems of adolescent pregnancy.
 Methodology: A comparative cross-sectional study was carried out among 100 respondents (50 adolescents and 50 adults) in Munshigonj General Hospital from 1st January to 31st December 2018. Respondents were admitted patients who have delivered either vaginally or by caesarian section. Women aged 15 to 19 years selected as adolescent and those aged 20 to 40 years selected as adult. Socio-demographic characteristics, past obstetric history, antenatal checkup, antenatal and intrapartum complications, and clinical state on admission were recorded in a semi structured questionnaire. Obstetrical parameters of adolescent and adult groups were compared.
 Results: Among total admitted patients 11% were adolescent. 70% were from rural area, 68% were poor, 50% didn’t have even primary education, 92% adolescent never use contraceptive, 56% had no ANC. Anemia (62%) and hypertension (24%) were prevalent among the pregnant adolescents. Complication rate were more in adolescent group, like preeclampsia (12%), eclampsia (14%), preterm labor (12%), prolonged labor (14%), obstructed labor (8%). Caesarean rate was higher (66%) in adolescent pregnancy.
 Conclusion: Majority of the adolescents had no ANC, complication rate were more prevalent in adolescent group. Adverse perinatal outcome was found in adolescent pregnancy.
 Mugda Med Coll J. 2022; 5(2): 55-59

Prenatal Workshops and Support Groups for Prospective Parents Whose Children Will Need Neonatal Care at Birth: A Feasibility and Pilot Study.

Introduction: Support groups in neonatal intensive care units (NICUs) are beneficial to parents. The usefulness of prenatal support groups for prospective parents who will have a newborn requiring admission to the NICU has never been investigated. Methods: We assessed the needs of NICU parents regarding topics they would have wished to discuss prenatally and developed the content of a prenatal support workshop. A standardized survey prospectively evaluated the perspectives of pregnant women admitted to a high-risk pregnancy unit who participated in the resulting workshops. Results: During needs assessment, 295 parents invoked themes they would have wished to discuss antenatally: parental guilt, future parental role, normalizing their experience/emotions, coping with many losses, adapting to their new reality, control and trust, information about the NICU, technology around the baby, common neonatal interventions, the NICU clinical team, and the role of parents in the team. These findings were used to develop the workshop, including a moderator checklist and a visual presentation. Practical aspects of the meetings were tested/finalized during a pre-pilot phase. Among 21 pregnant women who answered the survey (average gestational age 29.3 weeks), all agreed that the workshop was useful, that it made them feel less lonely (95%), that exchanges with other women were beneficial (95%) and gave them a certain amount of control over their situation (89%). All answers to open-ended questions were positive. Conclusion: Prenatal educational/support workshops provide a unique and useful means to support future NICU parents. Future investigations will explore whether these prenatal interventions improve clinical outcomes.

The impact of parental involvement laws on minors seeking abortion services: a systematic review.

On June 24, 2022, the US Supreme Court overturned the constitutional right to abortion in Dobbs v Jackson Women's Health Organization. Minors are a vulnerable population with a high risk of unintended pregnancy who are likely to be disproportionately affected by abortion restrictions. Examining the impact of historical abortion restrictions in minors may provide insight into the anticipated effects of the Dobbs decision. This study is a systematic review examining the impact of parental involvement (PI) laws on minors seeking abortion services. Our review suggests an association between PI laws and decreased abortion rates. Parental involvement laws also may increase pregnancy and birth rates and out-of-state travel for abortion procedures and lead to later abortions, although effects appear to be heterogenous.

Placental pathology in perinatal asphyxia: a case-control study.

Placentas of term infants with birth asphyxia are reported to have more lesion such as maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM) and chorioamnionitis with fetal response (FIR) than those of term infants without birth asphyxia. We compared the placental pathology of asphyxiated newborns, including those who developed hypoxic-ischemic encephalopathy (HIE), with non-asphyxiated controls. We conducted a retrospective case-control study of placentas from neonates with a gestational age ≥ 35 weeks, a birthweight ≥ 1,800 g, and no malformations. Cases were asphyxiated newborns (defined as those with an umbilical artery pH ≤ 7.0 or base excess ≤ -12 mMol, 10-minute Apgar score ≤ 5, or the need for resuscitation lasting >10 min) from a previous cohort, with (n=32) and without (n=173) diagnosis of HIE. Controls were non-asphyxiated newborns from low-risk l (n= 50) or high-risk (n= 68) pregnancies. Placentas were analyzed according to the Amsterdam Placental Workshop Group Consensus Statement 2014. Cases had a higher prevalence of nulliparity, BMI>25, thick meconium, abnormal fetal heart monitoring, and acute intrapartum events than controls (p<0.001). MVM and FVM were more frequent among non-asphyxiated than asphyxiated newborns (p<0.001). There was no significant difference in inflammatory lesions or abnormal umbilical insertion site. Histologic meconium-associated changes (MAC) were observed in asphyxiated newborns only (p= 0.039). Our results confirm the role of antepartum and intrapartum risk factors in neonatal asphyxia and HIE. No association between neonatal asphyxia and placental lesions was found, except for in the case of MAC. The association between clinical and placental data is crucial to understanding and possibly preventing perinatal asphyxia in subsequent pregnancies.

Development and validation of the 23-item preterm birth risk assessment scale-Korean version

BackgroundPreterm birth (PTB) is a complex and significant challenge in obstetrics. Thus, clinicians and researchers have paid a keen interest in the identification of women at a high risk for PTB. This study aimed to develop a PTB risk assessment scale based on the preliminary 32-item Preterm Birth Risk Assessment Scale-Korean version (PBRAS-K).MethodsWe enrolled 298 participants (167 in the exploratory factor analysis group from March 3, 2021 to August 31, 2021 and 131 in the confirmatory factor analysis group from December 3, 2021 to February 14, 2022) who delivered before 37+0 weeks after experiencing preterm symptoms and were admitted to high-risk pregnancy maternal–fetal intensive care units (MFICUs). After an item-reduction process in the exploratory factor analysis, the psychometric property scales were assessed using SPSS Statistics version 27.0, and the confirmatory factor analysis was conducted using AMOS version 27.0.ResultsThe Kaiser–Meyer–Olkin (KMO) test and Bartlett’s χ2 test of sphericity confirmed the adequacy of the sample for factor analysis (KMO = .81 (> .80), χ2 = 1841.38, p < .001). The final version of the PBRAS-K comprised 23 items within seven dimensions. Factor analysis identified items explaining 65.9% of the total variance. The PBRAS-K achieved a mean score of 35.58 (± 10.35) and showed high internal consistency and satisfactory reliability (Cronbach’s alpha = .85). Regarding concurrent validity, the PBRAS-K exhibited a low-to-moderate correlation with the PTB risk (r = .45, p < .001). As for criterion validity and convergent validity, the PBRAS-K showed a positive and high correlation with the Somatic Awareness Scale with Spontaneous Preterm Labor (SPL-SAS) (r = .65, p < .001) and pregnancy-related stress (r = .57, p < .001), respectively. Risk scoring for preterm delivery and SPL-SAS were moderately correlated (r = .53, p < .001).ConclusionsPBRAS-23-K is a valid and reliable instrument for assessing the risk for PTB in pregnant women. Clinical nurses are encouraged to apply and obtain information regarding effective interventions in MFICUs. This scale provides meaningful results and reflects the opinions of women who had experienced PTB. The PBRAS-23-K should be evaluated for standardization and cut-off scores using larger sample sizes in the future.

High-risk pregnancy in India: Prevalence and contributing risk factors - a national survey-based analysis.

High-risk pregnancies (HRP) place women and their offspring at the highest risk for morbidity and mortality. Maternal and medical risks increase pregnancy risk and complications during pregnancy and childbirth. Here, we reported the current prevalence of high-risk pregnancies among Indian women, which is defined through various factors such as maternal, lifestyle, medical, current health risk and adverse birth outcomes. This is a cross-sectional study based on secondary data from India's National Family Health Survey-5 (NFHS-5). A total of 23 853 currently pregnant women were considered for analysis after considering the inclusion and exclusion criteria. The prevalence and contributing factors of high-risk pregnancies were estimated using descriptive statistics and logistic regression, respectively. The prevalence of high-risk pregnancies among Indian women was 49.4%, with 33% of women having a single high-risk, and 16.4% having multiple high-risk pregnancies. Notably, pregnant women from Meghalaya and Manipur states had 67.8% and 66.7% with one or more high-risk factors, respectively. About 31.1% of women had short birth spacing, and 19.5% of women had adverse birth outcomes during the last birth. Logistic regression analysis showed that women with no education (adjusted odds ratio (AOR) = 2.02; 95% confidence interval (CI) = 1.84-2.22) and the poorest wealth quintile (AOR = 1.33; 95% CI = 1.04-1.29) had significantly higher odds of having HRP than those with higher education and the highest wealth quintile, respectively. Nearly half of all pregnancies in India have one or more high-risk factors, which is a matter of concern, and the risks were higher among the vulnerable population such as no educated, poorest groups etc. The leading high-risk factors such as short-birth spacing, adverse birth outcomes, and caesarean deliveries should be addressed through the health policy and programmes.

Family planning needs to limit childbearing are unmet, yet our parity is high: characterizing and unveiling the predictive factors

BackgroundThe unmet need for limiting childbearing (UNLC) remains a problem in Nigeria. Conception after four pregnancies is considered a high-risk pregnancy. We examined the level, reasons for non-use of contraception, and predictors of UNLC among high parity (≥ 4 live birth) women in Nigeria.MethodsThis cross-sectional design study was based on the analysis of nationally representative weighted data (2018 Nigeria Demographic Health Survey). The study focused on high-parity women of reproductive age (n = 4260) who do not want to have any more children irrespective of the number of their surviving children. Multi-stage cluster sampling approach was used for sample selection. Data were analyzed using logistic regression (α0.05).ResultsMean age of the respondents and children ever born was 38.92 ± 5.7 and 6.54 ± 2.3 respectively. The prevalence of UNLC was 40.9%, higher in the rural (48.8%) than urban (32.8%) areas, highest among women with no formal education (52.0%), higher among Muslims (48.4%) than Christians (34.8%), highest in the North-West (51.7%) and least in the South-East (26.1%). The most reported reasons for non-use of family planning (FP) were; respondents opposed (25.0%), infrequent sex (15.0%), fatalistic (13.2%), husband/partner opposed (11.2%), fear of side effects/health (8.5%), and religious prohibition (3.3%). The odds of UNLC was 100% higher among women aged 40–49 years compared to the younger women in age group 20–29 years. Living in the rural area predisposes high parity women of reproductive age to higher risks of UNLC (OR = 1.35, 95% C.I = 1.14–1.59, p < 0.001). Lack of access to family planning information through health workers (OR = 1.94, 95% C.I = 1.63–2.30, p < 0.001) increased the risks of UNLC. Being an Igbo or a Yoruba ethnic group was protective for UNLC compared to Fulani/Hausa women.ConclusionsA high level of UNLC was found among high-parity women in Nigeria. Access to FP information reduces the risk of UNLC. Expanding FP services would help respond to the expressed desires for contraception among high-parity Nigerian women who want to stop childbearing.

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies.

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.

IMPLEMENTASI KLASIFIKASI KEHAMILAN BERESIKO DENGAN METODE NAIVE BAYES PADA PUSKESMAS KELURAHAN MALAKA JAYA

Pregnancy risk is classified into three categories: Low Risk Pregnancy (KRR), High Risk Pregnancy (KRT), and Very High Risk Pregnancy (KRST). Examination data recorded in the Maternal and Child Health (MCH) book at Puskesmas is used to categorize pregnancy risk. Although the maternal mortality rate has decreased, recent surveys show a significant increase. The causes include lack of counseling on obstetric and gynecological health, lack of emergency obstetric and neonatal care, and the use of ineffective traditional medicine. To overcome this problem, it is necessary to improve quality maternal health services. Efforts to accelerate the reduction of maternal mortality rate (MMR) include access to appropriate health services, postpartum care, and family planning services. Data processing uses data mining techniques with the Naïve Bayes classification method, which has high accuracy and short execution time. This study aims to develop a Naïve Bayes classification model in early detection of pregnancy risk, so that it can help diagnose pregnant women with low or high risk.

The MothersBabies Study, an Australian Prospective Cohort Study Analyzing the Microbiome in the Preconception and Perinatal Period to Determine Risk of Adverse Pregnancy, Postpartum, and Child-Related Health Outcomes: Study Protocol.

The microbiome has emerged as a key determinant of human health and reproduction, with recent evidence suggesting a dysbiotic microbiome is implicated in adverse perinatal health outcomes. The existing research has been limited by the sample collection and timing, cohort design, sample design, and lack of data on the preconception microbiome. This prospective, longitudinal cohort study will recruit 2000 Australian women, in order to fully explore the role of the microbiome in the development of adverse perinatal outcomes. Participants are enrolled for a maximum of 7 years, from 1 year preconception, through to 5 years postpartum. Assessment occurs every three months until pregnancy occurs, then during Trimester 1 (5 + 0-12 + 6 weeks gestation), Trimester 2 (20 + 0-24 + 6 weeks gestation), Trimester 3 (32 + 0-36 + 6 weeks gestation), and postpartum at 1 week, 2 months, 6 months, and then annually from 1 to 5 years. At each assessment, maternal participants self-collect oral, skin, vaginal, urine, and stool samples. Oral, skin, urine, and stool samples will be collected from children. Blood samples will be obtained from maternal participants who can access a study collection center. The measurements taken will include anthropometric, blood pressure, heart rate, and serum hormonal and metabolic parameters. Validated self-report questionnaires will be administered to assess diet, physical activity, mental health, and child developmental milestones. Medications, medical, surgical, obstetric history, the impact of COVID-19, living environments, and pregnancy and child health outcomes will be recorded. Multiomic bioinformatic and statistical analyses will assess the association between participants who developed high-risk and low-risk pregnancies, adverse postnatal conditions, and/or childhood disease, and their microbiome for the different sample types.

Trends in cardiovascular complications of pregnancy: A nationwide inpatient sample analysis

BackgroundCardiovascular disease (CVD) is the leading cause of pregnancy-related mortality in the United States. Physiologic stress of pregnancy can induce several hemodynamic changes that contribute to an increased risk of cardiac complications in the peripartum period. There are ongoing efforts to improve cardiovascular mortality in pregnant patients. Understanding trends in cardiovascular complications during pregnancy may provide insight into improving care for high-risk pregnancies. MethodsWe retrospectively analyzed data from the National Inpatient Sample (NIS) Database and identified all inpatient hospitalizations for pregnancy and delivery. We then analyzed trends in the rates of cardiac complications in the pregnant patient. ResultsThere are concerning increases in trends of cardiac complications and comorbidities in pregnant people including: acute coronary syndrome, spontaneous coronary artery dissection, cardiogenic shock, pulmonary hypertension, chronic congestive heart failure, heart transplant, aortic syndromes, stroke, and pulmonary embolism. While the rates of STEMI have decreased, the incidence of peripartum cardiomyopathy has remained stable. ConclusionThere are concerning increases in certain cardiac complications during pregnancy. This is likely due to increasing age at the time of pregnancy and associated comorbidities.

The association between umbilical cord coiling index and adverse perinatal outcomes at term pregnancies

Objectives: The umbilical coiling index, calculated by dividing the total coil number to the cord length, is a representative parameter for umbilical cord coiling status. Recent studies have shown that abnormal umbilical coiling index is associated with adverse perinatal outcomes. Here, we aimed to determine this association at term gestation in our population. Methods: A total of 98 singleton, term pregnant women were included in this prospective study. Demographic, obstetric features and perinatal outcomes of the patients were recorded. Patients were grouped according to the umbilical coiling index as hypocoiled, normocoiled and hypercoiled. Recorded parameters were firstly compared between normocoiled (n = 60) and abnormal coiled (n = 38) groups. Then, they were compared between normocoiled, hypocoiled (n = 20) and hypercoiled (n = 18) groups. Significantly different adverse perinatal outcomes were compared between normocoiled and other groups. Results: Abnormal coiled group had an higher incidence of low fifth minutes Apgar scores, meconium-stained amniotic fluid, intrauterine growth restriction and acute fetal distress as compared to normocoiled group. No significant adverse perinatal outcome was detected between hypocoiled and normocoiled groups. Intrauterine growth restriction (p = 0.004), low Apgar scores (p = 0.046) and fetal distress (p = 0.038) and meconium-stained amniotic fluid were found to be more common in hypercoiled group than normocoiled ones. Conclusions: Abnormal umbilical coiling is associated with adverse perinatal outcomes. Hence antenatal measurement of umbilical coiling index could be a useful parameter to determine high-risk pregnancies and can provide close monitoring for fetal well-being.

Are our sub-centers prepared enough to tackle high-risk pregnancies? A cross-sectional survey from Southern Rajasthan, India

Introduction and aim. Sub-centers (SC) are the first contact point with the community with auxiliary nurse midwife (ANM) as the instrument, delivering all the primary health care services. The SCs are under constant criticism for their inability to deliver quality services. This study assessed the preparation of facilities available at the SC to manage high-risk pregnancies (HRP) and to compare the same between rural and tribal blocks of the selected district. Material and methods. This health facility-based cross-sectional observational study was done for 6 months among 276 rural and tribal SC of the Udaipur district by a two-stage random sampling method using an observational checklist to assess the infrastructure and logistics of SCs. Data were analyzed using SPSS 20. Results. The study covered 264 (95.7%) non-24x7 SCs and 12 (4.3%) 24x7 SCs. Only one-third SCs, 93 (33.6%) were situated at the center of the village. Only 151 (54.7%) SCs had attached ANM quarters. All 24x7 SCs and 78.4% of non-24x7 SCs had adequate equipment and infrastructure. Conclusion. Most of the subcentres’ infrastructure and functional equipment was equipped to tackle HRP. Rural SC adhered more than tribal. Most HRPs were tracked and referred to higher centers. Unless we emphasize strengthening SCs, the dream of a healthy nation will remain obscure.

Rare Case of Systemic Lupus Erythematosus with Multiorgan Involvement in A Young Pregnant Women – A Case Report

Systemic Lupus erythematosus (SLE) is an autoimmune disease that notoriously varies in presentation, course, andoutcome. Active Nephritis, especially if the neuropsychiatry component is involved, is associated with adverse pregnancy outcomessuch as Gestational hypertension, pre-eclampsia, and renal failure. Our aim is to elaborate on the case report of young pregnantwomen diagnosed with SLE with multiorgan involvement about its course and management and the need for a multidisciplinaryapproach. A 20-year-old primigravida at 33 weeks of gestation with no known co-morbidities previously came with a history offever for 2 days, abdominal pain, and bleeding per vagina. Given placental abruption, the patient underwent an emergency lowersegment cesarean section. The patient developed postpartum hemorrhage (PPH), which was managed medically. On POD#8(postoperative day 8), the patient had generalized tonic-clonic seizures (GTCS) and developed hematuria. On evaluation, itrevealed abnormal renal parameters suggestive of Pregnancy-related Acute Kidney Injury (PRAKI). The patient's condition did notimprove with conservative management. After immunological investigations, a renal biopsy was done, and the diagnosis wasconfirmed as SLE-LN III (Systemic lupus erythematosus-Lupus nephritis) with Neuropsychiatry component involvement. Hence,the patient was started on Hydroxychloroquine based on the National Institute of Health protocol, and her condition improved.Hence given the relatively high number of maternal and neonatal deaths, lupus pregnancies should be followed by a multidisciplinaryteam, including nephrologists, rheumatologists, and obstetricians experienced in high-risk pregnancies, and deliveries should beplanned in tertiary-care settings provided with neonatology intensive care units.