High-risk Pregnant Women Research Articles

Aspirin versus metformin in pregnancies at high risk of preterm pre-eclampsia in China (AVERT): protocol for a multicentre, double-blind, 3-arm randomised controlled trial

IntroductionPre-eclampsia (PE) affects about 5% of Chinese pregnant women and is a major cause of maternal and perinatal morbidity and mortality. The first trimester screening model developed by the Fetal...

Effect of Probiotics on Plasma Glucose Level in obese patients on risk of Gestational Diabetes Mellitus

Background: A range of physiologic, metabolic, and gut microbial changes occur during pregnancy. Pregnancy is linked to insulin resistance and hyperinsulinemia, which increase the risk of gestational diabetes. Probiotics are being extensively examined for their potential benefits in the treatment of a variety of disorders. Moreover, there is no local study connected before on the supplementation of probiotics in such cases to find the improvement in glycemic control level and prevention of gestational diabetes (GDM), so this study was planned.
 Methods: This one-year randomised control trial was conducted at PIMS Islamabad, Department of Obstetrics and Gynaecology. After receiving informed permission, 126 patients were enrolled in the trial. In group A, patients were given a standard diet plan along with a probiotic sachet daily from 20 weeks of pregnancy until 26 weeks. In group B, patients were given a standard diet plan along with routine vitamins daily for the same period. Patients were followed-up in OPD up to 26 to 28 weeks, and OGTT was done, then GDM was labelled if OGTT deranged.
 Results: At the 28th week, in the probiotic group, the mean fasting blood glucose was 78.84±18.42 mg/dl, and in the control group, it was 81.25±22.49 mg/dl (p-value = 0.515). At the 28th week in the probiotic group, the GDM was noted in 12 (19%) patients, and in the control group, it was in 22 (34.9%) patients (p-value = 0.045).
 Conclusion: From this study, we may conclude that there is an effective role of probiotic supplementation in the prevention of GDM among high-risk obese pregnant women.

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.

PREGNANT WOMEN STRUGGLING WITH HIGH BLOOD PRESSURE AND STRESS IN PREGNANCY AND ROLE OF NITRIC OXIDE SUPPLEMENTS L-ARGININE FOR PROLONG PERIOD

INTRODUCTION: Mental stress can contribute to the exacerbation of hypertension in pregnant women and preeclampsia by the release of stress hormones such as adrenaline and cortisol level. Less nitric oxide (NO)-dependent vasodilation and excess formation of reactive oxygen species could explain poor placenta perfusion already in PIH and Preeclampsia due to impaired endothelial function. Studies have indicated that Nitric oxide supplement L-arginine can lead to beneficial effects on various cardiometabolic markers, including blood pressure and vascular function especially in pregnant mothers. OBJECTIVE: The primary objective of this meta-analysis study of placebo-controlled trials was to assess and ascertain the evidence of effectiveness of L-arginine and its use in enhancing nitric oxide synthesis to translate into tangible improvement in Hypertension and preeclampsia management, Nitric oxide supplement L-arginine’s ubiquitous molecule’s role is a subject of debate and research with focus on both systolic and diastolic values, pregnancy outcomes and understanding of its role in Hypertension resistant to currently available therapies. METHODS: In this study focused on role of L-arginine on high blood pressure during pregnancy, we did a thorough research, effective communication of information from relevant and up-to-date research articles, studies from reputable sources and great places of academic database like PubMed, Google Scholar, medical journals. Around 16 trials were searched in Pub-Med and Google scholar. A total of six trials were included in this meta-analysis. RESULTS: Result of this meta-analysis shows Nitric Oxide L-arginine supplementation showed a mean decrease in diastolic blood pressure and can lead to beneficial effect on blood pressure and vascular function especially in pregnant mothers with stress, mean increase up to 1. 23 weeks (p = 0. 002) for gestation period to delivery but did not showed reduction in systolic blood pressure as compared to placebo. CONCLUSION: This meta-analysis study supports the notion that availability of this substrate for NO synthesis prolongs the latency to development of preeclampsia and decrease the hypertension in a high-risk pregnant woman with Hypertension and stress.

A rapid PCR-free next-generation sequencing method for comprehensive diagnosis of chromosome disease syndromes in prenatal samples.

The aim of this study is to investigate the application performance of rapid copy number variation sequencing (rCNV-seq) technology for the detection of chromosomal abnormalities during prenatal diagnosis. Samples were collected from 424 pregnant women who were at high-risk for noninvasive prenatal screening in Kunming Maternal and Child Care Hospital from January 2018 to May 2022. rCNV-seq technique was used to detect fetal chromosome abnormalities and compare the results with that of chromosomal karyotype analysis. The Result showed that 330 (77.83%, 330/424) cases indicated chromosomal abnormalities among 424 high-risk pregnant women who underwent rCNV-seq. Moreover, 94 (22.17%, 94/424) cases were discovered to have copy number variations. Among the 330 fetuses with chromosomal abnormalities, common autosomal aneuploidy was observed in 203 cases (47.87%, 203/424) and sex chromosome aneuploidy was observed in 91 cases (21.46%, 91/424). Moreover, the abnormalities in multiple chromosomes were discovered in 33 cases (7.78%, 33/424), and the rare autosomal aneuploidy was observed in 3 cases (0.71%, 3/424). There were 63 fetuses (14.86%, 63/424) with pathogenic CNVs among the 94 fetuses with variable copy numbers. Of the 245 pregnant women who voluntarily selected G-band karyotyping, 1 fetus with copy number variation had normal karyotype results, and the remaining women were consistent with rCNV-seq. Our study revealed that rCNV-seq has higher accuracy in detecting common trisomy and can also detect chromosomal microdeletions or microduplications that cannot be detected by G-banding karyotype analysis. There is no effective treatment for chromosomal diseases, so it is particularly important to prevent chromosomal diseases through genetic counseling and prenatal diagnosis of chromosomal diseases.

Performance of the first-trimester Fetal Medicine Foundation competing risks model for preeclampsia prediction: an external validation study in Brazil

Background: The current version of the Fetal Medicine Foundation competing risks model for preeclampsia prediction has not been previously validated in Brazil.Objectives: (1) To validate the Fetal Medicine Foundation combined algorithm for the prediction of preterm preeclampsia in the Brazilian population and (2) to describe the accuracy and calibration of the Fetal Medicine Foundation algorithm when considering the prophylactic use of aspirin, by clinical criteria.Study design: Cohort study, including consecutive singleton pregnancies undergoing preeclampsia screening at 11-14 weeks, examining maternal characteristics, medical history, and biophysical markers between October 2010 and December 2018 in a university hospital in Brazil. Risks were calculated using the 2018 version of the algorithm available on the Fetal Medicine Foundation website, and cases were classified as low- or high-risk using cut-off of 1/100 to evaluate predictive performance. Expected and observed cases with PE according to the FMF estimated risk range (≥1 in 10; 1 in 11 to 1 in 50; 1 in 51 to 1 in 100; 1 in 101 to 1 in 150; and <1 in 150) were compared. After identifying high-risk pregnant women who used aspirin, the treatment effect of 62% reduction in preterm preeclampsia identified in the ASPRE trial was used to evaluate the predictive performance adjusted for the effect of aspirin. The number of potentially unpreventable cases in the group without aspirin use was estimated.Results: Among 2,749 pregnancies, preterm preeclampsia occurred in 84 (3.1%). With a risk cut-off of 1/100, the screen-positive rate was 25.8%. The detection rate was 71.4%, with a false positive rate of 24.4%. The area under the curve was 0.818 (95% confidence interval 0.773 to 0.863). In the risk range ≥1/10, there is an agreement between the number of expected and observed cases, and in the other ranges, the predicted risk was lower than the observed rates. Accounting for the effect of aspirin resulted in an increase in detection rate and positive predictive values and a slight decrease in the false positive rate. With 27 cases of preterm preeclampsia in the high-risk group without aspirin use, we estimate that 16 of these cases of preterm preeclampsia would have been avoided if this group had received prophylaxis.Conclusions: In a high prevalence setting, the Fetal Medicine Foundation algorithm can identify women who are more likely to develop preterm preeclampsia. Not accounting for the effect of aspirin underestimates the screening performance.

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

Triglyceride-glucose index in early pregnancy predicts the risk of gestational diabetes: a prospective cohort study

ObjectiveThis study aimed to investigate the association between the triglyceride-glucose (TyG) index in early pregnancy and the development of gestational diabetes mellitus (GDM) in the second trimester. The primary objectives were to evaluate the predictive potential of the TyG index for GDM, determine the optimal threshold value of the TyG index for GDM assessment, and compare the predictive performance of the TyG index alone versus its combination with maternal age and pre-pregnancy body mass index on GDM. Moreover, the study explored the association between the TyG index in early pregnancy and the risk of other pregnancy-related complications (PRCs), such as placental abruption and gestational hypertension.Patients and methodsThis prospective cohort study recruited 1,624 pregnant women who underwent early pregnancy antenatal counseling and comprehensive assessments with continuous monitoring until delivery. To calculate the TyG index, health indicators, including maternal triglycerides and fasting plasma glucose, were measured in early pregnancy (< 14 weeks of gestation). The predictive power of the TyG index for evaluating GDM in Chinese pregnant women was determined using multifactorial logistic regression to derive the odds ratios and 95% confidence interval (CI). Subgroup analyses were conducted, and the efficacy of the TyG index in predicting PRCs was assessed via receiver operating characteristic (ROC) curve analysis and restricted cubic spline, with the optimal cutoff value calculated.ResultsLogistic regression analyses revealed a 2.10-fold increase in the GDM risk for every 1-unit increase in the TyG index, after adjusting for covariates. The highest GDM risk was observed in the group with the highest TyG index compared with the lowest quintile group (odds ratios: 3.25; 95% CI: 2.23–4.75). Subgroup analyses indicated that exceeding the recommended range of gestational weight gain and an increased GDM risk were significantly associated (P = 0.001). Regarding predictive performance, the TyG index exhibited the highest area under the curve (AUC) value in the ROC curve for GDM (AUC: 0.641, 95% CI: 0.61–0.671). The optimal cutoff value was 8.890, with both sensitivity and specificity of 0.617.The combination of the TyG index, maternal age, and pre-pregnancy body mass index proved to be a superior predictor of GDM than the TyG index alone (AUC: 0.672 vs. 0.641, P < 0.01). After adjusting for multiple factors, the analyses indicated that the TyG index was associated with an increased risk of gestational hypertension. However, no significant association was noted between the TyG index and the risk of preeclampsia, placental abruption, intrauterine distress, or premature rupture of membranes.ConclusionThe TyG index can effectively identify the occurrence of GDM in the second trimester, aligning with previous research. Incorporating the TyG index into routine clinical assessments of maternal health holds significant practical implications. Early identification of high-risk groups enables healthcare providers to implement timely interventions, such as increased monitoring frequency for high-risk pregnant women and personalized nutritional counseling and health education. These measures can help prevent or alleviate potential maternal and infant complications, thereby enhancing the overall health outcomes for both mothers and babies.

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

In the current times, fetal growth monitoring has become readily available with the help of Doppler ultrasound. Identification of pregnancies that are at risk for perinatal morbidity and mortality has been a primary goal of obstetric care. Doppler study is a fast, non-invasive test that provides significant information about the hemodynamic status of the fetus. It is an efficient diagnostic modality to assess fetal compromise, which helps in timely intervention in high-risk pregnancies for better perinatal outcomes. The objectives of this study were to know the correlation between antenatal Doppler findings and perinatal outcomes, including preterm labor, cesarean section, birth weight, and rate of admission of neonates in the neonatal intensive care unit (NICU). Admission to NICU was taken as the primary outcome. This is a tertiary care hospital-based prospective study done at Maharaja Agrasen Medical College, Agroha, India. A hundred high-risk pregnant women with oligohydramnios, intrauterine growth restriction (IUGR), pregnancy-induced hypertension (PIH), diabetes mellitus (DM), anemia, or Rh incompatibility were included. Pregnancies in the first and second trimestersand congenital anomalies in babies were excluded from the study. The patients were examined for a Doppler study of the umbilical artery, fetal middle cerebral artery (MCA), and both maternal uterine arteries. Parameters in the form of a resistance index (RI), pulsatility index (PI), and systolic/diastolic ratio (S/D) of all the arteries were taken. Details of delivery and fetal outcomes were recorded. Data were correlated with Doppler findings. For comparing categorical data, the chi-square (X2) test and Fisher's exact test were performed. The comparison of continuous data between the two groups was done using an independent t-test. All statistical calculations were done using the computer programIBM SPSS Statistics for Windows, version 25 (released 2015; IBM Corp., Armonk, New York, United States). All the 100 cases with either normal or abnormal Dopplerwere comparable in terms of maternal age and parity. The prevalence of oligohydramnios was 27% (N = 27), PIH was seen in 20% (N = 20), anemia in 19% (N = 19), IUGR in 12% (N = 12), and oligohydramnios with IUGR in 13% (N = 13). In oligohydramnios, maternal anemia, Rh incompatibility, and DM, Doppler was found to be normal. In PIH, IUGR, and oligohydramnios with IUGR, abnormal Doppler was seen in four (20%), two (16%), and 10 (76%) cases, respectively. Among 84 candidates with normal Doppler, 49 (58%) got delivered by the vaginal route. Out of 16 abnormal Doppler cases, five were vaginally delivered (31%). Among 16 patients with abnormal Doppler, 15 patients, i.e., 93.75%, had low birth weight (LBW, <2.5 kg) (p-value < 0.001), 93.75% (N = 15) delivered before 37 weeks, and 13 (81.25%) newborns were admitted in the nursery. Abnormal Doppler was associated with an increased rate of low birth weight and admissions to the NICU with no effect on preterm delivery or cesarean section rates. The study strengthens the fact that Doppler studies in mothers can be used to plan the mode of delivery, predict the need for resuscitation, and anticipate the outcome of newborns.

Anxiety Levels among High-risk Pregnant Women in a Selected Hospital of Bagalkot

Anxiety Levels among High-risk Pregnant Women in a Selected Hospital of Bagalkot

Factors Related to Husband's Involment in Antenatal Care Visits in High Risk Pregnant Women

High-risk pregnancy is a pregnancy that can cause harm and complications to the mother and fetus during pregnancy, childbirth or after delivery compared to normal pregnancy and childbirth. The aim of this research is to determine "Factors Associated with Husband's Involvement in Antenatal Care Visits for High Risk Pregnant Women". The design in this research is cross-sectional. The sample in the study was 187 people. The validated questionnaire was used in collecting data for this research. and analyzed univariately using frequency distribution, bivariate using chi-square test, and multivariate using logistic regression test. The research results showed that age (p=0.875), education (p=0.004), income (p=0.015). Based on the multivariate results, it was found that the most dominant factor related to husband's involvement in antenatal care visits was education with the highest OR value of 0.139.

Outbreak investigation of Serratia marcescens bloodstream infection in an obstetric ward for high-risk pregnant women

BackgroundSerratia marcescens is a gram-negative bacterium that is widespread in the environment. S. marcescens bacteremia can be fatal during pregnancy and cause persistent chorioamnionitis. This study reports an outbreak of Serratia marcescens bloodstream infection (BSI) among high-risk pregnant women in an obstetric ward. The purpose of this study is to report our experience with the usefulness of the ATP test in hospital environmental management and to confirm that bloodstream infections of patients with the same strain were correlated by WGS testing.MethodsThis retrospective study collected the data of inpatients with S. marcescens bacteremia in obstetric ward for high-risk pregnant women from August 22, 2021, to October 14, 2021. We performed: an adenosine triphosphate (ATP) bioluminescence test in the environment with a high-contact area; environmental culture; on-site monitoring and staff education; and whole-genome sequencing (WGS) to evaluate genetic relationships among S. marcescens isolates.ResultsS. marcescens BSI occurred in four consecutive patients. None of the patients had central venous catheters. An ATP bioluminescence test revealed that high-contact areas and areas for injection preparation were not clean (≥ 1000 relative light units). However, S. marcescens was not identified in the environmental cultures, likely due to intensive environmental cleaning and discarding of potentially contaminated specimens before the culture test. On-site monitoring and education were conducted for 1 month. There were no further reports of BSI until 6 months after the last patient was discharged. WGS performed on three isolates from three patients indicated that the isolated S. marcescens was likely from the same strain.ConclusionsWe controlled an S. marcescens outbreak by improving environmental cleaning as well as education of and behavior changes in healthcare workers. Using the ATP bioluminescence test can provide feedback on environmental cleaning and education. WGS played a role in determining the spread of BSI caused by the same strain.

Can placental shear wave elastography predict preeclampsia in high-risk pregnant women during second trimester? Insights from a prospective cohort study

BackgroundPreeclampsia, a condition very frequently linked to maternal and fetal deaths worldwide, remains a pressing concern due to delays in recognition and response. Effective screening tests for early detection of high-risk cases and appropriate preventive measures are currently lacking. Well planned prenatal care, timely detection, monitoring, and appropriate management are vital to prevent preeclampsia-related fatalities.MethodsThis prospective study evaluated the use of shear wave elastography (SWE) in identifying placental structural issues caused by preeclampsia in high-risk pregnancies. A total of 143 high-risk pregnant women with singleton pregnancies and an anterior placental position were included in the study.ResultsWomen with preeclampsia exhibited significantly elevated SWE values in both center (27.98 ± 16.12 vs. 4.57 ± 6.57 kPa) and peripheral areas of the placenta (29.14 ± 16.12 vs. 4.80 ± 7.70 kPa) when compared to non-preeclampsia women (p = 0.000). Cutoff values of 8.70 kPa and 8.15 kPa at the Center and edge of the placenta respectively, accurately predicted preeclampsia in second-trimester pregnancies, with 84.62% sensitivity and 94% specificity. However no significant difference was observed between elastography values obtained from the center and edge of the placenta.ConclusionsIn conclusion, shear wave elastography can help diagnose preeclampsia early by assessing placental stiffness.

Maternal-fetal attachment among pregnant women at risk for mental health: A Comparative Study

&lt;b&gt;Aim:&lt;/b&gt; In this study, it was aimed to determine maternal-fetal attachment among pregnant women at risk for mental health.&lt;br /&gt; &lt;b&gt;Methods:&lt;/b&gt; This cross-sectional study was conducted with 404 women between June 10, 2023 and August 1, 2023. Data were collected with the Personal Information Form, the Maternal Antenatal Attachment Scale (MAAS), and the General Health Questionnaire (GHQ-28). The data were evaluated according to the General Health Questionnaire (GHQ-28) mean score, by dividing them into two groups as those at risk for mental health and those without risk for mental health.&lt;br /&gt; &lt;b&gt;Results:&lt;/b&gt; The MAAS mean score of the women participating in the study was 67.78±9.66, and the mean scores of the subscales of "Attachment Quality" and "Time Spent on Attachment" of the MAAS were 40.82±55.33 and 26.95±5.62, respectively; it was determined that the mean score they got from the GHQ-28 was 2.98±3.81. Between the groups with high-risk and non-risky pregnancies, the mean scores of the MAAS and the subscale of Attachment Quality were found to be higher in non-risky pregnancies (p&amp;lt;0.05). Additionally, it was determined that the mean score of “Time Spent on Attachment” of non-risky pregnant women was higher than that of high-risk pregnant women, but there was no statistically significant difference between the groups (p&amp;gt; 0.05). The GHQ-28 mean score was lower in non-risky pregnant women (p&amp;lt;0.05).&lt;br /&gt; &lt;b&gt;Conclusion&lt;/b&gt;: In the study, it was determined that the maternal-fetal attachment levels of pregnant women with psychological risk were low. Therefore, the results suggest that it is necessary to determine mental problems in pregnant women and to conduct screening programs more frequently.

The effect of virtual reality and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests: Randomized controlled trial

BackgroundPrenatal tests cause high-risk pregnant women to experience high anxiety levels. AimThis paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs). MethodsThis was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT). ResultsThe VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) ConclusionVirtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing.

Exploring the relationship of perinatal depression regarding body image dissatisfaction, intuitive eating, and gestational and social factors in high-risk pregnancy

To assess the prevalence of depressive symptoms and associated factors (i.e.: intuitive eating, body image dissatisfaction, and gestational and sociodemographic factors) in high-risk pregnant women. This cross-sectional study included 139 pregnant women, assisted by high-risk prenatal care in a university hospital in northeastern Brazil between January and May 2021. Self-report instruments were used to evaluate depressive symptoms, body image dissatisfaction, and intuitive eating (i.e.: Beck Depression Inventory, Body Shape Questionnaire, and Intuitive Eating Scale-2). Depressive symptoms were found in 33.09% of the sample, especially among women with lower education. Depressive symptoms, body image dissatisfaction, and intuitive eating were correlated (p&lt;0.001; depression and body image dissatisfaction r=0.53; depression and intuitive eating r=-0.32; body image dissatisfaction and intuitive eating r=-0.39). Women presenting more depressive symptoms made more choices based on emotional reasons and with less attention to body-food congruence. This study has unveiled a notable occurrence of depressive symptoms within the examined group of high-risk pregnant women, particularly among those with limited educational backgrounds. The findings also highlight that positive eating behaviors, such as intuitive eating, and body image satisfaction are less displayed when there are high levels of depressive symptoms. These results emphasize the critical necessity for understanding of depression correlations with behaviors capable of exerting an influence on, or exacerbating, clinical conditions among high-risk pregnant individuals remains imperative.

Aspirin administration from early pregnancy versus initiation after 11 weeks of gestation for prevention of pre-eclampsia in high-risk pregnant women: Study protocol for randomized controlled trial.

Pre-eclampsia (PE) is a multiorgan disorder that affects 2-5% of all pregnant women. Present recommendations for when to start aspirin in high-risk women are after 11 wk of gestation. We present a protocol to investigate the effectiveness of aspirin use from early pregnancy, which is a randomized controlled trial to assess whether prescribed low-dose aspirin from early pregnancy reduces the prevalence of early and late-onset PE. Additionally, to compare the effectiveness of aspirin administration before and after 11 wk in reducing the occurrence of PE? All pregnancies at risk of PE, according to demographic and midwifery history, who are referred to the Maternal-Fetal Clinic of Tehran University hospital, Tehran, Iran were invited to take part in the trial. The outcomes of pregnancy and newborns will be gathered and analyzed. The first registration for the pilot study was in January 2023, and the participants were recognized as high-risk for PE. In addition, enrollment in the main study will begin as of October 2023.

Pre-Pregnancy Transvaginal Double Cervico-Isthmic Cerclage To Treat Women With Previous Conventional Failed Cerclage For Cervical Insufficiency: A Novel Modification of Treatment

Objective: To report pregnancy outcome following a pre-pregnancy transvaginal cervico-isthmic cerclage using a double non-absorbable synthetic polyester thread in a population of high-risk pregnant women. Methods: A retrospective descriptive study with a continuous series of 76 women presenting with at least one prior prophylactic failure of McDonald cerclage and submitted a pre-gestational transvaginal cervico-isthmic cerclage by the same surgical team between 2010 and 2019. The pregnancy outcome was analyzed for the first subsequent pregnancy of 64 women. The main outcome measure was the overall survival rate. Results: The median age of the patients was 30 years (SD 4.9; range 19-45 years). No intra-operative complication occurred. The median operating time was 39.8 minutes (range 35.5-55.8 min). Cesarean delivery was systematically performed in all patients. The mean gestational age at delivery was 35.5 weeks (SD 5.67; range 16-39 weeks), term birth rate (≥37 weeks) was 64.1%; 84.4% of babies were delivered at ≥34.0 weeks gestation. The overall neonatal survival rate was 94%. Conclusion: The pre-conceptional transvaginal cervico-isthimic cerclage here described as Shirodkar-Barini surgery is safe and results in high percentage of live born babies and low prematurity rate on the following pregnancy, in the patients with heavy obstetrics past suggestive of cervical incompetence and previous prophylactic McDonald’s failure

Assessing the Impact of Patient Characteristics on Genetic Clinical Pathways: A Regression Approach

Molecular genetic techniques allow for the diagnosing of hereditary diseases and congenital abnormalities prenatally. A high variability of treatments exists, engendering an inappropriate clinical response, an inefficient use of resources, and the violation of the principle of the equality of treatment for equal needs. The proposed framework is based on modeling clinical pathways that contribute to identifying major causes of variability in treatments justified by the clinical needs’ variability as well as depending on individual characteristics. An electronic data collection method for high-risk pregnant women addressing genetic facilities and laboratories was implemented. The collected data were analyzed retrospectively with two aims. The first is to identify how the whole activity of genetic services can be broken down into different clinical pathways. This was performed by building a flow chart with the help of doctors. The second aim consists of measuring the variability, within and among, the different paths due to individual characteristics. A set of statistical models was developed to determine the impact of the patient characteristics on the clinical pathway and its length. The results show the importance of considering these characteristics together with the clinical information to define the care pathway and the use of resources.

Management of Pregnant Women with Mental Disorders Requires Attention to Gestational Diabetes Mellitus.

Psychiatric interventions may be required during pregnancy. In the aspect of the management of psychiatric symptoms and the consideration of the need for pharmacotherapy, possibly to manage the effects on the fetus, pregnant women with mental disorders are considered high risk as other physical illnesses. We investigated the characteristics of pregnant women with psychiatric disorders compared with high-risk pregnant women with physical illnesses at our university hospital and the effects of psychotropic drug use on pregnant women with mental disorders and their children. In a multivariate analysis of 1282 pregnant women, excluding those with multiple pregnancies who gave birth at our hospital between January 2017 and the end of December 2019, we evaluated the effects of mental disorders and the use of psychotropic drugs throughout at least the third trimester up to the day of delivery on obstetric complications and infants. All data were collected retrospectively. Ninety-nine pregnant women had mental disorders and 62 took psychotropic drugs. Among multiple factors, pregnant women with mental disorders were associated with significantly higher rates of smoking and gestational diabetes mellitus (GDM) and significantly lower child abnormalities. The cause or effect was difficult to determine; however, the use of antipsychotics or antidepressants was also significantly associated with GDM, while psychotropic use was not related to any of the other factors investigated in this study. Attention to GDM might be important in the management of pregnant women with mental disorders.