History Of Delivery Research Articles

Efficacy of Manual Vacuum Aspiration versus Dilatation and Curettage in First Trimester Miscarriages

Objective: To compare the efficacy of Manual Vacuum Aspiration (MVA) with Dilatation and Curettage (DNC) in miscarriages of the first trimester. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology CMH, Peshawar Pakistan, from Feb to Aug 2018. Methodology: A total number of 182 Adult female (20-35 years of age) patients having miscarriage during the first trimester who were either primigravida or with previous history of spontaneous vaginal delivery were included in this study. Patients were assigned randomly into Manual vacuum aspiration (MVA) and Dilatation and Curettage (DNC) groups using the draw randomization technique. Data regarding the efficacy of both procedures and procedural success rate was measured in all patients. Results: A total of 182 Adult female patients, with a mean age of 30.53+5.23 years, having miscarriage in the first trimester, were evaluated. The mean gestational age at the time of abortion was 8.64+1.30 weeks, and the mean parity of study females was 1.96±0.82. The procedure was successfully done in 87(95.6%) patients in the MVA Group versus 84(92.3%) in the D&C Group (p-value 0.35). Conclusion: Manual vacuum aspiration (MVA) is an effective and safe method of abortion with a success rate comparable to that of Dilatation and Curettage (D&C).

A prospective study of antepartum anxiety screening in patients with and without a history of spontaneous preterm birth

Maternal stress has been identified as one of the most common clinical phenotypes associated with preterm birth. The American College of Obstetricians and Gynecologists recommends anxiety screening at least once in the perinatal period. The prevalence of perinatal anxiety is challenged by the absence of formalized screening protocols and underreporting in high-risk populations, such as those with a history of adverse pregnancy outcomes. This study administered a validated anxiety screening tool in a cohort of patients with and without a previous spontaneous preterm birth and compared differences in score and rate of a positive screen between groups. Moreover, this study evaluated perinatal outcomes associated with a positive screen and described a referral protocol involving evaluation by a perinatal mental health counselor and clinical diagnoses. A hypothesis was made that patients with a previous history of spontaneous preterm birth would have higher self-reported anxiety symptoms than controls and that those with recurrent preterm delivery at <35 weeks of gestation would have the highest anxiety screening scores. This was a prospective observational cohort study administering the Generalized Anxiety Disorder 7-item screen to patients enrolled in 2 prenatal care clinics at our institution. The preterm birth cohort consisted of patients with a history of spontaneous preterm labor, premature rupture of membranes, or cervical insufficiency compared with the control cohort without this history. Screening was initiated at entry to prenatal care or referral to our high-risk obstetrical clinic. The inclusion criteria included English- or Spanish-speaking patients and singleton pregnancy, and the exclusion criteria included pregnancies complicated by a major congenital anomaly, enrollment after 34 weeks of gestation, delivery at <20 weeks of gestation, and incomplete delivery data. Referral to a mental health counselor was offered to those with a Generalized Anxiety Disorder 7-item screen score of ≥10. Perinatal outcomes as a comparison between the Generalized Anxiety Disorder 7-item screen-positive group and Generalized Anxiety Disorder 7-item screen-negative group were performed with statistical methods, including the Student t test, chi-square test, and Wilcoxon rank-sum test, with a P value of <.05 to determine significance. Between September 2020 and December 2021, 1349 participants were analyzed, with 143 patients (11%) in the previous preterm birth cohort and 1206 (89%) patients in the control cohort. Patients with a history of preterm birth and subsequent delivery at ≤35 weeks of gestation in the study pregnancy had significantly higher Generalized Anxiety Disorder 7-item screen scores than controls with delivery after 35 weeks of gestation (median score: 4 [interquartile range, 1-9] vs 2 [interquartile range, 0-6], respectively; P=.006). Overall, 187 participants (14%) screened positive with significantly higher rates in the previous preterm birth group than in the control group (20% vs 13%; P=.036). Of note, 117 patients (63%) accepted a referral, and 32 patients (17%) with a positive screen were diagnosed with a perinatal mood disorder. Patients with recurrent preterm birth have higher self-reported anxiety using the Generalized Anxiety Disorder 7-item screen than controls. Of those with a positive screen, 17% were diagnosed with a perinatal mood disorder.

Significance of site-specific factors to peat accumulation indicated by differences in Holocene histories of dust delivery and peat deposition at two neighboring locations in the Altai Mountains, northwestern China

Peatlands can archive exceptional paleoenvironmental histories of dust delivery because of their uninterrupted and elevated accumulation rates, yet long-term records of dust deposition and its effect on peat accumulation are rare in the arid and semiarid Asian regions that can be major dust sources. We present here high-resolution Holocene peat accumulation and paleodust records from the Tielishahan (TLSH) and Halashazi (HLSZ) peatlands in the Altai Mountains of northwestern China. We find that although the two peatlands share common histories of external climate forcing and dust delivery, they have significantly different long-term rates of peat accumulations. Peat deposition initiated ~2 kyr earlier in the HLSZ peatland than in the TLSH peatland, exhibiting higher peat accumulation rates and greater mineral dust fluxes during the early Holocene, but it has constantly smaller values from the mid-Holocene to the present. The TLSH peatland has a higher peat accumulation rate and mineral dust flux during the early Holocene, lower values during the mid-Holocene, and increasing values during the latest Holocene. The elemental proxies in the two peat cores indicate that atmospheric deposition is the major factor in controlling delivery of mineral elements in HLSZ peatland, whereas elemental delivery in the TLSH peat record is affected by both the regional atmospheric dust flux and the water table under this sequence.We also find that peat accumulation is closely related to mineral dust deposition, as most Asian locations generally share similar patterns in long-term peat accumulation and dust deposition. We postulate that increased aridity in the dust sources of arid central Asia and stronger westerly winds induced by negative NAO variations are key drivers on greater dust deliveries. We further postulate that local factors, such as site-specific differences in permafrost thawing, the areas of the peatlands, and their hydrology are the main reasons for the asynchronous Holocene histories of these two neighboring peatlands. These local factors should be considered when interpreting long-term paleoclimate records from rates of peat accumulation and paleodust delivery.

Natural history of neonatal radial nerve palsy.

IV.

Circulating Metabolomic Associations with Neurocognitive Outcomes in Pediatric CKD.

Children with CKD are at risk for impaired neurocognitive functioning. We investigated metabolomic associations with neurocognition in children with CKD. We leveraged data from the Chronic Kidney Disease in Children (CKiD) study and the Neurocognitive Assessment and Magnetic Resonance Imaging Analysis of Children and Young Adults with Chronic Kidney Disease (NiCK) study. CKiD is a multi-institutional cohort that enrolled children aged 6 months to 16 years with eGFR 30-90 ml/min per 1.73 m 2 ( n =569). NiCK is a single-center cross-sectional study of participants aged 8-25 years with eGFR<90 ml/min per 1.73 m 2 ( n =60) and matched healthy controls ( n =67). Untargeted metabolomic quantification was performed on plasma (CKiD, 622 metabolites) and serum (NiCK, 825 metabolites) samples. Four neurocognitive domains were assessed: intelligence, attention regulation, working memory, and parent ratings of executive function. Repeat assessments were performed in CKiD at 2-year intervals. Linear regression and linear mixed-effects regression analyses adjusting for age, sex, delivery history, hypertension, proteinuria, CKD duration, and glomerular versus nonglomerular diagnosis were used to identify metabolites associated with neurocognitive z-scores. Analyses were performed with and without adjustment for eGFR. There were multiple metabolite associations with neurocognition observed in at least two of the analytic samples (CKiD baseline, CKiD follow-up, and NiCK CKD). Most of these metabolites were significantly elevated in children with CKD compared with healthy controls in NiCK. Notable signals included associations with parental ratings of executive function: phenylacetylglutamine, indoleacetylglutamine, and trimethylamine N-oxide-and with intelligence: γ -glutamyl amino acids and aconitate. Several metabolites were associated with neurocognitive dysfunction in pediatric CKD, implicating gut microbiome-derived substances, mitochondrial dysfunction, and altered energy metabolism, circulating toxins, and redox homeostasis. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_17_CJN0000000000000318.mp3.

Differential diagnosis of bulging scalp: beyond cephalohematoma and subgaleal hematoma

A 30-day-old infant was brought to the pediatric emergency room with a bulge in the scalp in the parieto-occipital region, mobile and without associated phlogistic signs. He had no history of fever or any other complaints. The mother reported that the bulge appeared at 20 days of life and showed progressive growth. There was no history of trauma. The boy was born at term by cesarean delivery due to cephalopelvic disproportion.&#x0D; For initial evaluation, skull X-ray and cerebral ultrasound were performed (Figure 1). A magnetic resonance imaging and tomography of the brain were also performed (Figure 1). &#x0D; Faced with the diagnostic challenge, neurosurgery proceeded with drainage of the collection and biopsy of the galea. No malignant cells were found and the biopsy only found an inflammatory change. Given these findings, the diagnosis of delayed subaponeurotic fluid collection (DSFD) was made. There was no recurrence of the collection and the patient had a good evolution.&#x0D; DSFD are a rare condition, which occurs spontaneously between the 4th and 18th week of life, and makes the differential diagnosis with cephalohematoma, caput succedeneum and subgaleal hematoma [1]. Its pathophysiology is not fully elucidated; however, most reports share a similar history of prolonged or instrumented delivery [1,2]. Patients are otherwise healthy and with no history of trauma [2].&#x0D; The management of DSFD is conservative and the natural history is spontaneous resolution within 1 to 2 months [1,2].

Role of Vaginal Progesterone in Prevention of Preterm Labour in Patients with History of Spontaneous Preterm Delivery

Role of Vaginal Progesterone in Prevention of Preterm Labour in Patients with History of Spontaneous Preterm Delivery

EARLY FETAL GROWTH RETARDATION IN PREGNANT WOMEN WITH HYPERTENSIVE DISORDERS

Fetal growth retardation (FGR) is a complication of pregnancy that develops due to placental insufficiency and leads to the birth of a child with mass and growth parameters below the 10th percentile for a given gestational age. Newborns with FGR are at high risk of developing motor, neurological, cognitive and learning disorders, as well as cerebral palsy. Purpose. To determine the frequency, risk factors and perinatal outcomes in case of early fetal growth retardation (up to 32 weeks of gestation) in pregnant women with hypertensive disorders. Materials and methods. A retrospective analysis of delivery histories was performed in 116 (8.95%) cases in pregnant women with hypertensive disorders. Hypertensive disorders included: gestational hypertension - 27 (23.2%), chronic arterial hypertension combined with preeclampsia - 18 (15.5%), severe preeclampsia - 35 (30.2%), moderate preeclampsia - 36 (31.1%) cases. Early fetal growth retardation (up to 32 weeks of gestation) was in 32 (26.8%) cases, late fetal growth retardation - in 84 (73.2%) cases. Perinatal losses occurred in 4 (34.4%o) cases in pregnant women with early FGR. Results. Pregnant women with hypertensive disorders most often had concomitant kidney disease, hypertension, obesity of II-III degree, and varicose veins. The highest percentage of newborns with FGR as in pregnant women with chronic arterial hypertension of 2-3 grades (38.9%) and in women with severe preeclampsia (31.4%). The lowest average body weight (1260±52 g) was in newborns whose mothers had blood pressure above 200/130 mm Hg. The highest average body weight (1485±85 g) was in newborns whose mothers had blood pressure up to 160/100 mm Hg. Conclusions. Thus, pregnant women with hypertensive disorders are at high risk of developing a serious complication - early fetal growth retardation. The highest risk of uteroplacental circulation disorders is in pregnant women with chronic hypertension of 2-3 grades and severe preeclampsia.

Mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district, Uganda- a qualitative study.

In Uganda 27% of deliveries take place outside a health facility. The existing gaps in quality of maternal and newborn health care must be addressed for Uganda to attain its health targets and consequently its economic targets. Some of the gaps include but are not limited to; ill-equipped healthcare facilities in rural settings, inadequate client/customer care skills by healthcare providers, and health worker absenteeism especially in the night hours. In Kaberamaido District, only 38.3% of the deliveries in Alwa sub county took place at a health facility. Despite the district local government and stakeholder efforts to promote health facility-based deliveries, sadly, a very low proportion of women use the health facilities for delivery. We sought to explore mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district. The study adopted a cross-sectional descriptive qualitative design. We purposively included 115 mothers who delivered outside the health facility and consented to participate and those who lost their babies within the last 24 months preceding the study. Other participants included in the study were village health team (VHT), traditional birth attendants (TBA) and older women. The main instruments used to collect data were focus group discussion (FGD) and in-depth interview (IDI) guides. All voice recordings from FGDs and interviews were transcribed and translated from the local language (Kumam) into English. Thematic content analysis was used to synthesize data by applying codes to segments of the transcripts upon which major domains were derived. Key findings were synthesized and quotes were carefully selected based on their relevance and representativeness to the analysis and study objective. Our findings indicated general satisfaction with the care provided during and after home delivery by TBAs as expressed by mothers. Motivation to seek services from TBAs was attributable to their vast experience spanning decades with history of safe delivery. Few mothers expressed discontent with TBA services citing abuse and rudeness. Our study underscored the common view that TBAs effectively managed home deliveries, providing satisfactory care to mothers. However, concerns emerged on TBAs' capacity to manage complications, emphasizing a need for their reintegration into formal healthcare systems, alongside further training, and standardization in maternal care practices.

Association of Parity and Previous Birth Outcome With Brachial Plexus Birth Injury Risk.

To evaluate the association of maternal delivery history with a brachial plexus birth injury risk in subsequent deliveries and to estimate the effect of subsequent delivery method on brachial plexus birth injury risk. We conducted a retrospective cohort study of all live-birth deliveries occurring in California-licensed hospitals from 1996 to 2012. The primary outcome was recurrent brachial plexus birth injury in a subsequent pregnancy. The exposure was delivery history (parity, shoulder dystocia in a previous delivery, or previously delivering a neonate with brachial plexus birth injury). Multiple logistic regression was used to model adjusted associations of delivery history with brachial plexus birth injury in a subsequent pregnancy. The adjusted risk and adjusted risk difference for brachial plexus birth injury between vaginal and cesarean deliveries in subsequent pregnancies were determined, stratified by delivery history, and the number of cesarean deliveries needed to prevent one brachial plexus birth injury was determined. Of 6,286,324 neonates delivered by 4,104,825 individuals, 7,762 (0.12%) were diagnosed with a brachial plexus birth injury. Higher parity was associated with a 5.7% decrease in brachial plexus birth injury risk with each subsequent delivery (adjusted odds ratio [aOR] 0.94, 95% CI 0.92-0.97). Shoulder dystocia or brachial plexus birth injury in a previous delivery was associated with fivefold (0.58% vs 0.11%, aOR 5.39, 95% CI 4.10-7.08) and 17-fold (1.58% vs 0.11%, aOR 17.22, 95% CI 13.31-22.27) increases in brachial plexus birth injury risk, respectively. Among individuals with a history of delivering a neonate with a brachial plexus birth injury, cesarean delivery was associated with a 73.0% decrease in brachial plexus birth injury risk (0.60% vs 2.21%, aOR 0.27, 95% CI 0.13-0.55) compared with an 87.9% decrease in brachial plexus birth injury risk (0.02% vs 0.15%, aOR 0.12, 95% CI 0.10-0.15) in individuals without this history. Among individuals with a history of brachial plexus birth injury, 48.1 cesarean deliveries are needed to prevent one brachial plexus birth injury. Parity, previous shoulder dystocia, and previously delivering a neonate with brachial plexus birth injury are associated with future brachial plexus birth injury risk. These factors are identifiable prenatally and can inform discussions with pregnant individuals regarding brachial plexus birth injury risk and planned mode of delivery.

Contraceptive plans and purchase after an induced abortion: A nationwide register study from Finland

ObjectivesTo examine the types of hormonal contraceptive methods chosen at the time of the abortion, and how they correspond to post-abortion hormonal contraceptive purchase. Study designThis was a prospective register-based study. We identified the present cohort of 8428 women undergoing induced abortion between July 1, 2017 and December 31, 2018, using the Prescription Centre, Social Insurance Institution database and the Finnish National Register of Induced Abortions. From the Register of Induced Abortions, we gathered information on planned post-abortion contraception. The redeemed prescriptions of hormonal contraception were identified from the Prescription Centre until December 31, 2019. We analyzed the hormonal contraceptive methods planned at the time of the abortion, and how they corresponded to hormonal contraceptive purchase during the 1-year follow-up. We also assessed factors (age, socioeconomic status, education, civil status, and reproductive history) affecting post-abortion contraceptive purchase by using Poisson regression models. ResultsAt the time of the abortion, 83% (n = 7023) of the women were planning to start using hormonal contraception. Planning any hormonal contraception at the time of the abortion was associated with a higher probability to purchase hormonal contraception after the abortion (incidence rate ratio [IRR] 2.30, 95% confidence intervals [CI] 2.07–2.55), especially in cases of the vaginal ring (IRR 42.66, 95% CI 33.89–53.71) and contraceptive patch (IRR 156.33, 95% CI 111.31–219.55). The following variables were associated with lower incidence rates for purchasing hormonal contraception after the abortion: educational level of bachelor at the highest or missing information on education, civil status as married or divorced, and history of delivery or induced abortion. ConclusionsThe majority of women undergoing abortion plan to use hormonal contraceptive method for post-abortion contraception. Planning any hormonal contraceptive method at the time of an induced abortion is an important predictor of purchasing the method within the year after the abortion. ImplicationsHormonal contraceptive purchase after an abortion is associated with pre-abortion contraceptive planning. Many background factors for not purchasing hormonal contraception can be identified, which may guide counseling dedicated to these groups.

Foley catheter for induction of labor after cesarean section

Induction of labor may be necessary in around twenty-five to thirty percent of a woman's subsequent pregnancies when she has already given birth through cesarean section. During our research, the objective had been to ascertain the rate of spontaneous vaginal birth, rate of cesarean section, and rate of complications that followed the induction of labor with transcervical foley catheter in females who had previously had 1 cesarean section. This retrospective cohort trial was performed in the largest city in Palestine at a tertiary teaching hospital. In subsequent pregnancy, pregnant cases with a history of a prior CS delivery (n = 306) underwent labor induction at term with a Foley catheter. Women who underwent labor induction with transcervical foley catheter at Al-Ahli Hospital in Hebron, Palestine. From April 2017 until March 2020. Our research revealed that 46.7 percent of women had spontaneous vaginal births, 14.4 percent had assisted vaginal births, and one woman experienced uterine rupture. The frequency of postpartum hemorrhage is 30 percent, the most prevalent complication. 10 percent and 5 percent of mothers experienced intrapartum and postpartum infections, correspondingly. 5% of newborns had a confirmed infection, and there was one perinatal fatality related to uterine rupture.

Breastfeeding and Antepartum Breast Milk Expression (BABE): A Randomized Control Trial Utilizing an Electric Breast Pump and its Effect on Postpartum Breastfeeding.

Objective: To evaluate the effect of antenatal breast milk expression (ABE) on exclusive breastfeeding. Materials and Methods: A randomized control study was performed with the primary outcome being formula use during the postpartum hospital stay. Secondary outcomes were the exclusive breastfeeding rate at 6 months postpartum and peripartum safety outcomes. Participants included multiparous and nulliparous patients who planned to breastfeed. Exclusion criteria included exclusively breastfeeding in prior pregnancies for greater than 6 months, medical contraindications for breastfeeding, multiple gestation, history of preterm delivery, or any contraindication to vaginal delivery. ABE group participants were instructed to pump for 20 minutes, three times daily, starting at 37 weeks of gestation. Results: Three-hundred four participants from two clinics were enrolled. There was no significant difference in formula use during hospital admission (odds ratio [OR] 0.64, 95% confidence interval [CI] 0.34-1.22) or in exclusive breastfeeding at 6 months postpartum (OR 0.66, 95% CI 0.34-1.29). Colostrum use was more prevalent in the ABE group (OR 5.31, 95% CI 2.63-10.76). ABE participants were more likely to present in spontaneous labor (OR 2.09, 95% CI 1.05-4.14). Conclusion: ABE did not significantly improve exclusive breastfeeding rates, but safely provides women opportunities to become familiar with breastfeeding before delivery and can provide readily available colostrum. There was no negative secondary safety outcome related to ABE identified. Prenatal care providers can consider recommending ABE to patients with minimal to no experience with breastfeeding.

Comparison of treatment with insulin detemir and NPH in women with gestational diabetes mellitus: glycemic control and pregnancy outcomes. A retrospective study

PurposeThe objective of this retrospective study was to compare glycemic control, pregnancy outcomes, and neonatal outcomes in women with gestational diabetes mellitus (GDM) treated with (a) insulin detemir and (b) insulin neutral protamine Hagedorn (NPH).MethodsA total of 192 women with GDM were included in the analysis. Ninety-eight women received detemir, while 94 women received NPH. Data regarding medical history, glycemic control, and time and mode of delivery, as well as neonatal outcomes, were recorded.ResultsBaseline characteristics were comparable between the two groups. There were no differences with respect to the week of insulin initiation, total insulin dose, duration of insulin therapy, daily insulin dose/weight in early and late pregnancy, or the number of insulin injections per day. Maternal overall weight gain during pregnancy and weight gain per week did not differ either. The detemir group had slightly lower HbA1c levels at the end of gestation [median: det 5.2% (33 mmol/mol) vs NPH 5.4% (36 mmol/mol), p=0.035). There were no cases of hypoglycemia or allergic reactions in the two groups. There were also no differences regarding neonatal outcomes according to the available data, given that data in some cases were missing.ConclusionThe use of insulin detemir was found to be equally effective and safe compared to NPH in women with GDM.

Screening and Prevention of Preterm Birth in Twin Pregnancies.

Twins represent 3.2% of all live births. However, they account for 20% of all preterm deliveries, 60% delivering <37 weeks, 10.7% <32 weeks, and 5 times higher risk of infant death. Risk factors for preterm birth (PTB) include the history of preterm delivery, monochorionic twins, short cervical length, and cervical surgery. Transvaginal cervical length <24 weeks is the best tool to predict PTB. Only vaginal progesterone in women with transvaginal cervical length <25mm and physical exam indicated cerclage in women with cervical dilation >1cm have shown a significant decrease in PTB and improvement in neonatal outcomes.

Risk factors for placenta previa among pregnant women of Kyiv, Ukraine: a retrospective cohort study

Placenta previa is a significant obstetric problem with elevated morbidity and mortality rates for both mother and fetus. The risks associated with placenta previa underscore the necessity for comprehensive treatment and timely intervention to mitigate adverse outcomes. Purpose - to conduct a retrospective analysis of the impact of obstetric-gynecological factors on the prediction of placenta previa occurrence and its influence on perinatal outcomes. Materials and methods. A retrospective cohort study was conducted on cases of placenta previa between 2018 and 2022. The study included 22491 deliveries, of which 65 (0.29%) cases were registered as placenta previa. Data from delivery records of 374 patients without placenta previa were used for comparison. The following variables were evaluated for all patients: maternal age, characteristics of the menstrual cycle, gravidity, parity, history of cesarean sections, gestational age at delivery, method of delivery, blood loss during delivery, length of postpartum hospitalization, birth weight, gender of the newborn, Apgar scores at 1 and 5 minutes. Gynecological intervention histories, including curettage/hysteroscopy, laparoscopy, and cervical treatment, as well as obstetric pathologies, such as cesarean section, ectopic pregnancy, instrumental abortions, missed pregnancies, and assisted reproductive technologies in the last pregnancy, were examined. Results. Multifactorial analysis revealed four significant risk factors. The risk of placenta previa was found to increase with advanced maternal age (p&lt;0.001), OR=1.14 (95% CI 1.07-1.20), and the presence of previous cesarean sections (p&lt;0.001), OR=5.51 (95% CI 2.73-11.1), while a history of previous deliveries reduced the risk (p&lt;0.001), OR=0.24 (95% CI 0.15-0.40). Instrumental abortions increased the risk of placenta previa (p=0.001), OR=2.14 (95% CI 1.20-3.81). Newborns in the placenta previa group had lower Apgar scores at 1 and 5 minutes and lower birth weight. Conclusions. The obtained results emphasize the importance of considering risk factors in assessing placenta previa occurrence during antenatal monitoring and can contribute to improving obstetric and perinatal care for women. However, the morphological and functional basis of placenta previa remains unknown and requires further study. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. No conflict of interests was declared by the authors.

Role Of Low Dose Aspirin In Preventing Preterm Birth In Patients With Previous History Of Preterm Delivery

Objective: Preterm birth (PTB) occurs between 24-37 weeks of gestation. The important risk factor for PTB is a previous PTB and currently progesterone is used for the management of recurrent spontaneous PTB. Some studies have shown good outcomes but recent studies revealed that the use of vaginal progesterone was not related to a decreased likelihood of PTB or neonatal adverse effects. Thus, the controversy in the literature suggests multiple underlying pathological mechanisms involved in the progression of PTB. This study aims to determine the role of low-dose aspirin in the prevention of preterm birth in patients with a previous history of preterm delivery. Methodology: In this randomized controlled trial, a total of 172 patients fulfilling the inclusion criteria were selected from the inpatient and outpatient departments. Patients were divided randomly into two groups (group A and group B), using random number tables. In Group A, low-dose aspirin (75mg) was given while group B was taken as a control group. Patients were called every 8 weeks in the outpatient department for the assessment of compliance and side effects of the drug. The data were entered and analyzed by using SPSS v25.0. Chi-square was used to compare the two groups for incidence of preterm birth. Relative risk (along with a 95% confidence interval) for the decrease in the incidence of preterm birth with the use of aspirin was calculated. Results: The age of participants included in the study was 18 to 40 years. The mean age of patients in group A was 33.85±5.210 years and in group B was 32.86±4.139 years. The mean fetal birth weight in group A was 2281.1962±363.125 grams and in group B was 2271.4344±374.797 grams. In the low-dose aspirin group, 10(11.6%) had preterm birth and 31(36.0%) in the control group with a p-value of 0.001, which is statistically significant. The risk of having preterm birth with low-dose aspirin was 1.801 times less than controls. Conclusion: aspirin in low dose given before 14 weeks of gestation decrease spontaneous preterm birth as compared to the control group in a woman with a history of previous preterm birth which was spontaneous

Determinants of Prelabor Rupture of Membrane among Pregnant Women Admitted to Hospitals in Wolaita Zone, Southern Ethiopia, 2022

Introduction: Prelabor rupture of membrane refers to rupture of the membranes and leakage of amniotic fluid before the onset of true labor. It can lead to significant maternal, fetal, and neonatal morbidities, resulting in mortality and lifelong complications. It complicates 8% to 10% of all pregnancies. Objective: To identify the determinants of prelabor membrane rupture among pregnant women admitted to hospitals in the Wolaita zone in southern Ethiopia in 2022. Methods and Materials: A facility-based, unmatched case-control study was conducted at selected hospitals in Wolaita zone from 15 August to 20 October, 2022. Three consecutive controls were included in the study. The study population included all pregnant women admitted to the selected hospitals. The collected data were coded, cleaned, entered into Epi data version 4.6.0.2 and exported to the Statistical Package for Social Science (SPSS) version 25.0. Bivariable and multivariable logistic regression analyses were performed to determine the association between the outcome and explanatory variables. Result: A total of 384 participants (96 cases and 288 participants) were included in this study. A history of abortion (AOR 3.21 [95% CI: 1.15–8.92]), history of prelabor rupture of membrane (AOR 3.76 [95% CI: 1.46–9.62]), history of caesarean delivery (AOR 3.57 [95% CI: 1.83–6.96]), history of invasive uterine procedures (AOR 6.23 [95% CI: 2.08–18.55]), history of chronic medical conditions (AOR 5.20 [95% CI: 1.18–23.02]), and history of ever using contraceptive methods (AOR 0.33 [95% CI: 0.19–0.58]) were significantly associated. Conclusion: Advancing health technology contributes to the early detection, treatment, and workup of obstetric complications to reduce risk and maximize fetomaternal well-being. Women of reproductive age should be encouraged to use contraceptives.

The beneficial effects of conservative treatment with biofeedback and electrostimulation on pelvic floor disorders.

Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) can be managed through conservative treatments, such as conservative management involving biofeedback (BF) and electrostimulation. This study aimed to investigate the therapeutic effects of conservative treatments on PFDs. A retrospective cohort study was conducted. Women with PFD who underwent 1-3 months of BF and electrostimulation between January 1, 2020, and January 31, 2021, were included in the study. BF treatment was administered using three sensors to monitor pelvic floor muscle activity, providing patients with immediate feedback and guidance on muscle exercises. One session lasted for 5-10 min. Electrostimulation treatment utilized a specially made pelvic belt with electrode sheets to stimulate and contract pelvic floor muscles passively. One session lasted for 15 min. Six therapies in 1 month were prescribed. Pre- and post-treatment Pelvic Floor Distress Inventory (PFDI-20) scores, including POP distress inventory 6 (POPDI-6), colorectal-anal distress inventory (CRAD-8), and urinary distress inventory 6 (UDI-6) scores, were compared. Subgroup analysis by age, menopause, body mass index (BMI), and child delivery mode was performed. The study included 51 women with PFDs (SUI, POP, frequency or urgency or nocturia, and pain) treated with BF and electrostimulation, with a mean age of 49.94 ± 13.63 years. Sixteen patients (37.1%) were menopausal, with a mean menopause age of 50 ± 5.20 years. Twenty-six patients (68.4%) had a history of normal vaginal delivery. The mean PFDI-20 scores before and after treatment were 32.67 (standard deviation [SD] 10.05) and 25.99 (SD 9.61), respectively (P < 0.001). This decrease in scores reflected an improvement in subjective perceptions of symptoms and quality of life. The POPDI-6, CRAD-8, and UDI-6 scores significantly decreased after treatment. Subgroup analysis of scores change regarding age, menopause, BMI, and child delivery mode was not statistically significant. The study demonstrated the effectiveness of BF and electrostimulation for treating women with PFDs. The findings contributed to the understanding of treatment duration, patient characteristics, and the potential benefits of a multimodal approach. Moreover, the study's diverse participant population and the use of validated outcome measures enhance the generalizability and scientific rigor of the findings.

Reproductive health factors in relation to risk of hypertension in postmenopausal women: Results from NHANES 2011-2014.

Few studies have systematically assessed the relationship between multiple reproductive factors and hypertension, and these limited studies paid more attention to age at menarche and menopause, abortion, or the number of live births, and yielded controversial results. This study aimed to explore the relationship between reproductive health factors and hypertension from 5 aspects: history of menstruation, pregnancy, delivery, gynecological surgery, and reproductive-related medication use. We analyzed data from the National Health and Nutrition Examination Survey 2011 to 2014. Data on reproductive factors were collected using a questionnaire survey. The associations between multiple reproductive factors and the risk of hypertension were assessed using multivariable logistic regression models. There were significant inverse associations between age at menopause (odds ratio [OR] = 0.984, 95% confidence interval [CI]: 0.971-0.998, P = .0234 per 1-year increase), age at first live birth (OR = 0.970, 95% CI: 0.944-0.998, P = .0346 per 1-year increase), age at last live birth (OR = 0.982, 95% CI: 0.964-0.999, P = .0488 per 1-year increase), and the risk of hypertension. In contrast, a positive association was found between the risk of hypertension and a history of gestational diabetes (OR = 1.693, 95% CI: 1.042-2.751, P = .0333), hysterectomy (OR = 1.398, 95% CI: 1.139-1.717, P = .0014), ovariectomy (OR = 1.374, 95% CI: 1.074-1.758, P = .0115), and birth control pill use (OR = 1.293, 95% CI: 1.035-1.616, P = .0236). Age at menopause but not menarche, is inversely associated with hypertension. A history of gestational diabetes, hysterectomy, ovariectomy, or birth control pills was associated with a higher risk of hypertension.