Hospital Admission For Delivery Research Articles

Evaluation of maternal serum protein biomarkers in the prenatal evaluation of placenta accreta spectrum: A systematic scoping review.

Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available. Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood-specific biomarker(s) during pregnancies with PAS at birth. PRISMA Extension for Scoping Review (PRISMA-ScR) was used to extract data and report results. Of the 441 reviewed articles, 29 met the inclusion criteria reporting on 34 different biomarkers. 14 studies were retrospective and 15 prospective overall including 18 251 participants. Six studies had a cohort design and the remaining a case-control design. Wide clinical heterogeneity was found in the included studies. In eight studies, the samples were obtained in the first trimester; in five, the samples were collected on hospital admission for delivery; and in the rest, the samples were collected during the second and/or third trimester. Measurements of serum biomarkers, some of which have been or are still used in screening for other pregnancy complications, could contribute to the prenatal evaluation of patients at risk of PAS at delivery; however, important evidence gaps were identified for suitable cutoffs for most biomarkers, variability of gestational age at sampling and the potential overlap of the marker values with other placental-related complications of pregnancy.

Cardiovascular complications during delivery hospitalizations in inflammatory bowel disease patients.

The relationship between inflammatory bowel disease (IBD) and cardiovascular outcomes among pregnant women has yet to be thoroughly investigated. Our aim is to assess the odds of cardiovascular disease and cardiac arrhythmias during hospital admissions for delivery and identify contributing factors associated with cardiovascular complications in pregnant women with IBD. We performed a retrospective analysis of data from the National Inpatient Sample, obtained from delivery admissions of pregnant women with and without IBD, identified via International Classification of Diseases codes, from 2009 to 2019. Using a regression model, we compared the odds of cardiovascular complications between these two groups, adjusting for traditional cardiovascular risk factors as confounding variables. Our study included 71,361 pregnancies with IBD and 41,117,443 pregnancies without this condition. The incidence of IBD in pregnancy rose near three-fold increase over the decade. In comparison to pregnancies without IBD, those involving pregnant patients with IBD exhibited an increased likelihood of encountering cardiovascular complications, with an adjusted odds ratio (AOR) of 1.37 (95% CI, 1.29-1.46). This heightened risk encompasses a range of conditions, including peripartum cardiomyopathy (AOR, 9.45; 95% CI, 3.86-23.15), cardiac arrhythmias (AOR, 2.03; 95% CI, 1.59-2.60), and hypertensive disorders of pregnancy (AOR, 1.51; 95% CI, 1.37-1.66), notably preeclampsia, eclampsia, and the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome). Pregnancies with IBD were also associated with three-fold higher odds of venous thromboembolism (AOR, 3.91; 95% CI, 1.45-10.48). Pregnant patients with IBD had an increased odds of cardiovascular complications during delivery admissions, independent of traditional cardiovascular risk factors. Further research is needed to elucidate the underlying mechanisms and develop targeted prevention strategies for this high-risk population.

Association of severe maternal morbidity and post-traumatic stress disorder

BACKGROUNDSevere maternal morbidity refers to the most serious complications of pregnancy. Whether severe maternal morbidity is associated with post-traumatic stress disorder is currently under active investigation.OBJECTIVEThis study aimed to examine the association between severe maternal morbidity and post-traumatic stress disorder at delivery.STUDY DESIGNThis was a retrospective cohort study querying the Healthcare Cost and Utilization Project's National Inpatient Sample, which included 12,857,721 patients for national estimates who had vaginal or cesarean deliveries between January 2016 and December 2019. Patients with mental health conditions other than post-traumatic stress disorder and substance use disorder were excluded. Severe maternal morbidity was defined according to the Centers for Disease Control and Prevention definition (a total of 21 indicators). Main outcomes were trends and characteristics related to post-traumatic stress disorder, assessed with a multivariable binary logistic regression model. Sensitivity analysis included subcohort assessment restricted to patients per clinical and obstetrical demographics.RESULTSA total of 8880 patients had a diagnosis of post-traumatic stress disorder during the hospital admission for delivery (prevalence rate, 6.9 per 10,000). The prevalence rate of post-traumatic stress disorder increased from 5.0 to 8.8 per 10,000 deliveries between 2016 and 2019. This increasing trend remained independent in multivariable analysis. The adjusted odds ratio, compared with 2016, was 1.26 (95% confidence interval, 1.19–1.35) for 2017, 1.50 (95% confidence interval, 1.41–1.60) for 2018, and 1.73 (95% confidence interval, 1.63–1.84) for 2019. Severe maternal morbidity occurred in 210,605 (1.6%) patients. Patients who had severe maternal morbidity were more likely to have a diagnosis of post-traumatic stress disorder than those without severe maternal morbidity (12.8 vs 6.8 per 10,000 deliveries; adjusted odds ratio, 1.57; 95% confidence interval, 1.39–1.78) in multivariable analysis. This association remained robust in several subcohort analyses including (1) participants aged ≤35 years (adjusted odds ratio, 1.62; 95% confidence interval, 1.41–1.86), (2) those aged ≤35 years without medical comorbidity (adjusted odds ratio, 2.01; 95% confidence interval, 1.70–2.37), and (3) those aged <35 years without medical comorbidity, cesarean delivery, and preterm delivery (adjusted odds ratio, 4.52; 95% confidence interval, 3.56–5.74).CONCLUSIONThere has been a gradual increase in the number of patients with a diagnosis of post-traumatic stress disorder at delivery in recent years among those without other mental health or substance use conditions. These data suggest that there is a possible association between severe maternal morbidity and post-traumatic stress disorder.

The impact of the COVID-19 pandemic on stress and other psychological factors in pregnant women giving birth during the first wave of the pandemic

BackgroundThe onset of mental illness such as depression and anxiety disorders in pregnancy and postpartum period is common. The coronavirus induced disease 2019 (COVID-19) pandemic and the resulting public policy responses represent an exceptional situation worldwide and there are hints for adverse psychosocial impact, hence, the study of psychological effects of the pandemic in women during hospitalization for delivery and in the postpartum period is highly relevant.MethodsPatients who gave birth during the first wave of the COVID-19 pandemic in Germany (March to June 2020) at the Department of Obstetrics and Gynecology, University of Würzburg, Germany, were recruited at hospital admission for delivery. Biosamples were collected for analysis of SARS-CoV-2 infection and various stress hormones and interleukin-6 (IL-6). In addition to sociodemographic and medical obstetric data, survey questionnaires in relation to concerns about and fear of COVID-19, depression, stress, anxiety, loneliness, maternal self-efficacy and the mother–child bonding were administered at T1 (delivery stay) and T2 (3–6 months postpartum).ResultsIn total, all 94 recruited patients had a moderate concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at T1 with a significant rise at T2. This concern correlated with low to low-medium general psychosocial stress levels and stress symptoms, and the women showed a significant increase of active coping from T1 to T2. Anxiety levels were low and the Edinburgh Postnatal Depression Scale showed a medium score of 5 with a significant (T1), but only week correlation with the concerns about SARS-CoV-2. In contrast to the overall good maternal bonding without correlation to SARS-CoV-2 concern, the maternal self-efficiency correlated negatively with the obstetric impairment caused by the COVID-19 pandemic.ConclusionObstetric patients` concerns regarding SARS-CoV-2 and the accompanying pandemic increased during the course of the pandemic correlating positively with stress and depression. Of note is the increase in active coping over time and the overall good mother–child-bonding. Maternal self-efficacy was affected in part by the restrictions of the pandemic.Clinical trial registration DRKS00022506

Associations between prenatal exposure to polybrominated diphenyl ethers and physical growth in a seven year cohort study.

Although evidence suggests that prenatal exposure to polybrominated diphenyl ethers (PBDEs) alter offspring's physical growth, most studies rely upon physical growth at a single timepoint, and little is known regarding their longitudinal effects over time. In the current study, we determined the associations between prenatal PBDEs exposure and child physical growth by following up 207 mother-child pairs from the Laizhou Wan Birth Cohort (LWBC) from pregnancy until the children were seven years old. Child physical growth including weight, height, and body mass index (BMI) was assessed at birth, and at one, two and seven years of age. Prenatal exposure to PBDEs was quantified by measuring eight PBDE congeners (BDE-28, BDE-47, BDE-85, BDE-99, BDE-100, BDE-153, BDE-154, and BDE-183) in maternal serum samples collected upon hospital admission for delivery. Linear mixed models were applied to examine the associations between prenatal PBDEs exposure and repeated measures of child physical growth, and to determine whether these associations were modified by child's sex. Our findings indicated that BDE-28, BDE-85, BDE-153, BDE-183, and Σ7PBDEs were positively associated with child weight z-score; and that BDE-28, BDE-47, BDE-85, BDE-99, BDE-153, and Σ7PBDEs were positively associated with child height z-score. In addition, these associations were modified by the child's sex as reflected by pronounced positive associations among boys, while negative associations were noted among girls. In conclusion, our findings indicated the sex-specific associations between prenatal PBDE exposures and child physical growth during the first seven years of life.

Prenatal triclosan exposure and neurodevelopment at 2 years of age in Shandong, China

Background Triclosan (TCS) has been widely detected in pregnant women. Limited epidemiological studies suggest that prenatal exposure to TCS may interfere with the neurodevelopment of school-age children. However, there is a lack of evidence for effects on children in early childhood, especially in China. Methods Based on Laizhou Wan Birth Cohort in Shandong, China, TCS concentrations were measured in urine among 489 pregnant women during their hospital admission for delivery. Neurodevelopment of their children was assessed using the Gesell Development Schedules (adopted by the Chinese Pediatric Association and widely used for assessing early child development in China, including gross motor, fine motor, adaptive, language, and social domains) at 2 years of age (n=294). Linear regression and generalized linear models were used to analyze the association between prenatal TCS exposure and the toddlers’ developmental quotient scores (DQs).Results The median of maternal TCS concentrations was 0.24μg/L and 0.67μg/g creatinine. Although no association was found between prenatal TCS exposure and DQs in the five domains, adverse associations were detected after gender stratification. We found an inverse association between prenatal TCS concentrations and DQs in the language domain among boys. Specifically, for every 10-fold increase in TCS concentrations, DQs decreased by 2.13 points (β= -2.13; 95% CI: -4.06 to -0.19, p=0.03). Besides, prenatal TCS concentrations were adversely associated with DQs in the adaptive domain among boys (p-trend=0.01) and DQs in the gross motor domain among girls (p-trend=0.03) by the trend across TCS quartiles. Conclusions Based on a Chinese population, our findings suggest that prenatal TCS exposure might have adverse effects on neurodevelopment at the age of 2 in a gender-dependent manner. Further studies to replicate our findings are needed and further investigations are required to examine the potential mechanisms underlying the association between early-life TCS exposure and neurodevelopment in early childhood.

Evaluation of Knowledge, Attitudes, and Practices about Exclusive Breastfeeding among Women in Italy

Background: The aim of this study was to assess the level of knowledge, attitudes and behaviors of women about breastfeeding in Italy. Methods: A cross-sectional survey was carried out between January and June 2016 in the Campania Region among mothers who were going to six public vaccination centers. Data were collected by two researchers through face to face interviews. Results: Two thirds of the women had heard on exclusive breastfeeding (64.6%) and the 71% of them knew that exclusive breastfeeding should be practiced for at least six months. Nearly all mothers had breastfed their child (93.2%), but only 33.3% of them had practiced exclusive breastfeeding for at least six months. Women who agree that breastfeeding creates a positive relationship between the mother and the child, who practiced exclusive breastfeeding during the hospital stay, and who had received breastfeeding advice at hospital discharge were more likely to practice exclusive breastfeeding for at least six months. Conclusions: The results of this survey may be helpful to policy makers and managers when planning educational interventions on breastfeeding both during pregnancy and during hospital admissions for delivery. Indeed, there is a need to increase efforts to make mothers aware of health benefits of breastfeeding for themselves and their offspring during their hospital stay after delivery. This research has the potential to increase exclusive breastfeeding rates and subsequent maternal and child health outcomes.

Prenatal Bisphenol A exposure and early childhood neurodevelopment in Shandong, China.

Several epidemiological studies suggest that prenatal exposure to BPA may interfere with the neurodevelopment of pre-school and school-age children. However, a limited number of studies are available for effects during children at a younger age, especially in China. Based on Laizhou Wan Birth Cohort (LWBC), BPA concentrations were measured in urine among 506 pregnant women during their hospital admission for delivery and neurodevelopment of their children was assessed using the Gesell Development Schedules at 12 months (n = 368) and 24 months (n = 296). Linear regression and generalized linear models were used to analyze the association between prenatal BPA exposure and the children's developmental quotient scores (DQs). The median of maternal BPA concentration was 0.48 μg/L or 1.05 μg/g creatinine. Maternal BPA concentrations were adversely associated with children DQs at 12 months of age, with a 10-fold increase in prenatal BPA concentrations correlated to 1.43-point decrease in DQs in the adaptive domain (β = -1.43; 95% CI: -2.30 to -0.56, p = 0.001). When stratified by gender, prenatal BPA concentrations were adversely associated with the adaptive domain DQs among boys (p-trend = 0.012) and girls (p-trend = 0.028) and the social domain DQs (p-trend = 0.019) only among girls. At 24 months of age, the significant adverse association was only found in the language domain among girls (β = -1.69; 95% CI: -3.23 to -0.15, p = 0.032). Based on a Chinese population, we found potential impacts of prenatal BPA exposure on childhood neurodevelopment at 12 and 24 months of age, especially among girls.

Nonylphenol exposure is associated with oxidative and nitrative stress in pregnant women

ABSTRACTAnimal studies have shown that exposure to nonylphenol (NP) increases oxidative/nitrative stress, but whether it does so in humans is unknown. This study examines prenatal exposure to NP and its effects on oxidatively/nitratively damaged DNA, lipid peroxidation, and the activities of antioxidants. A total of 146 urine and blood specimens were collected during gestational weeks 27–38 and hospital admission for delivery, respectively. Urinary NP was analyzed by high-performance liquid chromatography (HPLC). Urinary biomarkers of oxidatively/nitratively damaged DNA and lipid peroxidation, including 8-oxo-7,8-dihydro-2’-deoxyguanosine (8-oxodG), 8-nitroguanine (8-NO2Gua), 8-iso-prostaglandin F2α (8-isoPF2α) and 4-hydroxy-2-nonenal-mercapturic acid (HNE-MA), were simultaneously analyzed using isotope-dilution liquid-chromatography/electron spray ionization tandem mass spectrometry. The activities of maternal plasma superoxide dismutase and glutathione peroxidase were analyzed by enzyme-linked immunosorbent assay. Urinary NP level was significantly associated with 8-oxodG and 8-NO2Gua levels in late pregnancy, suggesting that NP may enhance oxidatively and nitratively damaged DNA. The adjusted odds ratios for high 8-oxodG level exhibited a significantly dose–response relationship with NP levels, stratified into four quartiles. 8-oxodG appears to be a more sensitive and effective biomarker of NP exposure than 8-NO2Gua. These relationships suggest NP may play a role in the pregnancy complications.

HIV testing in the maternity ward and the start of breastfeeding: a survival analysis

ObjectiveThe purpose of this study was to analyze the influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery. MethodsCohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby‐Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan‐Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing. ResultsHospitals with median time to breastfeeding onset at birth of up to 60minutes were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR=1.75 [95% CI: 1.38 to 2.22]; RR=3.83 [95% CI: 3.03 to 4.85]) and rapid test result after birth (RR=1.45 [95% CI: 1.12 to 1.89]; RR=1.65 (95% CI: 1.35 to 2.02]), respectively; and hospitals with late onset: starting prenatal care in the third trimester (RR=1.86 [95% CI: 1.16 to 2.97]). ConclusionsThe onset of breastfeeding is postponed, even in Baby‐Friendly Hospitals, when the results of the rapid HIV test requested in the maternity are not available at the time of delivery.

HIV testing in the maternity ward and the start of breastfeeding: a survival analysis

ObjectiveThe purpose of this study was to analyze the factors that influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery. MethodsCohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby-Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan–Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing. ResultsHospitals with median time to breastfeeding onset at birth of up to 60min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR=1.75 [95% CI: 1.38–2.22]; RR=3.83 [95% CI: 3.03–4.85]) and rapid test result after birth (RR=1.45 [95% CI: 1.12–1.89]; RR=1.65 [95% CI: 1.35–2.02]), respectively; and hospitals with late onset: starting prenatal care in the third trimester (RR=1.86 [95% CI: 1.16–2.97]). ConclusionsThe onset of breastfeeding is postponed, even in Baby-Friendly Hospitals, when the results of the rapid HIV test requested in the maternity are not available at the time of delivery.

Abstract 9381: Comparison of Clinical Characteristics and Adverse Outcomes in Pregnant Women with Cardiomyopathy Subtypes at the Time of Delivery in the US: 2006-2010

Introduction: Investigation of patient characteristics and outcomes in women with cardiomyopathy (CDM) at the time of delivery has been limited. The aim of this study was to determine the clinical characteristics and outcomes in women with peripartum (PCDM) and hypertrophic cardiomyopathy (HCDM), and the predictors for adverse clinical outcomes in pregnant women at the time of delivery. Methods and Results: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with CDM subtypes (peripartum, hypertrophic and all others) from 2006-2010. Clinical characteristics and maternal outcomes were identified in women with subtypes of CDM and without. The primary outcome of interest was major adverse clinical events (MACE), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, or embolic event. Our study population consisted of 2,078 patients with CDM and 4,438,439 patients without CDM. Of those with CDM, 52 (2.5%) had HCDM, 1039 (50.0%) had PCDM, and 987 (47.5%) were classified as other CDM (OCDM). PCDM cohort was more likely to be insured by Medicaid and the HCDM patients were more likely to deliver at a teaching hospital (p&lt;0.01 for all). The PCDM and all OCDM cohorts had a larger proportion of black patients and most were from the South. PCDM patients experienced the highest rates of MACE (46%), compared with HCDM (23%) or OCDM (38.9%), mainly driven by heart failure and arrhythmia. Maternal mortality in all CDM subgroups was extremely low (&lt; 0.5%). Significant predictors of MACE in the PCDM cohort were the presence of valvular heart disease (OR 2.16, 95% CI 1.49-3.14), severe pre-eclampsia (OR 1.54, 95% CI: 1.08-2.21), and Cesarean delivery (OR 1.36, 95% CI: 1.04-1.78); delivery at a teaching hospital was associated with a reduction in MACE. In multivariable analysis, the presence of PCDM (OR 2.22, 95% CI 1.07-4.55) was independently predictive of MACE. Conclusions: Peripartum CDM patients had the highest likelihood of MACE compared to hypertrophic and all other CDM subtypes.

Prevalence of HTLV-1/2 in pregnant women living in the metropolitan area of Rio de Janeiro.

BackgroundHTLV-1/2 infection can cause severe and disabling diseases in children and adults. The aim of the study was to estimate the prevalence of HTLV-1/2 infection in pregnant women living in the metropolitan area of Rio de Janeiro.Methodology/Principal Findings1,204 pregnant women were tested upon hospital admission for delivery in two public hospitals in the cities of Rio de Janeiro and Mesquita, between November, 2012 and April, 2013. The samples were screened by chemiluminescent microparticle immunoassay (CMIA) and reactive ones were confirmed by Western blot (WB). Epi-info software was used for building the database and performing the statistical analysis. Eight patients had confirmed HTLV-1/2 infection (7 HTLV-1, one HTLV-2), equivalent to a prevalence rate of 0.66%. Two further reactive screening tests had negative Western blot results and therefore were considered negative in the statistical analysis. All HTLV-1/2-positive patients were born in Rio de Janeiro, most were non-Caucasian (87.5%), in a stable relationship (62.5%), had at least ten years of formal education (62.5%) and a monthly family income of up to US$600.00 (87.5%). There was only one case of coinfection with syphilis and none with HIV. The mean age of the infected women was 28.4 (SD = 6.3) years and of the seronegative ones was 24.8 (SD = 6.5) (p = 0.10). The median number of pregnancies were 3.0 and 1.0 (p = 0.06) and the median number of sexual partners were 3.5 and 3.0 (p = 0.33) in the seropositive and negative groups, respectively. There were no statistically significant differences between the groups.Conclusions/SignificanceA significant prevalence of HTLV-1/2 was found in our population. The socio-epidemiological profile of carrier mothers was similar to the controls. Such findings expose the need for a public health policy of routine HTLV-1/2 screening in antenatal care, since counselling and preventive measures are the only strategies currently available to interrupt the chain of transmission and the future development of HTLV-1/2-related diseases.

Pharmacologic intervention for managing uterine atony and related maternal hemorrhage: what is the most effective drug dose?

Hemorrhage remains the leading cause of maternal death and accounts for approximately 34% of the 350,000 maternal deaths annually worldwide. About 120,000 deaths annually are attributed to hemorrhage. Overall worldwide, the maternal mortality ratio (MMR) is 260/100,000, with a range from less than five in developed regions to more than 1,200 /100,000 in nations with very low income. In low-income countries, hemorrhage is the leading cause of maternal death; however, the problem remains in developed countries. From 2008-2010, there were 7.8 maternal deaths per 100,000 deliveries annually in Canada. Postpartum hemorrhage (PPH) is currently the third leading cause of maternal death in Canada, with a MMR of 1.6/100,000. In the USA, the MMR is much higher at 21/100,000 deliveries in 2010, up from 13.1 in 2006. In the USA, embolic disease, preeclampsia, and hemorrhage remain leading causes of maternal death. There are many causes of postpartum hemorrhage; however, the most prevalent cause is uterine atony. It is thought to be the etiology in over 70% of all events of postpartum hemorrhage. It is difficult to determine the contribution that uterine atony makes to maternal death from hemorrhage. In a recent study in the USA reporting a large cohort of patient data from 1995-2004 (876,641 hospital admission for delivery), 25,654 cases of PPH were identified, with uterine atony accounting for 79% of these cases. The investigators of this study found a strong association between PPH and a number of serious complications, including acute renal failure, coagulopathy, and acute respiratory failure. All of these complications were likely a consequence of hypovolemia and subsequent massive transfusion. In this cohort, PPH, secondary to uterine atony, was also a significant source of maternal mortality, accounting for approximately one-fifth of all deaths in delivering patients. When evaluating trends in PPH attributable to uterine atony, these investigators identified a 27% increase in the rate of PPH from atony from 1995-2004. Disturbingly, they were unable to identify antenatal risk factors for this trend, as the increase in PPH could not be accounted for by adjusting for changes in maternal demographics, maternal comorbidity, or delivery mode. Also noteworthy in this cohort was the observation that the rates of PPH from other causes, including retained placenta and coagulopathy, remained relatively stable during the study. The investigators also noted that PPH is more common among patients delivering at hospitals in the bottom quartile for delivery volume compared with those delivering at hospitals in the top quartile, which may be a factor with overall management of hemorrhage situations. In an 11-year population-based cohort study from Ireland, similar results were found. This group reported an overall increase in the rate of PPH from 1.5% in 1999 to 4.1% in 2009; with atonic PPH increasing from 1.0% in 1999 to 3.4% in 2009. These increasing trends in rates of atonic PPH were observed across all modes of delivery, i.e., vaginal, instrumental, and emergency and elective Cesarean deliveries. In their cohort, data were collected on 649,019 childbirth hospitalizations, with a 2.6% incidence of PPH. In the patients with PPH, 75.7% were attributed to uterine atony, a number very similar to that found in the USA-based study. They noted that the incidence of atony as a cause for PPH was consistently higher among deliveries that involved induction. The lowest rates of atonic PPH were among non-induced vaginal deliveries, H. A. Muir, MD (&) Department of Anesthesiology, Duke University Hospital, Durham, NC 27710, USA e-mail: holly.muir@duke.edu

Periodontal Disease and Pregnancy Hypertension: A Clinical Correlation

Periodontal disease is thought to be associated with increased risk of systemic diseases and adverse pregnancy outcomes, including pregnancy hypertension (PH). The aim of the present study is to find the prevalence of periodontal disease in females with PH in a rural-based medical institute. The present case control study was performed with 200 females, 100 with PH and 100 without PH. Antenatal periodontal screening was performed within 72 hours of their hospital admission for delivery. The periodontal parameters assessed were oral hygiene index-simplified, gingival index, mean probing depth, and loss of attachment. Prevalence of periodontal disease was 65.5% and was significantly higher (P <0.0001) in females with hypertension (relative risk = 1.5; 95% confidence interval [CI] = 1.3 to 1.9). Socioeconomic status, education, occupation, and body mass index did not appear to influence the relationship between periodontal disease and PH on bivariate multiple logistic regression analysis. Nulliparous females were at higher odds to develop periodontal disease and PH (odds ratio = 1.7; 95% CI = 0.5 to 6.1). As the severity of periodontal disease increased from moderate to severe, the severity of hypertension also increased (r(2) = 0.8 and 0.5 for moderate and severe periodontal disease, respectively). Periodontal disease is more prevalent in females with PH.

Clinical characteristics and outcomes of critically ill obstetric patients: a ten-year review

BACKGROUND AND OBJECTIVES:Pregnancy and delivery can involve complications that necessitate admission to critical care facilities. The objective of our study was to assess the incidence, indications, and outcomes of obstetric patients requiring admission to an intensive care unit (ICU) in a tertiary care hospital, in Saudi Arabia.DESIGN AND SETTING:Retrospective cohort study of consecutive obstetric admissions to the ICU at the King Abdulaziz Medical City over a 10-year period.PATIENTS AND METHODS:We collected baseline demographic data and acute physiology and chronic health evaluation II (APACHE II) scores. ICU mortality was the primary outcome.RESULTS:Over 10 years, 75 obstetric patients were admitted to the ICU, and 59 of these patients (78.6%) were admitted during the antepartum period. The main obstetric indication for ICU admission was pregnancy-induced hypertension (21 patients, 28%) and the leading non-obstetric indication was sepsis (12 patients, 16%). The APACHE II score was 19.59 (15.05). The predicted mortality rate based on the APACHE II score was 21.97%; however, there were only six maternal deaths (8%) among the obstetric patients admitted to the ICU.CONCLUSION:The overall mortality was low. A team approach facilitated the application of optimal care to these patients. Obstetric patients had better outcomes than those predicted by the APACHE II scores. Appropriate antenatal care is important for preventing obstetric complications.

Incontinencia urinaria a los 2 meses posparto. Persistencia de los síntomas a los 6 y 12 meses

ObjectivesTo determine the prevalence of urinary incontinence (UI) 2 months after delivery as well as the factors associated with delivery and pregnancy. To determine the persistence of UI at 6 and 12 months after delivery among women with UI at 2 months after delivery. Material and methodsWe performed an observational, prospective, longitudinal study with follow-up at 2, 6 and 12 months after inclusion in the study during hospital admission for delivery in the Vic General Hospital, the basic general hospital in the region of Osona (central Catalonia). Women who delivered live newborns at term between 1 January, 2001 and 31 March, 2002 were included. During admission for delivery, data were gathered on 707 women (age, parity, body mass index, symptoms of incontinence during pregnancy), type of delivery (vaginal, cesarean) and fetuses (weight, head circumference). At 2 months after delivery, 531 women were seen by a gynecologists to detect and establish a clinical diagnosis of UI through a specific protocol.Women were asked whether they had involuntary leaks of urine. Women with UI symptoms underwent a pelvic examination and a pad test was requested. Women with UI at 2 months after delivery were called for further clinical evaluation at 6 months. All women with persistent symptoms at the 6-month visit were contacted by telephone at 12 months. The prevalence of UI at 2 months after delivery was calculated and the persistence of symptoms at 6 and 12 months of delivery was determined. The association of IU at 2 months of delivery with maternal, fetal, and delivery-related factors was analyzed by obtaining odds radios (OR) and confidence intervals. ResultsOf the 531 women seen 2 months after delivery, 41 were diagnosed with UI. At 12 months after delivery, 11 (26.8%) of the 41 women with UI had persistent symptoms. The prevalence of UI at 2 months after delivery was 7.7% (95% CI, 5.6- 10.3). A logistic regression model for UI at 2 months (dependent variable), in which the independent variables of type of delivery, maternal age, and weight and head circumference of the newborn were introduced, revealed that UI was associated with vaginal delivery (OR=14.4; 95% CI, 1.9-107.2). ConclusionsVaginal delivery is a known risk factor for UI and our results confirm the impact of this route of delivery in clinical practice in a general hospital. Although severe cases persist, there is substantial reduction in symptoms in the first 12 months.

Sleep Disturbance in Late Pregnancy and Early Labor

Sleep disturbance is a typical complaint during pregnancy, particularly in the third trimester. Previous studies of this phenomenon have not measured sleep in the last days of pregnancy as women transition into labor. Poor sleep can have potentially adverse effects on labor and delivery. The purpose of this study was to evaluate the amount of sleep obtained in the 5 days preceding childbirth, and the relationship between sleep in this time frame and both pain and fatigue during early labor. Thirty-five nulliparous women were recruited from childbirth preparation classes. Sleep was measured with wrist actigraphy continuously until hospital admission for delivery. Participants completed self-report measures of pain and fatigue in early labor prior to hospital admission. Most women experienced spontaneous labor onset during the night. Sleep quality deteriorated progressively over the last 5 days of pregnancy, and was the lowest on the night before hospital admission. This was the case even when labor was induced (40%). There was a significant relationship between the amount of sleep the night before hospitalization and pain perception in women with spontaneous labor onset. Results from this study can be used to advise women in late pregnancy about expected sleep patterns and measures to optimize sleep and rest.

Freqüência de testagem rápida para o HIV durante a admissão para o parto em puérperas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP

OBJETIVOS: determinar a prevalência da testagem anti-HIV no pré-natal e internamento para o parto e identificar fatores associados à realização e recebimento do resultado dos testes em parturientes. MÉTODOS: estudo descritivo, com 400 puérperas atendidas no Centro de Atenção à Mulher do IMIP Instituto Materno Infantil Prof. Fernando Figueira, IMIP. RESULTADOS: chegaram à admissão para o parto sem o resultado do teste anti-HIV, 154 (38,5%) mulheres. Dessas, foi solicitado "teste rápido" em 134 (87,0%), porém só foram colhidos em 130 (84,5%). Observou-se que: o número de consultas realizadas no pré-natal, (p=0,001) o número de profissionais que atenderam a mulher no pré-natal e a escolaridade (p=0,006) tiveram associação significativa com a realização do exame anti-HIV no pré-natal, mas não com o recebimento do mesmo. O aconselhamento e oferecimento do teste tanto no pré-natal como na admissão para o parto também apresentaram associação significativa com a realização do anti-HIV durante o pré-natal. CONCLUSÕES: a prevalência de testagem anti-HIV no pré-natal e/ou na triagem foi satisfatório no aspecto quantitativo, porém o recebimento do resultado tanto no pré-natal quanto na admissão para o parto , bem como o aconselhamento pós-teste, foi aquém do recomendado.

Maternal Mortality During Hospital Admission for Delivery: A Retrospective Analysis Using a State-Maintained Database

Maternal Mortality During Hospital Admission for Delivery: A Retrospective Analysis Using a State-Maintained Database