Management Of High-risk Pregnancies Research Articles

IJCM_254A: A Study on Level of Satisfaction among Beneficiaries Under Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in Rural Field Practice Area Of Guntur Medical College. Guntur, Andhra Pradesh: A Cross-sectional Study

Background: With 30,000 estimated maternal deaths in a year across the country, high MMR remains a matter of grave concern, and thus it is paramount to ensure quality ANC to each pregnant woman, identify the high risk pregnancies (HRPs) and track these for counselling, management birth preparedness and referral till the outcome to close the loop. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016, as a fixed-day, assured, comprehensive quality ANC service on the 9th of every month to every pregnant woman across the country. Screening, identification, line listing and appropriate management of high-risk pregnancies by OBGY/CEmOC/ BEmOCspecialist and referral to appropriate higher facilities are some of the fundamental elements of PMSMA Objective: To determine the level of satisfaction among beneficiaries under PMSMA scheme Methodology: A cross-sectional study was done among 300 pregnant women who were delivered within 6 months from the date of the study and who had registered & availed the Ante-Natal Care (ANC) services under Rural field Practice area of Guntur Medical college. Guntur. Andhra Pradesh. The data thus collected were entered into Microsoft-Excel spreadsheet and was analyzed using IBM SPSS software Version 24.0 Results: Out of 300 beneficiaries, 237(79%) were satisfied with the cleanliness of wards & toilets followed by 278(92.69%) with Adequate privacy During Examination, 287(97.67%) with basic laboratory investigation, 166(55.34%) with transport facilities during discharge. The majority of study participants were in the age group of 20-30 years i.e. 269 (89.70%) and most of their educational status above intermediate i.e. 207(69%) Conclusion: If every pregnant woman in India is examined by a Medical Officer/Specialist and Investigated appropriately at least once during the PMSMA, the Abhiyan can play a crucial role in reducing the number of maternal deaths & High-Risk Pregnancy (HRP) in our country

Non-invasive in-utero quantification of vascular reactivity in human placenta.

Placental vascular reactivity (PlVR) indicates the ability of the placental vasculature to match blood supply to fetal demand. Many pregnancy disorders alter the characteristics of PlVR, resulting in suboptimal oxygen delivery, although current understanding is limited by the lack of non-invasive, repeatable methods to measure PlVR in utero. Our objective was to quantify PlVR by measuring the placental response to transient changes in maternal carbon dioxide (CO2) using blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI). We hypothesized that PlVR will increase with gestational age to meet the changing demands of a growing fetus, and that PlVR will be driven by a maternal response to changes in CO2 concentration. This was a cross-sectional study of 35 women with a healthy singleton pregnancy, of whom 31 were included in the analysis. The median gestational age was 32.6 (range, 22.6-38.4) weeks. Pregnant women were instructed to follow audiovisual breathing cues during a MRI scan. Maternal end-tidal CO2 (EtCO2) was measured concurrently with resting placental BOLD MRI for a total of 7-8 min. Preprocessing of magnetic resonance images consisted of manual delineation of placental anatomy and motion correction. In each placental voxel, vascular reactivity was computed using a coherence-weighted general linear model between MRI signal and EtCO2 stimulus. Global PlVR was computed as the mean of voxel-wise PlVR values across the placenta. PlVR, quantified by the placental response to induced, transient changes in maternal CO2, was consistently measured in utero using BOLD MRI. PlVR increased non-linearly with advancing gestational age (P < 0.001) and was higher on the fetal side of the placenta. PlVR was associated positively with fetal brain volume after accounting for gestational age. PlVR did not show any significant associations with maternal characteristics. We present, for the first time, a non-invasive paradigm to quantify PlVR in ongoing human pregnancies without the use of exogenous gases or contrast agents. Our findings suggest that PlVR is driven by a fetal response to changes in maternal CO2. Ease of translation to the clinical setting makes PlVR a promising biomarker for the identification and management of high-risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework.

High-risk pregnancy (HRP) conditions such as gestational diabetes mellitus (GDM), hypertension (HTN), and peripartum depression (PPD) affect maternal and neonatal health. Patient engagement is critical for effective HRP management (HRPM). While digital technologies and analytics hold promise, emerging research indicates limited and suboptimal support offered by the highly prevalent pregnancy digital solutions within the commercial marketplace. In this article, we describe our efforts to develop a portfolio of digital products leveraging advances in social computing, data science, and digital health. We describe three studies that leverage core methods from Digilego digital health development framework to (1) conduct large-scale social media analysis (n = 55 301 posts) to understand population-level patterns in women's needs, (2) architect a digital repository to enable women curate HRP related information, and (3) develop a digital platform to support PPD prevention. We applied a combination of qualitative coding, machine learning, theory-mapping, and programmatic implementation of theory-linked digital features. Further, we conducted preliminary testing of the resulting products for acceptance with sample of pregnant women for GDM/HTN information management (n = 10) and PPD prevention (n = 30). Scalable social computing models using deep learning classifiers with reasonable accuracy have allowed us to capture and examine psychosociobehavioral drivers associated with HRPM. Our work resulted in two digital health solutions, MyPregnancyChart and MomMind are developed. Initial evaluation of both tools indicates positive acceptance from potential end users. Further evaluation with MomMind revealed statistically significant improvements (P < .05) in PPD recognition and knowledge on how to seek PPD information. Digilego framework provides an integrative methodological lens to gain micro-macro perspective on women's needs, theory integration, engagement optimization, as well as subsequent feature and content engineering, which can be organized into core and specialized digital pathways for women engagement in disease management. Future works should focus on implementation and testing of digital solutions that facilitate women to capture, aggregate, preserve, and utilize, otherwise siloed, prenatal information artifacts for enhanced self-management of their high-risk conditions, ultimately leading to improved health outcomes.

Umbilical artery half peak systolic velocity deceleration time: a novel Doppler parameter for prediction of neonatal outcomes in pregnant women with preeclampsia.

To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28-41weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34weeks, and birth weight < 2500g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06-0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery.

Comparative evaluation of gestosis score vs uterine artery pulsatility index in predicting gestational hypertension: A study protocol

Background: Gestational hypertension and its consequences such as preeclampsia, eclampsia is a leading cause of maternal mortality in India. Multiple risk factors are already known to cause hypertension in pregnancy and with newer advances in the field of medicine, newer risk factors are also being detected which contribute to gestational hypertension. There is need to detect these risk factors so that women who are susceptible to developing hypertension in their pregnancy can be identified at the earliest and monitored and managed accordingly. This study includes two methods, gestosis score which is a newer method, and uterine artery Doppler pulsatility index which is commonly utilized in usually urban centers where ultrasonography facilities are available to look for these risk factors. Objective: The study intends to compare the results of both prediction approaches, the Gestosis score and the Uterine Artery Pulsatility Index in identifying women at risk for gestational hypertension so that these women can be monitored vigilantly for the development of hypertension during their pregnancies and contribute to better management and healthy outcomes of pregnancy. Methods: This study will include 140 pregnant women with gestational ages between 13 to 20 weeks. The gestosis score and mean uterine artery pulsatility index will be calculated. Women with a gestosis score of three or more are deemed at risk for gestational hypertension. Women with mean pulsatility index of 95th percentile or higher are labeled at risk of gestational hypertension. The outcomes of these two methods will be compared to assess which is more effective in predicting developing gestational hypertension. Expected outcome: The study aims to provide insights into the effectiveness of both the Gestosis Score and the Uterine Artery Pulsatility Index in predicting gestational hypertension. The results will contribute to employing better risk assessment in clinical practice and the management of high-risk pregnancies.

Acute intestinal pseudo-obstruction secondary to Sjogren’s syndrome in pregnancy: a case report and literature review

BackgroundIntestinal pseudo-obstruction (IPO) is a rare disease, and its clinical manifestations can resemble mechanical intestinal obstruction leading to unnecessary and potentially harmful surgery. Certain autoimmune diseases have been associated with IPO, however, cases secondary to Sjögren’s syndrome (SjS) are especially rare.Case presentationWe described the first case of SjS-associated acute IPO in pregnancy, which was successfully treated with combined immunosuppressive therapy and resulted in an uneventful caesarean delivery.ConclusionsWomen with SjS is likely to experience more complications during pregnancy, and IPO rather than the classic symptoms could be the first sign of SjS flares. IPO should be suspected in patients with unrelenting symptoms of small bowel obstruction, and a multidisciplinary approach can provide optimal management of such high-risk pregnancies.

Barriers and facilitators of the identification and management of high-risk pregnancies in tribal communities in Pune district in India: Findings from implementation research

Barriers and facilitators of the identification and management of high-risk pregnancies in tribal communities in Pune district in India: Findings from implementation research

Maternal and Perinatal Complications in Eclampsia Patients: Study in a Private Medical College, Dhaka, Bangladesh

Background: Eclampsia is a serious pregnancy complication that can lead to seizures and potentially fatal outcomes for both mother and baby. It is most common in developing countries but improved antenatal care and early intervention have significantly decreased its incidence in developed countries. Risk factors for eclampsia include pre-eclampsia, hypertension, obesity, and renal disease, and early detection and management are crucial for preventing adverse outcomes. Magnesium sulfate is the preferred treatment for seizures, and delivery timing depends on disease severity, gestational age, and fetal well-being. Maternal and perinatal mortality rates vary by country, highlighting the need for continued efforts to improve outcomes for those affected by eclampsia. The study aimed to observe the maternal and perinatal complications in eclampsia patients. Material &amp; Methods: This observational study was conducted at the Department of Gynecology, Gonoshasthaya Nagar Hospital, Dhaka, Bangladesh during the period of January 2020 to June 2020. We included a total of 270 patients with eclampsia who were admitted to a tertiary care hospital. A Purposive consecutive sampling method was followed for the selection of the participants. Results: This study analyzed the demographic and clinical characteristics, maternal and perinatal complications, and risk factors of 270 patients with eclampsia. The majority of patients were aged between 20-34 years (77.8%), and 61.1% were multiparous. Over half of the cases (55.6%) presented with eclampsia between 28-36 weeks of gestation, and 38.9% had a history of preeclampsia in a previous pregnancy. The most common symptoms reported were headaches (88.9%). All cases involved hypertensive disorders, and maternal death was reported in 1.9% of cases. Perinatal complications included low birth weight (44.4%), preterm delivery (36.3%), NICU admission (34.8%), stillbirth (4.4%), and early neonatal death (3.0%). Maternal mortality rates were highest among women aged 20-34 years (56.5%), while perinatal mortality rates were highest among women aged under 20 years (20.0%). The highest maternal mortality rate was observed among women with severe eclampsia (91.4%), and time to treatment was a crucial factor in maternal mortality rates. These findings underscore the need for timely and appropriate care to improve maternal and perinatal outcomes, particularly in high-risk populations. Conclusion: Eclampsia is a serious complication of pregnancy that can result in significant maternal and perinatal morbidity and mortality. Early detection, prompt management, and close monitoring of high-risk pregnancies are crucial in preventing adverse outcomes. Further research is needed to identify effective interventions for preventing and managing eclampsia.

Evaluation of second trimester uterine artery doppler indices in women diagnosed with COVID-19 during the first trimester of their pregnancy.

This study aimed at evaluating the hypothesis that 6-14 months pregnant women diagnosed with COVID-19 may have abnormal placental function detectable by increased uterine artery Doppler indices in the second trimester and whether these women could benefit from treatment.A total of 63 women were diagnosed with COVID-19 during the first trimester of their pregnancy and 68 healthy women were involved according to the exclusion criteria. In both groups, Doppler measurements were performed for the determination of high-risk pregnancy by increased uterine artery Doppler indices in the second trimester.It was observed that uterine artery Doppler indices (PI and RI) were significantly increased in second trimester women with COVID-19 infection compared to those without COVID-19. Furthermore, the number of women with a PI value exceeding the 95th percentile and the number of patients with early diastolic notch were higher in the COVID group compared to the control group.Doppler Ultrasound measurement may be a potential method for the management of high-risk pregnancies after asymptomatic/mild COVID-19 infection.

MATERNAL MORTALITY IN INDIA: PREVENTION AND ITSSTRATEGIES

Introduction: Maternal health is an important aspect of any countrys development in terms of equity and poverty reduction. The health of women before and during pregnancy, during childbirth, and after childbirth is referred to as Maternal Health. The Maternal Mortality Ratio (MMR) is an important indicator of the quality of the countrys health-care system. India has made remarkable progress in reducing maternal mortality over the last two decades. Methods: Relevant articles were searched using both electronically and print sources. Electronically from search engines such as PubMed and Google Scholar, as well as the WHO, CDC, and MoHFW websites. Print sources for the database included newspapers, the central library, and the departmental library of the Community Medicine, which included a variety of journals and standard textbooks. The following keywords were used in the literature search: maternal health, maternal death, maternal mortality and vaccination for pregnant women. Articles that did not contain these keywords were excluded from consideration. The search was not limited by publication year, and original articles, review articles, systematic reviews, and meta-analyses were all considered. Recommendation:Early detection and timely management of High-Risk Pregnancy (HRP) are critical factors in reducing maternal mortality.

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study.

After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide.

Obstetric Determinants of Birth Weight Status of Babies Born at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

Background: Low birth weight (LBW) is a serious public health problem, especially in developing countries. Globally, 15.5% of all births are born LBW and 95.6% of them are in developing countries. In Kenya, 8% of babies are born LBW and at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), it is 11.1%. Despite several efforts such as antenatal care services put in place to improve the quality of maternal and child health, the rates of LBW are still high. LBW is a major cause of mortality and morbidity in infants. Objective: The objective of this study was to assess obstetric determinants of the birth weight status of babies born at JOOTRH, Kenya. Materials and Methods: This was a cross-sectional study with a sample size of 131 babies plus their mothers from a total population of 538 deliveries during the study period. Systematic random sampling was used to select the respondents. Data was collected using a questionnaire and record review checklist. Data analysis was done using descriptive statistics and inferential statistics, specifically logistic regression. Result: The study results showed that the prevalence of LBW was 13.7%. LBW was strongly associated with a birth interval of &lt; 24 months (AOR = 13.722), hypertension (AOR = 11.753), previous history of LBW (COR = 14.0), and gestation at birth (COR = 3.75). Gravidity, previous history of miscarriage and gestation at which antenatal visits started had no association with LBW. Conclusion: The prevalence of LBW is 13.7%, higher than the national rate of 8% and statistically significant with a Z score of 2.398, p = 0.016. The birth interval of &lt; 24 months, hypertension, previous history of LBW, and gestation at birth influenced the occurrence of LBW. Focused antenatal care to ensure early detection and management of high-risk pregnancies and educate pregnant mothers on the birth spacing of more than two years between two successive pregnancies to allow replenishment of nutrient stores is important in reducing LBW.

Sonographic estimation of gestational age using transverse cerebellar diameter among late trimester pregnancies in Kano, Northwest Nigeria

Background/Context: Accurate estimation of fetal gestational age (GA) is of paramount importance in the management of all pregnancies, especially for the planning of mode of the delivery and management of high-risk pregnancies. Obstetric ultrasonography is a simple, available, affordable, and noninvasive modality for estimating fetal GA due to its high safety profile. The fetal cerebellum is easily visualized and reliably identified on ultrasound in the posterior cranial fossa after 14 weeks of gestation. Aim: The aim of this study was to evaluate the utility of transverse cerebellar diameter (TCD) in determining GA in second- and third-trimester pregnancies and compare its accuracy with other established sonographically derived fetal biometric parameters. Materials and Methods: A total of 424 pregnant women in their second and third trimesters who were sure of their last menstrual period (LMP) were recruited into the study over a period of 6 months (May to November 2019) at the Radiology Department of AKTH-Kano, Nigeria. The corresponding fetal TCD and other established fetal biometric indices (biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL]) were sonographically obtained and correlated. Pearson’s bivariate coefficient was used to establish the correlation between the traditional biometric indices with TCD and GA derived by LMP. Multivariate linear regression analysis was used to assess the accuracy of the studied indices in predicting GA. Results: The range for TCD in second- and third-trimester fetuses was 15.9–57.5 mm. The TCD parameter was more accurate (±1.753 days) than BPD (±2.298 days), HC (±2.337 days), and AC (±4.342 days) and marginally less accurate than FL (±1.165 days) in predicting GA among study subjects (P &lt; 0.001). Conclusion: TCD is a reliable and accurate parameter for GA estimation in late second- and third-trimester pregnancies when compared with established fetal biometric parameters among pregnant women in Kano, Nigeria.

S-11-1: ARTERIAL STIFFNESS AND HEMODYNAMIC PARAMETERS FOR THE EARLY PREDICTION OF PREECLAMPSIA: A PROSPECTIVE COHORT STUDY

Objective: Preeclampsia is a leading complication of pregnancy, yet there remains no reliable clinical tool for its early prediction. Assessment of vascular dysfunction, a central feature of preeclampsia, by arterial stiffness and hemodynamic measurements could be a promising tool for preeclampsia prediction. This study aimed to evaluate 1) arterial stiffness and hemodynamic parameters as an early predictive tool for preeclampsia, and 2) longitudinal changes in these parameters and identify changepoints prior to preeclampsia onset. Design and method: In this prospective longitudinal cohort study of women with singleton high-risk pregnancies (n = 236), arterial stiffness (carotid-femoral pulse wave velocity, cfPWV) and wave reflection (augmentation index [AIx], and time to wave reflection [T1R]) were assessed using applanation tonometry (SphygmoCor, AtCor) at 10–13 weeks and repeated every 4 weeks throughout pregnancy. Circulating angiogenic biomarkers (soluble fms-like tyrosine kinase, and placental growth factor) were measured (Quantikine, R&amp;D Systems) at each trimester, and a bilateral uterine artery Doppler (UAD) was performed in the second trimester. The predictive ability of arterial stiffness was compared to that of peripheral blood pressure, UAD indices, as well as angiogenic biomarkers. Furthermore, changepoints in cfPWV, AIx, and T1R were compared between women who did and did not subsequently develop preeclampsia. Results: A first-trimester 1 m/s increase in cfPWV was associated with 64% increased odds (p &lt; 0.05), while a 1 ms increase in T1R with 11% decreased odds for preeclampsia (p &lt; 0.01). The area under the curve of arterial stiffness, blood pressure, ultrasound indices, and angiogenic biomarkers was 0.84, 0.68, 0.66, and 0.64, respectively (Figure). A changepoint in cfPWV was detected at 14–17 weeks. cfPWV then increased in women who subsequently developed preeclampsia but decreased in women who did not; a 1.2 m/s difference in cfPWV between the groups was observed at 22–25 weeks. An increase in AIx was noted at 18–21 weeks while at 30–33 weeks in women who did and did not develop preeclampsia, respectively. Conclusions: Arterial stiffness and wave reflection were higher in the first trimester and throughout pregnancy in women destined to develop preeclampsia. These indices predicted preeclampsia earlier (in the first trimester) and with greater ability than blood pressure, UAD, and/or angiogenic biomarkers. Furthermore, altered vascular adaptations in the early second trimester were observed in women who subsequently developed preeclampsia. These findings demonstrate the potential clinical utility of arterial stiffness and hemodynamic parameters as an early screening tool for preeclampsia, which can be used to inform clinical management of high-risk pregnancies.

Clinico-epidemiological profile of women with high-risk pregnancy utilizing antenatal services in a rural primary health center in India

Objective: Early detection and effective management of high-risk pregnancies can substantially contribute to the reduction of adverse maternal and fetal outcomes. This study aimed to determine the prevalence and clinical profile of women with high-risk pregnancies in rural areas who utilize antenatal services in a primary health center (PHC). Materials and Methods: A retrospective analysis was carried out over a six-month period by reviewing the mother and child protection cards maintained at the PHC's Maternal and Child Health Center. During the study period, 950 pregnant women were registered, of whom 793 were included in the study based on the completeness of the records. Data analysis was performed using the licensed Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The prevalence of high-risk pregnancy among the antenatal women was 272 (34.3%) with 95% CI [31.1-37.7]. Of the 272 women, 240 (88.2%) had a single high-risk factor, while 32 (11.8%) had more than one high-risk factor. The major factor contributing to high-risk pregnancy was hypothyroidism (43.7% with 95% CI [37.9-49.6]), followed by a previous lower segment Caesarean section (LSCS) (19.1%). Conclusion: The study found that the prevalence of high-risk pregnancies was 34.3% in this rural setting. The majority of high-risk pregnancies were due to hypothyroidism, followed by more than one previous LSCS or abortion. Further research is required to track high-risk pregnancy outcomes and investigate the newborn thyroid profile of women with hypothyroidism.

Classification and Management of High-Risk Pregnancies and the Influence of Antenatal and Nutritional Interventions on Pregnancy and Delivery Outcomes in 1097 Pregnant Women on the MICHD program in Lagos State, Nigeria

This study was carried out to monitor 1097 women on the MICHD project. This was an independent monitoring and evaluation study on indigent women in Lagos State. The study was to evaluate the impact of antenatal visits and nutritional interventions on the Mother, Infants and Child and their pregnancy journey; while accessing the impact of the interventions on the High risk pregnancies and their outcome. The cohorts were divided into 2 major groups. The MICHD Plus group with 502 pregnant women (they attended weekly antenatal incentivized by weekly food Packs and Iron supplements for 12 weeks) and the MICHD control group with 595 pregnant (they attend regular antenatal for the same duration without the intervention). The antenatal visits reports were electronically automated and data of all pregnant women on the project collected and transcribed into a Gerocare MICHD application. Statistical analysis of antenatal variable and essential elements of a focused approach to Antenatal Care especially for the high-risk women were analyzed. Stability check reports of the antenatal visits monitored on the application at week 1, week 16 and week 20 showed the percentage of stable women at 56%, 71% and 93% respectively. Report shows that the MICHD cohorts’ attendance records estimates that 85% of the women attended antenatal between 4 - 13 times during the research period. The Highrisk pregnancies were identified and classified; there were 21 women below age 17, 13 had Hepatitis B, 36 had High Blood Pressure, 191 were Obese, 189 had Overweight BMI, 23 had Underweight BMI, and 14 women were above the age of 40. A total of 437 women were identified as High Risk and 610 women were No Risk. 78.3% of the 437 women had vaginal deliveries with no complications, while 87.7% of the no risk had vaginal deliveries. This shows that the interventions were able to improve pregnancy outcomes in 381 High risk women. Of the MICHD Plus intervention group 51% were high risk at takeoff but at delivery 84.2% of the women delivered with no complication and vaginally. An even higher percentage compared to the MICHD control that had less high risk women at takeoff. The results shows that focused approach to antenatal care and enhanced nutrition can improve pregnancy outcomes and reduce the chances of Caesarian surgery in high-risk pregnancies.

Telemedicine for home care of fetal growth restriction with mobile cardiotocography: A case series.

Modern technological advancements have made it possible to perform cardiotocography at home. Home-based management of high-risk pregnancies using a mobile cardiotocography system has been reported; however, its effectiveness in monitoring cases of fetal growth restriction (FGR) remains unclear. Therefore, the authors aimed to investigate the clinical usefulness of home-based telemedicine for FGR management using the mobile cardiotocography (iCTG). The authors conducted a single-center, retrospective case series of patients with FGR. Seventeen women diagnosed with FGR were enrolled. Patients performed iCTG for 1hour twice daily to examine their fetuses; data were uploaded and saved on the cloud. The median and minimum compliance rates were 93.33 (interquartile range [IQR], 70.00-100.00) and 40.7, respectively. The median and minimum validity rates were 100.00 (IQR, 90.48-100.00) and 36.4, respectively. In this study, many of the patients were managed at home and underwent delivery as planned. However, three patients required emergency visits; one had a nonreassuring fetal status and underwent an emergency cesarean section. Even when the fetal prognosis is good, careful pre-evaluation is required before initiating home care management. The current study shows that the economic burden of hospitalization for patients can be reduced by using iCTG.

출산 및 산후 합병증 행태의 특성과 변화 분석 : 퇴원손상심층조사자료를 이용하여

Objectives: The purpose of this study was to assess the incidence of delivery and puerperium complications in South Korea and analyze the correlations between the patient’s characteristics and delivery and complications before and after 10 years. Methods: This study used the data from an Korean National Hospital Discharge In-depth Injury Survey. Cases of which the principal diagnosis and second diagnoses were disease classification ICD code O00-O99(Pregnancy, childbirth and the puerperium) were defined as the study subjects, and the first study group was divided as the year of discharge from 2005 to 2007, and the second study group from 2015 to 2017. Results: The number of patients discharged whose principal diagnosis or second diagnoses was O00-O99 was 21,598(Weighted 423,306) from 2005 to 2007 and 19,028(Weighted 364,384) from 2015 to 2017, which decreased by 13.9% compared to 10 years ago. The average age of discharged patients increased by about 2 years and was statistically significant (p<.0001). Factors associating spontaneous delivery, caesarean section and puerperium complication were hospitalization route, bed size, maternal age, length of hospital stay, and the year of discharge. Conclusion: Based on the results of this study, health and education policies and economic support for medical care for high-risk pregnancy and delivery management would be necessary continuously. In addition, policies to strengthen the medical system for high-risk pregnancy management in non-metropolitan areas with high fertility rates would also be needed.

Comparison of alternative gestational age assessment methods in a low resource setting: a retrospective study

BackgroundAccurate gestational age (GA) determination allows correct management of high-risk, complicated or post-date pregnancies and prevention or anticipation of prematurity related complications. Ultrasound measurement in the first trimester is the gold standard for GA determination. In low- and middle-income countries elevated costs, lack of skills and poor maternal access to health service limit the availability of prenatal ultrasonography, making it necessary to use alternative methods. This study compared three methods of GA determination: Last Normal Menstrual Period recall (LNMP), New Ballard Score (NBS) and New Ballard Score corrected for Birth Weight (NBS + BW) with the locally available standard (Ultrasound measurement in the third trimester) in a low-resource setting (Tosamaganga Council Designated Hospital, Iringa, Tanzania).MethodsAll data were retrospectively collected from hospital charts. Comparisons were performed using Bland Altman method.ResultsThe analysis included 70 mother-newborn pairs. Median gestational age was 38 weeks (IQR 37–39) according to US. The mean difference between LNMP vs. US was 2.1 weeks (95% agreement limits − 3.5 to 7.7 weeks); NBS vs. US was 0.2 weeks (95% agreement limits − 3.7 to 4.1 weeks); NBS + BW vs. US was 1.2 weeks (95% agreement limits − 1.8 to 4.2 weeks).ConclusionsIn our setting, NBS + BW was the least biased method for GA determination as compared with the locally available standard. However, wide agreement bands suggested low accuracy for all three alternative methods. New evidence in the use of second/third trimester ultrasound suggests concentrating efforts and resources in further validating and implementing the use of late pregnancy biometry for gestational age dating in low and middle-income countries.

High Risk Pregnancy Detection and Management: Need of Present Day Obstetric Care

No abstract available.