Maternal Age Research Articles

Prediction models for postpartum stress urinary incontinence: A systematic review

BackgroundPostpartum stress urinary incontinence significantly impacts the quality of life and the physical and mental health of women. A reliable predictive model for postpartum stress urinary incontinence can serve as a preventive tool. Currently, there have been numerous studies developing predictive models to assess the risk of postpartum stress urinary incontinence, but the quality and clinical applicability of these models remain unknown. ObjectiveTo systematically review and evaluate existing models for predicting stressful postpartum risks. MethodsPubMed, EBSCO, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, WanFang Data, SinoMed, and VIP Data databases were systematically searched from the time of database construction to October 2023. Two researchers used Critical appraisal and data extraction for systematic reviews of prediction modeling studies: the CHARMS checklist for data extraction. Three researchers used The Prediction Model Risk of Bias Assessment Tool (PROBAST) checklist for bias and applicability assessment. ResultsEight papers including ten postpartum stress urinary incontinence prediction models were finalized. The most common predictors in the prediction models were urinary incontinence (UI) during pregnancy, followed by mode of delivery, Maternal age, parity, and UI before pregnancy. Nine of the prediction models reported discrimination with an area under the ROC curve (AUC) or C-index between 0.680 and 0.850. All included studies were at high risk of bias, mainly due to mishandling of continuous predictors, unreported or mishandled missing data, and inadequate assessment of predictive model performance. ConclusionsPostpartum stress urinary incontinence risk prediction models are in the initial development stage, and existing prediction models have a high risk of bias and poor modeling methodological quality, which may hinder their clinical application. In the future, healthcare practitioners should follow the norms of predictive model development and reporting to develop risk prediction models with superior predictive performance, low risk of bias, and easy clinical application.

Cesarean Scar Defect (Niche) Risk Factors: A Prospective Study on Indonesian Women

Introduction: Niche or cesarean scar defect is a complication of a cesarean section that has long-term implications for both obstetrics and gynecology. The rate of niche is believed to be increasing with the high number of cesarean sections. This study assesses the risk factors for niche development after cesarean section. Methods: A prospective cohort study was conducted on women who underwent cesarean section at the Haji Adam Malik General Hospital Medan between August 2020 and August 2022. Niche was assessed six weeks after cesarean section using transvaginal ultrasonography. The primary outcome was the presence of a niche. The antepartum, intrapartum and postpartum risk factors were analyzed for niche development. A logistic regression model was used to assess independent risk factors from the bivariate analysis. Results: There were 280 patients enrolled in this study. The prevalence of niche was 44.3% by using transvaginal ultrasound. There was no significant relationship between maternal age, gestational age, parity, nutritional status based on upper arm circumference, hypertension in pregnancy, anemia status, surgical indications, duration of surgery, volume blood loss, and puerperal infection to niche development (P > 0.05). The independent risk factors for niche development were Cervical dilatation > 4 cm (P = 0.035; RR = 1.75), locking suture technique (P = 0.015; RR = 13.81), non-closure vesicouterine folds (P = 0.04; RR = 0.14) and a retroflexed uterus (P = 0.001; RR = 0.039). Conclusion: Cervical dilatation > 4 cm, locking suture technique, non-closure vesicouterine folds, and a retroflexed uterus are risk factors for niche development after CS.

Maternal Age, Gestation, and Parturition as Predictor of Uterine Inertia Incidence

Maternal Age, Gestation, and Parturition as Predictor of Uterine Inertia Incidence

The Correlation between Small Placental Volume Measured by Three-dimensional Ultrasonography and Adverse Pregnancy Outcomes: An Observational Study

Objective: The placenta is a vital organ in the growth and development of fetuses within the uterus. The size of the placenta is positively associated with fetal well-being. The aim of this study was to investigate any potential correlation between placental volume and negative pregnancy outcomes. Materials and Methods: This prospective cohort study was conducted at the department of obstetrics and gynecology, Bhumibol Adulyadej Hospital, Thailand between October 2023 and February 2024. Subjects were singleton pregnant women ever the age of 18 without underlying diseases, namely: diabetes mellitus, hypertension, and autoimmune diseases. Ultrasonography was performed between the gestational ages of 28 and 36 weeks. Placental volume was measured via 3-dimensional ultrasonography and analyzed with maternal and neonatal outcomes. Results: A total of 132 participants were recruited. The mean age of participants was 28.6 years old. The abnormal (AV) and normal (NV) placental volume groups consisted of 14 and 118 cases, respectively. The AV group was older, with higher parity, cesarean delivery rate, and estimated blood loss. This group’s newborns had lower Apgar scores rated at 1 and 5 minutes and more neonatal complications than the NV group (with statistical significance). Maternal age exceeding 34 years could also be used to predict abnormal placental volume with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at percentages of 57.1, 81.4, 26.7 and 94.1, respectively. Conclusion: There is a correlation between placental volume abnormality and certainly adverse outcomes for newborns. Maternal age greater than 34 is associated with higher occurrence of placental volume abnormality.

Planning of National Policies on Maternal and Neonatal Safety

<p>台灣近年來，因晚婚、晚孕等因素，致使高危險妊娠案例增加；加之以醫療技術進步，原本難以懷孕的超高齡女性、患有嚴重子宮肌腺症而必須切除病灶者、因免疫或血栓問題而重複流產者，皆在獲得治療後成功懷孕，卻也使得高危險妊娠現象頻發，母嬰傷亡事故居高不下。為此，國家擬定孕產兒安全相關政策，茲就相對重要者略為概述，以幫助快速瞭解政策之規劃。</p> <p> </p><p>In recent years, factors such as delayed marriage and late pregnancies have increased the incidence of high-risk pregnancies in Taiwan. Following advancements in medical technology, women who were originally unlikely to conceive—such as those of advanced maternal age, those requiring lesion removal due to severe adenomyosis, and those experiencing recurrent miscarriages due to immune or thrombotic disorders—have successfully achieved pregnancy following treatment. However, such treatment has also led to a higher frequency of high-risk pregnancies, with maternal and neonatal mortality and morbidity rates elevated. In response to this problem, the Taiwanese government has formulated policies related to maternal and neonatal safety. A brief overview of the more critical policies is provided herein to facilitate a fast understanding of relevant national strategies.</p> <p> </p>

Oxytocin with calcium vs oxytocin for induction of labor in women with term premature rupture of membranes: a randomized controlled trial

BackgroundIntravenous calcium administration has shown promise in enhancing uterine contractions and reducing blood loss during cesarean section, but this regimen has not been compared in vaginal labor induction. ObjectiveTo determine the efficacy of oxytocin combined with calcium versus oxytocin alone for inducing labor among women with term premature rupture of membranes (PROM). Study designThis single-blind, randomized control trial was conducted between October 2022 and May 2023 in a tertiary university hospital. Patients diagnosed with PROM were randomly allocated into two groups. The intervention group received a bolus of 10 mL of calcium gluconate followed by a continuous infusion of oxytocin via a pump (n = 210), whereas the control group received only oxytocin infusion (n = 218). The primary outcome was successful vaginal deliveries within 24 hours of labor induction. Secondary outcomes included the interval from labor induction to delivery, vaginal delivery blood loss, and maternal and neonatal complications. ResultsBaseline characteristics, including maternal age, BMI, Bishop score before labor induction, were comparable between groups. The rate of vaginal delivery within 24 hours of labor induction was statistically higher in the intervention group (79.52% vs. 70.64%; P = 0.04). Participants in intervention group experienced a shortened interval between induction and delivery (10.48 h vs. 11.25h; P = 0.037), and demonstrated a higher success rate in induction of labor assessed by the onset of active phase (93.80% vs. 87.61%; P = 0.04) without increasing the cesarean rate. Reduced hemorrhage was presented in the intervention group (242.5ml vs. 255.0ml; P = 0.0015) while the maternal and neonatal outcomes were comparable between groups. ConclusionThe co-administration of calcium and oxytocin in labor induction among pregnancies with PROM was more efficient and safer than oxytocin alone. Our research suggests that the combination therapy of calcium and oxytocin may offer significant advantages during the process of labor induction and result in better outcomes.

Prevalence Of Congenital Abnormalities On Routine Antenatal Ultrasonography During Second And Third Trimester Of Pregnancy: A Study In A District Hospital Of North East India

Background Prevalence of congenital anomalies varies greatly from country to country. It is reported about 2.5% in India. In India, congenital anomalies are responsible for 15% of perinatal mortality and for 10% to 15% of neonatal deaths. The main aim of the study is to evaluate the prevalence of the congenital anomalies and malformation patterns in our hospital population. Material & Method This is a cross-sectional study carried out in the ‘Radiology unit’ of ‘District Hospital, Gomati’, Tripura. The study population includes about 910 antenatal mothers in the second and third trimester, who were referred to ‘Radiology unit’ from the outpatient and inpatient departments of ‘Obstetrics and Gynaecology’ of the same hospital between September 2017 to February 2018 were included in the study. Data of Antenatal ultrasounds was statistically analyzed on structured data collection form to determine the prevalence of congenital anomaly in 2nd & 3rd trimester. Results: Total 910 numbers of 2nd and 3rd trimester prenatal ultrasonography (USG) were done. Out of these 18 numbers of congenital anomalies were detected. The antenatal prevalence of congenital anomalies was 1.97%. The mean maternal age and mean gestational age at diagnosis was 22.9 years and 27.7 weeks respectively. Genitourinary system defect was the commonest (27.77%), of which maximum number had pyelactasis i.e. 3 (16.66%) cases. Conclusion: Ultrasonography is a cost-effective, non-invasive and sensitive tool in detecting the congenital anomalies antenatally in the hands of an experienced radiologist. Besides the first-trimester USG, the second trimester scan is mandatory in detecting anomaly in the growing foetus, as the majority of congenital anomalies are detected between 20 and 22 weeks of pregnancy

Using inflammatory biomarkers in early pregnancy to predict subsequent antenatal depression

BackgroundAntenatal depression (AD) is one of the most common pregnancy complications. Recent studies indicated that immune responses during pregnancy may contribute to development of AD. ObjectivesThis study aimed to identify possible inflammatory biomarkers in early pregnancy to predict maternal depressive symptoms before delivery. MethodsThis case-control study was conducted within the Maternal and Infant Health (MI-Health) birth cohort (Beijing, China) and depressive symptoms were assessed by Zung Self-rating Depression Scale (SDS) in both second and third trimesters. By using immune multi-factors kits, we tested 26 inflammatory factors in the serum of 38 cases with antenatal depression symptoms in both trimesters (SDS ≥ 53) and 38 controls. Logistic regression was used to identify candidate biomarkers, and the predictive capabilities were evaluated by using Receiver Operator Characteristics (ROC) analysis. ResultsThe concentrations of ln(CCL24) (p = 0.020), IL-7 (p = 0.006) and IL-10 (p = 0.014) were higher in early pregnancy among women with depressive symptoms comparing to healthy controls. The difference remained statistically significant after adjusting for maternal age, education level, gestational diabetes mellitus, pre-pregnancy BMI and gestational weeks of blood sampling (OR(ln(CCL24)) = 4.625, OR(IL-7) = 1.414, OR(IL-10) = 1.151). In ROC analysis, ln(CCL24), IL-7, and IL-10 achieved discrimination for depressive symptoms antepartum, with the values of AUC estimated at 0.75. LimitationsThe sample size is limited, and the infectious disease infection records were not collected for control. ConclusionHigher levels of CCL24, IL-7 and IL-10 may indicate the higher risk of antenatal depression and are potential biomarkers indicating pathogenesis of antenatal depression.

O103 ANTENATAL AND NEONATAL EXPOSURES AND CHILDHOOD HYPERTENSION: FINDINGS FROM THE BOSTON BIRTH COHORT

Background: Early-life factors impact the development of hypertension (HTN). Impact of antenatal exposures, prematurity and subsequent early life exposures (including those in the neonatal intensive care unit (NICU)) on the development of HTN warrants further investigation. Objective: 1. Expand our prior findings on the association of maternal cardiometabolic conditions with childhood HTN in the Boston Birth Cohort (BBC). 2.Investigate the combined association between prematurity and NICU exposures with childhood HTN. Methods: We analyzed factors associated with childhood HTN up to 18 years. HTN was defined according to national guidelines. Composite categories were created based on gestational age and NICU comorbidities. Chi-square and ANOVA tests were used for categorical and continuous variables, respectively. Regression analyses explored the association with HTN, while repeated measures analysis assessed BP percentiles. Results: We analyzed 2461 infants (695 preterm), with a total of 19,689 repeated BP measurements. Maternal pre-existing diabetes, older maternal age, maternal stress in index pregnancy and chronic maternal stress, were positively associated with childhood HTN, after adjusting for important covariables. HTN incidence (25.9% vs. 16.31%) was higher in children born preterm, with an inverse dose-response trend. Compared to children born term without NICU exposure, those born term with NICU stay (OR 1.65 CI: 1.03-2.65), and those born preterm with NICU stay even without complications (OR 1.84 CI:1.38-2.46) had higher odds of developing HTN. Preterm children with NICU stay had the highest odds of developing HTN (OR 2.36 CI: 1.38-4.04), if they also had one or more major comorbidities (sepsis, chronic lung disease, necrotizing enterocolitis and intraventricular hemorrhage). Repeated measures analysis further revealed a positive association of systolic and diastolic BP percentiles with maternal cardiometabolic conditions, prematurity, and presence of NICU complications. Results remained consistent after adjustment for child BMI. Conclusion: In this US minority cohort, we found various early life factors linked to childhood HTN. Notably, preterm infants with a history of major NICU complications were more likely to develop childhood HTN.

Maternal Exposure to Heavy Metals From Industrial Sources During Pregnancy and Childhood Cancer Risk in California.

The study investigated maternal exposure to heavy metals from industrial sources during pregnancy as potential risk factors for childhood cancer. Cases ages 0-19 were identified from California Cancer Registry. Controls (20:1 ratio) were randomly selected from California Birth Registry, frequency-matched by birth year (1998-2016). We estimated maternal exposure to lead, nickel, and cobalt in ambient air from the Toxics Release Inventory. We examined "ever/never" and "high/low" exposures categorized by median exposure. Models were adjusted for maternal age, race/ethnicity, method of payment for prenatal care, neighborhood socioeconomic status, and urban/rural residence. Among highly exposed persons, lead was associated with an increased teratoma risk (adjusted odds ratio [aOR]: 1.52; 95% confidence interval [CI]: 0.97, 2.37), whereas nickel was associated with an increased rhabdomyosarcoma risk (aOR: 1.45; 95% CI: 1.03, 2.04). Cobalt was associated with an increased glioma risk (aOR: 2.25; 95% CI: 1.39, 3.65) among ever-exposed persons. Inverse associations were found between Wilms tumor and nickel among the ever exposed and highly exposed (ever: aOR: 0.75; 95% CI: 0.59, 0.96; high: aOR: 0.64; 95% CI: 0.45, 0.93). Findings suggest that air pollution from heavy metals released by industrial sources may elevate childhood cancer risk.

Incidence of Natural Conception in Fertility Couples Delayed Treatment in the COVID-19 Shutdown in Australia

Background: In vitro fertilization (IVF) is the most widely applied fertility treatment. While the indication for IVF is not disputed in couples where natural conception chances are close to zero (blocked fallopian tubes or severe male infertility), it is less clear when IVF should be started in other couples. Natural conception occurs frequently and has been reported in patients pre- and post-IVF treatment. The outbreak of COVID-19 in the early months of 2020, resulted in Australian fertility clinics stopping treatment. This enabled the opportunity for fertility patients to try and conceive naturally. Methods: We studied couples who were scheduled to start IVF in March 2020 but who faced delayed treatment due to COVID-19 shutdowns. Outcomes were recorded as couples returned for treatment or were contacted via phone and asked why they did not return. We collected baseline characteristics including maternal age, day of next Day 1, and type of infertility, as well as the pregnancy outcome or reason for not returning. Results: We studied 533 couples who were delayed IVF treatment for a total of 1,204 observation months. From the initial cohort of 533 couples delayed treatment, 16 couples achieved pregnancy (3%) with 12 resulting in live birth (2.3%). When analyzed by indication, patients with ovulatory disorders (4 of 55 [7.2%]) or reduced ovarian reserve (7 of 141 [5%]) proved to have higher rates of natural conception compared to other diagnostic categories. There were 39 couples who did not return to treatment and did not achieve natural conception. Conclusion: There is a significant emotional toll that patients experience when undergoing fertility treatment. Natural conception is evident within cohorts scheduled for IVF treatment, and this study indicates that the chance per cycle of live birth in couples waiting to undergo medically assisted reproduction during the COVID pandemic was 2.3%.

Risk factors for hypertension in pregnant women in Indonesia: A cross-sectional study

Objective: To determine the risk factors for hypertension in pregnant women, which is a significant cause of maternal and newborn morbidity and mortality in Indonesia. Methods: This was a cross-sectional study used secondary data from the 2018 Indonesian Basic Health Research. Pregnant women aged 15-54 years in the second and third trimesters were eligible. The history of hypertension in pregnant women was the dependent variable. The independent variables consisted of the demographic characteristics of pregnant women including pregnancy age, gestational age, education, occupation, place of residence, and region of residence. This study used multivariate logistic regression to determine the risk factors for hypertension in pregnant women in Indonesia. Results: Among 6479 respondents included in this study, 11 (7.0%) had a history of diabetes mellitus (DM) and hypertension compared to pregnant women who did not have a history of DM (0.1%). The dominant risk factors for hypertension in pregnant women in Indonesia include maternal age above 35 years (OR 3.67, 95% CI 2.54-5.32), third-trimester pregnancy (OR 2.40, 95% CI 1.72-3.35), primigravida (OR 1.78, 95% CI 1.19-2.68), excessive consumption of salty foods (OR 1.44, 95% CI 1.03-2.03), and diabetes mellitus (OR 10.20, 95% CI 3.04-32.23). Conclusions: Great efforts must be made to increase public awareness about the dangers of hypertension in pregnant women through early diagnosis and treatment, education on sodium intake, and appropriate care for pregnant women with DM.

Survival of Children With Critical Congenital Heart Defects in the National Birth Defects Prevention Study.

Critical congenital heart defects (CCHDs) are associated with considerable morbidity and mortality. This study estimated survival of children with nonsyndromic CCHDs and evaluated relationships between exposures of interest and survival by CCHD severity (univentricular or biventricular function). This analysis included 4380 infants with CCHDs (cases) born during 1999-2011 and enrolled in the National Birth Defects Prevention Study, a multisite, population-based case-control study of major birth defects. Cases were linked to state death files. Nonparametric Kaplan-Meier survival functions were used to estimate 1- and 5-year survival probabilities overall and by severity group (univentricular/biventricular) stratified by demographic and clinical exposure variables of interest. The log-rank test was used to determine whether stratified survival curves were equivalent. Survival and 95% confidence intervals (CIs) were also estimated using Cox proportional hazards modeling adjusted for maternal age, education, race/ethnicity, study site, and birth year. One- and five-year survival rates were 85.8% (CI 84.7-86.8) and 83.7% (CI 82.5-84.9), respectively. Univentricular 5-year survival was lower than biventricular case survival [65.3% (CI 61.7-68.5) vs. 89.0% (CI 87.8-90.1; p < 0.001)]. Clinical factors (e.g. preterm birth, low birthweight, and complex/multiple defects) were associated with lower survival in each severity group. Sociodemographic factors (non-Hispanic Black race/ethnicity, <high school education, smoking, and lower household income) were only associated with survival among biventricular cases. Mortality among children with CCHDs occurred primarily in the first year of life. Survival was lower for those with univentricular defects, and social determinants of health were most important in predicting survival for those with biventricular defects.

Breastfeeding Versus Bottle Feeding and Risk of Bronchial Asthma in Children in Tabuk Area, Saudi Arabia: A Cross-Sectional Study.

Introduction Asthma is a common chronic airway disorder, particularly among children in Saudi Arabia, with an increasing global prevalence. Limited epidemiological studies in the region indicate variable asthma rates, potentially influenced by factors such as modernization and environmental changes. Given the potential health benefits of breastfeeding, it is critical to investigate the relationship between type of feeding, and asthma risk. This study aims to assess the relationship between breastfeeding and bottle-feeding practices and the risk of developing asthma, as well as to evaluate how breastfeeding practices influence the severity of asthma among children in Tabuk, Saudi Arabia. Methods A cross-sectional study was conducted among children with bronchial asthma at King Salman Armed Forces Hospital in Tabuk City, Saudi Arabia. The study took place from June to August 2023 using convenient sampling. Data were collected through a validated, structured web-based questionnaire distributed to the parents of children with bronchial asthma. The analysis was performed using SPSS (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Results The study comprised 103 participants, of whom 66 (64.1%) were breastfed. There was no significant association between the severity of asthma and breastfeeding practices, including the initiation time, duration, or the age at which formula milk was introduced, as well as the combination of breastfeeding with bottle feeding. However, paternal smoking was significantly associated with asthma (p = 0.003), with 78.5% of children with smoking fathers affected compared to 50% of those without smoking fathers. In the multivariate analysis, having a father employed in the health sector (p = 0.040) and a maternal age over 35 years (p = 0.026) were significantly associated with an increased risk of asthma. Other factors, such as the child's age, gender, birth order, monthly income, parental education, family size, type of accommodation, and maternal diet during pregnancy, did not demonstrate significant associations with asthma. Conclusion Our study underscores the significant role of paternal smoking and specific parental sociodemographic factors, such as having a father employed in the health sector and maternal age over 35 years, in influencing the risk of childhood asthma. While breastfeeding practices, including duration and method, were not significantly associated with asthma severity, understanding these key risk factors can aid in developing targeted interventions for asthma prevention and management.

Does Weathering Explain Low Birth Weight in Uttar Pradesh? Findings From NFHS-5

The present study uses concept of weathering by evaluating maternal age birth and birth-weight associations across caste and religious groups in Indian context under the presumption that that disadvantaged caste and religious groups experience more rapidly deteriorating birth-weight outcomes at older ages than others. Caste and religion stratified average marginal effects of maternal age at birth on low birth-weight are estimated using data from 2015-16 and 2019-21 NFHS Uttar Pradesh data-files. The average marginal effect suggests no evidence of weathering across caste and religious groups in birth-weight patterns by maternal age at birth in Uttar Pradesh.&amp;nbsp;&amp;nbsp;

Frequency of Placenta Previa among Women with Previous Cesarean-Section

Placenta Previa was defined as when the placenta was attached to the lower uterine segment, poses significant risks, including antepartum hemorrhage and maternal mortality. The incidence was rising, attributed partly to increased cesarean sections and advanced maternal age. Objective: To determine the frequency of placenta Previa among women with previous cesarean-sections. Methods: This cross sectional study was carried out at a Teaching Hospital of Sialkot, from June to December 2021. The sample size was 147 pregnant females. These pregnant females have a history of cesarean section. The non-probability Consecutive sampling technique was used, and data were analyzed by using SPSS version 25.0. Results: Among those, 16.3% had placenta Previa, which increased significantly in women with &gt;2 previous cesarean sections to 26.4% (p = 0.003). Regarding parity, the increase in the risk of placenta Previa was not significant: 12.8% for parity &lt; 3 and 20.3% for parity ≥ 3 (p = 0.087). However, in the stratified analysis by BMI, this became significant: 11.0% for normal-weight, 18.6% for overweight, and 66.7% for obese women (p = 0.001). There was no significant difference concerning age groups, p = 0.177. Such findings of the significant associations of placenta Previa with such factors as BMI and number of cesarean sections indicate that great attention to monitoring should be paid. Conclusion: Hence concluded that previous cesarean sections strongly correlate with placenta previa in subsequent pregnancies. Such findings underscore the need for rigorous monitoring and proactive measures, especially in cases of multiple cesarean deliveries, in the management of associated complications.

A RETROSPECTIVE STUDY OF MATERNAL AND FETAL OUTCOMES IN PLACENTAL ABRUPTION

Introduction:Placental abruption (PA) is a critical obstetrical emergency characterized by the premature separation of a normally implanted placenta, leading to maternal and fetal complications. It is unpredictable, with a sudden onset, often associated with risk factors like advanced maternal age, multiparity, pre-eclampsia, and history of high-risk pregnancy (HRP). Clinically, PA presents with abdominal pain, vaginal bleeding, uterine tenderness, and fetal distress.Patho physiologically, PA occurs when maternal vessels tear away from the placenta, causing a hematoma that disrupts maternal-fetal circulation, leading to hemodynamic instability, coagulation abnormalities, and potential fetal demise. The severity of PA varies, classified from asymptomatic (Class 0) to severe (Class 3), based on clinical symptoms and the extent of placental separation. Management strategies depend on the severity and gestational age, ranging from conservative management in mild cases to urgent delivery in severe cases.PA is associated with significant maternal and fetal morbidity and mortality, including hemorrhage, fetal demise, and potential recurrence in future pregnancies. Prompt recognition and management are essential to improve outcomes. Aim:To study the maternal and perinatal outcomes associated with placental abruption Material and Methods:This retrospective study was conducted on 22 cases of placental abruption in the Department of Obstetrics and Gynecology at MRMC Kalaburagi, covering the period from January 2023 to December 2023. The study exclusively included women diagnosed with placental abruption. Cases involving placenta previa and other extraplacental causes of antepartum hemorrhage were excluded from the analysis. Results:In the retrospective study of 22 cases of placental abruption, the age distribution of patients varied: 2 were 19 years old, 17 were between 21 and 30 years old, and 3 were over 30 years old. Among the women, 45% were primigravida, and 54% were multigravida. Delivery methods were split, with 40.9% undergoing a lower segment caesarean section (LSCS) and 59% delivering vaginally 7 patients required induction. Blood transfusion was necessary for 16 cases, which accounts for 72% of the sample. Couvelaire uterus was observed in 3 cases (13.6%). The study reported one maternal mortality, representing 4.5% of the cases. Conclusion:This study highlights significant maternal and perinatal outcomes associated with placental abruption. The majority of the women were within the 21-30-year age group, with a notable percentage being multigravida. A substantial portion of deliveries required lower segment cesarean section, and many patients underwent blood transfusions, reflecting the severity of the condition. Couvelaire uterus was observed in a notable subset of cases, and maternal mortality was relatively low but significant. These findings underscore the critical need for vigilant management and monitoring of placental abruption cases to improve both maternal and fetal outcomes.

The early prediction of gestational diabetes mellitus by machine learning models

BackgroundWe aimed to determine the best-performing machine learning (ML)-based algorithm for predicting gestational diabetes mellitus (GDM) with sociodemographic and obstetrics features in the pre-conceptional period.MethodsWe collected the data of pregnant women who were admitted to the obstetric clinic in the first trimester. The maternal age, body mass index, gravida, parity, previous birth weight, smoking status, the first-visit venous plasma glucose level, the family history of diabetes mellitus, and the results of an oral glucose tolerance test of the patients were evaluated. The women were categorized into groups based on having and not having a GDM diagnosis and also as being nulliparous or primiparous. 7 common ML algorithms were employed to construct the predictive model.Results97 mothers were included in the study. 19 and 26 nulliparous were with and without GDM, respectively. 29 and 23 primiparous were with and without GDM, respectively. It was found that the greatest feature importance variables were the venous plasma glucose level, maternal BMI, and the family history of diabetes mellitus. The eXtreme Gradient Boosting (XGB) Classifier had the best predictive value for the two models with the accuracy of 66.7% and 72.7%, respectively.DiscussionThe XGB classifier model constructed with maternal sociodemographic findings and the obstetric history could be used as an early prediction model for GDM especially in low-income countries.

Risk Factors and Profile of Congenital Anomalies Abnormalities in Central Morocco

Background: In Morocco, there is no official data on the prevalence of congenital anomalies (CAs). Available data are mostly derived from hospital-based retrospective epidemiological analyses. Objectives: This study aims to describe the prevalence, distribution, and risk factors of CAs in the Beni Mellal-Khenifra region of central Morocco. Methods: Epidemiological data were obtained from delivery files of 163,842 births recorded by local medical services from January 2017 to December 2021. Additionally, a case-control study was conducted to analyze the risk factors. Results: The prevalence of CAs in this study area was 6.18 per thousand births. Musculoskeletal system anomalies were the most common (32.88%), followed by nervous system anomalies (22.20%). Genital organ abnormalities represented 7.37%, and cleft lip and palate accounted for 7.03%. Analysis by type of CA revealed that clubfeet were the most commonly reported anomalies in the study area, with a prevalence of 18%, followed by spina bifida (9%), anencephaly (7%), and cleft lips and palate (7.9%). The sex ratio (males/females) for all CAs was 1.24. Risk factors identified in this study included rural residency, maternal age over 35 years, parity, consanguinity, family history of CA, medication use before and during pregnancy, and infection episodes during pregnancy. Conclusions: The relatively high prevalence of congenital abnormalities in the Beni Mellal-Khenifra region highlights the need for prevention strategies through preconception care counseling and pregnancy monitoring, especially in rural areas. It is urgent to establish a teratovigilance registry in Morocco.

SCM-198 ameliorates the quality of postovulatory and maternally aged oocytes by reducing oxidative stress

Oocyte aging is a key constraint on oocyte quality, leading to fertilization failure and abnormal embryonic development. In addition, it is likely to generate unfavorable assisted reproductive technology (ART) outcomes. SCM-198, a synthetic form of leonurine, was found to rescue the rate of oocyte fragmentation caused by postovulatory aging. Therefore, the aim of this study was to conduct a more in-depth investigation of SCM-198 by exploring its relationship with aged oocytes after ovulation or maternal aging and clarifying whether it affects cell quality. The results indicate that, compared to the postovulatory aged group, the 50 µM SCM-198 group significantly improved sperm-egg binding and increased fertilization of aged oocytes, restoring the spindle apparatus/chromosome structure, cortical granule distribution, and ovastacin and Juno protein distribution. The 50 µM SCM-198 group showed significantly normal mitochondrial distribution, low levels of reactive oxygen species (ROS), and a small quantity of early oocyte apoptosis compared to the postovulatory aged group. Above all, in vivo supplementation with SCM-198 effectively eliminated excess ROS and reduced the spindle/chromosome structural defects in aged mouse oocytes. In summary, these findings indicate that SCM-198 inhibits excessive oxidative stress in oocytes and alters oocyte quality both in vitro and in vivo.Graphical