Medical Complications Of Pregnancy Research Articles

Comparative study of circuit resistance training and aerobic training on glycemic control of gestational diabetes mellitus

Background Gestational diabetes mellitus (GDM) is a standout among the most well-known medical complications of pregnancy. The occurrence of GDM has multiplied in the most recent 6–8 years and is associated with the obesity epidemic. Objective To compare the effect of circuit resistance training (CRT) versus aerobic training (AT) on glycemic control in women with GDM. Participants and methods A total of 50 pregnant women with a diagnosis of GDM were randomly assigned to a CRT group or an AT group. Both the groups trained for 40 min, three times per week for 36 sessions, starting at 20–24 weeks gestation (second trimester) until the end of 37 weeks gestation. The fasting and 2-h postprandial plasma glucose levels were assessed in all the participants before and after the treatment program. Results The results revealed a significant decrease in both fasting and 2-h postprandial plasma glucose levels in both the groups after the training program (CRT group, P Conclusion These results suggest that the CRT was more effective than AT in improving glycemic control among gestational diabetic women.

Perinatal mortality associated with induction of labour versus expectant management in nulliparous women aged 35 years or over: An English national cohort study

BackgroundA recent randomised controlled trial (RCT) demonstrated that induction of labour at 39 weeks of gestational age has no short-term adverse effect on the mother or infant among nulliparous women aged ≥35 years. However, the trial was underpowered to address the effect of routine induction of labour on the risk of perinatal death. We aimed to determine the association between induction of labour at ≥39 weeks and the risk of perinatal mortality among nulliparous women aged ≥35 years.Methods and findingsWe used English Hospital Episode Statistics (HES) data collected between April 2009 and March 2014 to compare perinatal mortality between induction of labour at 39, 40, and 41 weeks of gestation and expectant management (continuation of pregnancy to either spontaneous labour, induction of labour, or caesarean section at a later gestation). Analysis was by multivariable Poisson regression with adjustment for maternal characteristics and pregnancy-related conditions. Among the cohort of 77,327 nulliparous women aged 35 to 50 years delivering a singleton infant, 33.1% had labour induced: these women tended to be older and more likely to have medical complications of pregnancy, and the infants were more likely to be small for gestational age.Induction of labour at 40 weeks (compared with expectant management) was associated with a lower risk of in-hospital perinatal death (0.08% versus 0.26%; adjusted risk ratio [adjRR] 0.33; 95% CI 0.13–0.80, P = 0.015) and meconium aspiration syndrome (0.44% versus 0.86%; adjRR 0.52; 95% CI 0.35–0.78, P = 0.002). Induction at 40 weeks was also associated with a slightly increased risk of instrumental vaginal delivery (adjRR 1.06; 95% CI 1.01–1.11, P = 0.020) and emergency caesarean section (adjRR 1.05; 95% CI 1.01–1.09, P = 0.019). The number needed to treat (NNT) analysis indicated that 562 (95% CI 366–1,210) inductions of labour at 40 weeks would be required to prevent 1 perinatal death. Limitations of the study include the reliance on observational data in which gestational age is recorded in weeks rather than days. There is also the potential for unmeasured confounders and under-recording of induction of labour or perinatal death in the dataset.ConclusionsBringing forward the routine offer of induction of labour from the current recommendation of 41–42 weeks to 40 weeks of gestation in nulliparous women aged ≥35 years may reduce overall rates of perinatal death.

Perinatal mental illness

Mental illness is the most common medical complication of pregnancy. The impact and prevalence are often underestimated. Depression and anxiety can occur, as at other times of life, but conditions such as postnatal psychosis and tokophobia (fear of childbirth) are specific to mental health in pregnancy and the first year after birth. In this article, we discuss the wide range of perinatal mental illness, using case histories to illustrate different presentations and evidence-based management. We also discuss the wider impact of perinatal mental illness.

Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial

Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70-86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76-91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, -5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, -4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P < .001), consistent with the known higher expulsion rate with immediate vs delayed postpartum intrauterine device insertion. No intrauterine device perforations occurred in either group. Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.

The Effect of Orally -Administered Calcium Carbonate to Pregnant Women with Mild Pre-eclampsia

Pre-eclampsia is the most common medical complication of pregnancy associated with increased maternal and infant mortality and morbidity. Its exact etiology is not known, although several evidences indicate that various elements might play an important role in pre-eclampsia. This study was carried out to analyze and to compare the concentration of calcium, in mild pre-eclampsia and in normal pregnant women , and to determine the effect of oral supplementation with calcium on mild pre-eclampsia , and whether this effect is related to the change in the level of serum calcium. Forty- five women in the third trimester of pregnancy were selected to participate in this study and divided into: fifteen apparently healthy, normotensive pregnant women served as a control group; thirty clinically diagnosed patients with mild pre-eclampsia ( 15 mild pre-eclamptic un-treated group , 15 mild pre-eclamptic treated with calcium carbonate 500 mg twice daily) , the serum calcium were estimated with an atomic absorption spectrophotometer .the data were analyzed using the un- paired Student’s-test.The serum calcium in mild pre-eclmpatic un-treated group was significantly lower than that in normal pregnant women (8.84 ± 1.14 Vs. 9.66 ± 0.87 , p&lt;0.05) , Serum calcium level significantly increased in mild pre-eclamptic treated with calcium carbonate 500mg twice daily as compared to mild pre-eclamptic un-treated group (9.76 ±0.96 Vs 8.84±1.14 ,p&lt;0.05) . Systolic ,diastolic, and mean arterial blood pressure were significantly reduced after one month of treatment with calcium carbonate 500 mg twice daily as compared to mild pre-eclamptic un –treated group.(134.83 ± 7.5 Vs139.33 ± 5.30, 88.46 ± 3.27 Vs 91 ± 3.38, 103.90 ± 3.8Vs106.66 ± 3.08 ,p&lt;0.05) respectively.This study showed that serum calcium level in mild pre-eclampsia are lower than in normotensive pregnant women ,this finding support the hypothesis that hypocalcemia is a possible etiology in pre-eclampsia ; additionally this study showed the possible beneficial effect of calcium supplementation in controlling pre-eclampsia and reducing blood pressure by increasing serum calcium level .&#x0D; Key words: Mild Pre-eclampsia, Calcium carbonate tablet, Pregnant women, Serum calcium

Hypertensive disorders of pregnancy in women with gestational diabetes mellitus on overweight status of their children.

Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear. The aim of the present study was to evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM).A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1–5 years old.Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1–5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08–2.79) and macrosomia (OR 2.02, 95%CI 1.23–3.31) at birth and childhood overweight/obesity at 1–5 years old age (OR 1.88, 95%CI 1.16–3.04).For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity, and controlling the maternal hypertension may be more important for preventing large for gestational age babies and childhood obesity.

Abstract P185: Hypertensive Disorders of Pregnancy in Women With Gestational Diabetes Mellitus on Overweight Status of Their Children

Background: Hypertensive disorders of pregnancy (HDP) as a group of medical complications in pregnancy are believed to be associated with an increased risk of poor fetal growth, but the influence on offspring’s body composition is not clear. Aims: To evaluate the association between maternal hypertensive disorders of pregnancy and overweight status in the offspring of mothers with gestational diabetes mellitus (GDM). Methods: A cross-sectional study among 1263 GDM mother-child pairs was performed in Tianjin, China. General linear models and logistic regression models were used to assess the associations of maternal hypertension in pregnancy with anthropometry and overweight status in the offspring from birth to 1-5 years old. Results: Offspring of GDM mothers who were diagnosed with hypertensive disorders during pregnancy had higher mean values of Z scores for birth weight for gestational age and birth weight for length, and higher mean values of Z scores for weight for age, weight for length/height, and body mass index for age at 1-5 years old than those of GDM mothers with normal blood pressure during pregnancy. Maternal hypertensive disorders of pregnancy were associated with increased risks of large for gestational age (OR 1.74, 95%CI 1.08-2.79) and macrosomia (OR 2.02, 95%CI 1.23-3.31) at birth and childhood overweight/obesity at 1-5 years old age (OR 1.88, 95%CI 1.16-3.04). Conclusion: For offspring of mothers with GDM, maternal hypertension during pregnancy was a risk factor for macrosomia at birth and childhood overweight and obesity.

Vascular endothelial growth factor expression in placenta of hypertensive disorder in pregnancy.

Hypertensive disorder in pregnancy (HDP) represents the most common medical complication in pregnancy. It is the leading cause of maternal and perinatal mortality and morbidity. Vascular endothelial growth factor (VEGF) stimulates vascular endothelial cell growth, survival, and proliferation, and they are known to be expressed in human placenta. The aim of this study was to determine the VEGF expression in the placenta of hypertensive and normotensive patients. This is a retrospective, cross-sectional study from January 1, 2015 to December 31, 2015. A total of 30 placentae comprised of 15 hypertensive and 15 normotensive cases were assessed. VEGF expression in placenta was assessed by immunohistochemistry, and the number of syncytial knots was counted. Our study showed an increased syncytial knot formation in the placenta of hypertensive mothers. VEGF expression was seen in syncytiotrophoblasts of 14 of the hypertensive cases (14/15, 93.3%), while only two of the normotensive cases were positive (2/15, 13.3%). There were no statistically significant differences in VEGF expression in other placenta cells, that is, cytotrophoblasts (P = 1.0), decidual cells (0.1394), maternal endothelial cells (0.5977), and fetal endothelial cells (P = 1.0). This study showed an increased number of syncytial knots is a consistent histological finding in the placenta of patient with HDP. VEGF expression was significantly increased in syncytiotrophoblasts in placenta of hypertensive group, and it could be used as a biomarker for hypertension.

Glycated hemoglobin in parturient mothers and anthropometry in term neonates: A hospital-based study

Context: Gestational diabetes mellitus is the most common medical complication of pregnancy and is considered a major public health problem associated with an increase in perinatal mortality and morbidity rates. Aims: The aim of this study is to correlate glycated hemoglobin (HbA1c) values of parturient mothers with anthropometry of their newborn babies. Settings and Design: This was a prospective, observational study. Subjects and Methods: A total of 1000 patients and their babies who had fulfilled the inclusion criteria and had signed the consent were enrolled in the study. The HbA1c values of parturient mothers with anthropometry of their newborn babies were documented. Correlation analysis of the observed values was of the anthropometry, and the HbA1c values were evaluated. Statistical Analysis Used: Correlation tests were used for statistical analysis. Results: A statistical correlation is seen between an HbA1c value >6% and a birth weight more than 3700 g. A similar correlation is seen between a normal HbA1c value and a birth weight between 2500 and 3700 g. Conclusions: The anthropometric findings could be of value in the management of the newborn babies in the absence of laboratory evidence of deranged sugar values in the antenatal period, especially in the low-resource settings.

A comparative study on coagulation profile and neutrophil-lymphocyte ratio in pregnancy-induced hypertension

Background: Hypertension is one of the common medical complications of pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. It is associated with alteration of hematological profile, of which thrombocytopenia is the most common which may be accompanied by a clinically evident consumptive coagulopathy or may be the sole abnormality seen. White blood cells are positively associated with inflammation. In medicine, neutrophilto-lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. An elevated ratio of peripheral neutrophil to lymphocytes has been recognized as a poor prognostic indicator in various cancers. Aims and Objectives: The objectives were to study and compare coagulation profile and NLR in pregnancy-induced hypertensive (PIH) patients with matched controls and to correlate the above parameters in relation to the severity of pregnancy-induced hypertension. Materials and Methods: Investigations were carried out in 90 PIH patients, aged 20–35 years, and in 90 normal pregnant women who are anthropometrically matched controls. Statistical analysis was done using Student’s t-test and one-way ANOVA test, SPSS software version 20. Result: A significant decline in total platelet count (TPC), increase in prothrombin time, activated partial thromboplastin time, bleeding time, and clotting time was seen in PIH as compared to normal pregnancy. NLR is also significantly raised in PIH compared to normal pregnancy. Conclusion: TPC and NLR estimation can be taken as an early and rapid procedure for screening preeclampsia cases at admission followed by serial platelet counts while monitoring coagulation indices.

Pregnancy gone wrong: Women's experiences of care in relation to coping with a medical complication in pregnancy

Pregnancy gone wrong: Women's experiences of care in relation to coping with a medical complication in pregnancy

Exercise and its role in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) refers to diabetes diagnosed in the second or third trimester of pregnancy that is not clearly either type 1 or type 2 diabetes. GDM is a common medical complication in pregnancy that has been rapidly increasing worldwide. GDM is associated with both short- and long-term health issues for both mothers and offspring. Consistent with type 2 diabetes, peripheral insulin resistance contributes to the hyperglycemia associated with GDM. Accordingly, it is important to identify strategies to reduce the insulin resistance associated with GDM. To date, observational studies have shown that exercise can be a non-invasive therapeutic option for preventing and managing GDM that can be readily applied to the antenatal population. However, the relevant mechanisms for these outcomes are yet to be fully elucidated. The present review aimed to explain the potential mechanisms of exercise from the perspective of reducing the insulin resistance, which is the root cause of GDM. Exercise recommendations and opinions of exercise during pregnancy are briefly summarized.

Risk Prediction Models for Hypertensive Disorders of Pregnancy: Role of 12-Lead Electrocardiography

Summary Hypertensive disorders represent the most common medical complications of pregnancy, affecting 6 to 8 percent of gestations. They may lead to severe maternal and fetal complications. Several observational studies have highlighted that weight, systolic and diastolic blood pressure, obtained at antenatal visit prior to 16 weeks, may be suitable to stratify the risk of developing hypertensive disorders during pregnancy. Recently, however, other markers have been proposed as potential predictors of hypertensive disorders during pregnancy. In this context, some electrocardiographic changes have shown significant power in refining risk stratification. Specifically, changes during pregnancy in QT interval and P wave morphology improved the accuracy of multivariable models for the prediction of hypertensive disorders. In particular, the presence of left atrial abnormalities at ECG seems to be associated with a marked increase in the risk of developing hypertensive disorders, and when included in a multivariable model taking into account some maternal features, it may discriminate between women who will develop hypertensive disorders during pregnancy and women who will remain normotensive. This prediction model was also able to identify pregnant women at increased risk for the occurrence of fetal/neonatal complications. The aim of the present overview is to discuss the available data supporting the evidence that specific ECG patterns occurring early in pregnancy may have clinical relevance for risk prediction of hypertensive disorders.

Management of medical complications in pregnancy

내과질환이 합병된 임신의 관리 5 고위험 산모는 일반 산모에 비해 엄마나 아기의 합병증이 동반되기 쉬운 산모를 지칭 한다. 예를 들면 심장질환, 당뇨 병, 만성고혈압, 신장질환 등의 여러 가지 내과적 질환이 있 었거나 현재 앓고 있는 경우, 자궁 및 자궁경부의 기형이 있 거나 자궁 외 임신이나 자연 유산의 경험이나 태아기형의 과거력, 조기분만, 자궁 내 태아사망이나 신생아 사망의 경 험 등의 산부인과적 과거력이 있는 사람을 말한다. 또한 분 만 전 출혈이 있었거나 임신성 고혈압 및 임신성 당뇨병으 로 진단된 경우, 양막의 조기파열이나 자궁 내 태아발육지 연, 지연임신 등이 금번 임신 후 진단된 경우, 고령임신이나 다태임신, 저 체중 또는 비만산모, 담배 또는 약물복용 등의 습관 등도 포함되며, 미혼모나 산전진찰을 받지 않은 산모도 고 위험 산모에 속한다. 여성의 사회진출이 많아지고 결혼 후에도 사회생활을 지 속하는 여성이 늘면서 점차 출산 연령이 늦어져 고령산모 가 늘고 있다. 결혼과 출산이 늦어지면서 산모 4명 중 1명 (24.3%)은 35세 이상이며, 반면 35세 미만의 산모는 줄어들 었다. 고령출산이 정상적인 임신이 아니라고 말할 수는 없지 만, 유산이나 다운증후군, 저 체중아 기형아를 출산할 확률 이 높아진다는 점에서 주의가 필요하다. 특히 고령 임산부는 임신중독증, 임신성 당뇨를 비롯해 여러 가지 합병증이 더 많고 특히 40대에는 고혈압이나 당뇨병 등 여러 가지 성인병 을 지니고 있는 경우가 많기 때문에 합병증이 생길 가능성이 더 높다. 따라서 35세 이후에 임신을 한 경우에는 초산부나 경산부 모두 정기검진 등을 통해 세심한 관리가 필요하다. 고혈압은 전체 임신의 5-10%에서 합병되는 대표적인 내 과질환으로서, 출혈, 유산, 감염과 더불어 모성사망의 주요 한 원인이 된다[1]. 모성사망의 원인 중 임신성 고혈압에 의 한 모성사망의 약 60%가 임상적 처치 및 의료보건인프라 등 을 개선했다면 예방 가능한 것이라는 보고가 있다[2]. 그러 나 현재까지도 고혈압은 산모와 태아 건강을 심각하게 위협 하는 질환으로 남아있고 2014년 세계보건기구는 전 세계에 서 발생한 모성사망의 원인 중 임신성 고혈압이 14%를 차지 한다고 하였다[3]. 임신 중 고혈압은 모체 및 태아의 사망위험을 높일 뿐만 아니라 여러 가지 합병증을 유발할 수 있다. 모체의 단기 합병증으로는 중추신경계 기능이상, 급성파종성혈관내응고, 폐부종, 태반조기박리 등이 있고, 장기적으로는 심혈관질환, 당뇨, 신장질환 등의 위험을 높인다. 태아 측에는 자궁 내 발 육지연, 저 체중아, 조산, 자궁 내 태아사망의 증가 등과 관 련이 있다[4]. 임신 중 고혈압 관리는 모체와 태아 모두에게 내과질환이 합병된 임신의 관리

Colour Doppler Study of Umbilical Artery in Antenatal Women with Severe Preeclampsia and Foetal Outcome

Hypertensive disorders are the most common medical complications of pregnancy (7.15%). Doppler analysis of umbilical artery S/D ratio PI and RI, absent or reversal of EDV were evaluated and follow up results studied in severe preeclampsia women between 26 to 40 weeks. Doppler analysis of Uterine Artery and Middle Cerebral Artery is also studied. Doppler study guides in decision making and follows up in severe preeclampsia and guides in reducing perinatal morbidity and mortality. Period of Study: This is a prospective randomised study conducted at Niloufer Hospital for Women and Children Red Hills Hyderabad from September 2011 to June 2014. Material and Methods: 100 pregnant women with severe preeclampsia who attended Antenatal Out-Patient Department and got admitted in Emergency ward underwent Umbilical artery velocimetry by means of a Colour doppler vision (6000 Toshiba corp Tokyo Japan) using 3.5_5 MHZ Trasabdominal traducer. Results: Total number of 100 women were studied. In this 60 women had foetuses with abnormal umbilical artery flow velocimetry and 40 had normal umbilical artery flow velocimetry. The average birth weight and diagnosis to delivery interval were lower in foetuses with abnormal umbilical artery doppler. Admission to neonatal intensive care unit is high. The APGAR score at 1 minute is <7 in 20 women with abnormal umbilical artery doppler compared to 17 women with normal umbilical artery doppler. Compared to 32 women with normal umbilical artery doppler, the APGAR score is more than 7 in 31 women with abnormal umbilical artery Doppler. P = 0.639647 and chi-square statistic = 0.2192, the result is statistically not significant at p-value < 0.05, implying that APGAR scores are not dependent on doppler findings alone. Conclusion: Doppler study guides obstetrician to assess the physiological status of the foetus and it helps in identifying the changes in the foetal circulation. This study suggests that doppler assessment of foe to placental circulation including umbilical artery is a better prognostic indicator in severe PE and helps in timely intervention. The foetuses with normal artery flow velocimetry area at a lower risk of having poor APGAR score than those with abnormal velocimetry and NICU admissions are less with normal umbilical artery flow velocimetry. The average birth weight of neonates with abnormal umbilical artery was lower compared to neonates with normal umbilical artery velocimetry.

Birth Order and Health of Newborns: What Can We Learn from Danish Registry Data?

Research has shown a strong negative correlation between birth order and cognitive test scores, IQ, and educational outcomes. We ask whether birth order differences in health are present at birth using matched administrative data for more than 1,000,000 children born in Denmark between 1981 and 2010. Using family fixed effects models, we find a positive and robust birth order effect; earlier born children are less healthy at birth. Looking at the potential mechanisms, we find that during earlier pregnancies women have higher labor market attachment, behave more risky in terms of smoking, receive more prenatal care, and are diagnosed with more medical pregnancy complications. Yet, none of these factors explain the birth order differences at birth. Combining our results with findings from the medical literature, we propose that biology is driving the early life advantage (nature). Finally, we show that these birth order differences at birth do not explain the negative birth order effect in educational performance, suggesting that nurture rather than nature is an important player later in life.

The prevalence of neonatal morbidities associated with late-preterm birth

ObjectiveObstetrical and medical complications in pregnancy may necessitate delivery between 34 and 37 weeks' gestation. To assist decision making and patient counseling, we sought to determine the prevalence of neonatal morbidities between 34 and 37 weeks' gestation. Study designRetrospective cohort study of live births was conducted at our institution over a seven year period. Multiple gestations and congenital anomalies were excluded. The prevalence of neonatal morbidities between 34 and 37 were calculated. Results1060 births between weeks 34–36 and 975 births occurred during week 37. Gestational age was inversely related to NICU admission, days in NICU, intubation, poor feeding, hyperbilirubinemia, and respiratory distress (p < 0.01 for all). Respiratory distress requiring surfactant (RDS), occurred in 4%, 1%, 0.2%, and 0% of infants born at 34, 35, 36, and 37 weeks, respectively (p < 0.01). ConclusionThere is decreased neonatal morbidity for each week gained between 34 and 37 weeks' gestation.

EPIDEMIOLOGÍA DE LA PREECLAMPSIA

Información epidemiológica y evidencia clínica apoyan la tesis de que el embarazo representa un desafío metabólico para algunas mujeres, de tal manera que una leve hiperlipidemia subclínica llega a ser detectable clínicamente. La preeclampsia es la complicación médica más frecuente del embarazo. La mortalidad materna y perinatal en el Perú es alta. Se considera como factores asociados al desarrollo de preeclampsia, la primigravidez, cambio de pareja, preeclampsia previa o historia familiar de preclampsia, edad materna joven o avanzada, índice de masa corporal aumentada, embarazo múltiple, diabetes mellitus, hiperhomocisteinemia,resistencia a la insulina, entre otros. Se revisa en el presente artículo dichos factores de riesgo asociados, así como algunos factores de protección.

English

Urinary tract infection (UTI) is one of the most frequently seen medical complications in pregnancy. UTI in pregnancy poses risk of complications such as premature birth, low birth weight, still birth and pyelonephritis. A prospective study was undertaken to determine the prevalence of urinary tract infection among pregnant women attending antenatal clinic in Amassoma and to identify the bacteria involved. A total of 138 urine samples were analyzed and cultured by the standard loop technique on cystein lactose electrolyte deficient (CLED) medium, MacConkey and blood agar. A prevalence rate of 25.3% was observed in this study and the relationship between age and bacteriuria was non-significant (P>0.05), which signifies that bacteriuria is independent on age, while the relationship between bacteuria and trimester was statistically significant as P<0.05. Escherichia coli (40%) was the most common bacteria isolated followed by Pseudomonas aeruginosa (22.9%). Screening of pregnant women for bacteriuria during every antenatal visit should be considered an essential care in the community to avoid complications in pregnancy at an early stage. Key words: Complication, pregnancy, prevalence, screening, UTI.

Oocyte donation is an independent risk factor for pregnancy complications: the implications for women of advanced age.

Maternal age at first pregnancy and age-related infertility are steadily increasing, and the demand for assisted reproductive technologies (ART) to treat age-related infertility is also on the rise. The latest registry findings from Europe and the United States show that the meager results of ART in women above 43 years of age have not improved much over the past 10 years. The latest evidence shows that the demand for oocyte donation (OD) is steadily increasing. Contrary to previous belief-attributing increased perinatal complications in OD recipients to advanced maternal age and multifetal pregnancy-accumulating evidence from the past few years suggests that OD itself is a significant and independent risk factor for pregnancy complications, mostly for pre-eclampsia. The increased rate of chronic maternal disease and medical complications in pregnancy observed in advanced maternal age, coupled with the growing demand for OD, with its independent association with pre-eclampsia, create an urgent need to adopt a clear policy taking these risks into account. We present recent evidence showing that OD is an independent risk factor for pre-eclampsia and suggest recommendations for women approaching OD treatment in advanced age.