Multigravid Women Research Articles

Identify etiology of morbidity events of earlier children among multigravida women

Morbidity condition are more prevalent in the children who are exposed to various risk factors like overcrowding, poor nutrition etc. morbidity in the children residing in the rural area is more as compared to the urban area.Because socio-economical strata and standard of living, inadequate knowledge.Children are the future of any healthy nation they are asset of nation, unfortunately this assets falls children, because of poor maintenance of health, Malaria and acute respiratory infection are higher among children in rural setting and children whose mothers are 16–17 and 28–33 years of age. Objective: To identify the etiology of morbidity events of earlier children among multigravida women. Research Methodology: The quantitative approach and community based cross-sectional study design was used. Were enrolled 492 multigravida women with her 992 earlier children from 0-18 yr age group with used simple random sampling technique, Analyses was done using SPSS version 26.00 and identify etiology events of earlier children among multigravida women. Result: major finding identify etiology of morbidity events of earlier children among multigravida women’s group was G2P2 in that; 1(0.2%) illness having before pregnancy in multigravida women and having illness during pregnancy, 23(3.8%) were taken treatment during pregnancy, 50(8.2%) women were having consanguinity marriage.

Frequency of urinary incontinence among pregnant women: A cross-sectional survey

Background: Pregnancy is a well-known risk factor for urinary incontinence (UI), which occurs because of pregnancy-induced physiological and anatomical changes that can result in weak pelvic floor muscles. Objective: To determine the frequency of urinary incontinence among pregnant women. Methods: Hospital based cross-sectional study was conducted among 300 pregnant women, aged between 18 to 45 years, following antenatal care at the Federal Government Polyclinic Hospital Islamabad between July 2021 and October 2021. Revised Urinary Incontinence Scale (RUIS) was used as outcome measure. Data was analyzed using SPSS. Results: Out of 300 the pregnant women, 64.7% had urinary incontinence and only 35.3% did not have urinary incontinence. The frequency of urinary incontinence in first, second and third trimester was 4%, 20% and 76%, respectively. In primigravida and multigravida, the frequency of urinary incontinence was 38% and 62%, respectively. Conclusion: Urinary incontinence is more common in third trimester, especially multigravida women aged between 25-31 years.

Faktor-Faktor yang Berhubungan dengan Kejadian Kurang Energi Kronis pada Ibu Hamil

Chronic Energy Deficiency is a condition in which the mother is malnourished due to a chronic deficiency of one or more dietary nutrients which results in relatively or absolute health problems for the mother. This study aims to determine knowledge, maternal age, gestational age and income with chronic energy deficiency in pregnant women in the Muara Enim Public Health Center Work Area, Muara Enim Regency in 2021. The method used in this study is an analytical survey with a cross sectional approach. The statistical test used was the Chi-Square test. The population in this study were all multigravida pregnant women, with a sample of 54. Through data analysis with statistical tests using the Chi-Square test, it was found that there was a significant relationship (P-value 0.001), gestational distance (P-value 0.011), and income (P-value = 0.005). with chronic energy deficiency, and there is no relationship between maternal age and chronic energy deficiency in pregnant women with a Pvalue of 0.275. The results of this study can be used as input for the preparation of health programs to reduce the incidence of chronic energy deficiency in pregnant women and as input for improving the quality of health services.

Study of indications of primary cesarean section in multigravida patients: A retrospective study

Background: Caesarean section is one of the most widely performed surgical procedures in obstetrics worldwide. It was mainly evolved as a lifesaving procedure for mother and foetus during the difficult delivery. Multiparous means those who had delivered once or more after the age of viability. It includes multipara (para 2, 3, 4) and grand multipara (para more than 4). Primary Caesarean section in the multipara means first Caesarean section done in the patients who had delivered vaginally once or more. Aims and Objectives: The aims of this study were to study the indications for the primary cesarean section in multigravida women at tertiary care center, Medical College Jhalawar. Materials and Methods: Retrospective record-based study of all primary cesarean section in multigravida women admitted at Janana Hospital, Medical college Jhalawar during the period of 3 months. Retrospective analysis of case sheet was done in parous women who had previous vaginal deliveries. Inclusion criteria were all multigravida who went for the lower segment cesarean section (LSCS). Results: During the study period of 3 months, total 1968 deliveries occurred, out of which 806 (40.95%) underwent cesarean section and 208 (25.80%) among these cesarean sections were underwent primary cesarean section in multigravida. Maximum number of the patients were in the age group of 25–30 years 120 (57.69%). Maximum number of patients were gravida 2 (G2) 135 (63.67%) and gravida 3 (G3), 52 (24.52%). Almost all of them (96.63%) underwent emergency cesarean section. The most common indication for the primary LSCS in multigravida patients was fetal distress 46 (22.11%) followed by malpresentation 38 (18.26%) cases, meconium stained liquor with fetal distress 23 (11.05%), severe oligohydramnios 15 (7.21%), non-progress of labor 13 (6.25%), pre-eclampsia and big baby 8 (3.84%) each, elective CS with bad obstetric history, obstructed labor and placenta praevia 7 (3.36%) reach, APH and cephalopelvic disproportion 6 (2.28%) each, and PIH 5 (2.24%). Conclusion: The most common indication for the primary LSCS in multigravida patients was fetal distress 46 (22.11%) followed by malpresentation 38 (18.26%) cases in our study.

Awareness among Pregnant Women about Epidural Analgesia: A Cross-Sectional Study.

Background Epidural analgesia (EPA) is an effective anesthetic technique to overcome pain during labor. This study aimed to evaluate the current awareness of EPA among pregnant women. Methods We carried out a cross-sectional study using a questionnaire to measure awareness about EPA among pregnant women visiting the obstetrics and gynaecology clinic in King Abdulaziz Medical City in Jeddah. Following the results, a group of women was selected and educated by trained medical students. Results This study comprised 105 women. We found that 25 (23.8%) respondents revealed a complete lack of knowledge regarding EPA, 63 (60%) showed minimal awareness, and 17 (16.2%) were aware of EPA from various sources. The gravidity and history of EPA administration were significantly associated with knowledge. Multigravida women and those who had received EPA showed higher level of knowledge (p=0.048 and p < 0.001, respectively). In addition, there was a significant association between the level of education and request for EPA (p=0.027). Forty-one participants were enrolled in an educational program that explained the importance of EPA. Twenty (48.8%) women decided to undergo EPA during delivery; however, 7 (17.7%) refused and 14 (34.1%) were not sure about their decision. Conclusion This study revealed a lack of awareness about EPA among pregnant women. Educational programs were effective as many participants chose EPA following the educational session as a form of pain relief during labor. We recommend the implementation of routine education on EPA in vaginal delivery during antenatal visits for all pregnant women.

STUDI KASUS: ANEMIA RINGAN PADA KEHAMILAN TRIMESTER III

Anemia is a condition which the body lacks red blood cells (erythrocytes) in the blood so that the tissue lacks oxygen. Anemia of pregnancy or so called potential danger to mother and child is very dangerous for mother and child is very dangerous for mother and child, so anemia in pregnancy becomes a serious problem. Gravida, age, parity, education level, economic status and adherence to consuming Fe tablets or blood boosters are the causes of anemia during pregnancy. This case study describes mild anemia in pregnancy experienced by a 26 years old multigravida pregnant women who was pregnant with her fourth child with close pregnancy intervals. The care provided for this problem is by offering Fe tablets and vitamin C supplements during pregnancy, as well as education on the consumption of nutritious foods that contain iron.

Associations of maternal iron deficiency with malaria infection in a cohort of pregnant Papua New Guinean women

BackgroundIron deficiency (ID) is common in malaria-endemic settings. Intermittent preventative treatment of malaria in pregnancy (IPTp) and iron supplementation are core components of antenatal care in endemic regions to prevent adverse pregnancy outcomes. ID has been associated with reduced risk of malaria infection, and correspondingly, iron supplementation with increased risk of malaria infection, in some studies.MethodsA secondary analysis was conducted amongst 1888 pregnant women enrolled in a malaria prevention trial in Papua New Guinea. Maternal ID was defined as inflammation-corrected plasma ferritin levels < 15 μg/L at antenatal enrolment. Malaria burden (Plasmodium falciparum, Plasmodium vivax) was determined by light microscopy, polymerase chain reaction, and placental histology. Multiple logistic and linear regression analyses explored the relationship of ID or ferritin levels with indicators of malaria infection. Models were fitted with interaction terms to assess for modification of iron-malaria relationships by gravidity or treatment arm.ResultsTwo-thirds (n = 1226) and 13.7% (n = 258) of women had ID and peripheral parasitaemia, respectively, at antenatal enrolment (median gestational age: 22 weeks), and 18.7% (120/1,356) had evidence of malaria infection on placental histology. Overall, ID was associated with reduced odds of peripheral parasitaemia at enrolment (adjusted odds ratio [aOR] 0.50; 95% confidence interval [95% CI] 0.38, 0.66, P < 0.001); peripheral parasitaemia at delivery (aOR 0.68, 95% CI 0.46, 1.00; P = 0.050); and past placental infection (aOR 0.35, 95% CI 0.24, 0.50; P < 0.001). Corresponding increases in the odds of infection were observed with two-fold increases in ferritin levels. There was effect modification of iron-malaria relationships by gravidity. At delivery, ID was associated with reduced odds of peripheral parasitaemia amongst primigravid (AOR 0.44, 95% CI 0.25, 0.76; P = 0.003), but not multigravid women (AOR 1.12, 95% CI 0.61, 2.05; P = 0.720). A two-fold increase in ferritin associated with increased odds of placental blood infection (1.44, 95% CI 1.06, 1.96; P = 0.019) and active placental infection on histology amongst primigravid women only (1.24, 95% CI 1.00, 1.54; P = 0.052).ConclusionsLow maternal ferritin at first antenatal visit was associated with a lower risk of malaria infection during pregnancy, most notably in primigravid women. The mechanisms by which maternal iron stores influence susceptibility to infection with Plasmodium species require further investigation.Trial registration

Epidural analgesia-efficacy and feto-maternal outcome: A cross sectional study

The delivery of an alert and active baby into the arms of a conscious and pain free mother is one of the most exciting and rewarding experiences in medicineEpidural analgesia is considered one of the most effective methods for pain relief during labor, and the intrapartum use of epidural analgesia has substantially increased over the previous two decades.To study efficacy of epidural analgesia in labour and its feto-maternal outcome.Present descriptive observational study was conducted at a tertiary care hospital. The study was conducted over the period one year from 2019 to 2020. Pregnant women reporting for delivery at study setting were the study population. Healthy pregnant primigravidae or multigravida women who had gestational age of greater than 37 weeks without any risk factors, in true labour with vertex presentation of fetus were included after obtaining an informed consent.Total number of patients were 50 with mean age 23.57 ± 2.73. Mode of delivery in 70% (35) parturient was spontaneous while 14% (07) and 6% (03) had forceps and vacuum delivery respectively. The remaining 10% (5) underwent lower section caesarian section (LSCS). The mean Apgar score of babies at one minute and at 5 minutes was 9.0±1.5and 9.6±1.4 respectively. Majority of the mothers were relieved from pain after epidural analgesia. Present study concludes that Epidural analgesia provides good pain relief in majority of the patients without any evidence of foeto-maternal compromise.

Polymorphic Molecular Signatures in Variable Regions of the Plasmodium falciparum var2csa DBL3x Domain Are Associated with Virulence in Placental Malaria.

The Plasmodium falciparum protein VAR2CSA allows infected erythrocytes to accumulate within the placenta, inducing pathology and poor birth outcomes. Multiple exposures to placental malaria (PM) induce partial immunity against VAR2CSA, making it a promising vaccine candidate. However, the extent to which VAR2CSA genetic diversity contributes to immune evasion and virulence remains poorly understood. The deep sequencing of the var2csa DBL3X domain in placental blood from forty-nine primigravid and multigravid women living in malaria-endemic western Kenya revealed numerous unique sequences within individuals in association with chronic PM but not gravidity. Additional analysis unveiled four distinct sequence types that were variably present in mixed proportions amongst the study population. An analysis of the abundance of each of these sequence types revealed that one was inversely related to infant gestational age, another was inversely related to placental parasitemia, and a third was associated with chronic PM. The categorization of women according to the type to which their dominant sequence belonged resulted in the segregation of types as a function of gravidity: two types predominated in multigravidae whereas the other two predominated in primigravidae. The univariate logistic regression analysis of sequence type dominance further revealed that gravidity, maternal age, placental parasitemia, and hemozoin burden (within maternal leukocytes), reported a lack of antimalarial drug use, and infant gestational age and birth weight influenced the odds of membership in one or more of these sequence predominance groups. Cumulatively, these results show that unique var2csa sequences differentially appear in women with different PM exposure histories and segregate to types independently associated with maternal factors, infection parameters, and birth outcomes. The association of some var2csa sequence types with indicators of pathogenesis should motivate vaccine efforts to further identify and target VAR2CSA epitopes associated with maternal morbidity and poor birth outcomes.

EFFECT OF CASTOR OIL ON GRAVIDA OF PREGNANT WOMEN WHEN USED AS A LABOUR INDUCTION AGENT

Labour is an inevitable consequence of Pregnancy. Only two events can prevent the onset of labour once pregnancy has become well established – the death of the undelivered mother or surgical removal of the fetus Castor oil is a herbal 4 preparation that has been used for induction of labor from ancient Egypt until now. Castor oil is regarded as a uterine stimulant and irritant laxative AIMS AND OBJECTIVES: EFFECT OF CASTOR OIL ON GRAVIDA OF PREGNANT WOMEN WHEN USED AS A LABOUR INDUCTION AGENT MATERIAL AND METHODS: 190 Patients admitted to labour ward of OBG Dept of MDM Hospital with an indication for induction of labour.from MARCH 2019 to SEPTEMBER 2019 Method of Induction: This is a hospital based observational study which was conducted at Dr S N Medical College, Jodhpur,Rajasthan by evaluating the women who were admitted in our hospital (MDMH)for delivery. After informed consent had been obtained,the patients selected for the study were evaluated Castor oil was administered in 2 doses form in 18-24hrs interval and every given dose is5047.75gm) in 200warm milk.Antiemetic drug was given 30 minutes prior to administered castor oil to minimize nausea and vomiting RESULTS: 74 (71.15%) out of 104 multigravida women were successfully induced by castor oil. Among primigravida women 36 (41.86%) out of 86 were successfully induced by castor oil. there were total 86 primigravida in the study population and out of this 66 women has normal vaginal delivery 20 primigravida women who had caesarean section. there were total 104 multigravida in the study population ,out of this 89 women has normal vaginal delievery CONCLUSION: Castor oil is stable at room temperature and does not need refrigeration. Induction delivery interval, requirement of Oxytocin augmentation is less in castor oil user.Vaginal delivery rate is high in castor oil user those use castor oil as a labour inducing agent.

Does prior uterine surgery increase the risks of uterine leiomyoma and adenomyosis? a retrospective study

Aim: Women frequently undergo obstetric and gynecologic surgeries throughout their life, and the two common gynecologic conditions are uterine leiomyoma (UL) and adenomyosis. This study aims to investigate the relationship between the presence and the types of prior uterine surgery and the risks of developing UL and adenomyosis.&#x0D; Material and Method: This study is a single-center eleven-year cross-sectional study, in which we studied the effects of previous uterine surgery on developing UL and adenomyosis in patients who underwent hysterectomy for any indication in our hospital between 01/01/2004 and 31/12/2014.&#x0D; Results: During the time period, 1299 eligible patients were included in the study. The median age was 49.0 years and the study population was mostly consisted of multigravid women. The overall prevalence of UL was 61.9% and the overall prevalence of adenomyosis was 18.3%.In the univariate analysis of patient characteristics for UL, age, gravida and parity were found as statistically significant protective factors for UL (OR [95.0% CI]: 0.92 [0.91-0.93], 0.91 [0.88-0.95], 0.88 [0.83-0.93], respectively). On the other hand, women who underwent previous any uterine surgery had 1.28 folded (95.0% CI: 1.02-1.61) risk for UL. However, we found that only undergoing myomectomy statistically significantly increased the risk of UL (OR [95.0% CI]: 8.59 [2.62-27.91]) among the types of uterine surgery. In the multivariate model, the protective effect of age remained (adjusted OR [95.0% CI]: 0.92 [0.91-0.94]), and the risk-increasing effect of having previous myomectomy dropped slightly with retaining its statistical significance (adjusted OR [95.0% CI]: 5.87 [1.78-19.41]). We also conducted similar analysis for adenomyosis, and we found that gravida was a risk factor (OR [95.0% CI]: 1.06 [1.01-1.12]), conversely to its risk-decreasing effect for UL. Also, women who had a history of any uterine surgery had 1.42 folded (95.0% CI: 1.07-1.88), and women who had a history of D&amp;C had 1.62 folded (95.0% CI: 1.02-1.61) risk adenomyosis. In the multivariate model for the risk of adenomyosis, the risk-increasing effects of the gravida and the history of D&amp;C decreased very slightly with saving their statistical significances (adjusted OR [95.0% CI]: 1.06 [1.01-1.12], 1.44 [1.07-1.95], respectively).&#x0D; Conclusion: According to our findings, the frequency of adenomyosis is higher but, the frequency of UL is compatible with the literature. Patients, who underwent uterine surgery previously, diagnosed with adenomyosis and UL more than the others who did not, but this seems to be a correlation rather than a causative association.

Plasmodium falciparum in Aotus nancymaae: A New Model for Placental Malaria

Plasmodium falciparum (Pf)-infected erythrocytes that display the variant surface antigen VAR2CSA bind chondroitin sulfate A (CSA) to sequester in placental intervillous spaces, causing severe sequelae for mother and offspring. Here, we establish a placental malaria (PM) monkey model. Pregnant Aotus infected with CSA-binding Pf-CS2 parasites during 3rd trimester developed pronounced sequestration of late-stage parasites in placental intervillous spaces that express VAR2CSA and bind specifically to CSA. Similar to immune multigravid women, a monkey infected with Pf-CS2 parasites over successive pregnancies acquired antibodies against VAR2CSA, with potent functional activity that was boosted upon subsequent pregnancy infections. Aotus also developed functional antibodies after multiple acute PM episodes and subsequent VAR2CSA immunization. In summary, Pf infections in pregnant Aotus monkeys recapitulate all the prominent features of human PM infection and immunity, and this model can be useful for basic mechanistic studies and preclinical studies to qualify candidate PM vaccines.

Investigating the association between severity of COVID-19 infection during pregnancy and neonatal outcomes

Pregnant women with COVID-19 require special attention and care, since the infection does not only affect the mother, but also her neonate and adversely affects pregnancy outcomes. The main goal of this retrospective cohort study is to investigate association between the maternal COVID-19 severity and risk of developing adverse neonatal outcomes. Patients were stratified into asymptomatic/mild and moderate to severe COVID-19. The following neonatal outcomes were assessed: gestational age at the time of delivery, birth weight, neonatal infection, neonatal intensive care unit (NICU) admission. The average age of patients was 28.5 ± 1.4 years old and majority were multigravida (74.0%, n = 148). Of total 200 pregnant women with COVID-19, 26.5% (n = 53) had moderate/severe disease and presented with higher incidence of preterm delivery and low birth weight (88.7%, n = 47; p < 0.001). In addition, more than half of the newborns delivered by mothers with severe disease were infected by SARS-COV-2 (58.5%, n = 31) and majority were admitted to the NICU (95.0%, n = 52). Based on the multivariate logistic regression analysis, pregnant women with moderate to severe COVID-19 were at much higher risk of preterm delivery, lower birth weight, neonatal infection, as well as neonatal ICU admission (p < 0.001). In addition, multigravida women were at higher risk for preterm delivery and lower birth weight (p = 0.017 and p = 0.02; respectively). Appropriate protective measures and early detection of suspected COVID-19 should be addressed for more favorable obstetric outcomes.

Assessment and validation of the Community Maternal Danger Score algorithm

BackgroundHigh rates of maternal mortality in low-and-middle-income countries (LMICs) are associated with the lack of skilled birth attendants (SBAs) at delivery. Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs. We sought to develop and validate a low-cost maternal risk tool, the Community Maternal Danger Score (CMDS), which is designed to identify pregnant women who need an SBA at delivery.MethodsTo design the CMDS algorithm, an initial scoping review was conducted to identify predictors of the need for an SBA. Medical records of women who delivered at the Federal Medical Centre in Makurdi, Nigeria (2019–2020) were examined for predictors identified from the literature review. Outcomes associated with the need for an SBA were recorded: caesarean section, postpartum hemorrhage, eclampsia, and sepsis. A maternal mortality ratio (MMR) was determined. Multivariate logistic regression analysis and area under the curve (AUC) were used to assess the predictive ability of the CMDS algorithm.ResultsSeven factors from the literature predicted the need for an SBA: age (under 20 years of age or 35 and older), parity (nulliparity or grand-multiparity), BMI (underweight or overweight), fundal height (less than 35 cm or 40 cm and over), adverse obstetrical history, signs of pre-eclampsia, and co-existing medical conditions. These factors were recorded in 589 women of whom 67% required an SBA (n = 396) and 1% died (n = 7). The MMR was 1189 per 100,000 (95% CI 478–2449). Signs of pre-eclampsia, obstetrical history, and co-existing conditions were associated with the need for an SBA. Age was found to interact with parity, suggesting that the CMDS requires adjustment to indicate higher risk among younger multigravida and older primigravida women. The CMDS algorithm had an AUC of 0.73 (95% CI 0.69–0.77) for predicting whether women required an SBA, and an AUC of 0.85 (95% CI 0.67–1.00) for in-hospital mortality.ConclusionsThe CMDS is a low-cost evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi. Non-specialist health workers can use the CMDS to standardize assessment and encourage pregnant women to seek an SBA in preparation for delivery, thus improving care in countries with high rates of maternal mortality.

Sociodemographic patterns of preterm birth and low birth weight among pregnant women in rural Mysore district, India: A latent class analysis.

Few studies have utilized person-centered approaches to examine co-occurrence of risk factors among pregnant women in low-and middle-income settings. The objective of this study was to utilize latent class analysis (LCA) to identify sociodemographic patterns and assess the association of these patterns on preterm birth (PTB) and/or low birth weight (LBW) in rural Mysore District, India. Secondary data analysis of a prospective cohort study among 1540 pregnant women was conducted. Latent class analysis was performed to identify distinct group memberships based on a chosen set of sociodemographic factors. Binary logistic regression was conducted to estimate the association between latent classes and preterm birth and low birth weight. LCA yielded four latent classes. Women belonging to Class 1 "low socioeconomic status (SES)/early marriage/multigravida/1 child or more", had higher odds of preterm birth (adjusted Odds Ratio (aOR): 95% Confidence Intervals (CI): 1.77, 95% CI: 1.05-2.97) compared to women in Class 4 "high SES/later marriage/primigravida/no children". Women in Class 2 "low SES/later marriage/primigravida/no children" had higher odds of low birth weight (aOR: 2.52, 95% CI: 1.51-4.22) compared to women in Class 4. Women less than 20 years old were twice as likely to have PTB compared to women aged 25 years and older (aOR: 2.00, 95% CI: 1.08-3.71). Hypertension (>140/>90 mm/Hg) was a significant determinant of PTB (aOR: 2.28, 95% CI: 1.02-5.07). Furthermore, women with a previous LBW infant had higher odds of delivering a subsequent LBW infant (aOR: 2.15, 95% CI: 1.40-3.29). Overall study findings highlighted that woman belonging to low socioeconomic status, and multigravida women had increased odds of preterm birth and low birth weight infants. Targeted government programs are crucial in reducing inequalities in preterm births and low birth weight infants in rural Mysore, India.

Early- and Late-Onset Preeclampsia at a Tertiary Hospital in 2016

Introduction: Preeclampsia is still one of the major causes of maternal morbidity and mortality worldwide. Preeclampsia nowadays has another classification, early-onset preeclampsia and late-onset preeclampsia. This study aimed to evaluate the differences between early-onset and late-onset preeclampsia in Dr. Soetomo General Hospital, Surabaya in 2016.Methods: This was an analytic observational study, evaluating the difference between early- and late-onset preeclampsia in terms of maternal data, medical history, and obstetric history. The samples were taken from the medical record of Dr. Soetomo General Hospital, Surabaya from January until December 2016.Results: In maternal data, early- and late-onset preeclampsia mostly happened in productive age, consisted of 34 patients of early-onset preeclampsia (77.3%) and 31 patients of late-onset preeclampsia (73.8%). Early-onset preeclampsia tended to happen in nullipara (42.2%) and primigravida (35.6%) women, and late-onset preeclampsia usually happened in multipara (43.9%) and multigravida (85.4%) women. In medical and obstetric history, early-onset preeclampsia mostly had a history of hypertension (61.7%), rather than late-onset preeclampsia (32.7%). Moreover, there were no significant differences in other variables.Conclusion: Early-onset and late-onset preeclampsia had a significant difference in parity, gravidity, and hypertension disease.

Prevalence of Pre-eclampsia and Eclampsia in Unbooked Pregnant Women: A Cross-sectional Study

Introduction: The goal of prenatal care is to improve maternal and fetal outcomes and identify and manage high-risk patients early. Antenatal surveillance, lifestyle change, nutritional supplements, and pharmaceutical therapy are current strategies for preventing pre-eclampsia, which is the precursor to eclampsia. Aim: To determine the prevalence of pre-eclampsia and eclampsia in unbooked pregnant women. Methodology: The study included 295 unbooked primigravida and multigravida women. Participants with any other confirmed medical conditions, such as persistent hypertension, diabetes, thyroid abnormalities, or known renal illness, were excluded from the study. Complete blood count, liver function tests, renal function tests, coagulation profile, and 24-hour urine for protein were all done on the study population. All of the patients were treated according to the department’s standard procedure. Proteinuria was detected using a urine dipstick, a detailed urine report, or a 24-hour urinary protein test. Pre-eclampsia was identified with blood pressure monitoring. Study design: A cross-sectional study. Place and Duration: This study was conducted at Sohail Trust Hospital Karachi, Pakistan from November 2020 to November 2021. Results: The majority of the patients, 135 (45.76 %), were between 31 to 40 years of age. The average gestational age was 25.14± 4.67 weeks. The average gravidity was 3.56 ± 5.65. The average parity was 2.34± 0.67. The average height was 158.67 cm, with a margin of error of 15.67 cm. The average weight was 70.6±6.65 kilograms. The average BMI was 30.76 kg/m2. Pre-eclampsia and eclampsia were found in 40 (13.55 %) and 25 (8.4 %) in unbooked pregnant women respectively. Conclusion: According to this study, pre-eclampsia and eclampsia are much more common in unbooked pregnant women. So, to improve the fetomaternal outcome, we recommend that national awareness programs be established in which pregnant women are encouraged and emphasized for early antenatal care, accurate dating, and early detection of maternal disorders that can threaten pregnancy and its outcome.

Incidence, types and outcomes of congenital anomalies in babies born at a public, tertiary hospital in South Africa

Background. Limited information is available on the incidence of major congenital abnormalities (MCAs) in low- and middle-income countries (LMICs). Objective. To determine the incidence and types of MCA and associated all-cause mortality from a facility with a large delivery service in an LMIC. Methods. Births and neonatal admission registers of live inborn births between 1 January 2012 and 31 December 2013 at the Chris Hani Baragwanath Academic Hospital, South Africa, were reviewed for diagnosis of MCA. Results. A total of 201 infants were admitted with a diagnosis of MCA, of which 114 were inborn. This translated to an incidence of 2.60 per 1 000 live births. The cardiovascular (43.9%), gastrointestinal (21%), musculoskeletal (13.2%) and central nervous system (12.3%) were commonly affected systems. Most MCAs were single defects (75.4%), followed by trisomies (19.3%). A significant number of infants with trisomies were born to multigravid women older than 35 years (p&lt;0.001). A significant number of infants with single defects were preterm (p&lt;0.002) and of low birth weight (p&lt;0.002). One third (34%) required surgical intervention before hospital discharge. All-cause mortality at hospital discharge was 20.2%, with more deaths among patients with trisomy 13 (50%) and trisomy 18 (40%) compared with patients with single defects (19.8%) or trisomy 21 (7.8%) (p&lt;0.05). Conclusion. The incidence of MCAs found in this study is much lower than what has been reported from HICs but similar to findings from other LMICs. MCAs in LMIC settings are associated with high mortality rates.

Perinatal Delivery in Women with Retrochorial Hematomas in the First Trimester

The objective: an analysis of the peculiarities of childbirth and the condition of newborns in women with retrochorial hematoma (RCH) in the I trimester of pregnancy. Materials and methods. At the beginning of the study, 100 pregnant women 18–44 years old (mean age 28.08±3.5 years) were examined – 70 women included in the main group and 30 – control one. In 10 cases out of 70, the pregnancy was interrupted in the I trimester on the background of RCH. Sixty patients of the main group, in whom the pregnancy progressed, were divided into two subgroups: subgroup A (n=39) – primigravida pregnant women with the threat of abortion due to RCH; subgroup B (n=21) – multigravida women with complicated obstetrical and gynecological history and RCH. The control group (n=30) included primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination. The patients with a risk of abortion and RCH received pathogenetical therapy for pregnancy preservation (sedative, anti stress therapy, spasmolytics, hormonal support (progestogens), fibrinolysis inhibitors, anticoagulants and antiplatelet agents, tocolytics). The condition of newborns in the first minutes of life was assessed by the Apgar scale, if necessary, rehabilitation measures were applied. Results. The majority of patients in all groups had complicated obstetrical and gynecological history: 22.5% of patients in subgroup A, 30% – subgroup B, 16.6% – control group, and half of them were diagnosed two or more somatic diseases. Every third patient of the main group (7 (17.9%) women in subgroup A and 5 (23.8%) in subgroup B) delivered by cesarean section, in the control group – 5 (16.6%) persons. Spontaneous vaginal childbirth in the main group had 71.7% of the women, in the control group – 80%, premature birth – 2 (5.1%) women in subgroup A, 4 (19%) – subgroup B and 1 (3,3%) case – control group. The average duration of pregnancy in the main group was 37.3±2.4 weeks, in the control group – 39.4±0.3 weeks. In the main group 54 (90%) full-term newborns were born, in the control group – 29 (96.7%); premature infants – 2 (5.1%) in subgroup A, 4 (19%) – subgroup B, 1 (3.3%) – control group. In the main group the frequency of infants birth with hypoxia, who needed resuscitation and intensive care, was more than 2 times higher compared to the control group (5 (8.3%) and 2 (6.7%) infants, respectively). Newborns of subgroups A and B, due to intrauterine hypoxia, had pathological conditions such as morphological and functional immaturity, neurological disorders, signs of intrauterine infection, but not a single child needed to be transferred to a specialized department for the second stage of care. Conclusions. Preservation of pregnancy in the patients with a risk of abortion and RCH in the I trimester is possible in 85.7% of cases. Pregnant women with complicated obstetrical and gynecological history are at risk for preterm birth. The infants born in women with the threat of abortion and the formation of RCH in the I trimester belong to the risk group of intrauterine hypoxia and infectious complications. Comprehensive pathogenetical therapy helps to prolong pregnancy, reduce the incidence of early reproductive losses, improve perinatal outcomes and reduce the incidence of perinatal morbidity.

Threatened abortion in women with retrohorial hematomas in the first trimester

The objective: to study the features of the clinical course of the first trimester of pregnancy, complicated by the threat of abortion with the formation of retrochorial hematoma (RCH). Materials and methods. 100 pregnant women aged 18–44 years (average age 28.08±3.5 years) in 6–13 weeks of gestation were examined. The main group consisted of 70 patients and was divided into two subgroups: subgroup A (n=40) – 40 primigravida women with the threat of abortion and RCH; subgroup B (n=30) – 30 multigravida women with the threat of abortion and RCH and a complicated obstetric and gynecological history. Control group (n=30) – primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination, ultrasound examination of the uterus and fetus with Doppler, determination of the infectious profile (bacterioscopy).Results. The majority of the patients in all groups had a complicated somatic history, while in half of the cases there was a combination of two or more somatic diseases – in 45.7% of pregnant women in the main group and 33.3% – control group. 32.9% of women in the main group had a genetically determined form of thrombophilia. A complicated obstetrical and gynecological history was established in 22.5% of patients in subgroup A, 30% – subgroup B and 16.6% of pregnant women in the control group. Mostly, inflammatory diseases of the pelvic organs were detected in the main group – 15–21.4% (in both subgroups) and previous surgery on the pelvic organs (11.4% in total). A high incidence of spontaneous miscarriages was found in patients of subgroup B (13–43.3%). Every fourth pregnant woman in the main group had a 3–4 degree of purity of vaginal smears. For the first time, the hematoma was diagnosed before 6 weeks of gestation in 8% of pregnant women of subgroup A (2.5% of these patients had a spontaneous abortion at 9–10 weeks) and in 30% of women in subgroup B (23.3% of them had an interruption of pregnancy at 7–12 weeks). The corporal location of RCH was found in 28.6% of patients in the main group (15.7% and 12.9% in subgroups, respectively), supracervical – 71.4% (almost the same in both subgroups), while hematomas of more than 25 cm3 were detected in 8 patients of the main group (25% and 75% in subgroups, respectively), all of such RCH were located corporally. In 70% of supracervical RCH, a small and medium volume of hematoma was diagnosed, which was in 1.5 times more often detected in pregnant women of subgroup A. Hematomas of a larger size were found in 3 times more often in women of subgroup B. The main clinical symptoms of threatened abortion with the formation of RCH were bleeding from the genital tract (53–75.7%), pain syndrome (48–68.5%), uterine hypertonus or a combination of these symptoms (39–55.7%).Conclusions. The presence of chronic extragenital pathology, chronic urogenital infection, surgical interventions on the pelvic organs, a high frequency of artificial and spontaneous abortions, recurrent miscarriage, a history of missed pregnancy in combination with a large volume of RCH, the corporal location of PCH, the term of gestation in which a hematoma is found, as well as ultrasound signs of uterine hypertonus are unfavorable predictors of early miscarriage and reproductive losses.