Obstetric History Research Articles

Assessing Second-Trimester Ferning in Diagnosing Preterm Prelabor Rupture of Membranes.

Preterm prelabor rupture of membranes (PPROM) diagnosis is made through visualization of amniotic fluid (pooling), nitrizine testing, sonographic low amniotic fluid, and microscopic detection of amniotic fluid arborization (ferning). Data exist on the specificity and sensitivity of ferning detection but have not focused on the second trimester. Our objective is to evaluate the presence of ferning in transvaginally collected amniotic fluid in pregnancies with known second-trimester PPROM to determine if there is a difference in ferning based on gestational age and sample drying time. This was a prospective study evaluating amniotic fluid in individuals undergoing termination of pregnancy between 15 and 24 weeks gestation. A control vaginal swab was collected prior to rupture of membranes and a sample vaginal swab was collected at the time of rupture of membranes at a termination procedure. A 10-mL sample of amniotic fluid was collected too and then centrifuged to separate blood. Slides were analyzed at five different drying time intervals after rupture of membranes, on both the vaginal and centrifuged samples, and examined by two blinded investigators to assess for ferning. Maternal demographics, obstetrical history, and termination information were collected. Statistical analysis was performed using descriptive statistics and regression analyses. A total of 99 individuals consented and 93 were included. The mean gestational age at the time of the termination was 19.5 ± 2.5 weeks. There was a significant effect of drying time with the odds of observing ferning increasing with longer drying time, up to 10 minutes (p < 0.001). Gestational age did not impact ferning detection (p = 0.09). Centrifuging increased ferning detection by 15% at 10 minutes compared to the vaginal swab. In cases of known second-trimester PPROM, ferning was detected more often after 10 minutes of sample drying, and centrifuging the amniotic fluid to remove blood. · The detection of ferning in the second trimester was improved with longer drying times.. · The highest detection rate was seen after at least 10 minutes of drying time.. · Gestational age did not impact the rates of ferning.. · Blood contamination impacts the ability to see ferning on microscopic examination..

Critical factors influencing live birth rates in fresh embryo transfer for IVF: insights from cluster ensemble algorithms

Infertility has emerged as a significant global health concern. Assisted reproductive technology (ART) assists numerous infertile couples in conceiving, yet some experience repeated, unsuccessful cycles. This study aims to identify the pivotal clinical factors influencing the success of fresh embryo transfer of in vitro fertilization (IVF). We introduce a novel Non-negative Matrix Factorization (NMF)-based Ensemble algorithm (NMFE). By combining feature matrices from NMF, accelerated multiplicative updates for non-negative matrix factorization (AMU-NMF), and the generalized deep learning clustering (GDLC) algorithm. NMFE exhibits superior accuracy and reliability in analyzing the in vitro fertilization and embryo transfer (IVF-ET) dataset. The dataset comprises 2238 cycles and 85 independent clinical features, categorized into 13 categories based on feature correlation. Subsequently, the NMFE model was trained and reached convergence. Then the features of 13 categories were sequentially masked to analyze their individual effects on IVF-ET live births. The NMFE analysis highlights the significant influence of therapeutic interventions, Embryo transfer outcomes, and ovarian response assessment on live births of IVF-ET. Therapeutic interventions, including ovarian stimulation protocols, ovulation stimulation drugs, and pre-and intra-stimulation cycle acupuncture play prominent roles. However, their impacts on the IVF-ET model are reduced, suggesting a potential synergistic effect when combined. Conversely, factors like basic information, diagnosis, and obstetric history have a lesser influence. The NMFE algorithm demonstrates promising potential in assessing the influence of clinical features on live births in IVF fresh embryo transfer.

Obstetrical Catastrophe: Ruptured UterusIncidence, Risk Factors, Fetomaternal Outcome and Management in Ad-Din Women’s Medical College and Hospital, Dhaka, Bangladesh

Background: A ruptured uterus is a catastrophic condition. It is associated with a high incidence of fetal and maternal mortality and morbidity. Objective: To determine the incidence, risk factors, maternal and fetal outcome, and management of uterine rupture in Ad-din Women’s Medical College and Hospital, Dhaka, Bangladesh. Materials and Methods: This prospective observational study of patients with ruptured uterus from July 2022 to June 2023 admitted at Gynaecology and Obstetrics department of Ad-din Women’s Medical College and Hospital, Dhaka. All the cases of ruptured uterus who were either admitted with ruptured uterus or who developed it in hospital were included in the study. Patients were initially assessed in emergency and labor wards, and relevant sociodemographic data, obstetric history, and previous antenatal and surgical history were recorded. Ways of management, and maternal and fetal outcomes were taken for analysis. Results: There were 45 cases of ruptured uterus out of a total of 17,288 deliveries over one year with a prevalence of 0.26%. The most common age group was 30-35 years, and most of the patients 37(82.2%) had a history of previous cesarean section. A maximum of 24 (53.3%) rupture of the uterus was found &gt;36-40 weeks. Subtotal hysterectomy was done in 4 (8.9%) patients, and Subtotal hysterectomy with the repair of the bladder was done in 2 (4.4%) patients, out of 45 patients, 4 (8.9%) patients developed acute renal failure and maternal death was found 4 (8.9%) patients. IUFD was found in 21 (46.7%) babies, 10 (22.2%) babies needed NICU and neonatal death was found in 4 (8.9%) babies. Conclusion: Uterine rupture is a preventable obstetric complication that carries severe risks both to the mother and to the baby. Proper antenatal care, appropriate counseling of patients with a history of previous caesarian section for hospital delivery, and training of skilled birth attendants can reduce maternal and perinatal mortality and morbidity due to ruptured uterus. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 5-10

Adverse birth outcome and associated factors among mothers with antepartum hemorrhage in public hospitals Tigray, northern Ethiopia, 2020

BackgroundAdverse birth outcome is a major public health problem in the world and in Ethiopia. Antepartum hemorrhage complicates 3–5% of pregnancies and is a primary cause of perinatal and maternal mortality worldwide. One in five of all preterm babies are born in association with antepartum hemorrhage. Preterm birth, low birth weight and asphyxiated babies are at high risk for mortality, morbidity and developmental problems Thus, the aim of this study was to assess adverse birth outcomes and associated factors among mothers with antepartum hemorrhage in Tigray public hospitals, northern Ethiopia.MethodsInstitution based cross sectional study design was conducted from February to April 2020 among randomly selected 309 charts of mothers with chart completeness of 95.4%. A simple random sampling technique was used to select hospitals and charts of study participants. A Pretested check list was used to collect data. Data were analyzed using SPSS version 20. Logistic regression was computed and variables which have a P-value less than 0.2 on bivariable analysis were taken to multivariable analysis. A P-value of less than 0.05 and 95% confidence level was used as a cut-off point for statistical significance in multivariable analysis.ResultsThe magnitude of adverse birth outcome was 46.3% at 95% CI and 15.2% of the neonates were admitted to neonatal intensive care unit due to preterm birth and low birth weight. Rural residence [AOR = 2.16, 95%CI (1.069, 4.38)], three and below antenatal care follow-up visits [AOR = 6.6, 95%CI (3.345,13.10)], bad obstetric history [AOR = 2.8, 95%CI (1.044,7.691)], and having less than or equal 11 g/dl hemoglobin level at admission were [AOR = 3.7,95%Cl (1.93,6.914)] found as predictors of adverse birth outcome in this study.Conclusion and recommendationadverse birth outcomes were higher in magnitude and the higher public health problem in the Tigray region. Predictors could be minimized by strengthening antenatal care follow up, ensuring early arrival to health institution, and focusing on rural area.

Personality traits of women with hereditary risk for breast/ovarian cancer versus obstetric history and cancer preventive behaviors

The aim of the study is to analyze the relationship between personality traits of women with hereditary predisposition to breast/ovarian cancer and their obstetric history and cancer-preventive behaviors. A total of 357 women, participants of ‘The National Program for Families With Genetic/Familial High Risk for Cancer’, were included in the study. The Neo Five-Factor Inventory (NEO-FFI) and a standardized original questionnaire designed for the purpose of the study were used. Breast ultrasound examination at a younger age was associated with Extraversion. Openness to Experience was linked with lower number of children, more frequent use of hormonal contraceptives, and younger age at first breast ultrasound examination. Women with higher Agreeableness scores were less likely to use contraceptives and underwent their first breast ultrasound later in life. Conscientiousness was associated with more frequent use of hormonal contraceptives and younger age at first breast ultrasound examination. Women at increased risk for developing breast/ovarian cancer who used hormonal contraceptives underwent breast ultrasound examinations earlier in life, while those who had breastfed their children chose to have their first mammogram earlier in life. Personality traits affect health-related behaviors and should be taken into account when designing theoretical models as well as interventions regarding health habits.

Intrauterine and Neonatal Deaths: The 2013-2023 Experience of the Cuyahoga County Medical Examiner's Office.

Forensic investigation of intrauterine and perinatal deaths can be challenging, given their relative infrequency and the possible involvement of maternal substance use, trauma, and socioeconomic factors. Intrauterine and perinatal deaths investigated by the Cuyahoga County Medical Examiner's Officer between 2013-2023 were reviewed. One hundred twenty-eight cases were identified (83 stillborn and 45 live births). The predominant indications for referral were concern for maternal substance use (57.8%) or trauma (35.2%). Gestational ages ranged from 11.5 to 42.5 weeks; 36.7% were <22 weeks, and only 10.2% were full term (>37 weeks). The maternal age range was 16-41 years, with most (65.2%) between 20-34 years. Not all case files included obstetric history or home address; of those which did, 53.0% received no prenatal care and 81.7% came from zip codes in the bottom quartile of household incomes. Causes of death included acute and/or chronic maternal substance use (28.9%), chorioamnionitis (21.9%), and abruption (19.5%). Manners of death (when applicable) included natural (53.3%), accident (26.7%), homicide (8.9%), and undetermined/unassigned (11.1%). Potentially confounding socioeconomic factors were identified in most cases. This demonstrates the importance of considering these factors and exercising caution when assigning specific causes and manners to intrauterine and perinatal deaths.

Analysis of Maternity Rights Perception: Impact of Maternal Care in Diverse Socio-Health Contexts

Maternity rights are perceived and fulfilled differently according to women’s psychosocial characteristics, leading to varying maternal experiences and outcomes. It is necessary to know the impact of cultural context, emotional well-being, and resource availability on the maternal woman’s clinical care experience. The aim is to identify if these factors contribute to disparities in the perception of maternity rights fulfillment in Spain and Colombia. This retrospective observational study focused on women who received maternity-related healthcare in Spain or Colombia. A total of 185 women were included (Spanish = 53; Colombian = 132). Data collected included social and obstetric history, as well as psychological variables such as resilience, positive and negative affect, derailment, and maternity beliefs. The study also assessed women’s knowledge of healthcare rights (MatCODE), perceptions of resource scarcity (MatER), and the fulfillment of maternity rights (FMR). C-section was more prevalent in Colombia, where women also scored higher on maternity beliefs as a sense of life and as a social duty compared to Spanish women. Conversely, FMR was higher in the Spanish context. Colombian women reported lower levels of social support and less involvement in medical decision-making. The FMR was positively correlated with positive affect, MatCODE, and MatER. Predictive modeling identified negative factors for FMR, including giving birth in Colombia (β = −0.30 [−0.58; −0.03]), previous miscarriage (β = −0.32 [−0.54; −0.09]), C-section in the most recent labor (β = −0.46 [−0.54; −0.0]), and higher MatER scores. Positive predictors included gestational age, maternal age, and previous C-section (β = 0.39 [0.11; 0.66]). The perception of the fulfillment of maternity rights depends on socio-healthcare contexts, women’s age, obstetric history, and resources. It is suggested to apply culturally sensitive strategies focused on women’s needs in terms of information, emotional and social support, privacy, and autonomy to manage a positive experience.

Predicting risk of maternal critical care admission in Scotland: Development of a risk prediction model.

Identifying women at highest or lowest risk of perinatal intensive care unit (ICU) admission may enable clinicians to risk stratify women antenatally so that enhanced care or elective admission to ICU may be considered or excluded in birthing plans. We aimed to develop a statistical model to predict the risk of maternal ICU admission. We studied 762,918 pregnancies between 2005 and 2018. Predictive models were constructed using multivariable logistic regression. The primary outcome was ICU admission. Additional analyses were performed to allow inclusion of delivery-related factors. Predictors were selected following expert consultation and reviewing literature, resulting in 13 variables being included in the primary analysis: demographics, prior health status, obstetric history and pregnancy-related factors. A complete case analysis was performed. K-fold cross validation was used to mitigate against overfitting. Complete data were available for 578,310 pregnancies, of whom 1087 were admitted to ICU (0.19%). Model performance was fair (area under the ROC curve = 0.66). A comparatively high cut-point of ⩾0.6% for ICU admission risk resulted in a negative predictive value (NPV) of 99.8% (specificity 97.8%) but positive predictive value (PPV) of 0.8% (sensitivity 9.1%). Models including delivery-related factors demonstrated superior discriminative performance. Our model for maternal ICU admission has an acceptable discriminative performance. The low frequency of ICU admission and resulting low PPV indicates that the model would be unlikely to be useful as a 'rule-in' test for pre-emptive consideration of ICU admission. Its potential for improving efficiency in screening as a 'rule-out' test remains uncertain.

Maternal and Perinatal Outcome in Women with Gestational Diabetes Mellitus

Back ground: Gestational Diabetes Mellitus (GDM) is a growing global Public health problem, with a rising prevalence and is associated with short and long-term health consequences for the mother and baby. Objective of this study is to assess the maternal and perinatal outcome of pregnancy with GDM. Materials and methods: This prospective observational study was conducted at Chattagram Maa-O-Shishu Hospital Medical College from January to December 2021 on all admitted pregnant women with Gestational Diabetes Mellitus (GDM) more than 28 weeks. Detailed history, clinical examination, associated conditions, mode of delivery,fetal conditions and investigation were analyzed. Results: A total of 218 GDM Cases were reported amongst 5724 pregnant women with its incidence of 3.8%. GDM was seen commonly in patients (38.07%) with age group between 26-30 years, multigravida (74.8%), over weight (58.72%), positive family history (62.4%) and past poor obstetric history (51%). There were no maternal mortality. However, pregnancy complications were remarkably higher, the most common maternal complications were vaginal candidiasis (69.7%), urinarytract infection (46.8%), polyhydramnios (42.7%), pre-eclampsia (40.8%), PROM (28.4%), preterm- labor (22%). The commonest mode of delivery was caesarean section (65.1%). Common perinatal complications were prematurity (25.2%), hypoglycemia (15.5%), perinatal asphyxia (9.9%), stillbirth (6.4%), macrosomia (11.6%) and most common causes of neonatal death were prematurity and neonatal sepsis. Conclusions: Gestational Diabetes mellitus is associated with significant maternal and perinatal morbidity as well as perinatal mortality. Hence early detection and treatment would reduce the feto-maternal morbidity and mortality Chatt Maa Shi Hosp Med Coll J; Vol.23 (1); January 2024; Page 68-72

The microcirculation : master in normal pregnancy, puppet in preeclampsia.

To investigate the association between functional parameters of the microcirculation and the systemic cardiovascular system in a population of pregnant women at risk for gestational hypertension disorders. For this observational study, women at high cardiovascular risk according to maternal anthropometrics, obstetric and medical history, were recruited at random gestational age depending on time of referral to the outpatient clinic for high risk prenatal care at Ziekenhuis Oost Limburg, Genk Belgium. After birth, data of maternal and neonatal outcome were obtained from the hospital records: only women with normal pregnancy (n = 142) and with preeclampsia (n = 34) were included in this analysis. Nailfold video capillaroscopy measurements were performed in first and/or second and/or third trimester. Video magnification of 200x was used at all fingers except thumbs, and stored images were analyzed offline. Capillary density was counted (n/mm2), mean capillary diameter measured (μm) and capillary bed was calculated as density x diameter. Cardiac output and total peripheral resistance were measured using impedance cardiography, together with sphygmomanometric blood pressure measurement. Linear mixed model for repeated measures was employed to investigate the association between the microvascular and macrovascular parameters. No correction for multiple testing was used. In normal pregnancies, a positive association was observed between capillary bed and total vascular resistance (1.807, p =0.01), and a negative association between capillary density and cardiac output (-0.269, p =0.037). In preeclampsia, a negative association was observed between capillary density and mean arterial pressure (-0.5649, p = 0.010), and between capillary diameter and cardiac output (-0.165, p=0.032). A reduction of capillary density with increase of blood pressure in preeclampsia is similar to observations in chronic hypertension. Here, this is considered the result of capillary closure after constriction of precapillary arterioles. In normal pregnancy however, the increase of the capillary bed with rising vascular resistance can only be explained by a primary role for the microcirculation, preventing capillary overflow via stimulation of arteriolar constriction. These observations enlighten the very first hemodynamic origins of hypertension at the level of the microcirculation in preeclampsia.

Recent HCMV infection in early pregnancy associates with congenital transmission &amp; adverse pregnancy outcome: A prospective cohort study

Background &amp; objectives Human Cytomegalovirus (HCMV) infection, leading to &gt;90 per cent seropositivity in women of reproductive age from India, is the largest cause of congenital infections worldwide. HCMV infection status was prospectively monitored together with congenital transmission (cCMV) and adverse pregnancy outcomes (APO) in a public health setting where maternal or neonatal screening was not in practice. Methods Eighty three pregnant women, with (n=45) and without (n=38) bad obstetric history (BOH), were monitored for HCMV infection by ELISA-(IgM, IgG, IgG avidity) for all TORCH (Toxoplasma, Rubella, HCMV, HSV 1 &amp; 2) pathogens along with HCMV-specific chemiluminescent microparticle immunoassay (CMIA) and nested polymerase chain reaction (PCR). Descriptive statistics were applied on data sets to determine associations between maternal infection status, pregnancy outcome and cCMV in 52 mother-neonate dyads. Results Combined avidity, PCR-based and HCMV IgM screening, compared to the latter alone, was successful in identifying incident infection during early pregnancy. Pregnancy loss was associated strongly with BOH and concurrent HCMV infection. Features associated with APO and cCMV, were high PCR positivity (first trimester) and high rates of HCMV-specific IgM and intermediate IgG avidity (P=0.0211, 0.0455). Also, recent HCMV infection (intermediate IgG avidity), observed mainly in the BOH group, but not recurrent infection (IgM positivity), in first and second trimesters, was associated with neonatal saliva positivity and adverse outcomes, including neonatal death (P=0.0762). Exposure to other TORCH pathogens, while detected, did not include IgM positivity or low/intermediate IgG. Conclusion This study highlights the significance of conducting early, multi-pronged screening for maternal HCMV infection during pregnancy, especially in public health settings with high HCMV seroprevalence.

Factors Associated with the Severity of Stress Urinary Incontinence in Elderly Women

Background: Stress urinary incontinence (SUI) is prevalent and significantly impacts morbidity. While some risk factors for SUI have been identified, those specifically related to the severity of SUI have not been thoroughly investigated. Methods: This study recruited elderly female patients with SUI, aged over 60 years old, from Wuhan, Hubei, China, between October and November 2020. Data collection encompassed demographic information, clinical features (including obstetric history, chronic diseases, Urogenital Distress Inventory-6 (UDI-6), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scores), as well as physical examinations (including assessments of pelvic floor muscle strength, pelvic organ prolapse quantification (POP-Q) system, and pelvic floor ultrasound imaging). Results: Univariate analysis revealed that a history of postpartum urinary incontinence and chronic constipation significantly influenced the severity of SUI symptoms in the elderly (p &lt; 0.05). Additionally, age, the number of vaginal deliveries, and a history of chronic cough were correlated with the severity of SUI symptoms, with p-values of 0.05, 0.08, and 0.12, respectively. Factors such as pelvic floor muscle strength, vaginal wall prolapse, uterine prolapse, and the morphology of the largest urethral opening all significantly impacted the severity of SUI symptoms in this population (p &lt; 0.05). Multivariate logistic regression analysis identified age, the number of vaginal deliveries, chronic constipation, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, and the shape of the maximum urethral opening as independent factors influencing SUI severity in older women (p &lt; 0.05). The results of the Hosmer-Lemeshow test indicate that the model fits well (p = 0.37). Conclusions: Age, the number of vaginal deliveries, anterior vaginal wall prolapse, a history of postpartum urinary incontinence, chronic constipation, and a funnel-shaped maximum urethral opening are associated with increased severity of SUI symptoms in elderly women. The severity of SUI escalates with advancing age and an increased number of vaginal deliveries.

ToRCH pathogens-induced histopathological changes in placental tissues and associated post obstetric complications.

Maternal infections caused by the ToRCH complex, comprising Toxoplasma gondii (T.gondii), Rubella Virus (RV), Cytomegalovirus (CMV), and Herpes Simplex Virus (HSV), are significant contributors to Bad Obstetric History (BOH). These infections can vertically transmit through the placental barrier, leading to complications in fetal development. This study investigates the histopathological changes induced by ToRCH pathogens in placental tissues and their association with post-obstetric complications in Pakistani women. A total of 83 women were enrolled in the study and divided into two groups: the Experimental group and the Control group. The Experimental group consisted of women with BOH and was further subdivided into two categories: Group A and Group B. Group A comprised women who experienced a recent miscarriage at the time of sample collection, while Group B consisted of women who gave birth normally at the time of sample collection. In contrast, the Control group included women with normal delivery and a normal obstetric history. To investigate ToRCH infections, venous blood samples were analyzed for ToRCH antibodies using enzyme-linked immunosorbent assay (ELISA). Additionally, small pieces of placental tissue collected after miscarriage or delivery were subjected to nucleic acid (NA) detection by conventional polymerase chain reaction (PCR) using ToRCH pathogen-specific primers. Histopathological examination of placental tissue was also performed to identify microscopic changes. The data obtained were analyzed using descriptive statistics (percentages) and chi-square tests to determine significant associations. The study revealed an overall seroprevalence of ToRCH pathogens of 57.83 % in the study population, with 53.01 % detected in the Experimental group and 4.81 % in the Control group. In the Experimental group, IgM and IgG antibodies were detected in 14.45 % and 37.34 % of participants, respectively, with 1.20 % testing positive for both. Notably, the Control group showed no IgM positivity, while IgG was detected in 4.81 %. Nucleic acid (NA) detection revealed ToRCH pathogens in 54.21 % of placental tissues from the Experimental group only. Specifically, antibodies for T.gondii and RV were most prevalent (19.27 % each), while NA detection was highest for RV, CMV, and HSV (14.45 % each). In contrast, the Control group showed minimal antibody detection, with only 2.40 % positivity for T.gondii and CMV each. Statistical analysis revealed significant differences in ToRCH infection (antibodies and NA) between study groups for CMV only (p > 0.05). Discrepancies between ToRCH antibodies and NA positivity were observed in 75.90 % of cases, with 71.08 % occurring in the Experimental group and 4.81 % in the Control group. Histopathological examination revealed chorionic villitis (CV) in 16.86 % of the Experimental group; specifically 10.84 % in Group A and 6.02 % in Group B. CV was detected in women infected with T.gondii (in 4 cases), RV (in 6 cases), CMV, and HSV (both in 2 cases, each). The most common previous BOH complications were recurrent spontaneous abortions (RSAs) (47.05 %), with 21.87 % of these cases showing CV positivity. The study's key conclusion is that ToRCH pathogens are prevalent in the study population, and CV was identified as the primary histopathological change associated with BOH complications (majorly RSAs). These results underscore the importance of investigating ToRCH infections in women experiencing BOH complications.

Depression in pregnant non-diabetic women and women with gestational diabetes in Bangladesh-a comparative study based on multiple logistic regression.

Depression and gestational diabetes mellitus (GDM) pose significant challenges during pregnancy. Limited literature exists on depression in women with GDM, with most studies focusing on pre-pregnancy diabetes or postpartum depression. This study fills a crucial gap by specifically investigating and comparing antenatal depression among subjects with and without GDM in Bangladesh, utilizing data from the gestational period. A cross-sectional study with a convenient, purposive sampling technique was undertaken among 111 pregnant women with (66) and without (45) GDM from September 2017 to March 2018 in the BIRDEM-2 GENERAL HOSPITAL, Dhaka. A semi-structured interview schedulewas designed with items relevant to socio-demographics, obstetric history, diabetes, and depression. Different degrees of antenatal depression were identified in 61.3% of the subjects (i.e., 27% had mild, 4.5% had moderate, and 29.7% had severe depression, respectively). Out of 45 non-diabetic mothers, 11 (24.4%) had depression whereas out of 66 GDM mothers, 57 (86.4%) have depression. The exploratory analysis revealed that age group, menstruation history, and presence of GDM significantly affected depression but the multiple logistic regression model supported only GDM as a significant factor of depression. All the socio-demographic factors in this study were statistically insignificant to explain depression. The risk of developing depressive symptoms increases with the presence of GDM. Therefore, it is important to screen for depression and provide treatment if necessary in women who are diagnosed with GDM.

The Prevalence and Risk Factors of Postpartum Depression in Western India: A Cross-Sectional Study

Background: Postpartum depression (PPD) is a nonpsychotic mental health condition associated with child birth. It poses a major global public health challenge as it remains unrecognized most of the time and impairs both the immediate and long-term health of both the mother and child. The study was conducted to estimate the prevalence and associated risk factors for PPD. Materials and Methods: A cross-sectional study was conducted among 450 women who delivered babies within the past 1–12 months and attending a tertiary care hospital during April to November 2021. Systemic random sampling was used to obtain the desired sample size. Basic sociodemographic variables (age, duration of postpartum period, residence, religion, education, occupation, birth spacing, complication during pregnancy, desired gender of child, birth weight of baby) related to pregnancy were collected. The Edinburgh Postnatal Depression Scale was used to estimate the prevalence of PPD. Results: The prevalence of PPD in the study was 14.2%. The mean ± standard deviation age of women was 27.1 ± 4.7 years. Sociodemographic factors such as maternal age, low level of education, and family type and obstetric factors such as age at first pregnancy, parity, and history of abortion were significantly associated with PPD (P &lt; 0.05). Conclusion: Risk factors related to sociodemographic and obstetric history were found to be significantly associated with PPD. To prevent major depression in postpartum, early detection and timely referral are needed.

Period Prevalence and Determinants of Antara Injectable Contraceptive use among Women of Reproductive Age Group in a Tribal Village of Dadra and Nagar Haveli

ABSTRACT Background: Antara injectable contraceptive is a safe, low-cost, reversible, and highly effective contraceptive method. The objectives of the study were to estimate the period prevalence of injectable contraceptive use and its determinants among women of reproductive age group in a tribal village of Dadra and Nagar Haveli (DNH), India. Materials and Methods: A cross-sectional study was conducted at two sub-centers, and women of reproductive age groups were selected using a simple random sampling method. Data was collected about sociodemographic details, obstetric history, knowledge, and perceptions about Antara injection and its practice among Antara users. Mean, median, and proportion were used for quantitative variables, whereas qualitative attributes were presented by proportion. To find out the predictors of injectable contraceptive use, binary logistic regression was applied, taking injectable contraceptive use as the dependent variable. Results: The study participants had a mean age of 31.8 years (standard deviation: 7.1). The majority of them were homemakers (94%) and had received primary education (47.4%). Among the total 325 participants, only 15 women had used Antara injectable in the last year, resulting in a period prevalence of 4.6%. Most of the women who discontinued injectable contraceptives (80%) cited irregular bleeding as the reason. Multiple logistic regression revealed that age, type of family, and knowledge about the interval between two doses were determinants of injectable contraceptive use. Conclusion: There is a need to provide correct information and counseling before starting injectable contraceptives and during follow-up visits to increase the uptake of Antara injection among women of the reproductive age group.

How Can Obstetric History Help in the Risk Assessment of Thyroid Dysfunction?

How Can Obstetric History Help in the Risk Assessment of Thyroid Dysfunction?

ANALYSIS OF REGIONALLY METASTATIC CERVICAL CANCER ACCORDING TO DATA FROM THE SAMARKAND REGION OF THE REPUBLIC OF UZBEKISTAN

Today, cervical cancer is the most important global medical and social problem. Purpose of the study. To study the incidence of cervical cancer and analyze the results of treatment of stage III-IV disease in the Samarkand region. Material and methods. The study was conducted on the basis of the Samarkand branch of the Republican Specialized Scientific and Practical Medical Center of Oncology and Radiology of the Republic of Uzbekistan. The collection of research data included analysis of outpatient cards and anamnesis of patients admitted with the diagnosis of regionally metastasized forms of cervical cancer, data of patients with malignant neoplasms and advanced cases of malignant neoplasms - an accounting and reporting form. Interpretation work was carried out by age categories. At the same time, data from histologic and cytologic reports in the control group of cervical cancer stages III - IV, treated between 2020 and 2022, were used and processed. Results of the study. The reason for the first visit to the gynecologist at the time of diagnosis is mainly pain in the lower abdomen and lower back, bloody discharge from the genital tract on non-menstrual days and after contact, which are signs of advanced disease. The obstetric history revealed that 56 (53.3%) women did not consult a gynecologist at all after their last childbirth, and all patients had one to five medical abortions. Thirty-eight (36.2%) patients of early reproductive age were registered with an endocrinologist with a diagnosis of diffuse goiter. In 46% of the patients the menarche occurred at the age of 12-13 years, in 50% of the patients at the age of 14-16 years, and in 4% at the age of 18-19 years. Conclusion. The main goal of modern radiotherapy for cervical cancer today is radiation therapy without complications, elimination of relapse, and prolongation of survival. Our research continues in this direction.

Association Between Maternal Periodontitis and Adverse Pregnancy Outcomes: A Cross-Sectional Study at a Maternity Hospital in Kathmandu, Nepal.

Adverse pregnancy outcomes, including preterm birth and low birth weight, are major global health challenges, leading to millions of newborn deaths each year. Since 1996, periodontitis and related gum diseases have been proposed as potential contributing factors, but research findings remain mixed. Further research is needed to clarify this link. This study aims to assess the status of periodontitis and its association with adverse pregnancy outcomes. A cross-sectional study was conducted among 145 third-trimester mothers attending antenatal care (ANC) checkups at Maternity Hospital in Kathmandu. Data were gathered from medical records, interviews, and oral health screenings using the Community Periodontal Index (CPI) for periodontitis. Birth outcomes were assessed after delivery through medical records, which are considered highly reliable, with established protocols for data entry, consistent documentation, and regular quality control measures ensuring accuracy and consistency across healthcare providers. Ethical approval was obtained from the Nepal Health Research Council (NHRC) (approval no. 423) on September 19, 2023. Periodontitis was observed in 53 (36.6%) participants, with a higher prevalence in individuals aged 30 or more (10, 43.5%) and those who were illiterate (4, 50%). Health conditions such as hypertension, diabetes, and urinary tract infections were associated with higher periodontitis rates. However, no significant associations were found between age, education, obstetric history, or health conditions and adverse pregnancy outcomes. Periodontitis showed a significant association with adverse outcomes, with 56.6% of those with periodontitis experiencing adverse outcomes, compared to 32.6% without periodontitis (P = 0.005). The odds ratio of 2.69 indicates individuals with periodontitis are 2.69 times more likely to experience adverse outcomes. Maternal periodontitis is significantly associated with adverse pregnancy outcomes, with individuals having periodontitis being 2.69 times more likely to experience such outcomes. These findings highlight the importance of incorporating periodontal care into prenatal healthcare.

BIOMEDICAL RISK FACTORS FOR THE DEVELOPMENT OF PREECLAMPSIA OF VARYING SEVERITY IN PREGNANT WOMEN

The aim of this study was to identify biomedical risk factors for the development of preeclampsia of varying severity in the group of examined pregnant women. Material and methods. 70 women whose pregnancy was complicated by the development of preeclampsia were under observation. The first group included 46 (65.7%) patients with moderate preeclampsia; the second group included 24 (34.2%) women with severe preeclampsia. The diagnosis was established on the basis of the patient's complaints, clinical examination, somatic, obstetric and gynecological anamnesis, analysis of the course of the present pregnancy, ultrasound fetometry and Dopplerometry findings. The patients who participated in the study had an assessment of clinical and anamnestic parameters, somatic status, obstetric and gynecological anamnesis. Data from 45 pregnant women with an unencumbered obstetric and gynecological history and a physiologically occurring pregnancy were used as control values. Results. The prognostic risk factors for the development of moderate and severe preeclampsia were analyzed based on the calculation of relative risk indicators (RR) and 95% confidence interval (95% CI). In the group of pregnant women with both severe and moderate preeclampsia, strong prognostic risk factors were: place of residence in the regions, extragenital pathology in the anamnesis, gynecological diseases in the anamnesis, the number of pregnancies in the anamnesis, birth parity, and arterial hypertension. The early identification of risk factors for moderate and severe preeclampsia enables timely preventive measures, thereby improving patient outcomes and prognosis. Conclusion. The analysis revealed that preeclampsia was more prevalent among pregnant women with a history of various extragenital diseases, a complicated obstetric and gynecological history, and concomitant hypertension.