Obstetric History Research Articles

Unravelling Streptococcus agalactiae: Serotype distribution, virulence factors, obstetrics history and clinical presentation correlations in tertiary care hospitals of the western province of Sri Lanka

PurposeThis study investigated to detect serotypes and virulence genes of Group B Streptococcus (GBS) isolated from pregnant women. MethodsForty-five samples of GBS isolates from January to August 2019 at antenatal clinics of 4 teaching hospitals in Western Province, Sri Lanka were included. Isolated GBS were carried to identify 9 serotypes by multiplex PCR. Different virulence determinants, including bac, rib and scp(B) have been detected by PCR. ResultsAmong GBS-positive culture isolates most abundant serotype detected was type III 12/45 (26.7%) while serotype VII, VIII and IX were not seen. Furthermore, serotype Ia (15.6%); II (20%); V (17.8%); VI (15.6%); Ib (2.2%) and IV (2.2%) were identified. Among 5 rectal isolates, 1 isolate was serotype Ia, 2 isolates were serotype II and 2 isolates were serotype III.Forty (40/45) isolates expressed scpB gene (88.8%). Presence of rib gene was confirmed in 17.8%, bac in 13.3% isolates. ScpB, rib and bac were identified in 4.4% isolates, 8.9% isolates were scpB, rib positive and bac negative, 8.9% isolates were scpB, bac positive and rib negative. These three-virulence genes did not express in 8.9% isolates.ScpB gene was found once in serotype Ib and IV and all serotype VI expressed scpB gene. Rib gene was more common among serotype II and it was not found in serotype Ib, IV and VI. Bac gene was more common in serotype V and it was not found in serotype Ia, Ib and IV. There was not significant association between serotypes and virulence gene (p > 0.05). ConclusionSerotype III is the most abundant serotype. In formulation of vaccine against GBS for Sri Lanka, serotype III should be targeted. Prevalence of vaccine candidate virulence protein such as β antigens of the C protein (bac) and surface protein Rib (rib) genes were low in this study.

A Case Series of Round Block Techniques for Large, Recurrent, and Multicentric Benign Breast Diseases.

Benign breast diseases are a common presentation in the breast clinic outpatient department. These diseases, including giant fibroadenoma, multiple fibroadenoma in different quadrants, and large or recurrent phyllodes tumors, pose challenges in surgical management. We present a case series of 16 patients aged 19 to 63 years (average age, 41.5 years) who presented with breast lumps and underwent surgery using the round block technique for benign breast diseases at our institute between November 2019 and March 2024. Prior to surgery, all patients had clinical, radiological, and pathological assessments. Age, duration of lump, and detailed menstrual, obstetric, and family history of each patient were recorded. Eight (50%) of the patients had phyllodes tumor, four (31.25%) had fibroadenoma, three (18.75%) had both fibroadenoma and phyllodes tumor, and one (6.25%) had adenolipoma. The average size of tumors was 7.5 cm in our study. During postsurgical follow-up, none of the patients had nipple areola necrosis, and they reported that nipple sensation was acceptable. A mastectomy was avoided in all circumstances. Good cosmetic outcomes and clear margin status are achievable using the round block technique.

Comparison of early risk factors between healthy siblings and subjects with schizophrenia and bipolar disorder.

The following work aims to compare the types and magnitude of risk events in patients with Schizophrenia and Bipolar Disorder and each of those groups with of a group of healthy siblings, exploring differences and similarities of the two psychotic disorders. Retrospective interviews were conducted with 20 families to investigate maternal and obstetric health, social support and the presence of early trauma for the affected family members and healthy siblings. Mothers were interviewed with the Prenatal Psychosocial Profile and each family participant was assessed with the Early Trauma Inventory, Screening Questionnaire of the Genomic Psychiatry Cohort and the Diagnostic Interview for Psychosis and Affective Disorders. Obstetric and gestational history, pregnancy weight changes and early trauma were associated with offspring's mental illness, including statistically significant findings for complications of pregnancy, pregnancy weight changes, general trauma, physical punishment and emotional abuse. These findings highlight the different risk factor exposures that occur within a family, which may increase the risk for severe mental illness.

Perinatal Outcomes of High Risk Pregnancies: Experience of a Tertiary Care Hospital

High Risk Pregnancy (HRP) denotes a condition where the mother, the fetus, or both are predisposed to complications during the gestation period, at birth, or postnatally, which is affected by several factors. Objective: To analyze the perinatal outcomes of high-risk pregnancies, focusing on the experience of a tertiary care hospital. Methods: A longitudinal study over two years, from October 1, 2020, to December 31, 2022, was conducted on 213 high-risk pregnant women, via purposive sampling, who attended the antenatal clinic Liaquat University Hospital, Hyderabad and Jamshoro. After obtaining informed written consent, interviews were conducted with the participants to collect data about their sociodemographic, obstetric, and gynecological histories. Perinatal outcomes were evaluated on the 8th day post-delivery, during which details concerning maternal and fetal complications in terms of morbidity and mortality, were documented. Results: Rh-negative pregnancy was found to be the most high-risk factor with 24.4% (52) of the cases, followed by teenage pregnancy at 12.2% (26), and short stature at 10.9% (23). Additionally, severe anemia was found in 21 women (9.8%), Pregnancy Induced Hypertension (PIH) in 18 women (8.6%), and obesity was also seen in 18 women (8.6%). Other noted risk factors included grand multigravida in 13 women (6.1%), thyroid disorder 4.9% (10), twin pregnancy 3.7% (8) and congenital fetal anomaly, polyhydramnios, oligohydramnios each with 2.4% (5). Conclusions: This study significantly contributes to the body of knowledge on high-risk pregnancies and their outcomes.

Obstetric antiphospholipid syndrome carries an increased lifetime risk for obstetric and thrombotic complications—a population-based study

BackgroundAntiphospholipid syndrome (APS) can present with either a thromboembolic event (thrombotic APS, TAPS) or an obstetric complication (obstetric APS, OAPS). Data on long-term complications in the different APS phenotypes are limited. ObjectivesWe aimed to compare obstetric history, antiphospholipid antibody profiles, obstetric and thromboembolic complications, and pregnancy outcomes between TAPS and OAPS. MethodsThis retrospective cohort study included women who delivered singleton pregnancies between 1998 and 2020. One hundred sixteen thousand four hundred nine women were included, resulting in 320,455 deliveries. Among the included patients, 71 were diagnosed with APS, 49 were classified as OAPS, and 22 as TAPS. The demographics, obstetric, neonatal, and thrombotic outcomes were compared among TAPS, OAPS, and the general obstetric population. ResultsOAPS patients had an increased risk of thrombotic events compared with the general obstetric population (odds ratio [OR] 18.0; 95% CI, 8.7-37.2). In pregnancies following the diagnosis of APS, despite standard antithrombotic treatment, OAPS patients exhibited an elevated risk of placenta-related and neonatal complications compared with the general obstetric population (late fetal loss [adjusted OR {aOR}, 15.3; 95% CI, 0.5-27.5], stillbirth [aOR, 5.9; 95% CI, 2.2-15.4], placental abruption [aOR, 4.8; 95% CI, 1.5-15.3], preeclampsia [aOR, 4.4; 95% CI, 2.5-7.7], fetal growth restriction [aOR, 4.3; 95% CI, 8.5-27.5], small for gestational age neonate [aOR, 4.0; 95% CI, 2.4-6.6], and low Apgar scores [Apgar'1: aOR, 2.6; 95% CI, 1.3-10.4; Apgar'5: aOR, 3.7; 95% CI, 1.3-10.4]). TAPS patients exhibited increased risk of preeclampsia (aOR, 3.1; 95% CI, 1.2-8). ConclusionOAPS patients exhibit a heightened risk of thrombotic events compared with the general obstetric population. Despite treatment, OAPS and TAPS still presented obstetric complications. These findings, after confirmation in prospective studies, need to be taken into consideration when planning the treatment approach for these patients.

Prediction of bleeding in labor in women with uterine scar as a tool to prevent massive blood loss: an observational cohort study

Background. Postpartum hemorrhage is recognized as a leading cause of maternal mortality and morbidity in the world. Predicting postpartum hemorrhage in high-risk patients with uterine scar enables preventive measures to be scheduled and costs of treatment and rehabilitation to be reduced.Objective. To determine antenatal predictors of high postpartum hemorrhage risk in pregnant women with uterine scar in order to improve the prevention of massive blood loss.Methods. An observational cohort study involves the medical records of 4494 maternity women with uterine scar (pregnancy and delivery histories) of the Perinatal Center of Regional Clinical Hospital No. 2, Krasnodar Krai. The study sample included data of maternity women coded O34.2 according to International Classification of Diseases, 10th Edition, for the period from 2017 to 2020. The sample participants were distributed into two groups depending on the blood loss during delivery, determined in compliance with clinical recommendations: a group of patients without massive blood loss during delivery and a group of patients with massive blood loss in labor/early postpartum period. The study was mainly focused on parameters of the prediction performance of bleeding in labor and early postpartum period in pregnant women with uterine scar using a multiparametric, logistic regression models. The study considered demographic data, comorbidity, obstetric history, pregnancy course, ultrasound data, and volume of blood loss at delivery. The performance of prediction for postpartum hemorrhage was calculated using multivariate binary logistic regression. Descriptive statistical analysis was carried out by means of statistical software package SPSS Version 26 (IBM, USA). Two-sided p-value < 0.05 was taken as a statistically significant difference. A prognostic significance of predictors was determined by binary logistic regression. The Wald statistic was used to determine an observed significance. In order to define the performance of the model, the study involved calculating sensitivity, specificity, positive and negative predictive value, Nagelkerke coefficient of determination, as well as performing ROC analysis. The DeLong test was used for paired comparisons of ROC curves.Results. In the retrospective follow-up group (2017–2020) (n = 502), postpartum hemorrhage with massive blood loss occurred in 41 cases (8.17%). For the model based on clinical-anamnestic predictors, the prediction performance for postpartum hemorrhage comprised: sensitivity = 12.2% (95% confidence interval (CI) 4.1–26.2); specificity = 99.3% (95% CI 98.1–99.9); positive predictive value = 62.5% (95% CI 24.5–91.5); negative predictive value = 92.6% (95% CI 89.9–94.8); area under the ROC curve = 0.864 (95% CI 0.807–0.920), p < 0.001. The prediction performance for the model based on three ultrasound predictors (asymmetry coefficient of placental thickness, uterine wall bulging in the scar and myometrial thickness in the placentation zone) comprised: sensitivity = 85.4% (95% CI 70.8–94.4); specificity = 98.5% (95% CI 96.9–99.4); positive predictive value = 83.3% (95% CI 68.6–93.0); negative predictive value = 98.7% (95% CI 97.2–99.5); area under the ROC curve = 0.919 (95% CI 0.855–0.983), p < 0.001. No significant difference was revealed for the performance of the models ( p = 0.170). For the model based on ultrasound predictors and placenta previa, the prediction performance comprised: sensitivity = 85.4% (95% CI 70.8–94.4); specificity = 98.5% (95% CI 96.9–99.4); positive predictive value = 83.3% (95% CI 68.6–93.0); negative predictive value = 98.7% (95% CI 97.2–99.5); area under the ROC curve = 0.955 (95% CI 0.912–0.999), p < 0.001. The model based on clinical-anamnestic and ultrasound indicators predicted postpartum hemorrhage with sensitivity equal to 85.4% (95% CI 70.8–94.4); specificity — 98.9% (95% CI 97.4–99.6); positive predictive value — 87.5% (95% CI 73.2–95.8); negative predictive value — 98.7% (95% CI 97.1–99.5); area under the ROC curve — 0.984 (95% CI 0.966–1.0), р < 0,001. Thus, this model outperformed the model based on clinical-anamnestic data (p < 0.001), based on ultrasound predictors (p = 0.006) and revealed no difference with the model considering placenta previa and ultrasound predictors (p = 0.127). Using prenatal prediction of postpartum hemorrhage based on ultrasound features, the incidence of massive blood loss at delivery decreased from 6.88/1000 deliveries (2019–2020) to 4.18/1000 deliveries (2021–2022) (p < 0.001).Conclusion. Ultrasound predictors in pregnant women with uterine scar increase the sensitivity of antenatal prediction of postpartum hemorrhage based on the assessment of clinical and anamnestic risk factors, thereby enabling preventive measures to be scheduled in the risk group and incidence of massive blood loss to be reduced.

Comparison of Pre-eclampsia Screening Algorithms in the First Trimester of Pregnancy Being Used in Thai Nguyen Province.

Objective To compare the rates of pregnancies in high-risk groups for preeclampsia recommended for aspirin prophylactic when screened using various common algorithms. Methods This cross-sectional study was conducted on 1726 pregnant women from 11 to 13 weeks six days of gestation receiving antenatal care at two hospitals: Thai Nguyen National Hospital and a hospital in Thai Nguyen Province from October 2022 to October 2023. All participants provided consent for the study. We collected maternal characteristics, obstetric history,mean arterial pressure (MAP), mean uterine artery-PI (UtA-PI), and placental growth factor serum (PLGF). Screening performance estimates were calculated using the Fetal Medicine Foundation (FMF) and National Institute for Health and Care Excellence (NICE) guidelines. All pregnant women in the study had their preeclampsia risk assessed using all three algorithms with two cut-off points.Our data was collected, entered and analyzed using SPSS software 20.0 (IBM Corp., Armonk, NY). Categorical data was reported as frequency and percentage. McNemar's test was used for analyzing differences in the sizes of individual groups. Results In our study, the most common high-risk factor identified was the history of preeclampsia, 132 cases (7.6%). According to the NICE guideline, BMI ≥ 35 (kg/m²) is considered a moderate risk factor for preeclampsia. Several risk factors, such as BMI ≥ 35 kg/m² and history of diabetes mellitus type 1, were not present in any participants. Only one pregnant woman had chronic kidney disease (0.06%). Out of the 1726 pregnant women surveyed, the rates of high-risk preeclampsia were as follows: 9.9% (171 cases) based on algorithm 1; 10.8% (187 cases) based on algorithm 2 with a cut-off point > 1/100, 11.8% (203 cases) with a cut-off point > 1/150; 10.3 % (178 cases) based on algorithm 3 with a cut-off point > 1/100, and 11.6% (201 cases) with a cut-off point > 1/150. Among these algorithms, pregnant women in the high-risk preeclampsia group were advised to consider taking low-dose aspirin. Conclusion Screening for pre-eclampsia based on NICE recommendations resulted in a lower number of high-risk pregnant women requiring prophylactic aspirin use compared to other algorithms. This means that some pregnant women at risk of developing preeclampsia are not recommended to use aspirin as a preventive measure. Adding PLGF to the screening strategy will help us get closer to pregnant women who are truly at risk of progressing to preterm preeclampsia.

Prophylactic occlusion balloons of both internal iliac arteries in caesarean hysterectomy for placenta accreta spectrum disorder reduces blood loss: A retrospective comparative study

BackgroundThe placenta accreta spectrum is a complex disorder characterized by abnormal invasion of the placenta into the uterine wall, posing a significant risk of life-threatening haemorrhage for patients. Its incidence is on the rise, largely attributed to the increasing rates of caesarean sections. Management of this spectrum involves a multidisciplinary approach, although standardized protocols are not yet established. While caesarean hysterectomy remains the standard Gold, several adjunctive treatments have emerged in recent years to mitigate bleeding risk and associated morbidity. Among these, prophylactic occlusion balloons placed in the internal iliac arteries have shown promise. The aim of our study is to demonstrate the effect of prophylactic occlusion balloons in both uterine iliac arteries in the management of placental accreta spectrum disorders. MethodsA retrospective monocentric cohort study was conducted in the Department "C" of Gynaecology and Obstetrics at the Maternity Center of Tunis. The study spanned three years, from January 2nd, 2020, to December 31st, 2022. The study population consisted of two groups: Control Group (CG) comprised patients who underwent caesarean hysterectomy without internal-iliac prophylactic occlusion balloons, and Occlusion balloons of both internal iliac arteries Group (OBIIAG) included patients who underwent caesarean hysterectomy with internal-iliac prophylactic occlusion balloons. ResultsA total of 38 patients were included in the study, all of whom exhibited similar epidemiological characteristics and comparable personal and obstetric histories. The most prevalent risk factor among the patients was a history of caesarean section (92%). On average, patients were diagnosed at 30 weeks of gestation, with third-trimester bleeding being the most common presentation (71% of cases). The median gestational age at delivery was between 36 and 37 weeks. We observed a significant difference in blood loss between the two groups (2888 ml in the control group and 1828 ml in the group with internal-iliac prophylactic occlusion balloons, p < 0.05). Implementation of this technique resulted in a reduced need for massive transfusions (p < 0.01) and shorter operating times (126 min for the control group and 92 min for the group with internal-iliac prophylactic occlusion balloons; p = 0.04). There were no significant differences in morbidity between the two groups. ConclusionThe intra-iliac prophylactic occlusion balloons can help reduce the risk of hemorrhage and the morbidities that come with the placenta accreta spectrum disorder.

Intrauterine fetal hypoxia: risk factors for development and diagnosis

Fetal hypoxia is not an independent disease, but is a complication resulting from pathological processes, primarily in the mother’s body. There are many risk factors for the development of this pathological condition, which results in adverse changes in the fetal body. That is why early diagnosis is so important, the ―gold standard‖ of which is cardiotocographic examination, ultrasound diagnostics and assessment of minimal facial movements in the early stages. The purpose of the study is to study the risk factor for the development of acute and frequent fetal hypoxia, as well as the possibility of the occurrence of diseases during pregnancy and childbirth in order to determine preventive measures. For this purpose, an analysis of the necessary literature was carried out. As a result, in order to reduce the development of fetal hypoxia, it is necessary to improve the quality of health of the population in the preconception period; women with a complicated obstetric history are at high risk for this nature

Postpartum Depression: Etiology, Treatment, and Consequences for Maternal Care.

Postpartum depression (PPD) is a disabling condition that has recently shown an increase in prevalence, becoming an essential public health problem. This study is a qualitative review summarizing the most frequent risk factors associated with PPD, evaluating molecular aspects of PPD and current approaches to detect and prevent PPD. The most prevalent risk factors were detected in the areas of economic and social factors, obstetrical history, lifestyle, and history of mental illness. Research on the genetic basis for PPD has taken place in recent years to identify the genes responsible for establishing targeted therapeutic methods and understanding its pathogenesis. The most frequently studied candidate gene was the serotonin transporter gene (SERT) associated with PPD. Among biological studies, antidepressants and psychological interventions provided the most evidence of successful intervention. The obstetrician can serve an essential role in screening for and treating PPD. Postpartum women with risk factors should be screened using the Edinburgh Postnatal Depression Scale (EPDS), but, at the moment, there are no prevention programs in Europe. In conclusion, data from this review increase concerns among this vulnerable population and can be used to design a screening tool for high-risk pregnant women and create a prevention program.

Imaging and molecular features of adenomyosis after menopause

ObjectivesTo explore the imaging features and the molecular characterization of adenomyosis after menopause. Study designAn observational cross-sectional study was performed in a group of postmenopausal patients undergoing a transvaginal ultrasound (TVUS) (n = 468). Among those presenting the US criteria for adenomyosis, also confirmed by magnetic resonance imaging (MRI), previous menstrual symptoms, gynecological and obstetric history were reviewed. In a subgroup undergoing hysterectomy, uterine specimens were analyzed by histology and expression of genes implicated in the epithelial-mesenchymal transition, inflammation and fibrosis, including the sphingosine-1-phosphate (S1P) pathway, was evaluated and compared to matched non-menopausal adenomyosis specimens. Main outcome measuresDirect and indirect US features of adenomyosis according to Morphological Uterus Sonographic Assessment at TVUS. Molecular characterization of postmenopausal versus pre-menopausal adenomyosis samples. ResultsAccording to TVUS and MRI, adenomyosis was identified in 49 patients (10.4 %). On US, diffuse adenomyosis was the most common phenotype, whereas internal adenomyosis with diffuse pattern and asymmetric type was the most prevalent on MRI. Molecular analysis showed that adenomyosis lesions express markers of epithelial-mesenchymal transition, inflammation and fibrosis also in postmenopausal women. By comparing the results with those from pre-menopausal samples, the expression of α smooth muscle actin (αSMA), a marker of fibrosis, was significantly greater after menopause, and altered S1P catabolism and signaling were observed. ConclusionsAdenomyosis may be identified in postmenopausal women by imaging, either TVUS or MRI, and fibrosis is one of the key features on molecular analysis.

Breastfeeding Practices among Urban Mothers of Central Kerala, India: A Cross-Sectional Study

Background: The practice of breastfeeding is vital in child nutrition and morbidity. The authors aimed to determine breastfeeding practices and factors related to Exclusive Breastfeeding (EBF) among mothers with children aged six months to 2 years in an urban area of Thrissur district, Kerala, India.&#x0D; Methods: This was a community-based and cross-sectional study conducted on 339 mothers using cluster sampling in 2016 for one year in the urban area of Thrissur district, Kerala. Details regarding sociodemographic factors, obstetric history, child-related data and breastfeeding practices were collected from mothers using a pretested and semi-structured questionnaire. Analyses were done using SPSS16 and Epi Info 7.&#x0D; Results: The mean age of study population was 27.21 ± 4.27. 223 mothers (65.78 %, 95% CI = 60.43-70.77) initiated breastfeeding within 1 hour, and prelacteal feeding was observed in 25 cases (7.37%, 95% CI = 4.92-10.83). 99.71% practiced feeding on demand, and 30.97% (95% CI = 26.15- 36.24) of children were exclusively breastfed up to 6 months with mean duration of 3.95± 1.79 months. The mean age at which complementary feeding started was 4.83±1.32 months. Cultural beliefs, mothers' employment, and problems during breastfeeding were significant predictors of EBF for up to 6months.&#x0D; Conclusion: Despite high educational status and good antenatal care among the study population, breastfeeding practices were not carried out at the recommended level. Breastfeeding was initiated within 1 hour of delivery by 2/3rd ,and 1/3rd of the children were exclusively breastfed up to 6 months. Cultural beliefs and mothers' employment were factors associated with EBF.&#x0D;

Comparative Study of Fetomaternal Outcome in Abruptio Placenta and Placenta Previa

Background: Abruptio placenta and placenta previa are obstetric complications associated with significant risks for both the fetus and the mother, potentially leading to severe hemorrhage, preterm birth, and maternal shock. Early detection and prompt medical intervention are crucial for optimizing outcomes and reducing maternal and fetal morbidity and mortality.&#x0D; Objective: The study aims to analyze the maternal and perinatal outcomes of APH cases due to placenta previa and abruptio placenta.&#x0D; Methods: This prospective study conducted at Ad Din Akij Medical College, Boyra, Khulna July 1, 2021, to June 30, 2023, included 150 APH cases, with 109 meeting inclusion criteria for comparison between placenta previa and abruptio placenta. Data collection encompassed maternal demographics, obstetric history, severity of hemorrhage, and neonatal outcomes. Diagnosis was based on clinical evaluation and ultrasound. Statistical analysis was performed using MS Excel.&#x0D; Results: In our Study, the distribution of causes of placental issues reveals that Placenta Previa accounts for the majority, comprising 71.55% of cases, while Abruptio Placentae represents 28.44% of instances. Placenta Previa predominantly affects individuals aged 26-30 years and over 35 years, with the highest occurrence among those with 2 pregnancies. Conversely, Abruptio Placentae shows a varied distribution across age groups, with the highest incidence among those aged 31-35 years and with gravidity of 1 pregnancy. Gestationally, the majority of Abruptio Placentae cases present between 31-33 weeks, while Placenta Previa cases peak at 34-36.6 weeks. Preterm births are prevalent in both conditions, with Placenta Previa leading in preterm deliveries. Placenta Previa is associated with a history of abortion and dilation and curettage (D&amp;C), while hypertension is a significant risk factor for Abruptio Placentae. Maternal complications include anemia, postpartum hemorrhage (PPH), and shock, with Placenta Previa being associated with anemia and PPH, while Abruptio Placentae correlated with shock.&#x0D; Conclusion: Placenta previa emerged as the primary cause of APH, affecting multiparous women, while abruptio placenta correlated with hypertension and primigravida. Both conditions posed significant risks of maternal and perinatal morbidity and mortality, highlighting the importance of prompt diagnosis and intervention.

Clinical and Paraclinical Features in Pregnancies Associated With Renal Impairment Due to Hypertensive Complications.

Background An association between renal impairment and hypertensive complications occurring during pregnancy has been shown in a limited number of studies. As a consequence of a lack of clear criteria for diagnostic certainty, acute renal failure during pregnancy is a challenging pathology to diagnose, mainly due to the physiological reduction of nitrogen retention parameters. In light of the fact that renal injury is associated with a poor maternal and fetal prognosis, this study aims to determine the maternal demographic features and the cut-off of serum creatinine that can lead to a heightened risk of prematurity, stillbirth, intrauterine growth restriction, or the necessity of neonatal intensive care. Methods We performed a study that included a cohort of 45 pregnant women with acute renal injury who delivered in the Department of Obstetrics and Gynecology of the University Emergency Hospital in Bucharest between January 1, 2017, and December 31, 2022, a cohort of 45 pregnant women with a value of serum creatinine between 0.8 and 1 mg/dL, and a cohort of 45 pregnant women, selected at random, with a value of serum creatinine under 0.8 mg/dL, who delivered in the same period in the aforementioned unit. The analysis included neonatal outcomes (preterm birth, intrauterine growth restriction, stillbirth, Apgar score calculated at one minute, the need for neonatal intensive care), maternal demographic features, medical and obstetrical history, and paraclinical parameters. Results The incidence of acute renal injury was 0.33% for the entire cohort of patients who gave birth in our hospital. Out of that lot, 65.21% of the cases of acute renal impairment associated with pregnancy were caused by hypertensive complications. The mean age of patients with acute kidney injury (AKI) was 29.4 ± 6.66, preponderantly primiparous. The majority of the neonates from patients with AKI (62.22%) were born with a birth weight under 2.500 grams. Preterm deliveries were preponderant (66.66%) in patients with AKI, while in the control group, the incidence of preterm deliveries was 48.88%. Stillbirth in the AKI group had an incidence of 13.33%, while in the control group, there were none. Due to these neonatal complications, most of the newborns in the AKI group needed neonatal intensive care. An important percentage of the patients who developed AKI (40%) did not benefit from proper medical care during pregnancy or before admission to our unit. The cutoff of 1.09 mg/dL of serum creatinine level was established following receiver operating characteristic curve analysis. Conclusion AKI during pregnancy is associated with hypertensive disorders, low birth weight, and preterm deliveries.

Ultrasound Morphometry of the Pelvic Floor Muscles in Women of Reproductive Age

Biometric studies in nulliparous women conducted to date are limited by small sample sizes. The pelvic floor muscles perform an important function throughout a woman’s life. They provide fixation and maintenance of the pelvic organs, stretches during childbirth, ensuring the formation of the birth canal, and are a potential site for the formation of a hernia in the female body. Impaired function of this muscle group can lead to either excessive muscle contraction (chronic pelvic pain syndrome) or excessive stretching (pelvic organ prolapse). The purpose of the study is to assess the morphometric properties of the pelvic floor muscles in nulliparous women using 3D ultrasound scanning (sonography). Material and methods. The observation group consisted of 60 women of middle reproductive age who applied for an appointment with an obstetriciangynecologist with complaints of pain of various types localized in the perineum and pelvis, decreased desire and quality of sexual life, clinically confirmed by a diagnosis of incompetence of the pelvic floor muscles. The control group consisted of 30 women without dysfunction of the pelvic floor muscles according to clinical examination. The main criterion for inclusion of patients in the study was reproductive age - 18–45 years and natural childbirth in obstetric and gynecological history. Results. We found that the absence of visible sonographic markers of changes in the myofascial structures of the pelvis is not a prognostically significant criterion for muscle dysfunction, since predominantly changes in morphometric parameters are a reliable sign of the formation of pelvic floor muscle failure. Conclusion. The ultrasound morphometry method, which allows one to assess dynamic changes in the size of muscle and fascial structures, can be used in the clinical practice of an obstetrician-gynecologist. Early diagnosis of a violation of the structure of pelvis myofascial complex will allow early implementation of measures aimed at prevention and timely treatment.

Skin disorders in women with poor obstetric history: MTHFR polymorphisms and importance of preconceptional counseling

Objectives This study focused on the link between skin disorders and Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. Methods Study cases were taken from a pre-conceptional care program where patients with poor obstetric history were evaluated in terms of systemic disorders including skin diseases. This retrospective cohort (n = 472) consisted of 110 (23.3%) and 362 (76.7%) women with or without skin disorders, respectively. For ease of analysis, the history of skin diseases was classified into seven categories: (1) acne/rosacea/other acneiform disorders; (2) fungal disease; (3) pruritis/xerosis; (4) psoriasis vulgaris; (5) acrochordons and other benign skin growths; (6) urticaria/dermatitis; and (7) viral diseases. Results In this retrospective cohort of 472 women, we explored the impact of MTHFR A1298C and C677T polymorphisms on skin disorders. Despite similar allelic frequencies, our findings revealed a statistically significant association between the presence of MTHFR polymorphisms and skin disorders (p = .027). Subgroup analysis indicated significantly higher rates of MTHFR polymorphisms in patients with psoriasis vulgaris (p = .033) and acrochordons (p = .030), highlighting their potential relevance in specific skin disorder subtypes. Conclusions The increased prevalence of psoriasis and acrochordons among women with MTHFR deficiency underscores the complex relationship between genetic factors and dermatological health. Our findings emphasized the critical role of MTHFR polymorphisms not only in poor obstetric history but also as significant contributors to skin disorders. This dual association highlights the importance of comprehensive preconception counseling, especially customized for women affected by skin disorders.

Cardiovascular morbidity and mortality following hypertensive disorders of pregnancy

ObjectivesTo determine whether hypertensive disorders of pregnancy (HDP) are associated with maternal coronary artery disease (CAD) and other cardiovascular (CV) diseases within 10–20 years following delivery. Study designRetrospective cohort including all women who delivered ≥ 1 pregnancy ≥ 20 weeks’ gestation within a single health system from 1998 to 2008. We excluded those with CV risk factors preceding first delivery or with no follow-up after delivery. The exposure of interest was any HDP, determined by ICD coding. Main outcome measuresThe primary outcome was a composite of ICD codes for CAD, peripheral vascular disease, and CV events (myocardial infarction, stroke, and death). Multivariable Cox proportional hazards estimated the association between exposure and outcomes. A nested cohort of women who underwent cardiac catheterization had a primary outcome of angiographic CAD, and multivariable logistic regression estimated the association between HDP and CAD. ResultsOf 33,959 women included, 2,385 women had HDP. HDP was associated with the composite outcome (adjusted HR 1.50, 95 % CI 1.11, 2.03). There was a significant difference in event-free survival between groups (p = 0.003) with a median follow-up of 17.3 years. 592 women (1.7 %) underwent cardiac catheterization: 20 of 90 women with HDP had CAD (22.2 %) on angiography vs 49 of 502 without HDP (9.8 %, p < 0.001). HDP was associated with angiographic CAD (adjusted OR 2.08, 95 % CI 1.05, 4.11). ConclusionsWomen with HDP had twice the incidence of CAD on angiography compared to parous women without HDP. Obstetric history may inform the decision to perform cardiac catheterization in relatively young women.

Pregnancy-Related Decision-Making and Perceptions of Risk among Reproductive-Age Females Undergoing Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Single-Surgeon Cross-Sectional Study

Females of reproductive age constitute one of the largest demographics of the hip arthroscopy population, but it is unclear as to how pregnancy planning affects decision-making regarding surgery or vice versa. The purpose of this study was to assess perceived risks to pregnancy from hip pain and/or hip arthroscopy among reproductive-age females who underwent arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). A cross-sectional study was conducted involving females aged 18–44 years who underwent hip arthroscopy for the treatment of FAIS, with a single surgeon included in the study. Subjects completed a survey that assessed obstetric and gynecologic history, decision-making regarding the planning and timing of hip surgery and pregnancy, and perceived risks to pregnancy from hip pain and/or hip surgery. Subjects were classified as nulligravid (Group 1), pregnant at least once before hip surgery but never again following hip surgery (Group 2), or pregnant at least once following hip surgery (Group 3). A total of 85 patients were enrolled with a mean age of 32.3 ± 6.5 years at the time of surgery. The mean follow-up time was 51.9 ± 34.5 months. There were 39 subjects in Group 1 (45.9%), 20 in Group 2 (23.5%), and 26 in Group 3 (30.6%). About half of all subjects expressed “some” to “a lot of” concern that their hip pain could get worse during pregnancy (49.4%), and about half had “no concern” that hip arthroscopy would affect the health of their fetus/baby (54.1%). Reproductive-age females undergoing hip arthroscopy for FAIS generally consider the procedure to be safe with respect to future pregnancy outcomes.

The Impact of Latent Cytomegalovirus Infection on Spontaneous Abortion History and Pregnancy Outcomes in Romanian Pregnant Women.

Serum samples from 806 pregnant women (28.29 ± 4.50 years old) who came for a consultation at the Timisoara Clinical Emergency City Hospital between 2008 and 2010 were tested for anti-CMV IgM/IgG antibodies, and data about demography, obstetrical history, pregnancy complications, birth, and neonate were collected. The data were compared between the groups with and without latent CMV infection, and statistical significance was calculated. We did not find a difference regarding cesarean section (OR = 0.916, p = 0.856), placental abruption (OR = 1.004, p = 1.00), pregnancy-induced hypertension rate (OR = 1.078, p = 1.00), secondary sex ratio (0.882, p = 0.857), APGAR score (p = 0.225), gestational age at birth (p = 0.434), or birth weight (p = 0.365). A borderline significant difference was found regarding the presence of miscarriage history: OR = 8.467, p = 0.051. The presence of latent CMV infection does not affect the likelihood of complications in healthy women. A borderline significantly higher prevalence of miscarriage history was found in women with latent CMV infection.

Prediction of the healing efficiency of episiotomy wounds using hydrogel dressings with lidocaine

The objective: to study the factors affecting the healing process of an episiotomy wound and the effectiveness of using hydrogel dressings with lidocaine for its healing.Materials and methods. The prospective randomized study includes the analysis of anamnestic data from the medical cards of 123 primiparous women with episiotomy wounds who gave birth in the Kyiv City Maternity Hospital No. 5 during 2021–2022. The women were divided into two groups: a comparison group – 63 patients who received standard treatment, and a research group – 60 patients who additionally used hydrogel dressings with lidocaine on the wound.The healing of episiotomy wounds was evaluated according to the REEDA scale. Factors that may influence episiotomy wound healing were studied in patients of both groups: anthropometric indicators (age, height, body mass index), interventions during childbirth, and indicators of obstetric and gynecological history (term of gestation, volume of blood loss during childbirth, body weight of the newborn, etc.). Statistical analysis was performed using the Fisher, Mann–Whitney, Student and chi-square tests of the statistical package EZR v. 1.54.Results. Age (p=0.689) and body mass index (p=0.974) of patients in both groups did not show statistically significant differences. The duration of the second period of labor on average was 72 min (57.6–86.4) in the comparison group versus 43.2 min (28.8–57.6) in the research group with a statistically significant difference (p&lt;0.001). No statistically significant differences were found between the two groups regarding the term of delivery, the volume of blood loss, the weight of the newborn, the risk of pregnancy loss, the frequency of labor induction, the weakness of labor activity, manual revision of the uterine cavity, and vacuum extraction of the fetus. The frequency of use of different types of anesthesia during childbirth also did not differ (p=0.396).REEDA scale assessment revealed a reduced risk of high sum scores in the research group (odds ratio (OR) = 0.16, 95% confidence interval (CI): 0.07–0.38), that supports the efficacy of hydrogel dressings with lidocaine. Analysis of the duration of the second labor period and gestational term also revealed an association with the risk of a high sum of points on the REEDA scale (OR = 1.22, 95% CI: 1.02–1.45 per 0.01 days; OR = 1.65, 95% CI: 1.16–2.35 per week of pregnancy).A multivariate model which included research group, body mass index, duration of the second labor period, gestational term confirmed a reduced risk according to the REEDA scale in this group (OR = 0.19, 95% CI: 0.08–0.47). The four-factor model had a high accuracy (AUC = 0.81, 95% CI: 0.73–0.88), indicating a strong relationship between the selected factors and the risk of complications after episiotomy.Conclusions. The use of hydrogel dressings with lidocaine and taking into account some aspects of childbirth, namely, the duration of childbirth and gestational period, can contribute to the improvement of the course of healing of episiotomy wounds. Such a comprehensive approach supports the effectiveness and significance of using hydrogel dressings with lidocaine in the practice of modern obstetrics to improve the results of treatment of patients with an episiotomy wound.In the future, studies on the effectiveness of using hydrogel dressings for the treatment of episiotomy wounds are necessary.