Pregnancy Outcomes In Women Research Articles

Perinatal Outcome in Pregnant Women With Isolated Oligohydramnios Diagnosed With the Single Deepest Pocket Method.

The aim of this study was to investigate perinatal outcome in singleton pregnancies at term with isolated oligohydramnios, diagnosed by using the single deepest pocket method. In this historic cohort study, the perinatal outcomes of 196 women with isolated oligohydramnios at term, diagnosed by using the single deepest pocket method, were compared to 8,676 women with normal amniotic fluid volume. The primary outcome measure was the Cesarean section rate. Further outcome parameters included the rate of induction of labor, abnormal cardiotocography, umbilical cord pH and base excess, Apgar, meconium-stained liquor and admission to neonatal intensive care unit. In the group with isolated oligohydramnios, there were significantly more Cesarean sections (p=0.0081) and more abnormal cardiotocographies (p=0.0005). Univariate and multivariate analyses showed that this difference was seen particularly in nulliparous women (p=0.0025 for Cesarean section and 0.0368 for abnormal cardiotocography). Peripartal and perinatal outcome parameters were not different between the two groups. In women with isolated oligohydramnios at term, there is no impact on fetal outcome. The influence of isolated oligohydramnios on the rate of cesarean section and abnormal cardiotocography is considered to be less than that of parity.

Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation (BHGAL) due to severe postpartum hemorrhage

Objective: To evaluate the effect of bilateral hypogastric artery ligation (BHGAL) on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage. Methods: Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study. The records of cases were obtained from the hospital database, retrospectively. Maternal demographic data, morbidities or complications associated with BHGAL surgery, any additional haemostatic interventional or surgical procedures, preoperative admission and lowest postoperative haematocrit-hemoglobin values, blood products given, type of anaesthesia, intensive care unit (ICU) and length of hospital stay were recorded. In cases without surgical sterilization, future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation. Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed. Results: Sixty-eight patients with BHGAL surgery history were included in the study. 26 Of 37 cases (70%) that did not undergo surgical sterilization had a desire for pregnancy after the surgery. Six of these cases (23%) were diagnosed with secondary infertility. The fertility rate of these cases was 77%, and subsequent pregnancy was detected in 20 women. A total of 25 pregnancies, including first and second pregnancies, developed, and 15 of these pregnancies resulted in term delivery, six preterm births, one stillbirth, and three abortions. Conclusions: The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems, and this surgery does not seem to adversely affect pregnancy outcomes. This is a tertiary center experience and cohort studies with large patient series are needed.

Extra-amniotic saline instillation versus combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section: A randomized controlled trial

Background: To study and compare the efficacy and safety of extra-amniotic saline instillation (EASI) and combination of oral mifepristone and vaginal misoprostol for second trimester termination of pregnancy in women with previous one caesarean section.Methods: This randomized controlled trial was conducted in Puducherry, South India. Pregnant women aged 18-45 years with history of previous one caesarean section at 16-27+6 weeks of gestation admitted for pregnancy termination were randomized to receive EASI or combination of oral mifepristone and vaginal misoprostol. Efficacy and safety were compared between the groups in an intention-to-treat analysis.Results: There were 50 patients randomized to the EASI (n=25) and oral mifepristone + vaginal misoprostol (n=25) groups. The median induction to abortion interval was 48 vs 60 hours (p value=0.029), need for another method of termination was 16% vs 44% and side effects were 36% vs 8% with combination of oral mifepristone and vaginal misoprostol in comparison to EASI.Conclusion: Combination of oral mifepristone and vaginal misoprostol appears to be more effective than EASI in reducing the induction-abortion interval, need for another method of termination and duration of hospital stay. The maternal safety profile appears to be comparable but requires further studies.

The Effect of Vitamin D Supplementation in Pregnant Women with Overweight and Obesity: A Randomised Controlled Trial.

The impact of vitamin D supplementation on 25-hydroxyvitamin D (25OHD) levels, metabolic status, and pregnancy outcomes in pregnant women with overweight and obesity (OW/OB) is uncertain. This study aimed to examine whether administrating 800 IU of vitamin D3 orally would improve maternal serum 25OHD levels, lipid profile, and pregnancy outcomes compared to 400 IU. This was a two-arm, parallel, non-blinded randomised controlled trial involving 274 pregnant women recruited from KK Women's and Children's Hospital, with a body mass index of ≥25 kg/m2 within 16 weeks gestation. The participants were randomly assigned to receive 800 IU/day (intervention group) or 400 IU/day (control group) of oral vitamin D3 supplements. The primary outcomes were maternal serum 25OHD and lipid levels at 24-28 weeks gestation. The secondary outcomes included maternal and birth outcomes. Compared with controls (n = 119), the intervention group (n = 112) exhibited higher 25OHD levels at 24-28 weeks gestation (adjusted mean difference 6.52 nmol/L; 95% confidence interval 2.74, 10.31). More women in the intervention group achieved sufficient 25OHD levels (77.7% vs. 55.5%; p < 0.001). No differences were observed in lipid profiles or maternal or birth outcomes between the groups. An additional 400 IU of oral vitamin D3 supplementation increased serum 25OHD levels but did not impact lipid profiles or pregnancy outcomes.

Autologous Blood Cell Derivative - ABCD-Endosera - A Next Generation Platelet Derivative Improves Endometrial Thickness and Pregnancy Outcome in Women with Thin Endometrium Undergoing IVF Procedure: A Prospective Self-Controlled Study

This study aimed to assess the efficacy of intrauterine instillation of Autologous Blood Cell Derivative (ABCD-Endosera) in improving endometrial receptivity among infertile women with thin endometrium undergoing Frozen Embryo Transfer (FET).

Evaluation of Perinatal Outcomes in Pregnant Women With Low Amniotic Fluid Index.

The outcomes and management of low amniotic fluid index (AFI) in pregnancy are controversial. The purpose of this study was to determine the relationship between low AFI and perinatal outcomes. This prospective study was conducted on 420 uncomplicated singleton pregnant women with a gestational age of over 28 weeks who referred to Al-Zahra Hospital in Rasht (Iran) for routine perinatal care. Pregnant women were divided into 3 groups of 140 patients based on the AFI and were followed up until delivery. Three groups included normal (8<AFI≤25 cm), borderline (5<AFI≤8 cm) and oligohydramnios (AFI≤5cm) AFI. The three adverse outcomes of respiratory distress, hospitalization in NICU, and length of hospitalization were statistically significantly different between the two groups with normal and borderline AFI and in the borderline group was more than the normal group. Adverse outcomes including; low birth weight (LBW), small for gestational age (SGA), respiratory distress, 1- min APGAR scores<7, hospitalization in NICU and its duration were statistically significantly different between the two groups with normal AFI and oligohydramnios, and it was more in the oligohydramnios group than the normal group. The three adverse outcomes of LBW, SGA and1- min APGAR scores<7 in the two borderline and oligohydramnios groups had statistically significant differences and were more in the oligohydramnios group than the borderline group. Consideration to the AFI in perinatal care to predict adverse perinatal outcomes and perform necessary interventions to improve these outcomes is necessary.

Impact Of Anemia On Feto-Maternal Outcomes In One Of The Tertiary Care Hospitals In Khyber Pakhtunkhwa

Objective: This descriptive case series aimed to determine the frequency of feto-maternal outcomes in pregnant women with iron deficiency anaemia at the Mardan Medical Complex, Mardan. The study was conducted between December 2020 and May 2021 in the Department of Obstetrics and Gynecology. Methods: A total of 125 pregnant women diagnosed with anaemia were included in the study. Participants were followed up until delivery, and fetomaternal outcomes, including gestational hypertension, preeclampsia, postpartum haemorrhage, prolonged labour, low Apgar score, low birth weight, preterm delivery, and early neonatal death, were recorded based on predefined operational definitions. Results: The study participants ranged from 18 to 40 years, with a mean age of 27.784±3.13 years. The mean gestational age was 30.112±2.89 weeks. Among the participants, gestational hypertension was observed in 47.2% of patients, preeclampsia in 60.8%, postpartum haemorrhage in 33.6%, prolonged labour in 40%, low Apgar score in 50.4%, low birth weight in 30.4%, preterm delivery in 28.8%, and early neonatal death in 8%. Conclusions: The study findings suggest that maternal anaemia, specifically iron deficiency anaemia, increases the risk of adverse maternal and neonatal outcomes. It is crucial to closely monitor and promptly treat pregnant women with iron anaemia to reduce the risk of feto-maternal complications. Keywords: Pregnancy, Iron deficiency anemia, Feto-maternal outcomes.

Outcomes for pregnant women with Borderline Personality Disorder who attended a specialist antenatal service.

Our study focussed on the obstetric and psychosocial outcomes of pregnant women with Borderline Personality Disorder (BPD) who received care via a specialist antenatal clinic in Western Australia. This study is a retrospective examination of outcomes for 80 women with a confirmed diagnosis of BPD, with findings compared with published population outcome data for the state. Pregnant women with BPD appeared to be at a risk of complications including pre-eclampsia and special care nursery admission for their newborns when compared to population data. Furthermore, the studied women had elevated rates of psychiatric admissions during pregnancy, child protection involvement, and domestic violence. Polypharmacy exposure was frequent, with the likely impact on obstetric and neonatal outcomes requiring further study. The findings reinforced the notion that pregnant women with BPD experience complex multifaceted vulnerabilities and require enhanced multidisciplinary care. Our study further calls for the development of clinical practice guidelines for managing BPD in the perinatal period.

Comparing the Effects of Oral and Vaginal Evening Primrose Capsules with Concurrent Labor Induction and Exclusive Labor Induction on Bishop Score and Some Labor Outcomes: A Triple-Blind Clinical Trial

Background: Cervical ripening and achieving a favorable Bishop score are crucial for a successful delivery. When the cervix is not adequately ripe, exclusive labor induction might not succeed. Therefore, there is a need to identify safe concurrent interventions to improve the Bishop score. Objectives: This study aimed to compare the effects of oral (capsule) and vaginal evening primrose oil, in conjunction with labor induction, on the Bishop score and various labor outcomes in pregnant women. Methods: This randomized, triple-blind clinical trial was conducted on 170 pregnant women admitted to terminate their pregnancies at Niknafs Maternity hospital in Rafsanjan, Iran, in 2020. The subjects were randomly allocated to 2 intervention groups: the oral evening primrose oil group (n = 57) and the vaginal evening primrose oil group (n = 56). A control group (n = 57) received oxytocin induction alone. Group assignment was performed using the minimization method. The first intervention group received two oral evening primrose 1 000 mg capsules; however, the second group received two 1 000 mg vaginal capsules, both in conjunction with labor induction using 10 units of oxytocin per 1 000 cc of Ringer’s serum. The data were collected using a checklist with three parts: The mother’s demographic characteristics, obstetric characteristics, and childbirth details. Descriptive statistics, including frequency, percentage, mean, median, and standard deviation (SD), were employed. Statistical analyses included one-way analysis of variance (ANOVA), independent t-tests (the Kruskal-Wallis test and Mann-Whitney test for non-parametric tests), and the chi-square test. Results: Two hours after induction, the mean Bishop scores in the oral, vaginal, and control groups were 5.47 ± 1.67, 6.28 ± 1.91, and 4.09 ± 1.61, respectively (P &lt; 0.001). Four hours after induction, the respective scores were 7.63 ± 1.59, 8.00 ± 1.20, and 5.18 ± 1.97 (P &lt; 0.001). The vaginal group had significantly higher Bishop scores. Furthermore, the duration of the first and second phases of labor was significantly shorter in the vaginal group than in the oral and control groups (P &lt; 0.001). Conclusions: Vaginal evening primrose oil was significantly more effective than oral capsules and induction with oxytocin alone in terms of the Bishop score and most labor outcomes.

Prediction of adverse clinical outcomes in pregnant women with severe and extremely severe forms of coronavirus infection

The objective was to identify prognostic criteria for unfavorable outcome in pregnant women with severe and extremely severe forms of COVID-19 and to build a model for predicting clinical outcome.Materials and methods. The cohort single-center retrospective study was conducted, which included 83 patients who were treated in the intensive care unit (ICU) from January 1 to December 31, 2021. Of these, 13 patients had an unfavorable outcome – death, and 70 patients with a successful outcome – recovery. The differences in the main clinical and laboratory parameters of patients of both groups during hospitalization in the ICU and on the 3rd day of treatment (Δ – delta) were analyzed.Results. The Cox regression analysis identified laboratory parameters, the difference of which (Δ) on admission to the ICU and on the 3rd day of treatment is associated with the development of the unfavorable outcome (death). These indicators were used as variables in a linear regression equation. The equation for calculating the prognostic index met the criteria of a statistically significant model (sensitivity 84.6 %, specificity 85.7 %, area under the operating characteristic curve (AUROC – Area Under Receiver Operator Curve) – 0.959 (95 % confidence interval [95 % CI] 0.918 – 1.0).Conclusion. The calculation of the prognostic index can be an additional clinical tool that allows one to predict the development of an unfavorable outcome, concentrate the work of a multidisciplinary team, attract additional reserves of a medical institution and/or evacuate such patients to high-level hospitals.

The comparison between fixed versus degressive doses of medroxyprogesterone acetate combined with letrozole in patients of progestin-primed ovarian stimulation protocol: a propensity score-matched study.

To explore the cycle characteristics and pregnancy outcomes of progestin-primed ovarian stimulation (PPOS) using fixed versus degressive doses of medroxyprogesterone acetate (MPA) in conjunction with letrozole (LE) in infertile women by propensity score matching (PSM) analysis. A retrospective cohort study. Tertiary-care academic medical center. A total of 3173 infertile women undergoing their first in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment within the period from January 2017 to December 2020. A total of 1068 and 783 patients who underwent a fixed dose of MPA combined with LE and a degressive dose of MPA combined with LE protocols, respectively, were enrolled in this study. The freeze-all approach and later frozen-thawed embryo transfer (FET) were performed in both groups. Propensity score matching (1:1) was performed. The primary outcomes were the dosage of MPA and the incidence of premature luteinizing hormone (LH) surges. The secondary outcomes were the number of oocytes retrieved, the cumulative live birth rate (CLBR) and the fetal malformation rate. We created a perfect match of 478 patients in each group. The dosage of MPA, the LH serum level on the eighth day of stimulation, progesterone (P) level and LH level on the hCG trigger day were significantly higher in the LE + fixed MPA group than in the LE + degressive MPA group (52.1 ± 13.1 mg vs. 44.9 ± 12.5 mg; 5.0 ± 2.7 IU/L vs. 3.7 ± 1.7 IU/L; 0.9 ± 0.5 ng/ml vs. 0.8 ± 0.5 ng/ml; 3.3 ± 2.4 IU/L vs. 2.8 ± 1.9 IU/L; P < 0.01). The duration of Gn, the number of follicles with diameter more than 16mm on trigger day, the estradiol (E2) level on the hCG trigger day were lower in the LE + fixed MPA group than in the LE + degressive MPA group (9.7 ± 1.7 days vs. 10.3 ± 1.5 days; 5.6 ± 3.0 vs. 6.3 ± 3.0; 1752.5 ± 1120.8 pg/ml vs. 1997.2 ± 1108.5 pg/ml; P < 0.001). No significant difference was found in the incidence of premature LH surge, the number of oocytes retrieved, the number of top-quality embryos, clinical pregnancy rate (CPR), CLBR or fetal malformation rate between the two groups. The combination of a degressive MPA dose with LE proved effective in reducing the total MPA dosage with comparable premature LH surge and pregnancy outcomes in women undergoing the PPOS protocol.

Serum Taurocholic Acid Levels Have Predictive Value for Adverse Maternal and Infant Outcomes in Pregnant Women with Intrahepatic Cholestasis of Pregnancy: A Prospective Cohort Study

Serum Taurocholic Acid Levels Have Predictive Value for Adverse Maternal and Infant Outcomes in Pregnant Women with Intrahepatic Cholestasis of Pregnancy: A Prospective Cohort Study

Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis.

This study aimed to investigate the association between a history of recurrent spontaneous abortion (RSA) and adverse outcomes in women with spontaneous conception. A search strategy from the inception to March 3, 2023 was run in PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratio (OR), and the 95% confidence interval (CI) or point estimation were used as the evaluation indexes. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. Sensitivity analyses were performed to test the credibility of the meta-analysis results. Fifteen studies involving 1 475 389 pregnant women were included. A history of RSA was associated with gestational diabetes (OR: 2.21, 95% CI: 1.70-2.87, p < 0.001), preeclampsia (OR: 2.06, 95% CI: 1.49-2.86, p < 0.001), placenta previa (OR: 1.82, 95% CI: 1.09-3.02, p = 0.021), placental abruption (OR: 1.67, 95% CI: 1.36-2.06, p < 0.001), miscarriage (OR: 6.37, 95% CI: 3.83-10.57, p < 0.001), preterm birth (OR: 1.80, 95% CI: 1.36-2.37, p < 0.001), cesarean section (OR: 1.47, 95% CI: (1.13-1.91, p = 0.004), perinatal death (OR: 2.24, 95% CI: 1.39-3.60, p = 0.001), and neonatal intensive care unit admission (OR: 1.39, 95% CI: 1.01-1.92, p = 0.047). However, the associations of a history of RSA with gestational hypertension, small for gestational age, fetal anomalies, fetal growth restriction, and postpartum hemorrhage were not observed. This meta-analysis indicates a history of RSA was associated with increased risks of several adverse outcomes in pregnant women with spontaneous conception.

The management and clinical outcomes of pregnancies in women with urea cycle disorders: A review of the literature and results of an international survey

AbstractAn increasing number of women with urea cycle disorders (UCDs) are reaching child‐bearing age and becoming pregnant. Improved diagnostics and increased awareness of inherited metabolic diseases has also led to more previously undetected women being diagnosed with a UCD during or shortly after pregnancy. Pregnancy increases the risk of acute metabolic decompensation with hyperammonemia—which can occur in any trimester, and/or the postpartum period, and may lead to encephalopathy, psychosis, coma, and even death, if not diagnosed promptly and treated appropriately. There are also (theoretical) concerns that a maternal UCD, or its treatment, may cause potential risks for the unborn child. Currently evidence on management and outcome of pregnancies in UCDs is limited to case reports and there are no clear guidelines. In order to inform management and investigate outcomes of pregnancies in women with a UCD, we performed a retrospective review of published cases and analyzed data collected from an international online survey. We conclude that, although risk during the intra‐ and postpartum period exists, multidisciplinary management by an experienced team and a prospective plan usually result in successful pregnancy, labor, delivery, and postpartum period. No deaths were reported in mothers managed accordingly. With the exception of male neonates with Ornithine Transcarbamylase deficiency, the clinical outcome of children born to mothers with UCDs appears positive, although follow‐up is limited. The outcome for women presenting with a first acute metabolic decompensation during pregnancy or postpartum is less favorable. Deaths were associated with diagnostic delay/late management of hyperammonemia in previously undiagnosed women.

Predicting cardiac and pregnancy outcomes in women with adult congenital heart disease using the Anatomic and Physiological (AP) Classification System: How much does physiology matter?

BackgroundPregnancy in women with congenital heart disease (CHD) is associated with an increased risk of adverse maternal and fetal events. Despite the physiological impact of CHD on pregnancy, current risk stratification scores primarily consider anatomical lesions. We assessed the performance of the novel American Heart Association Anatomic and Physiological (AP) classification system in predicting adverse maternal cardiac, obstetric and fetal events, and compared it with established risk models. MethodsThis retrospective cohort study enrolled pregnant women with CHD managed by the Westmead Hospital high-risk pregnancy team. Preconception risk stratification scores (AP classification, mWHO classification, CARPREG II and ZAHARA scores) were retrospectively assigned to each pregnancy by an adult CHD cardiologist and compared with the primary outcome measures, which were maternal cardiac, obstetric and fetal complications. ResultsWe analysed 176 pregnancies in 120 women with CHD. Maternal cardiac risk significantly increased between AP class 2 and 3 (p = 0.001). Within class 3, higher physiological status correlated with maternal cardiac events (p < 0.001). Increasing AP severity correlated with lower fetal birthweight percentiles (p = 0.003). The AP classification was similar to mWHO at predicting maternal cardiac outcomes (AUC 0.787 vs 0.777, p < 0.001), but the CARPREG II (AUC 0.852, p < 0.001) and ZAHARA scores (AUC 0.864, p < 0.001) had higher discriminatory ability within our cohort. ConclusionThe AP classification system shows non-inferior preconception maternal cardiac risk prediction compared to current validated scores. Consideration of physiological status has additive predictive value in the most complex patients (Stage III). Prospective, multicenter studies are required for further validation for preconception risk estimation.

Outcome and Indication of Caesarean Section amongst Pregnant Women Experiencing Premature Rupture of Membranes

Premature rupture of membranes (PROM) is characterized by the spontaneous rupture of chorioamniotic membranes more than one hour before the onset of labor. This condition typically arises spontaneously in most cases, affecting a significant portion of pregnancies. Notably, PROM can also occur in full-term pregnancies. This cross-sectional follow-up study was conducted among pregnant women had premature rupture of membranes and experiencing Caesarean Section (CS) in the department of Obstetrics and Gynaecology of Dhaka National Medical College Hospital (DNMCH), Dhaka, Bangladesh during the period of March to August 2011. The main aim of the study was to find out the indication and outcome of pregnant women with PROM and completed CS. A total of 90 data were collected purposively from all pregnant women more than 28 weeks of gestational age with PROM admitted in the Department of Obstetrics and Gynaecology, DNMCH, Dhaka for labour and underwent CS during study period. The data were collected using a semi-structured data sheet through direct questioning of the patients and physical examinations. Daily follow-ups were conducted until the patients were discharged, and data were also obtained from the clinical records of the patients. PROM patients encompassed all age groups, with ages ranging from 18 to 38 years. The overall educational level of the participants was low, with less than two-third (61.1%) belonging to the low socio-economic status. The average gestational age was 36.65 weeks, with 53.3% being primigravida, 45.6% being multigravida and grand multipara was 1 (1.11%). Only two had multiple pregnancies, and 11 respondents had experienced per vaginal bleeding. During previous gestations, 20 had a history of Caesarean section, 12 had experienced abortion, and 2 had previous cases of PROM. Nutritional deficits were found in 36.7% of patients, Pregnancy Induced Hypertension (PIH) in 35.6%, infections in 12.2%, and chronic hypertension in 5.6%. Four foetuses were in breech presentations, one had a single compound presentation, and two had a transverse or oblique lie. All the women were experiencing gushing of fluid per vagina, with one-fifth (20.0%) having meconium-stained and 12.2% blood-stained vaginal discharge. Attempts to prolong pregnancy were not very successful, with the longest duration being 75 hours. Caesarean sections had to be performed in all cases, with 34.4% within 24 hours and 41.2% within the next 24 hours. Elective caesarean sections following PROM were 28.9%. Indications for emergency caesarean section included a previous history of Caesarean section in 19 cases, foetal distress was found in 18 cases, failed induction in 7 cases, chorioamnionitis in 6 cases, foetal malpresentation was in 5 cases, and other reasons in 9 cases. More than one-third (35.56%) respondents had morbid condition to complicate the postpartum period. Among the complications, 21.11% suffered from wound infection; followed by puerperal sepsis 8.89% and postpartum haemorrhage 5.56%. At termination, all 92 foetuses were alive, but 6 babies had an Apgar score &lt;7 at 5 minutes after delivery, 30.4% of babies had low birth weight and 73.9% were in good condition, whereas 26.1% were admitted in neonatal ward, and out of the admitted 7 died with neonatal sepsis being the primary cause of death. A better understanding of the diagnosis babies and management of PROM will enable obstetric care providers to optimize perinatal outcomes and minimize neonatal morbidity and mortality. Therefore, this study finds the indication and outcome of caesarean section in pregnant women experiencing PROM. Bangladesh Med J. 2022 May; 51(2): 45-53

Evaluation of maternal-fetal outcomes in pregnancy complicated with severe pulmonary hypertension and its influencing factors: a single-center retrospective study in China

ObjectivePregnancy is not recommended for patients with severe pulmonary hypertension (PH) due to the significant risks it poses to both the mother and fetus. The objective of this study is to describe the maternal-fetal outcomes in pregnant women with PH and identify the factors that influence these outcomes.MethodThis retrospective study analyzed clinical data from 25 patients with severe PH who were admitted to our hospital between January 2018 and December 2022. The data we used came from a public general hospital in Fujian Province.ResultsThe mean systolic pulmonary artery pressure (sPAP) of 25 patients was 105.12 ± 22.70 mmHg. All patients had received one or more multidisciplinary team (MDT) treatments before terminating their pregnancies. Among the pregnant women, four experienced a pulmonary hypertensive crisis (PHC), seven had heart failure, and one had postpartum hemorrhage (PPH). Among them, seven (28%) pregnant women died primarily due to heart failure and PHC. Among the fetal outcomes, twelve resulted in therapeutic abortion, and eleven resulted in preterm birth. Among the perinatal complications, eleven infants (84.6%) were born prematurely, six infants (46.2%) experienced neonatal asphyxia, eight infants (61.5%) had low birth weight, and two infants (15.4%) died during the perinatal period. According to the etiology, seven individuals had idiopathic pulmonary arterial hypertension (iPAH), ten had pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH), six had pulmonary hypertension associated with left heart disease (LDH-PH), and two had pulmonary arterial hypertension caused by other diseases (oPAH). The sPAP levels of iPAH and CHD-PAH were significantly higher than those of LDH-PH and oPAH (p < 0.05). Additionally, the gestational weeks of LDH-PH were higher than those of iPAH (p < 0.05). The number of patients with New York Heart Association (NYHA) heart function grade III-V was higher in the death group compared to the non-death group (p < 0.05).ConclusionPregnancy in women with severe PH carries a high risk of mortality. Therefore, contraception is strongly recommended for these women. NYHA cardiac function grade III-IV was useful in predicting the risk of mortality.

Pregnancy in Women on Dialysis: Success Stories from a Tertiary Care Hospital in Dubai, United Arab Emirates

Background:: Pregnancy is rare in women with end-stage renal disease (ESRD). However, this scenario has changed in recent years with considerable improvement and successful outcomes in pregnant women with end-stage renal disease on dialysis. The understanding of the principles related to pregnant dialysis patients, combined with a multidisciplinary approach to case management, has resulted in many success stories, and today, pregnancy for young women with ESRD is more plausible and far safer than ever before. Case Presentation:: We present a series of three women who conceived while on dialysis and delivered successfully. These women were managed with increasing dialysis frequency and developing a clinical protocol early on, with a multidisciplinary approach and close collaboration with obstetricians. Our case series is unique as one of the women had three successful deliveries while on dialysis, and one of them had a positive outcome with twin pregnancies while on dialysis. Conclusion:: Successful outcomes in these high-risk pregnancies while on dialysis suggest that with meticulous care and a multidisciplinary approach, conception and successful deliveries are plausible in women who receive dialysis.

The clinical manifestations and pregnancy outcomes of COVID-19 infection at a tertiary care hospital.

To evaluate clinical presentation and pregnancy outcomes in pregnant women with Covid-19 infection in our local tertiary care from lower middle-income country. A retrospective study was conducted at Obstetrics & Gynecology department, Sheikh Saeed Memorial Hospital (SSMH) of The Indus Hospital and Health Network (IHHN) from March 2020 to August 2021. Data of 422 admitted pregnant women with COVID-19 infection was retrieved for demographic and clinical information, laboratory tests, pregnancy outcome, and neonatal outcomes on RED-Cap and analyzed on SPSS 26. Univariate and multivariable logistic regression analyses were performed to estimate odds ratios (OR) for symptomology with categorical variables and feto-maternal outcome. Of the total 422 pregnant women, 24.4% were symptomatic, 74.7% exhibiting mild symptoms. Largely reported symptoms were fever (71.8%), cough (36.9%) and body ache (35.0%); while odds of symptomatic COVID-19 infection was less in educated pregnant women (OR 0.3; 95% CI 0.1-0.9) compared to uneducated. Amongst maternal comorbidities, odds of having symptomatic COVID-19 infection were 3.8 times (95% CI 1.1-13.0) in women with chronic hypertension and 5.5 times (95% CI 2.9-10.4) in women with diabetes. Symptomatic women had significantly greater incidence of miscarriages (p= 0.009), PPROM (p= 0.001), preterm birth (p= 0.000), preeclampsia (p= 0.000), placental abruption (p= 0.006) and maternal ICU admission (p= 0.000) than asymptomatic patients. Still birth was higher (6.4% vs 1.3%, p-value= 0.013) in symptomatic group. The odds of having severe maternal outcome were higher (OR=3.5; 95% CI 1.9-6.0) in symptomatic pregnant women. Majority of pregnant women were asymptomatic. Symptomatic women with COVID-19 infection had an increased risk of adverse feto-maternal outcome.

The Effects of a Mindfulness-Based Intervention on Mental Health Outcomes in Pregnant Woman: A Systematic Review and Meta-Analysis.

Pregnancy stress, anxiety, and depression increase the risk of short-term and long-term health problems for the mother and fetus. Mindfulness-based intervention (MBI) is one of the most popular, nonpharmacological interventions used to treat mental health problems. The results of prior research indicate MBI has a less consistent effect on mental health problems in pregnant women. The purpose of this systematic review and meta-analysis was to clarify and determine the effect of MBI on mental health outcomes in pregnant women. Six databases, including Embase, Ovid MEDLINE, CINAHL, EBSCOhost, Cochrane Library, and ScienceDirect, were searched from their dates of inception to November 2021. Google Scholar was also used for the literature inquiry. The inclusion criteria followed the PICO (Patient/Problem, Intervention, Comparison, and Outcome) model in terms of only including studies that used mindfulness therapy, reported mental health outcomes, and applied randomized controlled trial and quasi-experimental approaches. The Cochrane risk of bias tool was applied to evaluate the quality of the studies. Review Manager 5 software with random effect with a standardized mean difference (SMD) was used to analyze level of effect. Thirteen studies (10 randomized controlled trials and three quasi-experimental studies) were included. MBI was found to have a small effect on mental health outcomes in pregnant women (p < .0001, SMDs = -0.48, 95% CI [-0.74, -0.22], I2 = 87%). Specifically, MBI had moderate effects on stress and anxiety (SMDs = -0.59, 95% CI [-1.09, -0.09], and SMDs = -0.55, 95% CI [-1.00, -0.10], respectively) and no significant effect on depression (SMDs = -0.33, 95% CI [-0.74, 0.08]). MBIs have a small but notable effect on mental health in pregnant women. The high heterogeneity found in this review may reflect the different types and durations of interventions used. Notably, none of the studies in the review examined intervention effects by trimester. Future research should use larger sample sizes and assess the effects of therapy for each trimester of pregnancy.