Childbirth Outcomes Research Articles

Factors associated with poorer childbirth outcomes in pregnant women diagnosed with placenta previa

ObjectivePlacenta previa is a health issue during pregnancy when the placenta wholly or partially covers the opening of the uterus. It can result in bleeding during pregnancy or after delivery, and preterm delivery. This study aimed to investigate the risk factors correlated with poorer childbirth outcomes of placenta previa. Materials and methodsBetween May 2019 and January 2021, pregnant women diagnosed with placenta previa in our hospital were enrolled. Outcomes were postpartum hemorrhage after childbirth, and lower Apgar score and preterm delivery of the neonate. Laboratory blood examination data preoperatively were collected from medical records. ResultsA total of 131 subjects were included, with a median age 31 years. Multivariate analysis showed that fibrinogen reduced risk for postpartum hemorrhage (adjusted odds ratio (aOR): 0.45, 95% confidence interval (CI): 0.26–0.79, p = 0.005). Homocysteine (aOR: 0.73, 95% CI: 0.54–0.99, p = 0.04) reduced the risk while D-dimer (aOR: 1.19, 95% CI: 1.02–1.37, p = 0.02) increased the risk for low Apgar score. Age (aOR: 0.86, 95% CI: 0.77–0.96, p = 0.005) decreased the risk but history of full-term pregnancy more than twice (aOR: 8.58, 95% CI: 2.32–31.71, p = 0.001) increased the risk for preterm delivery. ConclusionThe findings suggest that poorer childbirth outcomes in pregnant women with placenta previa are associated with young age, history of full-term pregnancy, and preoperative concentrations of low fibrinogen, low homocysteine and high D-dimer. This provides obstetricians adjunctive information for early screening of high-risk population and relevant treatment arrangement in advance.

Prevalence and risk factors for serious birth concerns in unselected population of mothers.

The aim of the study was to determine the prevalence of severe fear of childbirth in a group of pregnant women, to determine the risk factors, and to prove the impact of the fear of childbirth on various obstetrics outcomes in this group. The study population consists of pregnant women who gave birth at the 2nd Gynecology and Obstetrics Department of the Faculty of Medicine, Comenius University and University Hospital Bratislava, from January 1st, 2022, until April 31st, 2022. After signing an informed consent, the pregnant women were given a Slovak version of the Wijma Delivery Expectancy Questionnaire (S-WDEQ), which is a psychometric tool to evaluate the prevalence of severe fear of childbirth. They were given the S-WDEQ during the 36th and 38th week of gestational age. The childbirth data were collected from the hospital information system after the delivery of the baby. The studied group consists of 453 pregnant women who fulfilled the inclusion criteria. Extreme fear of childbirth was identified using S-WDEQ in 10.6% (48) of them. Level of education and age were not considered to be significant predictors of fear of childbirth. Statistically significant difference was not found in terms of the age groups and groups with different levels of education. At the edge of the statistical significance were primiparas, who made up 60.4% (RR: 1.29; 95% CI: 1.00-1.68; P = 0.0525) of all women with severe fear of childbirth. Women with a history of cesarean section were significantly more frequent in the group of women with serious concerns about childbirth (RR: 3.83; 95% CI: 1.56-9.40; P = 0.0033). Women who gave birth by cesarean section due to the indication of non-progressive labour were also more often represented in the group of women with serious concerns about childbirth (RR: 3.01; 95% CI: 1.07-8.42; P = 0.0358). A higher S-WDEQ score at the 36th week of gestational age in a group of primiparous women increased the statistical probability of cesarean delivery (P = 0.0030). The statistical results are not showing the impact of fear of childbirth on the induction success and the duration of the first stage of labour in primiparous women. The fear of childbirth prevalence is relatively high and it has impact on the outcome of childbirth. The use of a validated questionnaire as a screening tool to search for women with childbirth fear could positively influence their concerns by following psychoeducational interventions in clinical care settings.

Reducing psychiatric illness in the perinatal period: A review and commentary

This brief overview highlights the global crisis of perinatal psychiatric illness (PPI). PPI is a major contributor to many adverse pregnancy, childbirth, and childhood development outcomes. It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual, their family, and their community. It is also highly preventable. Current recommendations for intervention and management of PPI are limited and vary considerably from country to country. Furthermore, there are several significant challenges asso-ciated with implementation of these recommendations. These challenges are magnified in number and consequence among women of color and/or minority populations, who experience persistent and negative health disparities during pregnancy and the postpartum period. This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges. An equity-informed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health. Uniquely, this model emphasizes the importance of managing and eliminating known barriers to traditional health care models. Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.

Umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes in children: a systematic review and meta-analysis.

Umbilical cord blood acid-base sampling is routinely performed at many hospitals. Recent studies have questioned this practice and the association of acidosis with cerebral palsy. To investigate the associations between the results of umbilical cord blood acid-base analysis at birth and long-term neurodevelopmental outcomes and mortality in children. We searched six databases using the search strategy: umbilical cord AND outcomes. Randomised controlled trials, cohorts and case-control studies from high-income countries that investigated the association between umbilical cord blood analysis and neurodevelopmental outcomes and mortality from 1 year after birth in children born at term. We critically assessed the included studies, extracted data and conducted meta-analyses comparing adverse outcomes between children with and without acidosis, and the mean proportions of adverse outcomes. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. We have very low confidence in the following findings: acidosis was associated with higher cognitive development scores compared with non-acidosis (mean difference 5.18, 95% CI 0.84-9.52; n = two studies). Children with acidosis also showed a tendency towards higher risk of death (relative risk [RR] 5.72, 95% CI 0.90-36.27; n = four studies) and CP (RR 3.40, 95% CI 0.86-13.39; n = four studies), although this was not statistically significant. The proportion of children with CP was 2.39/1000 across the studies, assessed as high certainty evidence. Due to low certainty of evidence, the associations between umbilical cord blood gas analysis at delivery and long-term neurodevelopmental outcomes in children remains unclear.

THE CONSEQUENCES OF POLYHYDRAMNIOS FOR THE MOTHER AND FETUS

Polyhydramnios is an obstetric pathology, which is characterized by an increase in the volume of amniotic fluid (amniotic fluid) of more than 1500 ml. The purpose of the study was to study the frequency of causes, the course of pregnancy, the outcome of childbirth and the condition of the newborn with polyhydramnios. To achieve this goal, a retrospective analysis of the history of childbirth of 72 women with polyhydramnios who delivered in the obstetric department of the Samara State Medical University clinic in 2022 was carried out. The course of pregnancy in women with polyhydramnios is complicated by: preeclampsia of the first and second half of pregnancy, miscarriage and premature birth. Perinatal outcomes are characterized by: intrauterine retention syndrome, prematurity, malformations of the central nervous system, cerebrovascular accidents and intrauterine infections.

Results of Histological Examination of the Placenta in Preterm Birth Among Residents of the Kaliningrad Region With Hereditary Maladaptation of Hemostasis

In modern obstetrics, the problem of premature birth is very relevant. Despite the active development of medical technologies, the number of preterm births stably remains at the level of 5-10% of the total number of births, and recurrent miscarriage reaches 20%. As is known, one of the causes of preterm birth and recurrent miscarriage is the carriage of genes associated with thrombophilia. We are studying the effect of thrombogenic allelic polymorphisms on the course of pregnancy and the outcome of childbirth in the population of the Kaliningrad region. One of the points of our research is devoted to the description of structural changes in the placenta during preterm labor in women with hereditary maladaptation of hemostasis.

Placenta previa: risk factors, maternal and perinatal outcomes

Introduction. Placenta previa (PP), especially invasive forms (placenta accreta spectrum PAS), is one of the leading causes of maternal and perinatal morbidity and mortality. The aim of the study is to study the features of the anamnesis, pregnancy and childbirth outcomes for the mother and fetus with placenta previa, and to identify the main risk factors for this pathology. Materials and methods. Retrospective cohort study by continuous sampling method: Group 1 – 64 patients with PP, 2 – 30 women with normal childbirth. The anamnesis of women and pregnancy outcomes were studied. Statistical calculations: Mann-Whitney criteria, χ2 Pearson, odds ratio indicator (OSH). Results. The probability of PP increases in a woman's history with cesarean section in anamnesis (OR 20.53 (7.2–58.53), p < 0.001), premature birth (OR 4.29 (1.45–12.68), p = 0.04), abortion (OR 3.77 (2.32– 6.12), p = 0.004), including induced (OR 14.16 (4.95–40.53), p = 0.001) and spontaneous (OR 3.65 (2.01–6.62), p = 0.02), as well as somatic diseases (OR 6.17 (3.8–10.02), p < 0.001), especially the presence of anemia (OR 19.84 (6.95–56.61), p < 0.001), gastrointestinal diseases (OR 13.18 (4.6–37.75), p = 0.002), overweight/obesity (OR 6.23 (2.14–18.14), p = 0.015), varicose veins (OR 5.37 (1.84–15.72), p = 0.005). The threat of miscarriage (p = 0.012), placental disorders (p = 0.012), anemia (p = 0.026), genital infection (p = 0.023) were recorded more often in women with placenta previa. All women with PP were delivered by operation caesarean section, often prematurely (45.3 %; p < 0.001), urgently (45.3 %, p < 0.001) because of bleeding (37.5 %, p < 0.001). The expansion of the volume of surgery was required in 37.5 % of cases, hemotransfusion – 50.0 %. Morphofunctional indicators of children from mothers with PP were significantly lower, and the frequency of asphyxia, respiratory distress syndrome, аrtificial lung ventilation was higher than in the control group. Discussion. PP and PASS are potentially dangerous pathologies for the life and health of women and children, which is confirmed by the results of this study. However, problems of diagnosis of this pathology were revealed at the outpatient stage. In addition to the well-known risk factors for abnormal placentation, associations of PP with a low socio-economic status of a woman and a number of somatic nosologies, such as obesity, anemia, gastrointestinal tract diseases, varicose veins, the influence of which is probably indirect. The association of abnormal placentation with excessive use of gestogens during pregnancy cannot be ruled out. Conclusions. The risk factors for PP were the presence of a history of cesarean section, abortions, premature birth, low socio-economic status, somatic pathology (overweight / obesity, anemia, gastrointestinal diseases, varicose veins). PP is associated with a high frequency of the threat of miscarriage, placental disorders, genital infection, premature birth, cesarean section operations, bleeding, decreased morphofunctional indicators of newborns, perinatal morbidity and mortality

Course of pregnancy and childbirth in women with primary hypothyroidism

Introduction. Primary hypothyroidism is observed in women of reproductive age in 2–3 % of cases. The most common thyroid pathology during pregnancy is subclinical hypothyroidism (SHT), which is caused by newly diagnosed autoimmune thyroiditis (AIT) or severe iodine deficiency. In some regions of the Russian Federation, the population has a mild iodine deficiency, the average concentration of iodine in the urine being found at 78 µg/L (the normal range is 100–200 µg/L). In women with primary hypothyroidism, complications of pregnancy and childbirth include: premature birth, weakness of labor, eclampsia, premature rupture of premature rupture of membranes (PROM), gestational diabetes mellitus (GDM), intrauterine growth retardation syndrome, fetal macrosomia, congenital hypothyroidism in the fetus, etc.Aim: to study the features of pregnancy and childbirth course in women with primary hypothyroidism.Materials and Methods. In a retrospective study, there were analyzed 62 birth histories, of which 37 were for patients with thyroid diseases. Two groups were formed: the main group – 25 patients with primary hypothyroidism, the comparison group – 25 patients without thyroid pathology. During the study, the next parameters were analyzed: age, number of pregnancies, number of births, term of delivery, body mass index, level of thyroid stimulating hormone (TSH), titer of thyroid peroxidase antibodies, newborn body weight, newborn assessment according to Apgar scale.Results. In the main group, the cause of primary hypothyroidism was as follows: newly diagnosed SHT – in 18 (48.6 %), AIT – in 7 (18.9 %) pregnant women. In the first trimester of pregnancy, TSH level in patients with hypothyroidism was 3.06 ± 0.36 mU/L. The following complications of pregnancy and childbirth course were identified: GDM (32.0 %), anemia of the first degree (12.0 %), large fetus (12.0 %), PROM (12.0 %), perineal rupture of the first degree (16.0 %), anomalies of labor activity with ineffective labor stimulation (8.0 %), pelvic-head disproportion (8.0 %).Conclusion. Timely diagnosis and compensation of hypothyroidism with hormone replacement therapy and iodine preparations, prediction of possible complications and correction of identified complications are the main ways to achieve a successful outcome of pregnancy and childbirth for mother and fetus.

Urban-rural differences in the pregnancy-related adverse outcome

BackgroundLittle is known about potential urban-rural differences in adverse pregnancy outcomes. The purpose of this study is to look into the urban-rural differences in the trend of adverse maternal and...

Obstetrical and perinatal consequences of birth in women depending on the term of gestation

The objecticve: to analyze peculiarities of pregnancy course, childbirth and the condition of newborns in women, depending on the gestation period on the basis of clinical and statistical analysis.Materials and methods. An analysis of pregnancy course, childbirth and perinatal outcomes has been carried out in 137 pregnant women. Patients were divided into 2 groups depending on the gestational age: 41 patients (I group) delivered in 37–40 weeks of gestation and 96 patients (II group) – in 41-42 weeks of pregnancy. Functional assessment of the fetal condition was performed using a cardiotocographic examination with cardiomonitors «Oxford Team 8000» and Hewlett Packard according to the generally accepted method, ultrasound examination – by ultrasound machine «Biomedica Au-530» with a linear sensor of 3.5 MHz frequency. Variational and statistical processing of the results has been carried out using licensed standard packages of multivariate statistical analysis application programs «STATISTICA 13».Results. An evaluation of anamnestic data allowed to establish that the majority of patients in the II group (53.13 %) had extragenital pathology that was in 2 times more than in the I group (24.39 %). The frequency of chronic salpingo-oophoritis was also significantly higher in the II group compared to the I one (12.50 % and 2.44 %, respectively), and such pathology as uterine leiomyoma (7.29 %) and cervical dysplasia (4.17 %) were diagnosed only among the women in the II group.A higher rate of pregnancy loss, anemia during pregnancy and disorders of uteroplacental bloodflow in patients in the II group was determined. The frequency of obstetric complications in the II group was in 4 times higher compared to the I group. This had a direct impact on the increase in the rate of cesarean section and vacuum extraction of fetus. Thus, fetal distress during childbirth was diagnosed in 13.54 % of women in the II group and in 7.32 % in the I group, and the weakness of labor activity (8,3 %) and clinically contracted pelvis (5.21 %) were determined only in the II group. Trauma of the birth canal was found in 37.5 % of women in the II group, which was almost 4 times higher than in the group I (9.76 %). The frequency of postpartum bleeding was also higher in the group II (15.6 %) and exceeded the indicator in the I group (4.88 %) in 3 times.The signs of prolonged pregnancy were found in 7.32 % newborns in the I group and 13.54 % – in the II group. It should be noted that the clinical features of early adaptation, which are characterized by a low Apgar score at birth, as well as higher morbidity, including high frequency of damage to the nervous system were determined in the newborns in the II group.Conclusions. Results of the study indicate the importance of constitutional and age characteristics, as well as concomitant somatic pathology and genital inflammatory diseases in women with a delivery date of 41–42 weeks of pregnancy, which can increase the probability of postterm pregnancy in these women. According to the results of the comparative analysis in the research groups, depending on the date of delivery, the predominance of obstetric and perinatal complications was established in women who delivered at 41–42 weeks of pregnancy compared to women who had labor at 37–40 weeks. A high rate of obstetric complications (anomalies of uterine activity in labor, fetal distress, clinically contracted pelvis) had a direct impact on the increase in a percentage of operative delivery (vacuum extraction of a fetus and caesarean sections). Babies born at 41–42 weeks had clinical features of early adaptation, characterized by a low Apgar score, higher morbidity and frequent damage of the nervous system compared to newborns with gestation period of 37–40 weeks.

Long-term quality of life after obstetric intensive care unit admission: A cross-sectional cohort study.

To assess the long-term quality of life (QoL) after obstetric Intensive Care Unit (ICU) admission. Cross-sectional survey study. Tertiary care centre. Women admitted to the level 3 ICU during pregnancy or ≤6 weeks postpartum, between 2000 and 2015. Quality of life measures were compared with the population reference values. Associations with baseline ICU parameters were assessed with multivariable linear regression. Patient-reported outcome and experience measures (PROMs/PREMs) were described. Quality of life according to the Linear Analogous Scale (LAS), the Satisfaction with Life Scale (SWLS) and the SF-36 questionnaire; PROMs/PREMs using the Pregnancy and Childbirth outcome set of the International Consortium for Health Outcomes Measurement. Of all 265 obstetric ICU admissions, 230 were eligible and 94 (41%) were included (median follow-up time 14 years). The LAS (75.7 versus 78.7, p=0.077) and SWLS (25.2 versus 26, p=0.176) sum scores were not different from the population reference values. The SF-36 subdomains bodily pain (55.3 versus 73.9), general health (58.2 versus 73.9) and vitality (56.9 versus 69.1) were lower than the reference values (all p < 0.001). PROMs/PREMs were low in 46.2% for pain, 15.1% for depression, 11.8% for satisfaction with care and 52.7% for healthcare responsiveness. An indirect obstetric ICU admission diagnosis was independently associated with a reduced physical health score (B -1.7, 95% confidence interval [CI] -3.4 to -0.1) and severe neonatal morbidity with a reduced mental health score (B -6.6, 95% CI -11.3 to -1.8). Obstetric ICU admission is associated with reductions in long-term physical health QoL and in some patients with mental health QoL. We suggest multidisciplinary rehabilitation and long-term psychosocial support.

Adverse Childbirth and Perinatal Outcomes Among Healthy, Low-Risk Pregnant Women with Abnormal Total Gestational Weight Gain.

Purpose: Little is known on the potential effects of abnormal gestational weight gain (GWG) among low-risk, healthy pregnant women with no comorbidities or gestational complications. We investigated perinatal outcomes of these pregnancies according to GWG as per the 2009 National Academy of Medicine (NAM) recommendations. Materials and Methods: A retrospective analysis of prospectively collected data of low-risk pregnant women giving birth at term between January 2016 and December 2020. Inclusion criteria were normal pregestational body mass index (pBMI) (18.5-24.9 kg/m2) and no pregestational or gestational complication. Self-reported prepregnancy weight was used to calculate pBMI; GWG was the difference between maternal weight at childbirth and prepregnancy weight. Women were classified according to the 2009 NAM guidelines for GWG: insufficient (iGWG, <11.5 kg), adequate (aGWG, 11.5-16 kg), and excessive (eGWG, >16 kg). Logistic regression analysis with aGWG as referent was performed to independently estimate dose-response associations. Results: During the study period, there were 4,127 (33.1%) births fulfilling the inclusion criteria. Fifty-two percent of women gained outside the recommended range: 33.5% had iGWG and 18.7% had eGWG. iGWG women were 40% more likely to have early-term births and small for gestational age neonates. In turn, eGWG women displayed increased odds of prolonged pregnancy (adjusted odds ratio [aOR] 1.32), cesarean section in labor (aOR 1.50), high-degree perineal tears (aOR 2.04), postpartum hemorrhage ≥1,000 mL (aOR 1.54), and large for gestational age newborns (aOR 1.83). Conclusion: Our data show that abnormal GWG independently associates with heightened risk of adverse outcomes among healthy, low-risk pregnant women with normal pBMI and no comorbidity or gestational complication.

A Study on the Perinatal Outcomes of Natural Childbirth Led by Midwives: A Retrospective Study

Purpose: The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families.Methods: This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test.Results: Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02.Conclusion: Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Определение риска осложнений беременности и родов у женщин с исходно нормальной массой тела в зависимости от прибавки массы в процессе гестационного периода

Aim. To study the results of the course and outcomes of pregnancy in women depending on weight gain and to determine the risk of complications of the gestational period. Using the continuous sampling method, we conducted a retrospective study of the outcomes of pregnancy and childbirth in 1080 women with initially normal body weight. The initial body mass index in pregnant women of the survey group was in the parameters of 18.5–24.9. Depending on the recommended (11.5–16.0 kg) weight gain, pregnant women were divided by us into 3 subgroups: MG; GS1; GS2. The MG (363 people) included pregnant women whose total body weight gain during the entire pregnancy corresponded to the recommended weight gain parameters (11.5–16.0 kg). GS1 (543 people) included pregnant women whose total body weight gain was below the reference values (11.5 kg). GS2 (174 people) included women whose weight gain during pregnancy exceeded the reference values (16.0 kg).was carried out using the polymerase chain reaction method (Kvant-21 test). Results. With an excess of the recommended weight gain in women, parameters in which the relative risk index was more than 2 were found to be 3.5 times more than in women with a deficiency in body weight gain. These include iron deficiency anemia (8.57); gestational arterial hypertension (2.59); pregnancy-induced edema (3.2); pathology of the urinary system of inflammatory origin (3.4); ZRP (2.63); the birth of infants with a body weight of 2000 to 2499 g (2.76) and a body weight of 4500–4999g (2.77). Conclusion. Our results suggest that excess weight gain during pregnancy, even against the background of normal initial body weight, is a risk factor that has a negative impact on the condition of women and infants, to a greater extent than lack of weight gain. However, it should be noted that at present there is a certain trend towards an increase in the number of pregnant women with a lack of weight gain, which also carries certain risks for their health, although to a lesser extent than excess weight gain.

Pregnancy, childbirth and neonatal outcomes of women with rare inherited coagulation disorders

Background We aimed to describe the characteristics and the pregnancy outcomes of women with rare inherited coagulation factor disorders managed at a tertiary obstetric-haematology unit in the United Kingdom. Methods A retrospective service evaluation was conducted using routinely collected medical records. Descriptive analyses were applied to investigate pregnancy, childbirth and neonatal management and outcomes. Results Overall, 20 patients with rare inherited coagulation disorders were included who birthed 30 live infants from 29 pregnancies. Regarding maternal bleeding outcomes, 3% experienced antepartum haemorrhage, 38% of pregnancies experienced primary post-partum haemorrhage, and none experienced secondary post-partum haemorrhage. Five (17%) neonates had cranial ultrasound scans for imaging to investigate for a neonatal haemorrhage, which were all normal. Conclusions Although women with rare inherited coagulation disorders may be more susceptible to complications in pregnancy, within this cohort there was no evidence that the condition led to increased morbidity or mortality when best practices were observed.

Влияние COVID-19 на репродуктивное здоровье женщин. Обзор литературы

Coronavirus disease (COVID-19), in addition to affecting the respiratory system, can also lead to extrapulmonary damage in the cardiovascular system, liver, kidney, neurological, intestinal, endocrine dysfunction, as well as disorders in the reproductive system. This manuscript reviews current information on the impact of coronavirus infection on women’s reproductive health. Evidence is presented on the likely mechanisms of abnormalities in the female reproductive system. Issues such as menstrual disorders after coronavirus infection, the impact of the SARS-CoV-2 virus on the hypothalamic-pituitary system are considered. Possible mechanisms of the effect of the virus on the endometrium in women are presented. Studies on the effect of SARS-CoV-2 virus on the course of pregnancy, the outcome of childbirth, and data on possible transplacental transmission from mother to fetus are reviewed.

Recent Trend and a Glory to Childbirth: Pilates - A Review

Various researches indicates about the effects of Pilates during pre-natal and post-natal period. But few studiesindicates the impact of Pilates to achieve the desired childbirth outcomes. Hence, the purpose of our studyis to review various childbirth outcomes through Pilates Training. Google Scholar, Pub Med, Science DirectDatabases were used to extract the research articles to review. Total 15 full text articles were selected for thisnarrative review. Qualitative analysis was done to extract the studies. The results indicates that Pilates Traininghelps in decreasing the intensity of the labour pain, second stage of labor during pregnancy, decreasing therate of Caesarian sections and obstructed labour, episiotomies, etc. The study concluded that Pilates Trainingassists in childbirth process by strengthening the pelvic floor muscles without causing any complications toboth mother and baby. The implications of this study is that it helps in creating awareness about GynaecologicalPhysiotherapy and Pilates Training which can be used as an assisting tool for the childbirth process.

Investigating the effects of financial crisis on pregnancy

Introduction: The global economic crisis has affected many European countries and especially Greece, with main feature that in a short time period it has affected rapidly Greeks’ life and especially the field of health. As far as pregnancy is concerned the consequences have manifested with disorder of different perinatal parameters and they concerned equally both mother and fetus. The purpose of this study is the investigation of consequences of financial crisis in pregnancy, the outcome of pregnancies and childbirth, in relationship to the birth weight of neonates and prematurity. Methods: This is a retrospective study, which covered periods before, during and after the crisis (2006, 2011 and 2019) and was carried out in a public General Hospital of Thessaloniki. The data were collected from the birth registers of the delivery room and for their processing were used the x2 test, the t-test, the nonparametric Mann-Whitney U-test, the anova test and the Spearman coefficient. Results: The present study showed an increase in the rate of caesareans sections from 35% (2006) to 53.5% (2019) (p = 0.04) and statistically significant differences between native and non-native women, with foreigners showing more favorable rates of prematurity ( p = 0.03), cesarean section (p = 0.05) and lower maternity age (p = 0.00). Finally, it was found that women who gave birth prematurely (p = 0.04) or by caesarean section (p= 0.02), were older. Conclusions: Immediate need for interventions was deemed necessary in the maternal care and special mention for the mitigation of factors which are affected by the socioeconomic fluctuations (mother’s age, percentage of caesareans sections, prematurity, birth weight of neonates) and constitute insurmountable elements which required to be set in the centre of interest of the Public Health bodies.

Прогнозирование и профилактика тромботических осложнений у беременных, перенесших новую коронавирусную инфекцию COVID-19

Aim: The aim of the study was to optimize diagnostic, treatment and preventive measures in pregnant women who had a new coronavirus infection (NCI) COVID-19 during the gestation period. Design: Comparative study. Materials and methods. We studied the course of pregnancy, childbirth and perinatal outcomes in 60 women who had COVID-19 during this pregnancy, delivered in the conditions of the MONIAH. Patients were divided into two groups depending on the period of visit to the outpatient department of MORIAG. Group I consisted of 45 pregnant women who underwent NCI in the I–II trimesters with subsequent treatment and observation in the conditions of the polyclinic department of MONIAH, Group II — 15 pregnant women who had had NCI during gestation and applied to the polyclinic department before delivery. In the course of the work, in addition to the general clinical examination, an extended study of the hemostasis system was additionally carried out (during registration, before delivery and according to indications in order to control ongoing therapy), ultrasound and Doppler studies in dynamics, analysis of gestational and perinatal outcomes, the timing of the disease and course of the NCI. Results. During the first consultation, all participants in the study underwent ultrasound and an analysis of standard hemostasiological tests was performed. In pregnant women who received low molecular weight heparins, as well as in cases of placental insufficiency and/or structural changes in the placenta, thrombodynamics was studied (n = 21). Women of group II had a significantly lower APTT, a higher level of prothrombin in the blood, and they also had statistically significantly more signs of hemodynamic disturbances in the BMD. According to ultrasound findings, uteroplacental blood flow disorders were diagnosed in 13 patients; thrombodynamics test results demonstrate hypercoagulation in 17 women, while the data from the routine assessment of hemostasis did not go beyond the reference values. Structural changes in the placenta were found in 8 (53.4%) examined patients of group II, and a thrombodynamic test was performed in 5 of them. Hypercoagulation was detected in 4 (26.7%) patients in group II. In patients of group I, depending on the results obtained, correction of therapy was carried out, followed by ultrasound control of the structure of the placenta, as well as an assessment of the thrombodynamic test. Conclusion. Women who have undergone NCI during gestation, regardless of the clinical course and duration of infection with NCI, are characterized by hypercoagulable changes, however, standard hemostasiological tests do not fully reflect post-covid changes, in contrast to the thrombodynamic test in combination with careful placentometry, in which structural changes in the placenta and violations of intraplacental blood flow may indirectly indicate the presence of hypercoagulability. Rational anticoagulant and antiplatelet therapy under the control of indicators of the blood coagulation system and the structure of the placenta contributes to a significant reduction in the incidence of adverse obstetric and perinatal outcomes. Keywords: new coronavirus infection, pregnancy, placental insufficiency, doplerometry, thrombodynamic test.

Determinants of Maternal Near Miss among Women in Northeast Iran: A Facility-Based Case-Control Study.

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.