Post-term Research Articles

The Prevalence of Endometriosis in Patients with Unexplained Infertility.

Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.

Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China.

Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project were grouped into three subgroups using two approaches: z-score percentile<25th, 25th to 75th, >75th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m2 to 23.9 kg/m2) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.

POSTTERM PREGNANCY: MATERNAL AND FETAL OUTCOMES

Postterm Pregnancy is one of the commonest obstetric conditions which associated with an increased risk of fetal and neonatal mortality and morbidity as well as an increased maternal morbidity. The aim of the present study is to determine the maternal and fetal outcomes of postterm pregnancy at Al-Sadaqa Teaching Hospital. A prospective case–control study was conducted at Al-Sadaqa Teaching Hospital, Aden from January 1st to December 31th 2020. Cases were considered postterm pregnancy (≥ 42 weeks) while control term pregnancy (37weeks - 41weeksand 6 days). Significant association between gestational age and the studied variables of postterm and term pregnancy were analyzed using appropriate statistical methods. A total of 185 cases of postterm pregnancy and 370 control group of term birth, the frequency of postterm pregnancy was (2.78%), we found statistically significant association between some of socio-demographic factors and postterm pregnancy, cesarean section was higher in postterm group (OR 2.80) with the indications were cephalopelvic disproportion (OR 12.38). Maternal complications were significantly association to postterm birth like prolonged labor (OR 12.99) and postpartum hemorrhage (OR 8.32). Regarding to fetal outcomes, Postterm pregnancy has showed a significant association with neonatal low Apgar score(p=0.000), Oligohydramnios (OR 42.24) asphyxia (OR 2.86), meconium aspiration (OR 9.41) and Perinatal death (p value 0.012). This study concluded that postterm pregnancy is associated with adverse maternal outcomes such as, prolonged labor and postpartum hemorrhage, and associated with adverse fetal outcomes like oligohydramnios, asphyxia and meconium aspiration syndrome. The outcome of prolonged pregnancy can be improved by proper counselling for follow up during pregnancy and proper monitoring and appropriate management during labor.

Comparison of Dinoprostone versus Oxytocin with Dinoprostone for the Induction of Labour: A Retrospective Case-control Study in a Tertiary Clinic in Türkiye

Aim: Even though the number of inductions is still rising, limited information is available about the results of subsequent pregnancies following induction. The current study was aimed at comparing the effectiveness of dinoprostone and low-dose oxytocin with dinoprostone in the induction of labour for term pregnancies to assess the need for additional uterotonic agents. Material and methods:In this retrospective study, 99 patients with full-term pregnancies (completed 37 weeks or more of pregnancy) who had unripe cervixes underwent labour induction for different reasons were evaluated. BISHOP score was performed to predict the patient who required labour induction. All participants were given either only a sustained-release dinoprostone vaginal insert or low-dose administration of oxytocin to the dinoprostone. Two patient groups’ clinical characteristics were compared. Results: No statistically significant differences were found between the two groups based on age, gravity, parity, and gestation weeks. However, there was a significant difference between the two groups in terms of the duration of the active phase of labour and time from admission until the end of the second stage of labour (p=0.04). Labour and birth occurred in a significantly shorter time in the dinoprostone + oxytocin group. Common indications for induction of labour were post-term pregnancy (77.14%). The cesarean section ratio was found to be similar in both groups (p=0.084). There was no statistically significant difference between the two groups in terms of adverse events such as tachysystole and hyperstimulation of the uterus and infant outcomes (p&gt;0.05). Conclusion: Sustained-release dinoprostone and dinoprostone with low-dose oxytocin were both found to be effective augmentations in the management of delay in labour. Our results supported that administration of oxytocin with dinoprostone vaginal insert dramatically shortened induction to delivery times, and no significant increase of cesarean section rate had been found.

Hypoxic-ischaemic encephalopathy based on clinical signs and symptoms and associated factors among neonates, Southern Ethiopian public hospitals: a case-control study.

Hypoxic-ischaemic encephalopathy (HIE) is a severe condition that results from reduced oxygen supply and blood flow to the brain, leading to brain injury and potential long-term neurodevelopmental impairments. This study aimed to identify the maternal and neonatal factors associated with hypoxic-ischaemic encephalopathy among Neonates. The authors conducted a case-control study in 15 public hospitals with 515 neonates and mothers (175 cases and 340 controls). The authors used a questionnaire and clinical records created and managed by Kobo software to collect data. The authors diagnosed hypoxic-ischaemic encephalopathy (HIE) by clinical signs and symptoms. The authors used logistic regression to identify HIE factors. Hypoxic-ischaemic encephalopathy (HIE) was associated with maternal education, ultrasound checkup, gestational age, delivery mode, and labour duration. Illiterate mothers [adjusted odds ratio (AOR)= 1.913, 95% CI: 1.177, 3.109], no ultrasound checkup (AOR= 1.859, 95% CI: 1.073, 3.221), preterm (AOR= 4.467, 95% CI: 1.993, 10.012) or post-term birth (AOR= 2.903, 95% CI: 1.325, 2.903), caesarean section (AOR= 7.569, 95% CI: 4.169, 13.741), and prolonged labour (AOR= 3.591, 95% CI: 2.067, 6.238) increased the incidence of HIE. This study reveals the factors for hypoxic-ischaemic encephalopathy among neonates in Ethiopia. The authors found that neonates born to illiterate women, those who experienced prolonged labour, those whose mothers did not have ultrasound checkups during pregnancy, those delivered by caesarean section, and those born preterm, or post-term were more likely to develop hypoxic-ischaemic encephalopathy. These findings indicate that enhancing maternal education and healthcare services during pregnancy and delivery may positively reduce hypoxic-ischaemic encephalopathy among neonates.

Prevalence and associated factors of mother-reported jaundice in newborns.

Newborns' jaundice is the result of bilirubin accumulation as fetal hemoglobin is metabolized by the immature liver. This study aimed to estimate the prevalence of mother-reported newborn jaundice and associated factors. A cross-sectional study was carried out using data from a longitudinal study involving 914 children. The data were reviewed using Poisson regression with a robust estimator in a hierarchical model in which the sociodemographic variables constituted the first level, those related to the conditions of the pregnancy constituted the second level, and those related to the report of jaundice, the third level. Prevalence ratios and their relevant confidence intervals were estimated. The prevalence of reported jaundice in newborns was 17.9%. The variables late pregnancy, urinary infection during pregnancy, and preterm and post-term birth were independently statistically associated with a higher prevalence of newborn jaundice reports. We can conclude that mother-reported newborn jaundice was 17.9% associated with maternal and birth aspects.

Diagnostic options, physiopathology, risk factors and genetic causes of permanent congenital hypothyroidism: A narrative review.

In Permanent congenital hypothyroidism (PCH) is a lifelong condition characterized by a deficiency in thyroid hormone, leading to various neurodevelopmental complications. Early clinical signs are often nonspecific and easily overlooked, but newborn screening programs have improved early detection. This narrative review aims to provide insights comparatively transient and permanent PCH and also the diagnosis, risk factors, underlying pathophysiology, and genetic causes associated with PCH. Relevant studies were identified through a comprehensive search using the term 'Permanent congenital hypothyroidism' (Mesh) across scientific databases of electronic databases such as PubMed, Scopus, and Web of Science. Prompt initiation of thyroid hormone replacement therapy, particularly within the initial two weeks postpartum, crucially enhances neurocognitive development outcomes. Multiple predictive approaches, encompassing screening TSH levels, maternal thyroid history, and levothyroxine dosage per kilogram assessment, aid in identifying PCH. Recent studies have demonstrated a mounting prevalence of PCH, contributing significantly to the overall rise in CH incidence. Genetic factors, primarily DUOX2 and DUOXA2 mutations, alongside environmental influences such as post-term birth, low birth weight, and macrosomia, may induce PCH. Nonetheless, reliable markers for early PCH prediction upon diagnosis remain elusive, leading to delayed recognition post-ceasing levothyroxine treatment around age 3. Recent studies have observed an increased incidence of PCH, contributing substantially to the overall rise in cases of congenital hypothyroidism. Understanding the diagnostic options and genetic etiologies associated with PCH is crucial for the early identification and appropriate management.

Factors Influencing Induction of Labor Success in Riyadh, Saudi Arabia.

The physiological process by which the fetus and placenta are delivered from the uterus and pass through the vaginal canal for delivery is known as labor. Induction of labor involves deliberately initiating labor before it occurs naturally, using medical interventions or techniques to stimulate contractions and initiate the birthing process. This study aimed to investigate the factors that influence the success of labor induction procedures in Riyadh, Saudi Arabia, from January to April 2023. Subject and Methods. This retrospective chart review was conducted at the National Guard Hospital in Riyadh, Saudi Arabia. Data were collected from the patient chart of those who underwent labor induction from January to April 2023. The collected data were tabulated and cleaned in MS Excel. Final data were transferred to SPSS for subsequent data analysis. Five hundred and thirty-one pregnant women were analyzed. 52.7% were aged 30 years or below. The most common indication of IOL was post-dated pregnancy (26.2%). 62% were normal deliveries, indicative of IOL success, while 31.1% were cesarean deliveries, indicative of IOL failure. In univariate analysis, women with lower gravidity (≤3) and who had received Propess were associated with cesarean delivery. In a multivariate regression analysis, women who received Prostin and increased parity were identified as the significant independent predictors of IOL success. IOL's success was dependent primarily on increasing parity and Prostin administration. However, lower gravidity (≤3) and Propess medication could lead to operative procedures among pregnant women. Hence, it is necessary to carefully assess the condition of pregnant women before directing them to IOL.

A prospective observational study on efficacy and safety of extra amniotic saline infusion with transcervical foley’s catheter in induction of labour in post-dated pregnancy

A prospective observational study on efficacy and safety of extra amniotic saline infusion with transcervical foley’s catheter in induction of labour in post-dated pregnancy

Safety and efficacy of phosphodiesterase-5 (PDE-5) inhibitors in fetal growth restriction: a systematic literature review and meta-analysis.

Introduction: Fetal growth restriction (FGR) is associated with a higher risk of perinatal morbidity and mortality, as well as long-term health issues in newborns. Currently, there is no effective medicine for FGR. Phosphodiesterase-5 (PDE-5) inhibitors have been shown in pre-clinical studies to improve FGR. This study aimed to evaluate the latest evidence about the clinical outcomes and safety of PDE-5 inhibitors for the management of FGR. Methods: Eight databases (PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database and WangFang Database) were searched for English and Chinese articles published from the database inception to December 2023. Randomized controlled trials (RCTs) reporting the use of PDE-5 inhibitors in FGR were included. The quality of the RCTs was assessed using the Cochrane Risk of Bias Tool. Odds ratio and mean difference (MD) (95% confidence intervals) were pooled for meta-analysis. Results: From 253 retrieved publications, 16 studies involving 1,492 pregnant women met the inclusion criteria. Only sildenafil (15 RCTs) and tadalafil (1 RCT) were studied for FGR. Compared with the control group (placebo, no treatment, or other medication therapies), sildenafil increased birth weight, pregnancy prolongation and umbilical artery pulsatility indices. However, it also increased the risk of pulmonary hypertension in newborns, as well as headache and flushing/rash in mothers. There were no significant differences in gestation age, perinatal mortality or major neonatal morbidity, stillbirth, neonate death, infants admitted to neonatal intensive care unit, intraventricular hemorrhage and necrotizing enterocolitis in infants, as well as pregnancy hypertension and gastrointestinal side effects in mothers between the treatment and the control groups. Discussion: Sildenafil was the most investigated PDE-5 inhibitors for FGR. Current evidence suggests that sildenafil can improve birth weight and duration of pregnancy but at the same time increase the risk of neonatal pulmonary hypertension. It remains uncertain whether the benefits of sildenafil in FGR outweigh the risks and further high-quality RCTs are warranted. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325909.

22 Vaginal progesterone for the prolongation of pregnancy after arrested pre-term labor-multicenter randomized controlled trial

22 Vaginal progesterone for the prolongation of pregnancy after arrested pre-term labor-multicenter randomized controlled trial

Investigating the Impact of Pregnancy-Induced Hypertension on Fetal Outcomes: A Comprehensive Study in Maternity Hospitals

Background: Hypertension in pregnancy is a major obstetric complication that poses a significant risk to maternal and fetal health, leading to increased morbidity and mortality. According to the World Health Organization, hypertensive disorders of pregnancy (HDP) claim the life of at least one woman every seven minutes. HDPs are associated with an increased risk of adverse fetal and neonatal outcomes, including preterm birth, intrauterine growth restriction (IUGR), perinatal mortality, and maternal morbidity and mortality. Prompt recognition and management of PIH are essential to mitigate these complications and ensure optimal maternal and fetal outcomes. Hence the study was undertaken to assess the impact of Pregnancy Induced Hypertension on fetal outcome among Antenatal mother with PIH at maternity hospital of Anand and Kheda district. Objectives: To assess the clinical presentation among mother with PIH at maternity hospital; To assess the impact of Pregnancy Induced Hypertension on fetal outcome. Methodology: A Prospective study was conducted at Dr. N. D. Desai hospital, Nadiad. Sample size was 30. Sample was selected by Consecutive Sampling Technique. The data regarding Demographic variable, Obstetric History, Classification of PIH, Blood pressure, Drug Received &amp; Fetal outcomes was collected using Structured Interview Scheduled. The result is computed by using descriptive and frequency and percentage using tables, graph etc. Data were analysed according to objectives of the study. Results: In present study, the incidence of gestational hypertension, pre-eclampsia, and eclampsia was 10%, 86.66%, and 3.33%, respectively. These conditions were more common in primipara. The symptoms of pregnancy-induced hypertension (PIH) included pedal edema (60%), vomiting (43.33%), blurry vision (6.66%), convulsions (3.33%), and dizziness (6.66%), as well as epigastric pain (16.66%) and lower abdominal pain (36.66%). Most mothers (83.33%) received antihypertensive medication. The study also found that fetal complications included preterm births (66.66%) and low birth weight (56.66%). Additionally, 63.33% of babies required NICU admission, and there were cases of post-term birth (3.33%), congenital abnormalities (3.33%), birth asphyxia (3.33%), and neonatal deaths (10%). Conclusion: Pregnancy-induced hypertension is a common and serious condition that can have devastating effects on both mothers and babies. To combat this, we need to raise awareness and take action at both community and hospital levels to reduce the risks and improve outcomes.

Neurological examination of healthy term infants at ages 6 and 10 weeks in Tshwane District.

Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress. Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE). A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks' postnatal age in the Tshwane district. The statuses of infants' neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points. Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively. This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages. The findings support the viewpoint to identify important milestone characteristics during early screening.

Експресія прогестеронових рецепторів при багатоплідній вагітності

Hormonal disorders, specifically progesterone insufficiency, constitute the primary cause of pregnancy loss. The role of progesterone insufficiency in the genesis of obstetric and gynecological losses is actively discussed worldwide. Progesterone and the quantity of its receptors play a crucial role in the maintenance and prolongation of pregnancy. The placenta, being the main site of progesterone synthesis, represents a significant source of information and serves as an essential diagnostic object. The obtained data during placental research are indispensable for understanding the etiopathogenic changes in pregnancy loss in the case of multiple pregnancies. Purpose - to analyze the immunohistochemical changes in the expression of progesterone receptors in placental structures of parturients with dichorionic diamniotic twins depending on the method of conception. Materials and methods. We conducted a clinical-statistical analysis of the course of pregnancy and childbirth in women with multiple pregnancies induced by assisted reproductive technologies (ART). To determine the expression of progesterone receptors, immunohistochemical research of placentas from women with dichorionic and diamniotic twins resulting from ART was carried out. Results.The study revealed that women with multiple pregnancies induced by ART had a complicated somatic and obstetric-gynecological history, which subsequently negatively influenced the outcomes and course of pregnancy. A complicated pregnancy not only affects the process of childbirth but also the timing of delivery, as premature births in multiple pregnancies occur twice as often as in singleton pregnancies. Immunohistochemical analysis of the placenta showed the highest quantity of progesterone receptors and their expression in the nuclei of decidual cells (50%) of the maternal structure of the placenta in women with dichorionic and diamniotic twins resulting from ART. Conclusions.The obtained data on the expression of progesterone receptors indicate an evident connection between structural interactions of the placenta and endometrium, which is a key component in the advisability of prescribing progesterone therapy for the prevention of obstetric and perinatal losses. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Prognostic Biomarkers of Pre-Eclampsia in Pregnant Women

Summary. According to various authors, the incidence of preeclampsia (PE) in pregnant women in our country ranges from 8 to 20% and does not tend to decrease. It has been shown that the pathogenesis of preeclampsia fits into the systemic inflammatory response syndrome with disturbances in the immune system and an imbalance in cytokine regulation. The aim of the study was to study pro-inflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines in women with preeclampsia of varying severity. Material and methods. We examined 76 pregnant women with PE aged from 24 to 36 years at a gestation period of 28–38 weeks. Of these, 42 developed PE (main group), and 34 women had no symptoms of PE (comparison group). 28 women with a physiological pregnancy formed the control group. The levels of pro- and anti-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-4 and IL-10) in blood serum were studied by ELISA. Results. In pregnant women with PE upon admission to the hospital, the blood serum levels of IL-1β increased by 1.3 times (p &lt; 0.05), IL-8 by 7 times (p &lt; 0.001) and a decrease in the level of IL-4 by 2 times (p &lt; 0.001). And in pregnant women without signs of PE, these changes in cytokine synthesis were less pronounced (p &lt; 0.01). Conclusion. Maintaining a dynamic balance in the cytokine system plays an important role for the normal development of pregnancy. Th2-type cytokines promote normal trophoblast differentiation and its full invasion and, therefore, mediate the prolongation of physiological pregnancy. Switching to the synthesis of Th1-type cytokines and their enhanced production leads to disruption of trophoblast differentiation and invasion with the development of pregnancy pathology.

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population-based cohort study.

Gestational age estimation by second-trimester ultrasound biometry introduces systematic errors due to sex differences in early foetal growth, consequently increasing the risk of adverse neonatal outcomes. Ultrasound estimation earlier in pregnancy may reduce this bias. To investigate the distribution of sex ratio by gestational age and estimate the risk of adverse outcomes in male foetuses born early-term and female foetuses born post-term by first- and second-trimester ultrasound estimations. This population-based study compared two cohorts of births with gestational age based on first- and second-trimester ultrasound in the Medical Birth Registry of Norway between 2016 and 2020. We used a log-binomial regression model to estimate adjusted relative risk (RR) with 95% confidence interval (CI) for Apgar score <7 at 5 min, umbilical artery pH <7.05, neonatal intensive care unit (NICU) admission and respiratory morbidity in relation to foetal sex. The sex ratio at birth in gestational weeks 36-43 showed less male predominance in pregnancies estimated in first compared to second trimester. Any adverse outcome was registered in 627 of 4470 male infants born in gestational weeks 37-38 and 618 of 6406 females born ≥41 weeks. Male infants born in weeks 37-38 had lower risk of NICU admission (RR 0.76, 95% CI 0.58, 0.99), Apgar score <7 at 5 min (RR 0.63, 95% CI 0.28, 1.41) and respiratory morbidity (RR 0.68, 95% CI 0.37, 1.25) in first- compared to second-trimester estimations. Female infants estimated in first trimester born ≥41 weeks had lower risk of umbilical artery pH <7.05, NICU admissions and respiratory morbidity; however, CIs were wide. Early ultrasound estimation of gestational age may reduce the excess risk of adverse neonatal outcomes and highlight the role of foetal sex and the timing of ultrasound assessment in the clinical evaluation of preterm and post-term pregnancies.

Maternal and fetal outcomes among women with GDMA1 before and post-date

ObjectiveTo investigate adverse pregnancy outcomes in patients complicated with GDMA1 who delivered at term before or after 40 weeks of gestation. Study DesignA population-based cohort study including all women with GDMA1 during pregnancy was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. ResultsDuring the study period, 11,765 women with GDMA1 met the inclusion criteria.Of these, 1303 (11 %) delivered after 40 weeks (post-date, study group), while 10,462 (89 %) delivered at term before 40 weeks of gestation (before date, control group).Those who delivered after 40 weeks of gestation (the study group) had a significantly lower percent of cesarean deliveries (CD), higher rates of spontaneous vaginal deliveries and induction of labor in comparison to those who delivered before 40 weeks of gestation (the control group). The control group had significantly higher rates of preeclampsia and intrauterine growth restriction than the study group.Using a multivariable logistic regression model, delivery after 40 weeks was noted as an independent protective factor for CD (adjusted OR = 0.78, 95 %CI 0.66–0.92, p value = 0.001). Delivery after 41 + 0 weeks had a significantly higher rate of CD and LGA. ConclusionNo significant increase in adverse pregnancy outcomes at term post-date pregnancies complicated with GDMA1 was demonstrated. Furthermore, there was no increase in the rate of CD with the increase in gestational age until 41 weeks of gestation.

Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim: a Swedish nationwide cohort study

To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts.

In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.