Trimester Of Pregnancy Research Articles

Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation - Part 1.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13+6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE:: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

Effects of Ursodeoxycholic Acid Treatment for Intrahepatic Cholestasis of Pregnancy on Maternal and Fetal Outcomes.

Intrahepatic cholestasis of pregnancy (ICP) appears in the second or third trimester of pregnancy and is characterized by pruritus and elevated blood bile acid (BA) levels. Complications from these symptoms may include preterm birth, fetal distress, or stillbirth. Although the precise causes of ICP are unknown, genetic, hormonal, and environmental variables may be involved. First-line treatment for ICP is ursodeoxycholic acid (UDCA), which improves bile flow and consequently lowers BA levels and pruritus. The objective of this study is to investigate the impact of UDCAtherapy on maternal and fetal outcomes in women with ICP. This was a prospective observational study of 123 pregnant women with ICP, aged between 20 and 45 years who were diagnosed clinically (pruritus) supported by abnormal laboratory results including elevated serum BA levels, and abnormalities in liver function tests, over the course of three years, from July 2021 to June 2024. Every patient received UDCA, commencing at 10-15 mg/kg/day and being titrated according to clinical guidelines. Maternal and fetal outcomes were tracked for the duration of the pregnancy, with data being collected at baseline (15 ± 1 weeks) and every two weeks until delivery. The mean age of the study participants was 29.6 ± 5.4 years, with the youngest patient being 20 years and the oldest being 45 years. Most womenwere multipara 65.9%, and the mean BMI was 27.8 ± 3.5 kg/m ². The mean time of gestational age at ICPdiagnosis was 31.2 ± 2.7 weeks, and the time of gestational age at delivery was 37.1 ± 2.4 weeks. On average, the serum BA level at diagnosis was 23.5 ± 8.1 µmol/L. In the majority of ICP patients with good fetal outcomes, UDCA not only normalizes serum BA levels but also reduces maternal symptoms. In addition to addressing patient response variability to this therapy and optimizing dissemination procedures, the researchers expect that the results of this study will support the continued use of UDCA as first-line treatment for ICP, at least until more evidence becomes available.

Prevalence and Predictors of Fear of Childbirth Among the Pregnant Women Attending a Tertiary Care Hospital in Imphal-East District Manipur, North-East India: A Cross-Sectional Study

Background: Fear of childbirth (FOC) is a feeling of uncertainty and anxiousness before, during or after delivery which may increase the risk of various physical problems and mental disorders thereby affecting maternal and infant morbidity and mortality. Objectives: To estimate the prevalence of fear of childbirth and to determine its associated factors among pregnant women. Methodology: A hospital-based cross-sectional study was conducted among pregnant women attending ante-natal clinic of a tertiary-care hospital in Imphal-East District of Manipur. A 30-item questionnaire was used for data collection. Descriptive statistics, univariate and multivariate logistic regression analysis were performed to test for association taking all variables with p < 0.2 for model building for the adjusted analysis. A p value <0.05 was taken as level of significance. Ethical approval was obtained from the Institutional Ethics Committee. Results: Out of 431 participants, fear of childbirth was seen in 36%. Increasing age of the respondent (AOR: 0.877) and residing in urban area (AOR: 0.548) showed a protective effect but respondents having past history of abortion (AOR: 2.054) and being in the third trimester of pregnancy (AOR: 1.964) were found to have an increased risk of having ‘Fear of childbirth’ (p<0.005). Conclusions: Overall, 155 (36%) of women had fear of childbirth. It is important that healthcare professionals to be aware of fear of childbirth and ensure that pregnant women receive adequate health education, counselling during regular ANC checkups.

A Mixed Methods Longitudinal Investigation of Maternal Depression Across the Perinatal Period Among Mothers Who Gave Birth During the COVID-19 Pandemic

BackgroundDepression during the perinatal period is associated with negative outcomes for both mothers and children, including higher rates of chronic depression in mothers and physical, emotional, and cognitive issues in children. This study aimed to determine how the stressors of the COVID-19 pandemic contributed to prenatal and postpartum depressive symptoms among a sample of peripartum mothers who gave birth during the pandemic. This study also examined risk factors for postpartum depression, including prenatal depressive symptoms, demographic characteristics, timing of birth during the pandemic, pregnancy intention, birth expectations and experiences, and pandemic-related concerns. MethodsThis mixed methods study included data from online surveys using a convenience sample of 284 expectant mothers with due dates from April 2020 to September 2021, and qualitative interviews with a subset of participants. Depressive symptoms and risk for clinical depression were assessed using the Edinburgh Postnatal Depression Scale during the third trimester of pregnancy and again within 8 weeks postpartum. Multiple regression models examined potential risk factors to determine which variables most predicted participants’ postpartum depressive symptoms and risk of clinical depression. ResultsAmong this nonrepresentative, mostly white, and highly resourced sample, one-third of participants (33.8%) met the criteria for risk of clinical depression during the prenatal period, and 32.7% met this threshold in the postpartum period. Participants who reported higher levels of prenatal depressive symptoms, gave birth earlier in the pandemic, reported lower income, or had more pandemic-related concerns tended to report more postpartum depressive symptoms, adjusting for demographic characteristics and other variables of interest. Peripartum mothers who reported symptoms consistent with risk of clinical depression prenatally were almost four times more likely to screen positive for depression in the postpartum period, even after adjusting for other variables. In interviews, participants attributed negative emotions in pregnancy to uncertainty related to pandemic-related changes in care and expressed grief about missed pregnancy and postpartum experiences. In the postpartum period, some participants reported that their births were ultimately less stressful than anticipated. ConclusionsFindings highlight the need for consistent and frequent depression screenings across the perinatal period, especially among participants who report depressive symptoms prenatally. Participants who gave birth early in the pandemic were at the highest risk of postpartum depression and may continue to need additional supports.

Overall congenital defect risk unchanged by antidepressant/benzo use

A population‐based cohort study has found that concomitant use of antidepressants and benzodiazepines in the first trimester of pregnancy did not substantially increase risk overall for congenital malformations. Digestive system malformations were the only defects for which a significant risk remained in adjusted analyses. Study results were published online July 2, 2024, in Lancet Psychiatry.

Pregnancy cholestasis typically occurs in the third trimester of pregnancy and is a significant clinical condition.

The aim of this study is to determine the albumin/bilirubin ratio index and the aspartate aminotransferase (AST)/alanine aminotransferase ratio (ALT) index in patients diagnosed with cholestasis during pregnancy, and to demonstrate their correlation with liver damage. Additionally, potential strategies to prevent liver damage will be elucidated. Our study is a retrospective study. A total of 4019 pregnant women aged between 18 and 40years, presenting with itching complaints at 32-36weeks of gestation, were screened at the Department of Obstetrics and Gynecology, Istanbul Training and Research Hospital of Health Sciences University between January 1, 2018, and December 31, 2023. Among them, 104 pregnant women without any other accompanying diseases were diagnosed with Gestational Cholestasis. Among the 104 diagnosed women, 78 met the inclusion criteria and were included in the study. Twenty-six women were excluded from the study due to missing albumin and total bilirubin values or due to blood samples being taken at different times. The serum albumin/bilirubin ratio index and the alanine aminotransferase/aspartate aminotransferase ratio index were calculated and statistically compared between pregnant women diagnosed with cholestasis and healthy pregnant women at the same gestational week. We found that AST, ALT, albumin, and total bilirubin levels were significantly higher in pregnant women diagnosed with cholestasis compared to the control group (p < 0.05). The AST/ALT index in the case group was significantly lower compared to the control group. However, there were no significant differences found between the case and control groups regarding the albumin/total bilirubin index and ALBI grade. When comparing ALBI grades in cases, no significant differences were found in terms of patients' age, gestational week, AST, ALT, and AST/ALT index. When compared according to ALBI grades, the albumin level was higher in patients with ALBI grade I compared to grade II, and in patients with grade II compared to grade III. The total bilirubin level was significantly higher in patients with ALBI grade III compared to grades I and II, but there was no significant difference between grades I and II. No significant differences were found among the groups separated according to ALBI grades when FBA values were compared. In this study, the negative correlation between lower AST/ALT ratio and FBA values in patients with severe cholestasis suggests the need for careful consideration regarding future liver damage. The lack of difference in ALBI score between the case and control groups, as well as the absence of correlation with FBA values, indicates the necessity to evaluate ALBI score based on patients' long-term prognosis.

Edinburgh postpartum depression scores are associated with vaginal and gut microbiota in pregnancy

BackgroundPrenatal and postpartum depression may be influenced by the composition of host associated microbiomes. As such, the objective of this study was to elucidate the relationship between the human gut or vaginal microbiomes in pregnancy with prenatal or postpartum depression. Methods140 female participants were recruited at their first prenatal visit and completed the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression and anxiety, in addition the EPDS was completed one month postpartum. Vaginal and stool biospecimens were collected in the third trimester, analyzed using 16S rRNA gene sequencing, and assessed for alpha and beta diversity. Individual taxa differences and clustering using the k-medoids algorithm enabled community state type classification. ResultsParticipants with higher postpartum EPDS scores had higher species richness and lower abundance of L. crispatus in the vaginal microbiota compared to those with lower EPDS scores. Participants with a higher prenatal EPDS score had lower species richness of the gut microbiome. Participants with a vaginal community state type dominated by L. iners had the highest mean prenatal EPDS scores, whereas postpartum EPDS scores were similar regardless of prenatal vaginal state type. LimitationsOur small sample size and participant's self-report bias limits generalizability of results. ConclusionsDepression in the prenatal and postpartum period is associated with the composition and diversity of the gut and vaginal microbiomes in the third trimester of pregnancy. These results provide a foundational understanding of the microbial relationships between maternal health and depression for identifying potential therapeutic treatments.

Indication-based use of low molecular weight heparin during pregnancy: A retrospective study in Northern Greece

Introduction: Venous thromboembolism (VTE) is a condition with high morbidity and mortality rates and presents as the third leading cause of cardiovascular deaths, globally. During the antenatal period, the risk of VTE occurrence increases, therefore, in pregnant women at high-risk for VTE, the use of low molecular weight heparin (LMWH) is recommended. This study aimed to investigate the indication-based administration of LMWH in pregnancy. Material and methods: This was a retrospective cohort study (2019-2022) conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece. All pregnant women at the first trimester of pregnancy were eligible. Their physical characteristics were recorded and information about their personal, familial, gynecological and obstetrical medical history was collected. By utilizing the above characteristics, a score of the risk of developing VTE during pregnancy was calculated for each woman, using the algorithm recommended by the Royal College of Obstetricians &amp; Gynecologists. Results: In total, 2,716 pregnant women were included in the study. Of these, 149 (5.5%) received LMWH throughout their pregnancy with only 2 of them (0.1%) having appropriate indications. Of the women not prescribed LMWH, 2,567 (94.5%), none had an indication for LMWH administration. Notably, 495 (19.3%) women had a history of at least one miscarriage and 89 (59.7%) of them used LMWH, regardless of whether they had an indication or not. Conclusion: There was a high percentage of women with no indication for LMWH who, in fact, received this medication. Physicians should refrain their use following evaluation based on appropriate risk factors.

Firsttrimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation- Part 2.

This extensive AWMF 085-002 S2e-guideline "First Trimester Diagnosis and Therapy @ 11-13+6 Weeks of Gestation" has systematically analyzed high-quality studies and publications and the existing evidence (evidence tables) and produced recommendations (level of recommendation, level of evidence, strength of consensus).This guideline deals with the following topics in the context of the 11-13+6 weeks scan: the legal basis, screening for anatomical malformations, screening for chromosomal defects, quality assessment and audit, screening for preeclampsia and FGR, screening for preterm birth, screening for abnormally invasive placenta (AIP) and placenta accreta spectrum (PAS), screening for velamentous cord insertion and vasa praevia, screening for diabetes mellitus and LGA.Screening for complications of pregnancy can best be carried out @ 11-13+6 weeks of gestation. The issues of how to identify malformations, chromosomal abnormalities and certain disorders of placentation (high blood pressure and proteinuria, intrauterine growth retardation) have been solved. The problem of how to identify placenta percreta and vasa previa has been partially solved. What is still unsolved is how to identify disorders of glucose metabolism and preterm birth.In the first trimester, solutions to some of these problems are available: parents can be given extensive counselling and the risk that a pregnancy complication will manifest at a later stage can be delayed and reduced. This means that screening is critically important as it helps in decision-making about the best way to manage pregnancy complications (prevention and intervals between follow-up examinations).If no treatment is available and if a termination of pregnancy is considered, the intervention can be carried out with far lower complications compared to the second trimester of pregnancy. In most cases, further examinations are not required and the parents can be reassured. A repeat examination at around week 20 of gestation to complete the screening for malformations is recommended. NOTE: The guideline will be published simultaneously in the official journals of both professional societies (i.e. Ultraschall in der Medizin/European Journal of Ultrasound for the DEGUM and Geburtshilfe und Frauenheilkunde for the DGGG).

Effects of Dichlorvos on Pregnancy Outcomes in Wistar Albino Rats

Dichlorvos is an organophosphate widely used as an insecticide. This study determines the effect of dichlorvos on pregnancy in Wistar rats. Forty-two bred female rats were divided into 7 groups (A, B, C, D, E, F and G) comprising of 6 rats each. Rats in 3 groups received 4.45mg/kg in the 1st, 2nd and 3rd trimester of pregnancy, respectively. The other 3 groups received 8.9mg/kg in 1st, 2nd and 3rd trimester, respectively. The dam to pups’ ratio decreased as the dose of dichlorvos increased except in the third trimester. The percentage birth weight of the treated groups was not different from the control except at third trimester when there was a significant (p 0.05) decrease in the 8.9mg/kg groups. There were no significant (p 0.05) differences in the crown-rump and gestation length within the groups and trimesters except in the third trimester where there was a significant difference (p 0.05) between 8.9mg/kg group and others. The study shows that dichlorvos is capable of altering pregnancy outcomes in female Wistar rats.

The influence of trophectoderm biopsy for preimplantation genetic testing in the serum level of first trimester biomarkers: PAPP-a, βhCG and PIGF

Research questionDoes trophectoderm biopsy for preimplantation genetic testing for aneuploidies (PGT-A) affect maternal serum first trimester pregnancy biomarkers (PAPP- A, free β-hCG, PlGF)? DesignRetrospective cohort study, including all singleton pregnancies (n=9794) following either spontaneous conceived (SC) (n=8005) in vitro fertilization and fresh embryo transfers (IVF) (n=478) or frozen embryo transfer of non PGT-A (FET)(n=963) or PGT-A tested embryos (FET+PGT-A) (n=348). In all women with a viable pregnancy at 8-13.6 weeks of pregnancy, we measured serum levels of free β-hCG and PAPP-A . PlGF was measured in 3784 patients. These biomarkers were converted to a multiple of the expected normal median (MoM) for a pregnancy of the same gestational day. We calculated the medians for the multiple of the median and compared them. ResultsFree β-hCG did not differ according to the mode of conception. PAPP-A concentrations were significantly lower in in vitro fertilization and fresh embryo transfers (-0,1 Log10 MoM raw PAPP-A) when comparing to FET+PGT-A (-0,04 Log 10 MoM raw PAPP-A) and SC (-0,0187 Log 10 MoM raw PAPP-A) (p<0,05). PlGF levels were significantly lower in the FET+PGTA group (p<0.05). The difference in means adjusted by CRL was 4.6 pg/ml 95%CI [2.7-6.6] for SC, 3.5 pg/ml 95%CI [0.34-6.6] for IVF and 2.2 pg/ml 95%CI [0.06-4.4] for FET. ConclusionThis study demonstrates that trophectoderm biopsy for PGT-A has a significant impact on first trimester maternal serum PAPP-A and PIGF. This needs to be further validated since it may mislead the estimation of the first trimester risk of aneuploidies and preeclampsia.

Accuracy of trans cerebellar diameter in comparison with biparietal diameter, femur length, fetal kidney length in the sonographic assessment of gestational age in the 2nd and 3rd trimester pregnancy

Accuracy of trans cerebellar diameter in comparison with biparietal diameter, femur length, fetal kidney length in the sonographic assessment of gestational age in the 2nd and 3rd trimester pregnancy

The Effect of Endorphin Massage with Jasmine Oil on Severe Back Pain Experienced in the Third Trimester of Pregnancy: A Case Study

Back pain is a common complication during the final trimester of pregnancy. This pain, which begins in the early stages, intensifies in the third trimester due to the enlargement of the uterus and pressure on the skeletal system. One method to alleviate back pain is endorphin massage. Objective: To evaluate the effect of endorphin massage using jasmine oil on a primiparous pregnant woman at the 30th gestational week experiencing back pain. Method: This clinical case study involved applying endorphin massage combined with jasmine oil to the entire back and sacral region of a primiparous woman in her third trimester for a total of 6 sessions over 12 days, every other day, each lasting 20 minutes. Data were collected using the Demographic Characteristics Form and the Brief Pain Inventory (BPI), and the scores were compared. Results: Analysis of the 1st and 6th applications of the massage showed a decrease in the woman’s severe back pain over time. The non-pharmacological approach was well-received by the pregnant woman, enhancing communication between the midwife and herself. The woman reported taking the recommendations more seriously. Conclusion: The study observed that endorphin massage with aromatherapy reduced severe back pain and positively affected emotional well-being. It is recommended as a safe, non-invasive, easy-to-apply, and cost-effective method in midwifery care. Further evidence-based research is suggested to generalize the benefits of jasmine oil back massage for pregnant women.

Low Levels of Complement Factor H in the First Trimester of Pregnancy Are Associated with Spontaneous Preterm Birth.

Preterm birth (PTB) remains a significant public health concern, and prediction is an important objective, particularly in the early stages of pregnancy. Many studies have relied on cervical characteristics in the mid-trimester, with limited results. It is therefore crucial to identify novel biomarkers to enhance the ability to identify women at risk. The complement pathway is implicated in the process of placentation, and recent proteomics studies have highlighted the potential roles of some complement proteins in the pathophysiology of PTB. To determine the association between the occurrence of spontaneous preterm birth (sPTB) and the concentration of complement C3, factor B, and factor H in the blood of pregnant women during the first trimester. This prospective cohort study included women with singleton pregnancies, both with and without a history of sPTB, from two health institutions in Bucaramanga, Colombia. The outcome was sPTB before 37 weeks. A blood sample was obtained between 11 + 0 to 13 + 6 weeks. ELISA immunoassay was performed to quantify the levels of C3, factor B, and factor H. A total of 355 patients were analyzed, with a rate of sPTB of 7.6% (27/355). The median plasma concentration for C3, factor B, and factor H were 488.3 μg/mL, 352.6 μg/mL, and 413.2 μg/mL, respectively. The median concentration of factor H was found to be significantly lower in patients who delivered preterm compared to patients who delivered at term (382 μg/mL vs. 415 μg/mL; p = 0.034). This study identified a significant association between low first-trimester levels of factor H and sPTB before 37 weeks. These results provide relevant information about a new possible early biomarker for sPTB. However, the results must be confirmed in different settings, and the predictive value must be examined.

Association of maternal blood mercury concentration during the first trimester of pregnancy with birth outcomes.

Exposure to mercury has been associated with adverse effects on pregnancy outcomes. However, there is limited literature on mercury exposure and pregnancy outcomes in Chinese pregnant women. Our study was to investigate the possible association between maternal mercury exposure and spontaneous preterm birth and birth weight. This study was a nested case-control study. The association between blood mercury concentration and both spontaneous preterm birth and birth weight was analyzed using conditional logistic regression and linear regression adjusted for the potential confounding factors, respectively. The dose-response relationship between mercury concentration and birth outcomes was estimated using restricted cubic spline regression. The mean concentration of mercury was 2.8 ± 2.2µg/L. A positive relationship was observed between maternal blood mercury concentration and SPB when analyzed as a continuous variable. However, it was not found to be statistically significant (adjusted OR = 1.10, 95% CI = 0.95-1.26, P = 0.202). Moderate mercury exposure was associated with a higher risk of SPB (Q3 vs. Q1: crude OR = 2.50, 95% CI = 1.16-5.41, P = 0.02; adjusted OR = 3.49, 95% CI = 1.33-9.11, P = 0.011). After considering the combined effects of chemicals other than mercury exposure (including lead, selenium, and cadmium), the results remained consistent. There was no statistically significant association between blood mercury levels and birth weight (adjusted coefficient = 18.64, P-value = 0.075). There were no statistically significant dose-response associations between mercury concentration and birth outcomes (SPB: P = 0.076; birth weight: P = 0.885). Public health policies should focus on reducing environmental releases of mercury, improving food safety standards, and providing education to pregnant women about the risks of mercury exposure and preventive measures.

Study of knowledge, attitudes and practices of self-medication among pregnant women in the town of Mokolo in Northern Cameroon

Self-medication is a major public health problem worldwide, given the consequences it can have. However, its consequences seem to be poorly understood by the general public. The aim of this study was to investigate the knowledge, attitudes and practices of self-medication among pregnant women, by identifying the reasons for this practice, the most commonly consumed drugs and their origin. This was an analytical cross-sectional study using a structured questionnaire among women in the town of Mokolo in northern Cameroon. Data were collected and analyzed using SPSS 25. A total of 300 pregnant women were included in the study, 189 of whom were self-medicating, representing a prevalence of 63.00%. The reasons given by these women were: economic difficulties (55.56%), previous experience of treating a similar illness (20.11%), difficulties in accessing a healthcare professional (15.34%) and the feeling that the condition/illness was benign and therefore did not require a medical consultation (8.99%). The drugs most concerned were paracetamol (47.7%), amoxicillin (7.67%), diclofenac (5.67%) and aluminum hydroxide (5.67%). In addition to these pharmaceutical products, some pregnant women also used herbal preparations for treatment. Self-medication was highest in the first trimester of pregnancy (79.89%). Pregnant women who were most likely to self-medicate were those who were unaware of the dangers of self-medication and those with non-formal, primary education. Patient knowledge of self-medication during pregnancy was poor in 224 women (74.67%). More than three-quarters of patients (75.33%) had negative attitudes to self-medication during pregnancy. More than half (52.33%) had inadequate practices.

Prevalence of Bacterial Urinary Tract Infection among Pregnant Women in Wasit Province in Iraq

Background: Urinary tract infections (UTIs) are the most common type of infection during pregnancy. UTI include a spectrum of disorders, ranging from those affecting the lower urinary tract, like asymptomatic bacteriuria and cystitis, to those affecting the kidney, such as pyelonephritis. In pregnancy UTI can lead to preterm labor, anemia and septicemia. Escherichia coli is the most common pathogenic microorganisms associated with UTI and counting up to 60–80% of all UTIs. Objective: The aim of this study is to determine the prevalence of urinary tract infection (UTI) among pregnant women in wasit province. Materials and Methods: Mid-stream urine samples from 100 pregnant women who attending to Al- Shaheed Fairuz hospital and private clinics in wasit province between the periods of March 2024 to July 2024 with the age range of (16-35) years. The urine samples were cultured on MacConkey and blood agars then examined by Macroscopic and Microscopic examination by Gram's stain. The colonies were examined by biochemical tests (Oxidase, catalase, manitol salt agar, novobiocin tests, IMViC) and confirmatory tests (API 20E and API Staph) for isolates. Results: The results showed that the percentage of bacterial growth culture among the pregnant women was 33%. Gram negative bacteria were the higher percentage with (73%). Eschirishia coli bacteria were the most frequently isolated organism (40%) while, the lower percentage for Streptococcus spp. (3%). UTI in pregnant women was commonest in the age group 20-24 years (42%). According to trimesters of pregnancy, the highest percentage of UTI was in third trimester (43%) followed by second trimester (39%), while the the first trimest was the the lowest percentage with (18%). Conclusions: Urinary tract infections (UTIs) are common during pregnancy. Untreated UTIs can lead to complications such as preterm labor, low birth weight and sepsis. E.coli is the predominant pathogen presently causing urinary tract infections at all stages of pregnancy. Urine culture and sensitivity tests are mandatory for all pregnant women during the different trimesters.

Early prediction of gestational diabetes mellitus using first trimester maternal serum pregnancy-associated plasma protein-a: A cross-sectional study.

The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy-associated plasma protein-A (PAPP-A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP-A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew-t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP-A in the absence of GS test outcomes. The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP-A MoM was 0.91 (0.69-1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP-A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP-A values ( -0.52, 95% CrI [-0.61, -0.46]). Generally, our findings confirmed that PAPP-A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.

Determination of the Microbial Shift in the Gingival Sulcus of Women during Each Trimester of Pregnancy: A Cross-Sectional Study

Background and Objectives: This study aims to identify types of bacterial species in women visiting obstetrics/gynecology centers in Riyadh City, Saudi Arabia, during different pregnancy trimesters. Materials and Methods: This cross-sectional study was conducted among pregnant and nonpregnant women seeking care at Alyamamah Hospital, obstetrics/gynecology center, Riyadh, Saudi Arabia. A total of 110 [pregnant = 90 and nonpregnant = 20] individuals were recruited based on inclusion/exclusion criteria. Personal data, plaque index (PI), and gingival index (GI) were recorded. Bacterial samples were collected using sterile absorbent paper points from the gingival sulcus of pregnant females during the first, second, and third trimesters and compared to a control group of nonpregnant females. Thioglycolate broth containing the absorbent paper points was incubated at 37 °C for 24–48 h. After growth, the microorganisms were subjected to a Gram stain. The VITEK 2 system and conventional methods were used to identify various types of bacterial species from the gingival sulcus of pregnant and nonpregnant women. Chi-square tests and nonparametric tests were applied to the data. Results: The bacterial characterization indicated that Actinomyces naeslundii (AN) was the most predominant bacteria found in the study participants, followed by Lactobacillus fermentum (LF) (23.6%), Veillonella (VL) (10%), and unidentified organisms (9.1%). When the presence of subgingival bacterial species was compared between pregnant and nonpregnant women, a statistically significant difference was observed (p &lt; 0.001). LF was the predominant bacteria in 9 nonpregnant women (45%) and 8 pregnant women in the first pregnancy trimester (44.4%). However, during the second (17 women: 48.6%) and third pregnancy (17 women: 45.9%) trimesters, AN becomes the predominant bacteria. A statistically significant difference was observed when the prevalence of various bacterial species was compared across the three pregnancy trimesters (p = 0.010). The plaque and gingival scores of pregnant and nonpregnant women showed no significant difference. Conclusions: In different trimesters of pregnancy, pregnant women’s gingival crevices showed significant microbial changes without affecting gingival inflammation.

FREQUENCY OFANXIETY AND DEPRESSION AND ITS PSYCHOSOCIAL CORRELATES AMONG WOMEN RECEIVING ANTENATAL CARE IN A TERTIARY CARE HOSPITAL IN KARACHI

Objective: To determine the proportion of women suffering from antenatal depression and anxiety visiting a tertiary care hospital for routine antenatal visits to evaluate the psychosocial factors associated with their depression and anxiety. Study Design: A descriptive cross-sectional study Place and Duration Department of Gynaecology &amp; Obstetrics Ward 9B, Jinnah Postgraduate Medical Center (JPMC), Karachi from January 2024 to May 2024. Top of FormMethods: This study was conducted with 249 pregnant women via non-probability, consecutive sampling. Anxiety and depression were assessed using Urdu validated version of Hospital Anxiety and Depression Scale. Psychosocial stressors were also recorded. Data was entered and analyzed using SPSS for Windows version 23.0. Results: In this study, 20% of women in their second and third trimesters of pregnancies were anxious and 5% were depressed. Critical psychosocial factors included low education, marital stressors such as low social support from husband and/or in-laws, living separately from husband, and intimate partner violence, financial stressors such as husband unemployment and pregnancy-related factors such as unplanned pregnancy and narrow birth spacing. Conclusion: The study provides a significant burden of antenatal mental health issues in our region and their specific associated psychosocial factors. The study emphasizes upon the need for Biopsychosocial support systems and interventions to mitigate the risk of antenatal depression and safeguard maternal well-being during this critical period.