Pregnant Women In First Trimester Research Articles

Efektifitas Teknik Relaksasi Otot Progresif Terhadap Kecemasan Pada Ibu Hamil Trimester I di UPTD. Puskesmas Kuta II

Abstract
 Intoduction: Pregnancy is a physiological state in which various changes are experienced by the mother, both physical and psychological changes. Changes in conditions experienced by the mother during pregnancy can cause psychological discomfort in the form of anxiety. Progressive muscle relaxation therapy is a non-pharmacological method that can provide a feeling of relaxation to patients so as to reduce anxiety. The purpose of this study was to determine the effectiveness of progressive muscle relaxation techniques on anxiety in the first trimester of pregnant women.
 Metohds: This study used a quasi-experimental research design with a one group pre-post test design with purposive sampling, which involved 30 pregnant women. Anxiety was measured using the Anxiety Questionnaire related to pregnancy-revision 2 (PRAQ-R2) and then analyzed the data with the Wilcoxon t-test because the data were not normally distributed.Suggestion: The results showed a decrease in anxiety levels after being given an intervention where most of them experienced mild anxiety as many as 19 respondents (63.3%), not anxious as many as 9 respondents (30%) and only 2 respondents (3.3%) experienced moderate anxiety. Analysis with Wilcoxon obtained a p value = 0.000 where <0.05, so it means that there is a significant effect of progressive muscle relaxation techniques on the anxiety level of first trimester pregnant women at the Kuta II Health Center. It is hoped progressive muscle relaxation techniques can be used as material for consideration in providing comprehensive midwifery care pregnant women to reduce anxiety.
 

The Effect of Infusing Mint Leaves in First Trimester Pregnant Women on The Frequency of Nausea and Vomiting

Common problems that often occur in first-trimester pregnant women are nausea and vomiting. Even though it is common and not detrimental to pregnant women, if it is not handled correctly, it will result in weight loss. Maintaining pregnancy is essential so that the health of the mother and future baby is maintained until the birth process. Non-pharmacological methods are the safest for dealing with this, one of which is infusing mint leaves. This study aimed to determine the effect of giving an infusion of mint leaves to pregnant women in the first trimester on reducing the frequency of nausea and vomiting. This type of research is quantitative with a pre-experimental design in one group of subjects. The number of samples was 30 pregnant women in the first trimester using purposive sampling. Research location in Pujud, Rokan Hilir, Riau, Indonesia. Statistical data analysis used the Wilcoxon test. The results of the study showed that infusing mint leaves had a significant effect on reducing the frequency of nausea and vomiting in pregnant women in the first trimester. This proves that the therapeutic benefits of mint leaves can overcome nausea and vomiting. The contribution of this research is as evidence of the benefits of infusing mint leaves and as a recommendation as an alternative therapy to reduce nausea and vomiting.

Maternal, obstetric and gynecological factors associated with preterm birth in Rwanda: findings from a national longitudinal study

BackgroundPreterm birth is one of the key causes of morbidity and mortality among neonates in low-income countries. In Rwanda, at least 35,000 babies are born prematurely each year, and 2600 children under the age of five die due to direct complications of prematurity each year. A limited number of studies have been conducted locally, many of which are not nationally representative. Thus, this study determined the prevalence as well as the maternal, obstetric, and gynecological factors associated with preterm birth in Rwanda at the national level.MethodsA longitudinal cohort study was conducted from July 2020 to July 2021 among first-trimester pregnant women. A total of 817 women from 30 health facilities in 10 districts were included in the analysis. A pre-tested questionnaire was used to collect data. In addition, medical records were reviewed to extract relevant data. Ultrasound examination was used to assess and confirm gestational age on recruitment. A multivariable logistic regression analysis was performed to determine the independent maternal, obstetric, and gynecological factors associated with preterm birth.ResultsThe prevalence of preterm births was 13.8%. Older maternal age- 35 to 49 years [Adjusted odds ratio (AOR) = 2.00; 95% Confidence Interval (CI) = 1.13–3.53)], secondhand smoke exposure during pregnancy (AOR = 1.91; 95% CI = 1.04–3.51), a history of abortion (AOR = 1.89; 95% CI = 1.13–3.15), premature membrane rupture (AOR = 9.30; 95% CI = 3.18–27.16), and hypertension during pregnancy (AOR = 4.40; 95% CI = 1.18–16.42) were identified as independent risk factors for preterm birth.ConclusionPreterm birth remains a significant public health issue in Rwanda. The associated risk factors for preterm birth were advanced maternal age, secondhand smoke, hypertension, history of abortion, and preterm membrane rupture. This study therefore recommends routine antenatal screening to identify and closely follow-up of those high-risk groups, in order to avoid the short- and long-term effects of preterm birth.

Physiological effects of prolactin on early pregnancy loss

Abortion generally presented as two types; the spontaneous and the induced abortion. Spontaneous one is the termination of pregnancy before fetal viability which occurs spontaneously. About 80% of spontaneous abortion losses occur in the first trimester, the incidence decreases with advance in pregnancy. Prolactin is a polypeptide hormone that is synthesized in and secreted from specialized cells of the anterior pituitary gland, the lactotrophs. The major action of prolactin is lactogenesis (milk production). It is the major hormone stimulating the production of milk. Prolactin seems to play an important role in implantation and subsequent placentation in the human endometrium, and it is recognized as a crucial signal for the initiation and maintenance of decidualization. In addition to that, prolactin inhibits the secretion of gonadotropin releasing hormone by the hypothalamus, and this inhibition lead to decreased secretion of luteinizing hormone (LH), which normally initiates ovulation, therefore with hyperprolactinemic state ovulation, does not occur (anovulation). The aim of this study is to study the effects of prolactin hormone in the incidence of abortion cases in first trimester pregnancy in women in Tikrit city. Serum Prolactin was measured by using kit made in France. VIDAS Prolactin (Made in Italy), for the enzyme immunoassay determination of human prolactin in human serum or plasma by using the technique of Enzyme Linked Fluorescent Assay (ELFA). One hundred and thirty four pregnant women were participated & finished the whole study; 56 normal pregnant women in first trimester as a control group and 78 women with different types of abortion in first trimester who are diagnosed by clinical examination and/or by ultrasonography as aborted group. Seventy eight aborted women were participating in the present study. Threatened abortion was the highest one among aborted women (44.9%). Followed by missed abortion (19.23%), incomplete abortion (14.1%), complete (9%), inevitable (7.69%) & the last is recurrent (2.57%). Regarding serum prolactin, there is a significant difference between normal pregnant women (47.1 ± 25.4 ng/ml) as compare with aborted women (69.4 ± 48.8 ng/ml). In another word, aborted women have a serum prolactin concentration than that of normal pregnant women (p≤0.01).

The effectiveness of the application of self-hypnosis and prenatal gentle yoga on emesis gravidarum in the first-trimester pregnant women

Background: Emesis gravidarum is an inconvenience that often occurs in the first trimester of pregnancy. Continuous emission of gravidarum can be bad for the health of pregnant women and the fetus is conceived, so it must be overcome as early as possible, one of which can use non-pharmacological therapy, namely applying self-hypnosis and prenatal gentle yoga to reduce emissions of gravidarum can make pregnant women relax. This study aimed to analyze the application of self-hypnosis with Prenatal Gentle Yoga on emissions of gravidarum in first-trimester pregnant women. Methods: The design of this study used a Quasi experimental design with a Two group pretest-posttest design without control using purposive sampling. This research was conducted on first-trimester pregnant women who experienced the emission of gravidarum in the PMB Nanik Sidoarjo of ​​32 pregnant women in the first trimester. The self-hypnosis was carried out every day for approximately 15-30 minutes for 1 week, while prenatal yoga was carried out 3 times a week for 30 minutes. Data collection on the intensity of nausea and vomiting used the Pregnancy Unique Quantification of Emesis and Nausea (PUQE)-24 scoring system questionnaire. Data analysis used an independent T-Test test. Results: The results of the analysis of this study indicate that the mean difference in the Self Hypnosis treatment group is greater (1.77) than in the Prenatal Gentle Yoga group (1.25), which means that Self Hypnosis is more effective in reducing the intensity of nausea and vomiting in emesis gravidarum versus Prenatal Gentle Yoga. Conclusion: Therapy Self Hypnosis and Prenatal Gentle Yoga can reduce the emission level of gravidarum in first-trimester pregnant women so that it can be used as an alternative therapy that is easy to apply and has minimal side effects by pregnant women who experience gravidarum emissions.

Early pregnancy metabolic syndrome and risk for adverse pregnancy outcomes: findings from Rajarata Pregnancy Cohort (RaPCo) in Sri Lanka

BackgroundDespite the intergenerational effects of metabolic disorders, evidence is greatly lacking on early pregnancy metabolic syndrome (MetS) and its effects on pregnancy outcomes from low- and middle-income countries. Thus, this prospective cohort of South Asian pregnant women aimed to evaluate how early pregnancy MetS would affect pregnancy outcomes.MethodsA prospective cohort study was conducted among first-trimester (T1) pregnant women of Anuradhapura district, Sri Lanka recruited to the Rajarata Pregnancy Cohort in 2019. MetS was diagnosed by the Joint Interim Statement criteria before 13 weeks of gestational age (GA). Participants were followed up until their delivery, and the major outcomes measured were large for gestational age (LGA), small for gestational age (SGA), preterm birth (PTB) and miscarriage (MC). Gestational weight gain, gestational age at delivery and neonatal birth weight were used as measurements to define the outcomes. Additionally, outcome measures were re-assessed with adjusting fasting plasma glucose (FPG) thresholds of MetS to be compatible with hyperglycemia in pregnancy (Revised MetS).Results2326 T1 pregnant women with a mean age of 28.1 years (SD-5.4), and a median GA of 8.0 weeks (IQR-2) were included. Baseline MetS prevalence was 5.9% (n = 137, 95%CI-5.0–6.9). Only 2027 (87.1%) women from baseline, had a live singleton birth, while 221(9.5%) had MC and 14(0.6%) had other pregnancy losses. Additionally, 64(2.8%) were lost to follow-up. A higher cumulative incidence of LGA, PTB, and MC was noted among the T1-MetS women. T1-MetS carried significant risk (RR-2.59, 95%CI-1.65–3.93) for LGA, but reduced the risk for SGA (RR-0.41, 95%CI-0.29–0.78). Revised MetS moderately increased the risk for PTB (RR-1.54, 95%CI-1.04–2.21). T1-MetS was not associated (p = 0.48) with MC. Lowered FPG thresholds were significantly associated with risk for all major pregnancy outcomes. After adjusting for sociodemographic and anthropometric confounders, revised MetS remained the only significant risk predictor for LGA.ConclusionPregnant women with T1 MetS in this population are at an increased risk for LGA and PTB and a reduced risk for SGA. We observed that a revised MetS definition with lower threshold for FPG compatible with GDM would provide a better estimation of MetS in pregnancy in relation to predicting LGA.

Evaluation of first- and third-trimester afamin levels in preeclampsia.

The aim of this study was to investigate serum afamin levels in the first and third trimesters in preeclampsia. Serum samples from 118 patients in the first and third trimesters were analyzed. Serum samples were collected from pregnant women who had enrolled in the first trimester. Blood was then collected from pregnant women who had developed preeclampsia and from healthy controls in the third trimester. The collected blood samples were resolved for analysis, and serum afamin concentrations were measured in the first and third trimesters. Preeclampsia and healthy controls were compared. There was no significant difference between the control and preeclampsia groups in terms of age, body mass index, and smoking. Afamin levels in the first and third trimesters were higher in the preeclampsia group than in the control group (p<0.05). In the subgroup analysis of the preeclampsia group, afamin levels were higher in the early-onset preeclampsia group than in the late-onset preeclampsia group in the first and third trimesters (p<0.05). In the receiver operating characteristic analysis afamin levels were 96.23 ng/mL in the first trimester and 123.57 ng/mL in the third trimester as cut-off values for preeclampsia. Serum afamin levels are useful for predicting preeclampsia in the first trimester in pregnant women and can be used in clinical practice as a supportive biomarker for the diagnosis of preeclampsia in the third trimester. Meta-analyzes are needed to investigate the effect of afamin levels in the prediction and diagnosis of preeclampsia and to determine the cut-off value.

Effect of pre-pregnancy body mass index on first-trimester pregnant women glucose and lipid metabolism

To examine the association of pre-pregnancy body mass index(BMI) and first-trimester glucose and lipid metabolism. A total of 298 pregnant women with high risk factors for gestational diabetes in early pregnancy, with an average age of 32.24 years, 66.11% were primiparous and the average time for blood collection was 12.5 weeks, were collected from August 2021 to April 2022 at the Department of Nutrition, Haidian District Maternal and Child Health Hospital, Beijing. Pregnant women were divided into low weight group(n=15), normal weight group(n=181), overweight/obese group(n=102) according to their pre-pregnancy BMI. Fasting glucose, fasting insulin, lipid quadruple, C-reactive protein, leptin and adiponectin levels were compared among groups. (1)Triglyceride concentrations were significantly higher in women in the overweight/obese group(1.51 mmol/L vs.1.15 mmol/L) than in women in low weight group(P&lt;0.01). HDL cholesterol(HDL-C) levels were lower than in women with low weight(1.64 mmol/L vs.1.95 mmol/L)(P&lt;0.01). (2)Pre-pregnancy low weight women had reduced pancreatic β-cell function in early pregnancy with the HOMA-β index of 60.41%, and women in the overweight/obese group had heavier fasting insulin levels(7.86 vs.3.42 μU/mL) and insulin resistance(1.75 vs 0.74) in early pregnancy than low weight women(P&lt;0.01). (3)Pre-pregnancy BMI was positively correlated with triglycerides, fasting insulin, C-reactive protein levels, and degree of insulin resistance in early pregnancy(r=0.30, 0.28, 0.45 and 0.45, P&lt;0.01)and negatively correlated with HDL-C levels in early pregnancy(r=-0.29, P&lt;0.01). Among pregnant women with risk factors for gestational diabetes, pre-pregnancy overweight and obesity are associated with glucose and lipid metabolism levels in early pregnancy.

A Community-Based Trial on The Comparison of Efficacy, Safety and Cost Effectiveness of Ferrous Sulphate and Ferrous Ascorbate for Anaemia in Pregnancy In Madhya Pradesh, India

Background: Anaemia has significant impact on health of the fetus as well as that of mother. Increased need of iron during pregnancy especially after 2nd trimester makes iron supplementation mandatory. Ferrous ascorbate is known to exist intact inside the gastrointestinal tract due to the stable chelation of iron with ascorbate. This compound does not dissociate due to any of the food inhibitors. The aim is to study the effectiveness of Ferrous Ascorbate and Ferrous sulphate in terms of compliance and cost effectiveness of management of anaemia in pregnancy. Methodology: Study design: Quasi Experimental study, Study area: District Vidisha, Study participants: Pregnant women of first trimester registered during the study period in the selected Anganwadis/ Gram Arogya Kendra (GAK), Sample size: 240 antenatal mothers. Results: Baseline mean haemoglobin was 11.31±1.05 gm/dl. The mean increase in Ferrous Sulphate was 0.55 gm/dl, and in Ferrous ascorbate was 1.27 gm/dl. Ferrous Sulphate was less compliant than Ferrous ascorbate, and has higher efficacy and lesser side effects. Only Rs. 10.2 additional cost per antenatal mothers for increase of ≥1gm% in Hb will be borne by government if Ferrous Sulphate is replaced by Ferrous Ascorbate. Conclusions: Study results show statistically significant difference in rise of haemoglobin amongst the antenatal mothers consuming Ferrous ascorbate over Ferrous Sulphate.

The Effect Of Avocado Fruit On The Nutritional Needs Of Pregnant Women Trimeter I At Pmb Tati Hidayat Jati Rahayu Bekasi In 2022

Pregnant women most commonly experience anemia during the first trimester of pregnancy as a result of poor diet, which causes nausea and a lack of appetite. Chronic energy deficiency (CED) in pregnant wom en is caused by a long-lasting lack of energy intake in the mother, causing health problems. Pregnant women's nutritional intake has a significant impact on fetal growth during pregnancy, the incidence of low birth weight during delivery, and the baby's growth and development. Avocado (Persea americana) is a fruit that is very well known and popular with the public. Apart from having a delicious taste and soft texture, avocados also have several health benefits. The main components of avocados are carotenoids, fatty acids, minerals, phenolics, phytosterols, proteins, and many vitamins. Avocado is a fruit that is rich in vitamin A. Vitamin A has a role in erythropoiesis related to its function of synthesizing protein so that it will affect the growth of bone cells. Bone marrow is the site of the formation of erythrocytes. Vitamin A is needed in several essential processes in the body, such as metabolism, hematopoiesis, and erythropoiesis; it also regulates cell differentiation and plays a role in the immune system.The approach used in this re search is experimental research. Experimental research is research that is carried out by manipulating, and it aims to determine the effect of manipulation on the observed individual's behavior. Manipulation carried out can be in the form of certain situations or actions given to individuals or groups, and after that, the effect can be seen. This experiment was conducted to determine the effects of a treatment given inten tionally by the researcher. Giving this treatment is a peculiarity of experimental research compared to other studies. The results showed that there was a significant relationship between giving avocado fruit and improving the nutrition of first-trimester pregnant women, as indicated by the p value of 0.000. This is supported by research data showing that giving avocado fruit increases nutrition more, namely by as much as 70%, while not regularly consuming a lot of avocado fruit does not increase nutrition by 30%.

Pengaruh Permen Jahe dalam Mengatasi Keluhan Mual dan Muntah pada Ibu Hamil

Pregnancy is a natural process that causes physical and psychological changes due to hormonal changes. Often pregnancy enters a critical period if it is not passed comfortably by pregnant women. Pregnant women must be able to adapt psychologically and physiologically to pregnancy hormones. The effect of hormonal changes is nausea and vomiting in early pregnancy, especially in the morning. Nausea and vomiting can be reduced by using herbal ingredients. The method used in this study was a literature study on the benefits of ginger, then ginger was processed into ginger candies with added sugar and water. The ginger candy was then given to women who were pregnant for 4 days in the first trimester of pregnant women. Nausea and vomiting were measured before and after being given the ginger candy using the Pregnancy Unique Quantification of Emesis and Nausea (PUQE) instrument. The data were processed statistically to determine the effect of extra ginger candy on nausea and vomiting of pregnant women. After measuring the pretest and posttest giving ginger candy, it was concluded that there was an effect of ginger candy on reducing nausea and vomiting.

Effectiveness of Ginger and Lemon Generation on Nau, Vovoging in Trimester I Pregnant Women

Nausea and vomiting in pregnancy if not treated properly can cause other problems, namely Hyperemesis gravidarum. Hyperemesis gravidarum and other complications of Hyperemesis gravidarum can cause birth defects and abortion. Data from the Ciomas Health Center showed that around 60-90% of pregnant women in the first trimester complain of nausea and vomiting every year. The research method used a quasi-experimental design with one group pre-posttest. The sample in this study was 30 pregnant women in the first trimester. The sampling method in this study was non-probability sampling in the form of accidental sampling. The research instrument used a questionnaire. Bivariate analysis used paired t-test. The average frequency of nausea and vomiting in the first trimester of pregnant women before consuming ginger and lemon was 6 times within 24 hours and after consuming ginger and lemon every day for 2 weeks, the average frequency of nausea and vomiting was 3 times within 24 hours. The results of statistical tests showed that giving ginger and lemon juice was effective in reducing the frequency of nausea and vomiting in the first trimester pregnant women with ap value = 0.000.

Association between Maternal Blood Glucose Levels during Pregnancy and Birth Outcomes: A Birth Cohort Study.

This study aimed to investigate the relationship between maternal blood glucose levels during pregnancy and neonatal birth outcomes in Northwest China. This population-based cohort study included 10,010 first-trimester pregnant women who joined the birth cohort of the Northwest Women's and Children's Hospital from July 2018 to July 2020. Basic demographic characteristics, lifestyle and behavior patterns were collected. Oral glucose tolerance test (OGTT) results during the second trimester and pregnancy outcomes after childbirth were also collected. A generalized linear model was constructed to analyze the effects of blood glucose levels on neonatal birth outcomes. We found that every 1 mmol/L increase in fasting plasma glucose (FPG) was associated with an increase in birth weight (β = 100.22 g, 95% confidence interval (95%CI): 81.91, 118.52), birth weight Z score (β = 0.23, 95%CI: 0.19, 0.27) and birth weight Z centile (β = 6.72%, 95%CI: 5.51, 7.94). Moreover, the risk of macrosomia, premature birth and being born large for gestational age (LGA) increased by 2.01 (95%CI: 1.67, 2.43), 1.35 (95%CI: 1.09, 1.66) and 1.80 (95%CI: 1.57, 2.07) times, respectively. Additionally, for every 1 mmol/L increase in FPG associated with a decrease in gestational age (β = -0.12 weeks, 95%CI: -0.19, -0.06), the risk of SGA decreased by 0.70 (OR = 0.70, 95%CI: 0.55, 0.89) times. Every 1 mmol/L increase in 1/2-h PG had similar outcomes as FPG, besides premature birth and SGA. Higher blood glucose in pregnant women may increase neonatal birth weight, decrease gestational age and lead to a higher risk of macrosomia, premature birth and LGA. Mothers should actively prevent and control hyperglycemia to promote maternal and infant health.

The effect of PEPPERMINT AND LEMONGRASS AROMATHERAPY CANDLES TO NAUSEA VOMITING IN FIRST TRIMESTER PREGNANT WOMEN

According to studies conducted in Indonesia, 14.8% of all pregnancies involved women who experienced nausea and vomiting. 40–60% of multigravidas and 60–80% of primigravida report experiencing nausea and vomiting. These symptoms can worsen once every 1,000 pregnancies. In the first trimester of the Zora era in the Merangin Regency, Jambi Province in 2021, this study seeks to ascertain the effectiveness of peppermint and lemongrass aromatherapy candles in reducing nausea and vomiting in pregnant women. One Group Pretest-Posttest Design was the quasi-experimental method employed in this investigation. The statistical test that was employed was the statistical test, which was based on the research's findings. There was a connection between peppermint and lemongrass aromatherapy candles and nausea and vomiting in first-trimester pregnant women at Midwife Clinic Era Zora, according to the T test's p-value of 0.000 0.05. According to the study's findings, peppermint and lemongrass aromatherapy candles have an effect on nausea and vomiting in first-trimester pregnant women at Midwife Clinic Era Zora in 2021. This relationship was found using the paired T-test statistical test (Wilcoxon Signed Rank Test). Candles with peppermint and aromatherapy Pregnant women are advised to use lemongrass in the first trimester to lessen nausea and vomiting

Effect of oral iron supplementation on glucose metabolism in non-anemic pregnant women who are in the risk group for gestational diabetes mellitus

Aim: There are opinions about the negative effects of the increase in iron storages or plasma iron levels during pregnancy on glucose metabolism. We aimed to investigate the effects of oral iron supplementation on glucose metabolism in non-anemic pregnant women who are in the risk group for gestational diabetes mellitus.&#x0D; Material and methods: While oral iron supplementation of 40 mg/day was givento 41 pregnant women in the study group (Group I) for eight weeks, oral iron supplementation was not givento 35 pregnant women in the control group (Group II). 100 g oral glucose tolerance test (OGTT) was applied for the diagnosis of GDM in pregnant women whose 50 g OGTT results were positive. Analyzing the results between groups.&#x0D; Results:There was no significant difference between the two groups in terms of mean fasting plasma glucose (FPG) value (p: 0.185), GDM (p:0.292) and mean results of 50gr OGLT (p: 0.109).A total of 26 pregnant women with 50 gr OGLT positive were applied 100 gr OGTT for diagnostic purposes.&#x0D; Conclusion:It was concluded that 40 mg/day oral iron supplement used from the first trimester in pregnant women in the risk group for GDM did not have a significant negative effect on glucose metabolism and did not cause an increase in the risk of GDM.

ULTRASOUND CHARACTERISTICS OF THE DEVELOPMENT OF THE FETOPLACENTARY COMPLEX IN PREMIER PREGNANCY

The article is devoted to the study of ultrasound changes in the fetoplacental complex in the early gestational period in pregnant womenwith miscarriage. Placental insufficiency (PI) is a syndrome caused by morpho-functional changes and is the result of a complex responseof the fetus and placenta to various pathological conditions of the maternal body [1]. It is based on disorders of compensatory-adaptivemechanisms of the fetoplacental complex (FPC) at the molecular, cellular and tissue levels. Ultrasound fetometry and placentometry are very important methods for diagnosing the state of the fetoplacental complex and can be used from the early term. Many researchers identify a number of prognostically unfavourable ultrasound markers: low chorion attachment, especially with the appearance of areas of detachment, discrepancy between the size of the foetus and gestational age, lack of clear visualization of the embryo, especially its heartbeat. In pregnant women with a history of miscarriage it is important to identify early signs of placental dysfunction from the firsttrimester onwards and to provide adequate correction for this condition. For this situation it is important to create appropriate conditions for the development and growth of the placenta and its adequate functioning. Significant fetal abnormalities occur as early as the first trimester and have a significant impact on the further process of ontogenesis.Aims and objectives of the study. To assess the normal parameters of embryonic and extraembryonic formation and to evaluate theparticular features of the formation and development of the fetoplacental system during pregnancy in women with a history of miscarriage.Materials and Methods. We erformed a comprehensive ultrasonographic examination of 25 somatically healthy women with aphysiological gestational process (control group) between 5 - 40 weeks’ gestation and 25 pregnant women with a history of miscarriage (study group). The SONOACE 8800 GAI MT with a 3.5 to 7.5 MHz convex transducer was used in the study. The data were statistically processed using standard methods of mathematical analysis with the use of Student’s and Fisher’s criteria, standard and specialized computer programs. Paired correlation indices were used to study the nature and degree of correlation between different parameters. The scientific research was positively evaluated by the Bioethics Commission of the Bukovinian State Medical University (Protocol No. 4 of 6.12.2021).Results and their discussion. In the transvaginal examination, uncomplicated pregnancy is characterized by the mandatoryvisualization of the embryo in the fetal cavity with a diameter of 14 mm or more, corresponding to 6 weeks' gestation. From the time of embryo identification in our study, we measured the coccygeal-parietal size (CPS) and compared its values with gestational age. It was found that in 22 (88.0%) cases the embryo size corresponded to the calculated gestational age and the mean inner diameter of the fetal egg. In severe clinical manifestations of threatened miscarriage the most sensitive echographic sign was a decrease in the volume of the foetus, which is a marker of further adverse pregnancy course and outcome. However, when there was an isolated increase in myometrial tone in the absence of clinical manifestations of threatened abortion, there was predominantly an isolated reduction in amniotic cavityvolume, easily corrected by the administration of conventional antispasmodic therapy.The ultrasonic criteria for alterations in pregnancy were developed, including delay in embryo CTR by 2 weeks or more on ultrasound examination up to 9 weeks' gestation; bradycardia at 90 bpm or less up to 8-12 weeks' gestation; chorionic detachment withretrochorial hematoma formation (over 25 ml); tachycardia at over 200 bpm with clinical manifestations of spontaneous miscarriage; marked progressive decrease of amniotic cavity volume; severe polyhydramnios with a thick echopositive suspension in the amniotic cavity. The risk of spontaneous miscarriage and formation of placental insufficiency increases with the simultaneous detection of 2 or more echographic markers.Conclusions. On the basis of the above, it is possible to conclude on the need to conduct an ultrasound examination with an assessment of the echographic parameters of the formation and development of the embryo and extraembryonic structures in the first trimester in pregnant women with a history of miscarriage and a risk of developing placental insufficiency in the history in order toidentify markers of a complicated course of gestation and the and the subsequent choice of rational tactics of pregnancy management.

The geo-spatial perspective of biological, social and environmental determinants of early pregnancy anaemia in rural Sri Lanka: Need for context-specific approaches on prevention.

We provide a novel approach to understanding the multiple causations of maternal anaemia in a geospatial context, highlighting how genetics, environment and socioeconomic disparities at the micro-geographical level lead to the inequitable distribution of anaemia. All first-trimester pregnant women registered for the antenatal care programme in Anuradhapura District, Sri Lanka from July to September 2019 were invited to the Rajarata Pregnancy Cohort (RaPCo), which assessed the prevalence of anaemia in early pregnancy. The combination of the prevalence of anaemia and minor haemoglobinopathy-related anaemia (MHA) with the poverty headcount index of the 22 health divisions in the district was investigated using GeoDa spatial K-means clustering. Sociodemographic and economic data at the divisional level were compared between identified clusters. Combining the analysis with the geographical and environmental characteristics of the region, further hypotheses regarding anaemia in this community were formulated. The study included data from 3,137 pregnant women in early pregnancy. The anaemia and MHA prevalence varied from 13.6 to 21.7% and from 2.6% to 5%, respectively. We identified four distinct spatial clusters. The cluster with the highest anaemia prevalence also included high poverty and the highest prevalence of MHA. The clusters had significant differences with regard to ethnic distribution, access to water, sanitation and dietary patterns. Areas supplied by major irrigation projects had significantly low levels of anaemia, probably attributable to internal migration and improved livelihood. It was evident that genetic, socioeconomic and environmental risk factors were grouped at the divisional level, and that their complex interactions make controlling anaemia with blanket interventions unsuccessful. Analysis of the distribution of heterogeneous risk factors at the micro-geospatial level helped identify context-specific approaches to tackle anaemia in pregnancy.

Diagnosing ectopic pregnancy using Bayes theorem: a retrospective cohort study

To verify the accuracy of an online algorithm using Bayes' theorem for diagnosing ectopic pregnancy (EP) using human chorionic gonadotropin (hCG), ultrasound, and clinical data in a real cohort. A retrospective cohort study. Gynecologic emergency unit in a tertiary teaching hospital. First-trimester pregnant women who attended the gynecologic emergency unit for any reason. Those who had <13 weeks of pregnancy confirmed by a recent positive pregnancy test; a digital image or electronic report of transvaginal ultrasound (TVUS) obtained from hospital database; and a follow-up with a pathology report or a clinical resolution of a confirmed pregnancy were included in the study. Clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels were independent variables obtained from the electronic medical records. From these data, the pretest probability, based on the clinical presentation and risk factors, and the likelihood ratio for each variable were calculated for their use in the algorithm, yielding a posttest probability. Not applicable. The accuracy of the online algorithm to identify cases of EP using clinical signs and symptoms, the presence of risk factors for EP, the TVUS findings in each consultation, and the hCG levels. The main outcome was EP, confirmed either by pathology report or by the presence of fetal heartbeat or gestational sac outside the uterine cavity. Between January 1, 2009 and December 27, 2016, 2,495 women were analyzed, and the algorithm was applied to 2,185 of them. The incidence of EP was 8.5% (212/2,495); 310 women were excluded because they were submitted to surgery with decision thresholds <95%. The algorithm was applied to 2,185 women. Just one case remained inconclusive after 3 consultations, and it was considered as an error in prediction. The sensitivity, specificity, and accuracy values (95% confidence interval) of the algorithm were 98.9% (96.1%-99.8%), 98.9% (98.3%-99.2%), and 98.9% (98.3%-99.2%), respectively. The accuracy of the Bayesian algorithm to confirm or rule out EP is excellent. Online Nomogram https://docs.google.com/spreadsheets/d/1jStXlMBjbPyDf6_W0deKGKQLZHU5EFAe8rLhNVPuJuY/edit?usp=sharing.

Factors associated with early pregnancy anemia in rural Sri Lanka: Does being 'under care' iron out socioeconomic disparities?

Globally, more than a third of pregnant women are anemic, and progress in its prevention and control is slow. Sri Lanka is a lower-middle-income country with a unique public health infrastructure that provides multiple interventions across the lifecycle for anemia prevention, despite which anemia in pregnancy remains a challenge. Studying the factors associated with maternal anemia in this context would provide unique information on challenges and opportunities encountered as low-and-middle-income countries attempt to control anemia by improving health care coverage. All first-trimester pregnant women registered for antenatal care in the Anuradhapura district between July 2019 to September 2019 were invited to participate in the baseline of a cohort study. Interviewer-administered and self-completed questionnaires were used. Anemia was defined using a full blood count. A hierarchical logistic regression model was built to identify factors associated with anemia. Out of 3127 participants, 451 (14.4%) were anemic. According to the regression model (Chi-square = 139.3, p<0.001, n = 2692), the odds of being anemic increased with the Period of gestation (PoG) (OR = 1.07, 95% CI = 1.01-1.13). While controlling for PoG, age and parity, history of anemia (OR = 3.22, 95%CI = 2.51-4.13), being underweight (OR = 1.64, 95%CI = 1.24-2.18), having the last pregnancy five or more years back (OR = 1.57,95%CI = 1.15-2.15) and having used intrauterine devices for one year or more (OR = 1.63, 95%CI = 1.16-2.30) increased the odds of anemia. Breast feeding during the last year (OR = 0.66, 95%CI = 0.49-0.90) and having used contraceptive injections for one year or more (OR = 0.61,95%CI = 0.45-0.83) reduced the risk of anemia. Proxy indicators of being in frequent contact with the national family health program have a protective effect over the socioeconomic disparities in preventing early pregnancy anemia. Maintaining the continuum of care through the lifecycle, especially through optimizing pre and inter-pregnancy care provision should be the way forward for anemia control.

Malaria Parasitemia and Anemia among Pregnant Women Attending General Hospital, Enugwu-Ukwu, Southeastern Nigeria

Women has been reported to be more susceptible to malaria parasites infection during pregnancy. The disease causes severe anemia in pregnancy sometimes resulting to maternal morbidity and mortality in many parts of the world including Nigeria. A study to determine malaria parasitaemia among pregnant women attending General hospital Enugwu-Ukwu, Anambra State, Nigeria, was conducted between July and December, 2019. The specific objectives were to determine the prevalence of malaria parasites and anemia among the pregnant women as well and the relationship between malaria and anemia. Two milliliters of venous blood were collected from 408 pregnant women during antenatal visits. Thick and thin blood films were made, stained with 10% Giemsa stain and examined under the microscope for malaria parasites. Hemoglobin (Hb) concentration was estimated using cyanmethemoglobin method. Hemoglobin concentration below 11.0g/dl was regarded as anemia in pregnancy. Of 408 blood samples collected, 112(27.5%) were positive for malaria parasites. The age group 15–20 years had the highest prevalence 8(40%) while the age group 36–40 years had the least 24(23.1%). The primigravidae had the highest malaria prevalence 72(36%), while the multigravidae had the least 40(19.2%). The pregnant women in first trimester had the highest malaria prevalence 48(50%), while those in third trimester had the least 24(16.7%). Malaria parasitaemia in relation to trimester was statistically significant (P&lt;0.05). A total of 248(60.7%) pregnant women had a Hb value less than 11g/dl. The multigravidae had the highest Hb 128(61.5%), while the primigravidae had the least 120(60%). Health education and proper administration of Intermittent Preventive Therapy (IPT) during pregnancy is recommended for malaria prevention and control in pregnancy.