Prenatal Consultations Research Articles

Fisioterapeuta em movimento: para onde os bebês de risco são encaminhados para acompanhamento após a alta hospitalar

Abstract Introduction Two facts may influence a newborn’s development. One is to be a newborn at risk and the other is to be hospitalized in Intensive Care Unit. Objective To examine where at-risk infants are being referred for longitudinal follow-up after hospital discharge, and to carry out an analysis of the epidemiological and care profile of these babies. Methods Documentary, descriptive and retrospective study, comprising the medical records of 479 newborns (NBs) hospitalized Hospital Materno Infantil Presidente Vargas from January 2019 to May 2020. The variables studied were: gender, baby's race/color, type of delivery, prenatal consultations, classification according to gestational age, weight, Apgar of the 1st, 5th, 10th minute, hospitalization diagnosis, main diagnosis, outcomes, length of stay, multidisciplinary follow-up during hospitalization, post-discharge referrals (specialized and non-specialized). Social and environmental data were: maternal age and race/color, maternal and paternal education. Results Higher prevalence of full-term male babies born by cesarean delivery, declared as white, with high Apgar scores, with varied diagnoses, with prematurity prevailing. Maternal mean was 26.2 years, (SD ± 7.3), the most reported race/color was also white, the mean of mothers' studies was 8.1 years (SD ± 2.4). Only 14% (n = 67) performed motor physical therapy at the hospital and 2.1% (n = 10) were referred for evaluation and early intervention for post-discharge physical therapy. The specialized service with the highest referral was the hospital's neuropediatrics graduates' outpatient clinic (17.3%, n = 83) and, for the non-specialized, it was the Basic Health Unit/BHU (39.7%, n = 190). Conclusion Most NBs are referred to the specific medical team or post-discharge BHU. The physiotherapist was the professional little remembered for monitoring this public in the hospital and after discharge.

Obstetric Hemorrhage during the Third Trimester of Pregnancy: Experience in a University Hospital in Guinea

Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives of this study were to describe the socio-demographic characteristics of the patients, identify the causes and contributing factors, describe the management and evaluate the maternal-fetal prognosis in such patients. Methods: We retrieved and analyzed patients with 3rd trimester hemorrhage whom we managed at Ignace Deen National Hospital, Guinea during 1-year period (1st of December 2019-30th of November 2020). Results: We experienced recorded 401 patients with 3rd trimester obstetric hemorrhage out of 5468 deliveries during the corresponding period; the rate being 7.33%. The main causes were as follows: placental hematoma (65.33%), placenta previa (27.68%) and uterine rupture (6.99%). The socio-demographic profiles were as follows: the age group of 25 - 29 years (28.42%), married (94.51%), uneducated (50.12%), and with a liberal profession. (43.64%) and pauciparous (30.42%). The conditions were considered to be preventable by managing risk factors during the prenatal consultation (PNC): 7.73% underwent no PNC. Cesarean accounted for 84.78% of patients. Prognosis was as follows: 14 maternal deaths (3.45% of a fatality), 34.66% of anemia, and 16.95% of hemorrhagic shock. Fetal/neonatal prognoses were poor. Conclusion: Obstetric hemorrhage during 3rd trimester remains the main cause of poor outcomes in Guinea. This study identified that this type of hemorrhage still represents an important cause of maternal and fetal morbidity and mortality in developing countries.

Longitudinal care: factors associated with adherence to postpartum follow-up according to data from PMAQ-AB

The aim was to identify factors of longitudinal care associated with women´s adherence to postpartum consultation in Brazil. This was a cross-sectional study of data from 19,177 postpartum women who participated in the external assessment of the third cycle of the Brazilian National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB), 2017. The dependent variable was postpartum consultation, and the independent variables, grouped hierarchically, were sociodemographic and economic at the distal level and issues analogous to longitudinal care at the proximal level. Multiple logistic regression analysis was performed with hierarchical entry of variables, where sociodemographic and economic variables were used to adjust the model. The results showed that 53% of women had undergone postpartum follow-up. The odds of adherence to postpartum follow-up were higher in women who received a home visit by a community health agents in the first week after childbirth (OR = 4.81), those with seven or more prenatal consultations (OR = 2.74), those who had sought care at the health unit in question (OR = 1.21), and those who had been seen by the same physician (OR = 1.14). In conclusion, the proportion of postpartum consultations was low (53%), and adherence to postpartum follow-up was higher when women received visits by community health agents, were accompanied by the same physician, had regular prenatal care, and had a specific healthcare unit as their regular source of care. Consistent longitudinal care was identified as an attribute of primary care that should be strengthened to improve postpartum care.

Rubella Immunity among Pregnant Women in Bangui, Central African Republic

Sero-positivity rates of the rubella virus among pregnant women vary from country to country widely throughout the world. In the Central African Republic, rubella vaccination is not included in the national immunization schedule. Thus, we propose to evaluate the immune status of pregnant women. This was an analytical retrospective study that consulted the records of pregnant women received in prenatal consultations at the Bangui Community Hospital maternity ward from January to December 2020. Socio-demographic and laboratory data (IgM, IgG) were collected from January to June 2021. Chi2 test was used. A total of 289 pregnant women were analyzed. Women with an IgM+ response accounted for 4.15%. Those with an IgG+ were 14.87%. The distribution by age group shows that patients aged 20 - 24 and those aged 25 - 29 had a rubella profile suggesting persistent infection (p = 0.010). The average age of women included was 28 (±6) years. The average parity for the entire sample was 2.18 (1.93). At any age pregnant women were not significantly exposed to rubella infection (p = 0.96), (ORbrut = 1.03; CI95% = [0.32 - 3.34]). Both immunized and non-immunized individuals are similarly exposed [OR = 0.86; 95% IC95% = 0.44 - 1.68] with no difference (p = 0.96). Rubella infection remains particularly severe when it occurs during pregnancy. It would be wise to seek immunity in all girls of childbearing age in order to rule out any risk of rubella embryopathy.

Assessment of Obstetric Evacuations: Received during the Year 2020 at the Touba Ndamatou Public Health Hospital Establishment

The counter-referral system is particularly important for care during pregnancy, childbirth and the post-partum period as it facilitates access to emergency obstetric and neonatal care. It allows people to access care that is not likely to be provided at the base and to manage certain complications arising in emergency settings. We therefore looked at the evaluation of obstetric evacuations from the Touba Ndamatou public health. Methodology: This was a retrospective study of descriptive and analytical type extending over a period of 12 months from January 1, 2020 to December 31, 2020 at the public hospital health establishment (PHHE) of Touba Ndamatou. Results: One thousand five hundred and sixty (1560) patients evacuated for obstetrical reasons were collected out of a total admission of 5560, i.e., a frequency of 28%. The average age of the patients was 25.54 years. The mean gestation was 3.24 pregnancies. The average parity was 3.04 deliveries. Almost all of our patients (99%) were married. Slightly more than one in two women (53.6%) had performed at least 2 or 3 Prenatal consultations. 80% of parturients had traveled a distance of less than 20 km. 623 patients came by their own means (54.6%). Evacuation was provided by an ambulance in 509 patients, i.e., 44.6%. Arterial hypertension and its complications were the frequent reason for evacuations with approximately one in four patients (26.2%). Only 3.6% of patients had qualified personnel on board being evacuated. In our series, 13 deaths were recorded, i.e., 1.1% of cases. The distance traveled seemed not to influence the future of the mother (p = 0.51). The non-accompaniment of the patient during the evacuation by a medical staff seemed to influence the prognosis of the mother (p = 0.031). Fetal morbidity was higher among evacuees not accompanied by medical personnel. The state of apparent death was observed in the majority of cases in patients received over a distance of more than 20 km. Conclusion: Evacuation requires a clear definition of the roles and responsibilities of each level of the health pyramid, good organization in the health structures as well as within the community, and a good information system.

DO PRÉ-NATAL AO PUERPÉRIO: MUDANÇAS NOS SERVIÇOS DE SAÚDE OBSTÉTRICOS DURANTE A PANDEMIA DA COVID-19

ABSTRACT Objective: to analyze changes in maternal health care during the Covid-19 pandemic, according to reports by health professionals. Method: qualitative research, conducted with managers, physicians, nurses, residents and nursing technicians working in a prenatal outpatient clinic, obstetric emergency department, delivery center and obstetric inpatient ward of a high complexity federal public hospital in the Northeast of Brazil. Data were collected from December 2020 to August 2021. The sample, chosen intentionally, sought the diversity of characteristics and situations, was closed by the criterion of saturation of meaning. A structured questionnaire and a semi-structured interview script were used for data collection. The interviews were recorded and transcribed. Content analysis was used in the thematic modality. Results: 28 professionals were interviewed. Changes in the dynamics of obstetric care were identified and categorized as: prenatal care; and childbirth/postpartum. In prenatal care, there was a decrease in elective consultations; increased time between consultations; delayed care due to paramentation; implementation of new hygiene protocols; limitation of the number of companions; creation of new environments such as the Covid-19 isolation room for symptomatic pregnant women; teleservice and work overload due to the increased demand coming from Primary Health Care. In childbirth/postparum, the reports indicated a reduction in the number of beds; testing and isolation of symptomatic patients; limitating walking, restriction of companions and mandatory use of mask by pregnant woman. Conclusion: the restructuring of services and the creation of new spaces to care for patients with Covid-19 led to a reduction in the availability of vacancies for prenatal and postpartum consultations. The changes were accompanied by new service rules, with setbacks regarding the guarantee of rights.

Homocysteine as a Predictor of Hypertensive Disorders of Pregnancy

Homocysteine is an amino acid that is a product of methionine metabolism, it is related to preeclampsia in 20-30%, the increase of this or hyperhomocysteinemia may result from the genetic defect of the enzyme methylenetetrahydrofolate reductase involved in the synthesis of homocysteine. Maternal mortality due to preeclampsia is up to 44% and perinatal mortality is reported at up to 27.8%. The objective of this research was to determine homocysteine levels as a predictor of preeclampsia in pregnant women that have 12 to 20 weeks. This was an observational, longitudinal and prospective investigation. The study population were patients attending the first prenatal care consultation between the 12^th to 20^th weeks, the sample was random and it included 360 patients from whom it was determined their serum homocysteine level. The study excluded 48 patients who did not meet the inclusion and exclusion criteria; it was found homogeneity among the patients, 270 patients (86.5%) had a normal evolution at pregnancy, 27 patients (8.65%) had gestational hypertension, 9 (2.88%) mild preeclampsia and 6 patients (1.9%) severe preeclampsia, none developed HELLP syndrome. Increased homocysteine levels were found in 9 patients who were not related to hypertensive pregnancy disorders. In the present research, homocysteine was not shown to be a predictor of hypertensive disease in pregnancy.

VULNERABILIDADE DE GESTANTES USUÁRIAS DE ÁLCOOL E OUTRAS DROGAS EM PRÉ-NATAL DE BAIXO RISCO

ABSTRACT Objective: to verify the contexts that enhance the dimensions of individual, social, and programmatic vulnerability associated with the use of alcohol and other drugs during pregnancy. Method: qualitative, descriptive, and exploratory, cross-sectional study. Participants were 38 pregnant women who used alcohol and other drugs, at a moderate and severe level, in low-risk prenatal care in the Primary Health Care of two cities in the Metropolitan Region of Maringá - Paraná. Data was collected from, December 2019 to March 2020. The Vulnerability analytical framework guided the discussion. Results: at the individual level, the vulnerability contexts were issues of gender, brown and black ethnicity/color, low education, reproductive period, and high parity. At the social level, the lack of insertion in the job market, family income below the poverty line, abusive intra-family relationships, addictive behavior in the family, and violence in the living community. In the programmatic plan, there was a low demand for health services, lack of welcoming for the treatment of drug use, screening for deficient drug use, low bond with family health teams, absence of dental, psychological, and social services, insertion in the inadequate level of prenatal care, usual risk, while they should have been classified as high risk, and mean prenatal consultations below recommended. Conclusion: the study made it possible to advance in the contexts of the vulnerability of these pregnant women. Recognizing these contexts makes it possible to formulate strategies to reduce harm and damages to maternal and fetal health related to drug use during pregnancy, leading to a favorable gestational outcome.

Determinants of Maternal Morbidity and Mortality Related to Anesthesia in Course of Cesarean Section in a Low-Income Country: Experience from the Centre Hospitalier Mère-Enfant Monkole

Objective: The role of anesthesia in maternal mortality is unknown in the Democratic Republic of Congo (DRC). This study was conducted with the objective of analyzing the determinants of morbidity and maternal mortality linked to anesthesia in course of cesarean section. Methods: This is a prospective, analytical and mono-centric study carried out on women who underwent cesarean section at the Centre Hospitalier Mère-Enfant Monkole from January 1st, 2011 to December 31st, 2018. The variables analyzed were socio-demographic, clinical, biological and anesthetic as well as the maternal issues. Data analysis was performed with SPSS 21.0 software. The determinants of mortality were sought by logistic regression with p Results: During this period, 1954 cesarean sections were performed. The mean age of the women was 31 years (range 14 to 47), 1549 women (79.3%) had completed prenatal consultation in Monkole and 405 (20.7%) elsewhere. The emergency was extreme in 192 cases (9.82%), absolute in 445 (22.77%) and relative in 1317 (67.4%). Locoregional anesthesia (LRA) was performed in 1811 cases (92.68%). The main complications were marked by arterial hypotension (22.9%) due to spinal anesthesia, and mortality was 0.56%. In multivariate analysis, only extreme emergency (aOR 7.62 95% CI: 2.80 - 71.23 p = 0.007), coma on admission (aOR 10.44 95% CI: 1.81 - 60.13 p = 0.009), general anesthesia (aOR 15.41 95% CI: 2.11 - 40.21 p = 0.007) and intraoperative transfusion due to anemia/hemorrhage (aOR 8.63 95% CI: 1.07 - 69.55 p = 0.043) persisted as determinants of maternal death. Conclusion: Maternal mortality (0.56%) in this series was relatively low for a low-income country and no death was directly related to anesthesia. General anesthesia, extreme urgency, intraoperative transfusion due to anemia/bleeding, and coma on admission were the major determinants of mortality.

Analysis of Indicators of Morbidity and Care Activities in a Health Center Within the Sanitary Cordon in Benin in the Context of COVID-19

<i>Background:</i> Response measures to the COVID-19 epidemic such as containment or sanitary cordon have had an impact on the health system. <i>Methods:</i> In an intra-cordon health center in Cotonou Benin, data on morbidity, health services and care indicators were collected and compared 10 months before COVID and 10 months during. A linear regression model was made. <i>Results:</i> During COVID, a significant increase in the number of women attending prenatal consultations was observed [77.30; 0.001] and significant decrease in the average number of malaria cases [-22.20; 0.008]. And non-significant negative effects on acute respiratory infections, sexually transmitted infections and diarrheal diseases identified. <i>Conclusion:</i> The establishment of a cordon sanitaire to contain the spread of COVID has had an impact on the functioning of the health system. This has led to a restriction of population movements, which has also affected health workers. The observed effects do not necessarily mean fewer diseases. Health centers were perceived by the public as places where the risk of contamination was higher, which led to their fear of traveling unless necessary. Strengthening strategies had to be put in place to maintain the accessibility of care to the population.

Practice of Essential Care for Newborns in the Referral Health Center of Commune 5 of Bamako District

Introduction: Delay in recognizing newborn health problems and delay in accessing quality care contribute to a high number of newborn deaths. The objective of this work was to study the practice of essential newborn care. Patients and method: This was a descriptive study on critical care newborns at the referral health Center of the Commune 5 (CSRéf C5) Bamako from 1st April to 31 May 2018. The acquisition, processing and data analysis were done on SPSS software. Results: The average age of the patients was 24.8 years. They were out of school and knew about the importance of prenatal consultations (83.3%). The majority of health workers were Nurses and Obstetricians (59.3%). The effective care (100%) given to the newborns was anthropometric measurements of the newborn and identification of the newborn. Treatments such as stimulated drying, skin-to-skin contact, warming, and administration of vitamin K1 were each administered at over 90%. The fight against heat loss by the head (14.1%) and early latching (41.5%) were insufficiently administered. Cord care was not provided at the Hospital prior to discharge for contextual reasons. The administration of ocular antiseptics was not administered in the hospital. Conclusion: The administration of essential newborn care at the referral health Center of the Commune 5 in Bamako has shortcomings.

Repercussões maternas e neonatais da gravidez na adolescência

OBJECTIVE: To compare the influence of maternal age on birth weight and other related factors. METHODS: the present study consists of a retrospective cohort carried out in two public maternity hospitals in Maceió - Brazil. The sample consisted of 84 puerperal women (28 adolescents and 56 aged between 20 and 30 years) and their respective newborns. RESULTS: Teenage pregnancy was significantly associated with low birth weight, inadequate prenatal consultations number, disproportionate Roher Index, father and mother of the child not living in the same household and prematurity. A difference of 471.5g occurred in newborns from young adult mothers compared to children of teen mothers. The use of alcohol, drugs and contraceptive methods did not obtain statistical significance. CONCLUSIONS: Due to the unfavorable socioeconomic and perinatal conditions of teen mothers compared to young adults, maternal age less than 16 years seems to have influenced the lower mean birth weight and the association of low birth weight and delayed uterine growth in this group of adolescents.

Knowledge, Attitudes of Pregnant Women and Practices of Women Who Have Recently Given Birth on Contraception in the Immediate Postpartum Period at Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF)

Background: The use of modern contraceptive methods contributes to the reduction of maternal and neonatal mortality. The initiation of a contraceptive method in the immediate postpartum period is one of the strategies to avoid missing out on contraceptive opportunities. This strategy will reduce the unmet need for contraception which is still high in the country. Objective: To describe the knowledge and attitudes of pregnant women and the practices of women who have given birth about immediate postpartum contraception. Methodology: This was a cross-sectional and descriptive study conducted at the main clinic of ATBEF from 20th March to 20th October 2020. Our study included pregnant women whose gestational age was greater than or equal to 37 weeks of amenorrhea who came for prenatal consultation or for any other consultation and then gave birth in the center. Data collection was based on a survey form. Data analysis and entry was done with the Epi info 2000 version 6.04 software. The parameters studied were: socio-demographic characteristics, knowledge and attitudes of pregnant women about contraception in the immediate postpartum period, and contraceptive practices of the women who gave birth. Results: During the study period, 201 women were selected for the survey. The average age of the respondents was 26.2 years. They were nulliparous in 41.3% of cases. Our respondents had knowledge of modern contraceptive methods in 82.10% of cases. About 59.2% of the respondents had an unfavourable attitude towards the adoption of contraceptive methods in the immediate postpartum period. The main reason was adverse effects in 33.6%. Of the 82 women who had a favourable attitude, 29 women had adopted a contraceptive method after delivery, which corresponds to a rate of use of 14.4% of the respondents. The main reason for non-adoption of a contraceptive method after childbirth for those who had a favourable attitude was the opposition of the husband in 34%. Conclusion: Couple counselling during prenatal and postnatal care and intensified awareness raising on planning and ideal spacing of pregnancies for health will increase the number of contraceptive users in the immediate postpartum period.

Trends in sociodemographic inequalities in prenatal care in Baixada Litorânea, a region of the state of Rio de Janeiro, Brazil, 2000-2020: an ecological study.

To analyze trends in sociodemographic inequalities in the access to and use of prenatal care in Baixada Litorânea, a region of the state of Rio de Janeiro, Brazil, 2000-2020. This was an ecological time-series study of the number of visits and adequacy of access to prenatal care. Absolute (differences) and relative (ratios) inequalities were calculated between extreme categories of variables; trends were estimated using joinpoint regression. A total of 185,242 pregnant women were studied. A proportion of ≥ 7 visits increased annually by 2.4% (95%CI 1.1;3.7) between 2013 (54.4%) and 2020 (63.4%), stable for less than eight years of schooling. Adequacy of access increased 2.6% (95%CI 1.2;4.0) between 2014 and 2020, stable for women ≥ 35 years old and schooling ≥ 12 years. Absolute inequalities decreased (between 3.5% and 6.4%) for age and race/skin color, and relative inequalities decreased (between 7.7% and 20.0%) for all variables. Access and number of prenatal consultations increased, however, remained lower for adolescents, women with low level of schooling and those of Black and mixed race/skin color.

Représentation Sociale De La Grossesse, Rapport À La Grossesse Et Consultations Prénatales Dans La Sous-Préfecture De Kokomian

Health is a fundamental human right. It is enshrined as such in the preamble of the WHO Constitution. Unfortunately, in southern countries in general, and particularly in Côte d'Ivoire, the effectiveness of this fundamental right leaves much to be desired. The factors generally highlighted to account for this state are the material and infrastructural aspects. Few works deal with psychosocial and anthropological factors. In reproductive health, for example, the existence in certain rural localities of health centers, provided with drugs, materials and personnel, and the free provision of certain reproductive care, are not enough to decide pregnant women to undergo antenatal consultations. . Through this research, we therefore wish to question the role of the aforementioned factors in the decision of pregnant women in rural areas to undergo prenatal consultations. This qualitative research was carried out in the department of Kokomiani in April 2021.

Prenatal consultation for micrognathia improves timely diagnosis and management of Robin Sequence

Robin sequence (RS) is a craniofacial anomaly characterized by a small jaw (micrognathia) with associated posterior displacement of the tongue, which in turn leads to airway obstruction. With advances in fetal imaging, fetuses with micrognathia may now be detected prenatally. This study aims to determine if differences in outcomes exist between infants with RS who underwent prenatal consultation and those who established care following delivery.

Study of the association of the nutritional profile of pregnant women with the birth weight of newborns in Morocco.

Low birth weight (LBW) is an important predictor of neonatal morbidity and mortality. It reflects the nutritional status of the mother and the quality of health care services during pregnancy. The objective of this study is to determine the factors associated with low birth weight of children born to Moroccan pregnant women in the province of El Jadida. This cross-sectional case-control study was carried out in the maternity ward of El Jadida provincial hospital on 344 parturient women, half of whom had given birth to children with an LBW and the other half of children with normal weight (NW) at birth. Information on maternal gestational and socioeconomic characteristics as well as eating habits was collected using a questionnaire and anthropometric measurements were taken on the newborns. The study identified 172 parturient who gave birth to newborns with LBW and 172 parturient who gave birth to newborns of NW. The proportions of LBW are greater in first-time mothers (50.6%) and professionally inactive (86.6%). The mean weight of LBW newborns is 2013.95 ± 372.95g compared to 3380 ± 217.59g for NW newborns. The determined factors associated with LBW are the low socio-economic level (OR = 3.18; 95% CI: 1.09-9.23), insufficient monitoring of prenatal consultation (OR = 2.91; 95% CI: 1, 71-4.95), origin from rural areas (OR = 0.52; 95% CI: 0.30-0.91) and lack of nutritional education (OR = 0.17; 95% CI: 0, 09-0.34). The daily calcium intake in mothers of newborns with LBW is 33.82% of the recommended daily allowance (RDA), the daily iron requirement coverage was 50%, folates 66, 16% and zinc 87.72% of the RDA. Well-targeted and coordinated education and awareness-raising actions on early pregnancy and feeding pregnant women could have a positive impact on improving the birth rate of children with a weight deficit.

Correlation of fetal ventriculomegaly with copy number variations and pregnancy outcome

To assess the correlation of borderline fetal ventriculomegaly with genomic copy number variations (CNVs) and outcome of pregnancy. For 84 singleton pregnancies diagnosed with VM, chromosomal microarray analysis (CMA) was carried out to detect the CNVs of the fetal genome. Outcome of the pregnancy and neonatal development were analyzed. The pregnant women were divided into mild group (10-12 mm), moderate group (12-15 mm) and severe group (>= 15 mm) based on the severity of fetal ventriculomegaly. The detection rate of pathogenic CNVs and pregnancy outcome were compared. Multivariate logistic regression was carried out to analyze the predictors for pregnancy outcome. Respectively, 24, 28 and 32 fetuses were assigned into the mild, moderate and severe groups. CMA has detected 15 cases of chromosomal abnormalities, including 11 pathogenic CNVs and 4 abnormal karyotypes. Abnormal pregnancy outcomes were found in 20 fetuses, including 12 with hydrocephalus and 8 with chromosomal microdeletion syndromes. A significant difference was found in the detection rate of fetal pathogenic CNVs and abnormal pregnancy outcome among the three groups (P<0.05). Multivariate logistic regression analysis showed that the largest change of lateral ventricle width (OR = 1.868, 95%CI = 1.120-3.116) and the extent of lateral ventricle widening (OR = 1.571, 95%CI = 1.120-2.206) were the key factors affecting the outcome of pregnancy (P<0.05). Borderline fetal VM is associated with the risk of pathogenic CNVs and adverse pregnancy outcome. A comprehensive examination is required after prenatal ultrasound diagnosis, which is conducive to prenatal consultation and prognostic evaluation of the fetus.

Updating preventive measures of children disability

The article provides an overview of special literature, which gives an opportunity to redefine some issues of disability prevention in children with rare (orphan) diseases, which will improve the organizational measures in this area. The prevention of children’s disability is considered as a system of measures to protect the health of the mother and child throughout childhood. The early disability prevention system in children and support for families raising children with disabilities remain among the main priorities of the State social policy of the Russian Federation. The authors describe modern technologies for reducing the genetic burden in the population from the point of view of preventing hereditary and congenital pathologies. They identify the priority areas of disability prevention in children with rare (orphan) diseases, i.e. introduction of prenatal and preimplantation diagnostics; use of the Prenatal Consultation organizational model; conducting a wider screening for congenital and hereditary metabolic diseases with the inclusion of the most common nosological forms of rare (orphan) diseases; finding pathogenetic therapy methods; increasing the knowledge of pediatricians about rare (orphan) diseases.

Risk factors associated with preterm birth in the Dominican Republic: a case-control study

ObjectivesThis study aimed to identify the risk factors associated with preterm birth, and to determine the prevalence of preterm births in the Dominican Republic.DesignCase-control study.SettingsSeven National Reference Hospitals from different...