Previous Pregnancy Complications Research Articles

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research.

A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues. This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a crosssectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8889 pregnant women and 77 012 women who had delivered between January 1, 2013 and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed. The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (adjusted odds ratio [aOR], 12.23; 95% confidence interval [CI], 9.01 to 16.60) and the postpartum period (aOR, 16.72; 95% CI, 14.85 to 18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, history of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include living in rural areas, history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use. CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.

POLAND SYNDROME: A CASE REPORT

Poland syndrome is a rare but serious condition that can affect a child's development and quality of life. Understanding the clinical features of this syndrome and the risk factors that can cause it is essential for timely diagnosis and treatment. However, there is currently a limited number of scientific studies on this pathological condition, so further research in this area is relevant and requires attention. The aim of the study was to review the literature, clinical features of Poland syndrome in a child and to analyse the risk factors that can lead to the onset of this condition.Results of the study. Premature placental abruption is a condition in which the placenta, an organ that forms during pregnancy to provide nutrition and oxygen to the fetus, detaches from the uterine wall before the onset of labour. It disrupts the balance between the forces of the uterine and fetal muscles, which can lead to thrombosis, bleeding and other complications for both mother and fetus. This condition can be observed in any trimester of pregnancy and requires the attention of doctors for timely diagnosis and treatment. Poland syndrome is a congenital anomaly characterised by chest and muscle defects, as well as other developmental defects. According to the Foucras classification, there are three or four degrees of severity, depending on the level of asymmetry and deformation of the chest. Hypoplasia of the chest muscles, cardiovascular anomalies, hand and finger abnormalities are among the complications that can accompany CP. A clinical study revealed severe chest asymmetry and motor disorders in a child diagnosed with Poland syndrome (incomplete form). The risk factors for premature placental abruption in the mother were a history of previous pregnancy complications and a viral urogenital infection.Conclusions. Studying the clinical features of Poland syndrome and the risk factors leading to its occurrence is important for the timely diagnosis and treatment of this condition in children. Understanding these aspects can help improve the quality of life of patients and prevent complications.

Factors related to Morbidity and Mortality in cases of Maternal death of the Mexican Social Security Institute of Sinaloa for the year 2021- 2022

Introduction: obstetric morbidity runs parallel to maternal mortality rates, so it is a way to evaluate the quality of care provided. Behind every maternal death lies a personal tragedy that can be resolved. The objective is to relate the factors of Maternal Morbidity and Mortality in cases of maternal death in the Mexican Social Security Institute, Sinaloa from 2021 to 2022.Method: study population integrated into a sample of 116 pregnant women from the IMSS Sinaloa, identified through the “PAMM” database and institutional records, associating sociodemographic variables, reproductive and prenatal risk factors, comorbidities in the pregnant stage and action protocols, achieving the creation of a logistic regression model. Non-probabilistic convenience sampling. Observational, analytical, retrospective and transversal research design.Results: the variables of pregestational care, BMI, transfer, place of occurrence, APP of DM2 and SAH, complications in previous pregnancies and immunization of COVID and influenza, explain maternal mortality by 55,2 % according to the Cox and Snell R2 coefficient.Conclusion: addressing the differences of the health institution by ethnicity, gender, social territory, life cycles will give the possibility of making visible the true scenarios behind a maternal death: Preconception risk factors and Specific Action Protocols

Influence of Sociodemographic Factors and Obstetric History on Choice of Place of Delivery: A Retrospective Study Among Post-Natal Women in Ghana.

Even though Ghana has recorded an appreciable level of facility delivery compared to other countries in sub-Saharan Africa, the country still has a lot of regional and community variations in facility delivery where professional maternal health care is guaranteed. This study assessed the main factors associated with facility delivery in the Sagnarigu Municipal Assembly of the Northern Region of Ghana. Using a simple random sampling method, a retrospective community-based cross-sectional study was conducted from July 12, 2021 to October 17, 2021, among 306 postnatal women within 15 to 49 years who had delivered within the last six months. We conducted descriptive analyses, and the Pearson chi-square test of association between the sociodemographic factors and obstetrics history with the outcome variable, choice of place of birth. Lastly, significant variables in the chi-square test were entered into adjusted multivariate logistics regression to determine their association with the place of delivery. Data analysis was performed using the Statistical Package for Social Sciences version-25, with statistical significance set at a p-value of 0.05. The study reported a facility delivery rate of 82%, which is slightly higher than the national target (80%). We observed that age group [AOR 2.34 (1.07-5.14)], marital status [AOR 0.31 (0.12-0.81)], ethnicity [AOR 3.78 (1.18-12.13)], and couple's occupation [AOR 24.74 (2.51-243.91)] were the significant sociodemographic factors influencing facility delivery. The number of antenatal care (ANC) attendance [AOR 8.73 (3.41 - 22.2)] and previous pregnancy complications [AOR 2.4 (1.11 - 5.7)] were the significant obstetrics factors influencing facility delivery. We found that specific sociodemographic and obstetric factors significantly influence the choice of place of delivery in the study area. To address this, the study recommends targeted interventions that focus on providing support and resources for women from different age groups, marital statuses, ethnicities, and occupational backgrounds to access facility delivery services. Additionally, improving ANC attendance and effectively managing pregnancy complications were highlighted as important measures to encourage facility-based deliveries.

Factores asociados al conocimiento de la atención preconcepcional

Objective: To analyze the factors associated with knowledge of preconception care in pregnant women in a public hospital. Methods: Case-control study that included pregnant women treated in the obstetric services of a public hospital. The sample consisted of 32 cases and 64 pregnant controls, who responded to a validated questionnaire. Relative and absolute frequencies were estimated, in addition to the chi-square test and Fisher’s exact test, as well as the odds ratio (OR) with 95% confidence intervals. Results: The associated personal factors were the woman’s interest in pre-pregnancy care [OR= 3.6; p= 0.014] and communication with a health professional about the intention of pregnancy [OR= 3.6; p= 0.009]. Regarding obstetric factors, complications in previous pregnancies were associated with knowledge of preconception care [OR= 2.6; p= 0.031]. The associated institutional factors were having perceived dissemination of information about this service [OR= 9.1; p< 0.001] and receive specific guidance from a health professional [OR= 7.8; p< 0.001]. Family factors did not show significant differences in the group of pregnant women with and without knowledge of this care. Conclusion: In pregnant women, knowledge of preconception care is associated with different personal, obstetric and institutional factors, but not with family factors

‘We are suffering. Nothing is changing.’ Black mother's experiences, communication, and support in the neonatal intensive care unit in the United States: A Qualitative Study

ABSTRACT Objectives Black mothers experience markedly disproportionate maternal morbidity and mortality in the United States, with racism often cited as the root cause manifesting through several pathways. The study examined Black mothers’ perceived provider communication, support needs, and overall experiences in the neonatal intensive care unit (NICU). Design This study used grounded theory embedded in the Black feminist theoretical (BFT) framework to generate new ideas grounded in the data. Data was collected through semi-structured interviews using videoconferencing, with questions related to the mother's overall NICU experiences, communication within the NICU, and perceived support needs. Data were analyzed using thematic analysis. Results Twelve mothers participated in the study; most were married (n = 10), had a cesarean birth, had a previous pregnancy complication (e.g., diabetes, hypertension), had attained a graduate degree or more (n = 9), earned an annual household income of $75,000 or more, and were between 35–44 years of age (n = 7). Three broad domains with several accompanying themes and sub-themes were identified, explicating the mother's experiences in the NICU. Specifically, factors influencing NICU hospitalization for mothers included maternal care/nursing experiences, interactions in the NICU, and the perceived support need that might attenuate negative care and birthing experiences. . Conclusion The study adds to the growing literature championing Black maternal health equity and multilevel quality improvement strategies to foster equitable maternal health. Our study reinforces the need for racially congruent interventions and policy reformations to protect Black birthing people regardless of socioeconomic factors and social class using life course, holistic approaches, and intersectionality mindset. Importantly, using the BFT, this study calls for culturally sensitive research to capture the nuances associated with the multiplicity of experiences of Black people.

An analysis of perinatal outcomes in pregnant women with arterial hypertension in Poland and Ukraine during times of conflict

Hypertensive problems are present in 10% of all pregnancies. Hypertensive disorders in pregnancy constitute one of the reasonsfor maternal death and perinatal too in the world.Women with hypertension are always at higher risk for preterm birth than women without disorder. The article is dedicated to analyzing pregnancy and its consequences, including perinatal outcomes, in women with arterial hypertension. The analysis was conducted at two powerful medical centers - the Princess Anna maternity hospital in city Warsaw, Poland, and the KNP KMPB No. 5 in city Kyiv, Ukraine. The prolonged war in Ukraine has complicated the timely diagnosis and proper treatment of pathological conditions. To assess this problem, two groups were created: control and experimental, and a total of 366 pregnant patients were studied. In Warsaw, 206 patients were analyzed, while in the Kyiv maternity hospital, 160 patients were analyzed. During the analysis, one of the conclusions drawn was that chronic hypertension during pregnancy is strongly associated with pregnancy complications and negatively affected by other complicating factors such as maternal age, previous pregnancy complications, and obesity. Separate groups were identified and calculated for complications in each center separately. The degree of depression among pregnant women undergoing examination was also taken into account, and those who needed help from specialists were referred to psychologists. The authors declare no conflicts of interest.

A Comparison of Antenatal Depressive Disorders in Urban and Rural Pregnant Women in Nigeria

Background: The prevalence of antenatal depression (AND) is consistently higher in urban areas in developed counties while the reverse is the case in developing counties developing countries. This highlights that socioeconomic gaps and health disparities between different settings could have important implications on perinatal mental health. Nigeria, the most populous nation in Africa, is home to multiple ethnic and cultural groups and about half of the population is rural. But then a majority of Nigerian studies on and were conducted in the urban and semi-urban southern regions. Few, if any, such studies were ever conducted in the urban or rural settings of northern Nigeria. The study aimed to determine and compare the prevalence and factors associated with AND among pregnant women in urban and rural northern Nigeria settings. A descriptive comparative cross-sectional study was conducted among antenatal clinic attendees of an urban and a rural health facility in Kano State, northern Nigeria. Data were collected from pregnant mothers. A socio-demographic and clinical characteristics questionnaire was used to obtain the relevant data. Edinburgh Postnatal Depression Scale (EPDS), Hamilton Depression Rating Scale (HDRS) and the major depression module of the Mini International Neuropsychiatric Interview (MINI-7) were used to screen, rate and diagnose depression among the respondents respectively.
 Results: The urban pregnant women were older (28.3±5.7 versus 26.0±5.6 years, p=0.001), better educated (12.8±2.8 versus 8.9±4.3 years of schooling, p<0.001), earning higher average monthly income (36.0 USD vs 13.0 USD, p<0.001), in the second trimester of the pregnancy (22% versus 9.7%, p=0.004). While the rural women were more likely to have planned to get pregnant (84.1% versus 69.3%, p=0.003) and used psychoactive substances while pregnant (20.7% versus 8.7%, p=0.003). The prevalence of AND was significantly higher among the rural respondents as compared to the urban respondents (33.1% versus 14.7% p<0.001). Anaemia in pregnancy (AIP), a history of a background medical problem (BMP) was significantly associated with AND in the urban setting (p= 0.032 and p= 0.001 respectively). While in the rural setting, AIP and a history of BMP were significantly associated with AND (p=0.0063 and p=0.008 respectively). Furthermore, among the multigravid urban and rural respondents, previous pregnancy complication was found to be significantly associated with AND (p=0.030). Among the urban women, the predictor for AND was a history of BMP (OR=5.049, 95%CI=1.451-17.570). The significant predictors for AND in the rural setting were AIP (OR=3.337, 95%CI=1.468-7.798) and history of BMP (OR=3.298, 95%CI=1.267-8.885).
 Conclusion: Rural prevalence of AND was significantly much higher than the urban rate. Certain factors, such as BMP and AIP, were associated with AND in both urban and rural settings.

The influence of birth outcomes and pregnancy complications on interpregnancy interval: a quantile regression analysis

To ascertain whether adverse pregnancy outcomes at first pregnancy influence subsequent interpregnancy intervals (IPIs) and whether the size of this effect varies with IPI distribution METHODS: We included 251,892 mothers who gave birth to their first two singletons in Western Australia, from 1980 to 2015. Using quantile regression, we investigated whether gestational diabetes, hypertension, or preeclampsia in the first pregnancy influenced IPI to subsequent pregnancy and whether effects were consistent across the IPI distribution. We considered intervals at the 25th centile of the distribution as 'short' and the 75th centile as 'long'. The average IPI was 26.6 mo. It was 0.56 mo(95% CI: 0.25-0.88 mo) and 1.12 mo(95% CI: 0.56 - 1.68 mo) longer after preeclampsia, and gestational hypertension respectively. There was insufficient evidence to suggest that the association between previous pregnancy complications and IPI differed by the extent of the interval. However, associations with marital status, race/ethnicity and stillbirth contributed to either shortening or prolonging IPIs differently across the distribution of IPI. Mothers with preeclampsia and gestational hypertension had slightly longer subsequent IPIs than mothers whose pregnancies were not complicated by these conditions. However, the extent of the delay was small (<2 mo).

PROFILE OF ANTENATAL CARE AMONG PREGNANT WOMEN ATTENDING OUTPATIENT CLINICS IN A RURAL BASED MEDICAL COLLEGE

Introduction: Antenatal care (ANC) provides monitoring and regular follow-up of maternal and fetal health during pregnancy. Women with appropriate ANC tend to have uneventful delivery and birth outcomes. This study describes the patterns of ANC care provided in a tertiary care rural teaching hospital. Methods: Baseline cross-sectional data from pregnant women who attended the ANC clinic at GITAM Institute of Medical Sciences and Research, Rushikonda, Visakhapatnam between May 2017 and January 2019 was analyzed. All the participants enrolled in the study completed a self-administered questionnaire in the regional language. The data collected were socio-demographic and pregnancy-related information. Regression models assessed the relationship between socio-demographic and pregnancy-related variables and “appropriate” (≤ 4 months' gestation) vs. “late” ANC initiation (&gt;4 months' gestation). Results:At enrolment, 841 participants reported that it was their rst ANC visit and half (50.2%) of the women attending were late i.e. &gt; 4 months gestation in registering for their ANC. Mothers who were more educated, had previous infertility treatment or previous miscarriages were all more likely to achieve appropriate ANC initiation [adjusted odds ratio (aOR): 1.66, 95% condence interval (CI): 1.05–2.62; aOR: 3.68, 95% CI: 1.50–9.04; aOR: 1.80, 95% CI: 1.16–2.79, respectively]. Women with anxieties about childbirth were less likely to achieve appropriate ANC initiation (aOR: 0.54, 95% CI: 0.34–0.85). Conclusion: Half of the pregnant women in this study did not achieve the global consensus guidelines on appropriate ANC initiation. Better counselling for the less educated women and those with previous pregnancy complications and childbirth anxieties are recommended to ensure appropriate ANC initiation and better outcomes.

Contributors to Preterm Birth: Data from a Single Polish Perinatal Center

Preterm birth may result from overlapping causes including maternal age, health, previous obstetric history and a variety of social factors. We aimed to identify factors contributing to preterm birth in respect to new social and environmental changes in the reproductive patterns. Our cross-sectional study included 495 mother-infant pairs and was based on maternal self-reporting in an originally developed questionnaire. Neonates were divided into two groups: 72 premature babies (study group) and 423 full-term babies (control group). We analyzed maternal, sociodemographic and economic characteristics, habits, chronic diseases, previous obstetric history and pregnancy complications. For statistical analysis, Pearson's Chi-squared independence test was used with a statistical significance level of 0.05. Preterm births were more common among mothers living in villages (p < 0.001) and with lower education level (p = 0.01). Premature births were also positively associated with mothers who were running their own businesses (p = 0.031). Mothers with a history of previous miscarriages gave birth at a significantly older age (p < 0.001). The most frequent pregnancy complications were hypothyroidism (41.4%), pregestational and gestational diabetes mellitus (DM; 17.8%) and hypertension (8.1%). Pregestational DM significantly influenced the occurrence of prematurity (p < 0.05). Pregestational DM, being professionally active, a lower education level and living outside cities are important risk factors of prematurity.

Investigating continuation of folic acid supplementation during peri-conceptional period: a community-based cross-sectional study

BackgroundMaternal folate may not reach an optimal level to prevent neural tube defects if supplementation commenced post-conception or took place pre-conception only. Our study aimed to investigate the continuation of folic acid (FA) supplementation from pre-conception to post-conception during peri-conceptional period and to examine its differences in FA supplementation between the subgroups taking the initiation timing into consideration.MethodsThis study was conducted in two community health service centers in Jing-an District of Shanghai. Women accompanying their children to pediatric health clinics of the centers were recruited and asked to recall information concerning their socioeconomic and previous obstetric characteristics, utilization of healthcare and FA supplementation before and/or during pregnancy. The continuation of FA supplementation during peri-conceptional period were categorized into three subgroups: Supplementing with FA pre- and post-conception; supplementing with FA preconception only or post-conception only; no FA supplements pre-conception and post-conception. The relationship between FA continuation and couples’ characteristics were examined as setting the first subgroup as the base reference.ResultsThree hundred and ninety-six women were recruited. Over 40% of the women started FA supplementation after conception and 30.3% of them supplemented with FA from pre-conception to the first trimester of their pregnancy. Compared to this one-third of participants, women who didn’t supplemented with any FA during peri-conceptional period were more likely to have no utilization of pre-conception healthcare (OR= 2.47, 95% CI: 1.33–4.61) or antenatal care (OR= 4.05, 95% CI: 1.76–9.34), or who had a lower family socioeconomic status (OR= 4.36, 95% CI: 1.79–10.64). Women who supplemented with FA pre-conception only or post-conception only were more likely to have no utilization of pre-conception healthcare (OR= 2.94, 95% CI: 1.79–4.82), or to have no previous pregnancy complication (OR=1.80, 95% CI: 0.99–3.28).ConclusionOver two-fifth of the women started FA supplementation and only one-third of them had an optimal supplementation from pre-conception to the first trimester. Maternal utilization of healthcare before or during pregnancy together with maternal and paternal socioeconomic status may play a role in the continuation to FA supplementation pre- and post-conception.

Antenatal depression and its correlates - a cross-sectional study in an urban resettlement colony of Delhi

Background- Antenatal depression is affecting 10% pregnant women worldwide with higher prevalence in developing countries. This causes poor maternal and foetal outcome and also affects cognitive development of the child. Aim and objective: To estimate magnitude of antenatal depression and its risk factors. Methodology- A cross-sectional survey was done at the antenatal clinic of community health department catering to an urban resettlement colony, East Delhi. Estimated sample size was 216 (including 10% non-response rate). Pregnant women attending the ANC clinic from October 2019 to February 2020 were enrolled. EPDS questionnaire was used to assess depression during pregnancy. Results-The antenatal depression was found in 11.8% subjects as per EPDS score. Working female and belonging to Muslim religion, past history of abortion, complications in previous pregnancy, financial debt, physical violence and substance use in family showed significant association with antenatal depression. Conclusion –Depression was prevalent among antenatal women and was found to be associated with various risk factors.

Verbal Autopsy of Maternal Mortality in Rawalpindi District

Objective: To identify the causes and risk factors leading to maternal mortality through verbal autopsy in the District of Rawalpindi, Pakistan. Study Design: A retrospective, descriptive study. Place and Duration of Study: The study was carried out in Community Department of Foundation University Medical College Islamabad from January 05, 2019, to December 25, 2019. Materials and Methods: Data of 105 women died of causes related to death during pregnancy/ delivery between 01 April 2013 and 30 April 2018 was retrieved from the office of District Health Officer (DHO) Rawalpindi. A Verbal Autopsy was conducted to determine cause of death and the possible risk factors, through a structured questionnaire that was filled by close relatives of the deceased women. Analysis of data was done using SPSS version 25.0. Results: The Mean age of the patients was 31 years, and it ranged from 15 to 49 years. In 26.7% of mothers cause of death could not be determined. Overall, the major and most obvious cause of maternal death was delivery related hemorrhage in 58% cases. Out of these, antepartum hemorrhage was the commonest cause occurring in 43.8% of the total cases. Postpartum hemorrhage occurred in 11.4% cases, while fatal hemorrhage during the delivery occurred in 2.8% mothers. Eclampsia was the next common cause that occurred in 11.4% mothers. Difficult and prolonged labour was found to be cause of death in 2.8% cases, while 0.95% died of Sepsis. Among the risk factors, lack of antenatal care emerged as the leading risk factor, present in 62% mothers, followed by anemia being present in 46.6% mothers. Multi-parity was found to be the next common risk factor being present in 26.6% mothers. Reduced interval in successive pregnancies was found in 21% cases. Systemic medical disorders like hypertension, renal disorders, Diabetes Mellitus, Pneumonia, hepatic failure, were found in 6.66% mothers. History of complications in previous pregnancies was present in 3.8% cases. History of lack of proper medical services in the hospital as possible factor leading to death was present in only 5 (4.8%) cases. Conclusion: Hemorrhage related with delivery, especially the antepartum hemorrhage emerged as the commonest cause of maternal mortality, followed by eclampsia. At the same time, lack of antenatal care and anaemia emerged as the commonest risk factors in this regard.

Outcomes in Pregnant HbSS and HbSβ0-Thalassemia Sickle Cell Disease Patients Receiving Scheduled Exchange Transfusions: A Retrospective Study

Introduction: The incidence of feto-maternal complications during pregnancy is high in women with sickle cell disease (SCD) which is the most common inherited hematologic disorder worldwide. Evidence on the impact of transfusions in pregnancy with SCD is lacking with only 12 observational studies and 1 RCT to date that has led to conditional recommendations for transfusional support in pregnant SCD patients. We aim to retrospectively chart review pregnant patients with severe sickle cell disease (HbSS and HbSβ0-thalassemia) and assess if scheduled red cell partial exchanges (RCE) impacted lab values, number of hospital and ED visits, prenatal, perinatal and postnatal outcomes. Methods: We identified 42 adult pregnancies (40 HbSS and 2 HbSβ0-thalassemia) between 04/2012 and 04/2022. HbSC and HbSβ+-thalassemia patients were excluded from the study as most patients did not get RCE due to overall less disease severity. Patients who received RCE had one unit of phlebotomy followed by one unit of packed red cell transfusion every 2 weeks as per the protocol followed at our institution. Collected data included demographics, lab values, number of hospital admissions/ED visits, prenatal, perinatal, and postnatal outcomes. Descriptive statistics as means and percentages, individual samples t-tests for comparison of means, chi-square tests for associations were utilized to report the data. A p value of <0.05 was considered significant. A binary regression model was utilized to adjust for demographics and comorbidities. Results: Mean age in the study group was 24.86±4.28 years. All 42 patients had medicare or medicaid. 11/42 (26.2%) patients received scheduled RCE with 73% compliance rate and no documented evidence of allo-immunization. Only 1/37 (2.7%) patients had venous thromboembolism. Patients who received scheduled RCE had higher hemoglobin (Hb) nadirs (7.80 g/dL vs 6.78 g/dL; p .02), lower number of hospital admissions for painful crises (1.00 vs 3.54; p .02) and higher gestational age in weeks at delivery (37.09 vs 33.64; p .007). The differences in means of other hematological and chemistry lab values were insignificant. Scheduled RCE was associated with lower incidence of preterm deliveries and subsequent NICU admission with unadjusted odds ratios of 0.153 (0.028-0.848) and 0.500 (0.323-0.775) respectively. There was no statistically significant association with respect to other prenatal, perinatal or postnatal outcomes such as preeclampsia, eclampsia, mode of delivery, intrauterine growth restriction or neonatal death. Binary logistic regression did not show any statistically significant associations when adjusted for demographics and comorbidities (Table 1). Conclusions: Pregnant patients with SCD who have had previous pregnancy complications, high hospital admission rates or low Hb nadirs might benefit from scheduled RCE or simple transfusions. Given limited sample size in all 12 reported observational studies, there is a need for multicenter study especially from centers in areas with higher prevalence of SCD. While the TAPS-2 trial was registered in 2019 in the UK and is currently recruiting patients, more trials are necessary to solidify evidence. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Determining factors associated with the prevalence of knowledge, attitude, and practice in seeking skilled maternal healthcare services among women in a remote area of Gesha district

BackgroundSkilled health care is essential for the mother's and newborn's health and well-being during pregnancy, labor, and the postpartum period. This study aimed to analyze women's knowledge, attitudes, and practices while requesting competent assistance for maternity healthcare in Gesha District, Southwest Region of Ethiopia.MethodsA community-based cross-sectional study design was conducted from September 20, 2021 to October 19, 2021. A total of 424 mothers participated in this study and a systematic sampling technique was used to select the respondents. The data were collected using a pretested and structured questionnaire. Statistical software SPSS-20 and R-4.1.2 were used to enter and analyze the data respectively. The factors associated with the prevalence of Knowledge, Attitude, and Practice in seeking Skilled Maternal Healthcare Services were identified using descriptive analysis and a binary logistic regression model.ResultsThis study result revealed that the overall proportions of good knowledge, positive attitude, and good practice in seeking skilled maternal health care services were 39.15%, 37.5%, and 34.67% respectively. Estimated odds of having knowledge, attitude, and practice were as follows: for having age between 20–24 years at first pregnancy 1.859, 1.86, and 1.799; having a plan for pregnancy 2.74,2.315 and 2.579; mothers attended elementary education 2.337, 2.565 and 3.312; having maternal age 20–24 years 4.336,4.989 and 5.870; maternal age 25–29 years 2.917, 3.794 and 4.017; maternal age 35–49 years 2.837, 2.991 and 3.412; having husbands who had attended elementary education level 2.736, 2.542 and 2.134; secondary and above education 3.464, 3.360 and 2.508; rich mothers 2.261, 1.995 and 2.452; having antenatal care 4 times and above 2.606, 2.570, 2.682; having transportation access 1.921, 1.956 and 2.404; having media access 1.979, 2.171 and 2.715 respectively. The odds of having attitude and practice respectively were as follows: married 1.762, and 2.208; having medium wealth index 1.933 and 2.424. The odds of having previous pregnancy complications was 2.147 which significantly affect the practice of seeking skilled maternal care assistance.ConclusionsThis study discovered that the study participants' knowledge, attitude, and practice of skilled maternal health care are low. Associated factors included age at first pregnancy, planned pregnancy, maternal education level, husband’s education level, maternal age, antenatal care service visits, transport access, and access to media were found to significantly affect the knowledge, attitude, and practice of the respondents in seeking skilled maternal care assistance in common. The household wealth index was also associated with attitude. Pregnancy complications, current marital status, and household wealth index also significantly affect the practice of seeking skilled maternal care assistance. As a result of the findings, initiatives to increase women's knowledge, attitudes, and use of expert maternal health services in the research area are needed for women residing in rural areas.

Fatores que predispõem a gravidez de alto risco

Introduction: High-risk pregnancy can be understood as a pregnancy in which the health or life of the mother and/or the fetus/newborn (NB) is at greater risk than the expected average. Most deaths and disorders that arise during pregnancy, childbirth and the puerperium are preventable, and for this, the active participation of the multiprofessional health team is necessary. Objective: To identify the main causes of high-risk pregnancies. Methodology: A literature review survey was carried out on the factors that predispose to high-risk pregnancy. The search for articles in the literature was performed covering articles from the last 10 years. Results and Discussion: From the search carried out, 11 articles were found that met the inclusion criteria, the main risk factors found in the studies were hypertensive syndromes, obesity, diabetes, smoking, social vulnerabilities (low education, illiteracy, low purchasing power), extremes of age (&lt;15 years and &gt;35 years), multiple pregnancies, complications in previous pregnancies and lack of support from the partner. Conclusion: It was evidenced that gestational risks can be multicausal and multifactorial, thus highlighting the importance of health professionals working in the health education of pregnant women, this attention can significantly reduce the possibility of future complications for mother and fetus.

Role of multiple- and single-pregnancy complications with incident cardiovascular diseases: a nationwide data linkage study in Wales

Abstract Background Prior evidence has suggested that pregnancy complications are associated with a higher risk of cardiovascular disease in women. However, associations between coexisting multiple pregnancy complications and incident cardiovascular disease remains unclear. Purpose To examine the risk of ischemic heart disease (IHD), stroke, atrial fibrillation or heart failure among women after their first pregnancy with a history of multiple pregnancy complications and women with a history of single-pregnancy complications, compared to women without pregnancy complications. Methods This retrospective cohort included women aged 16–45 years who had their first pregnancy between 2000 and 2018 in Wales using the Secure Anonymised Information Linkage (SAIL) Databank. Data were extracted from various sources such as Office for National Statistics (ONS) birth and death extracts, hospital admission, outpatient, emergency department and General Practice data sources, and pregnancy related data such as maternal indicators and national community child health. Cox proportional hazard regression was used to evaluate the association between multiple or specific single pregnancy complications and incidence of cardiovascular disease. Results A total of 298,515 women were included in the study, of which 64,794 (21.7%) women experienced a single pregnancy complication, and 10,038 (3.38%) women experienced more than one complication during their first pregnancy. During the a median of 9.7 years of follow-up, 2,484 women developed incident cardiovascular disease. IHD had the highest incidence rate among women with multiple pregnancy complications at 9.06 (7.36–11.15) per 10,000 person-years, compared to 4.24 (3.77–4.78) among women with a single pregnancy complication and 2.40 (2.20–2.61) among women without any pregnancy complications. After adjusting for potential confounding factors, compared to no previous pregnancy complications, a history of multiple pregnancy complications was associated with a higher risk of heart failure [hazard ratio (HR) 3.18 (95% confidence interval (CI) 2.34–4.32)], IHD [HR 2.88 (95% CI 2.27–3.67)], stroke [HR 2.03 (95% CI 1.55–2.65)] and atrial fibrillation [HR 1.80 (95% CI 1.20–2.72)]. There was also a consistent trend for a higher risk of all outcomes in women with a history of single-pregnancy complications compared to women without complications during the first pregnancy (Figure 1). Conclusion This population-scale study used anonymised individual-level linked data from multiple routinely collected data sources. In almost 300,000 women with a previous pregnancy, multiple pregnancy complications were associated with a higher risk of incident cardiovascular disease, including heart failure, ischaemic heart disease, stroke and atrial fibrillation. Women who experience multiple pregnancy complications may benefit from targeted intervention strategies to reduce their risk of incident cardiovascular disease. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Saudi Arabia governmental PhD studentship

Continuum of maternal health care services among peri-urban women- a community-based cross-sectional study in North India

Background: Low level of utilization of continuum of maternal health services (CMHS) is a major factor responsible for high maternal mortality and morbidity. This study was conducted to assess status of utilization, determinants and satisfaction of /about CMHS in peri-urban women of north India.Methods: A community based, cross-sectional study of 310 recently delivered women (RDWs) was conducted. Data were collected using a structured interviewer administered questionnaire and analysed using SPSS 26.0.Results: 158 (51%), 228 (73.5%) and 92 (29.7%) of RDWs had full utilization of antenatal care (ANC), intra natal care (INC) and post-natal care (PNC) respectively. Birth order, education of husband, complications in previous pregnancies, type of family, first ANC visit and place of ANC were significant (p&lt;0.05) predictor of full utilization of ANC. Education of RDW and husband, complications in previous pregnancies were significant (p&lt;0.05) predictor of full utilization of INC. Age, birth order and education of husband were significant predictors (p&lt;0.05) of full utilization of PNC. Full utilization of overall CMHS was only 60 (19.4%). &gt;70% RDWs expressed satisfaction with the quality of CMHS while 28.5% were not satisfied.Conclusions: Utilization of all the three aspects of CMHS still lagging behind with regards to required goals with full utilization of PNC, as limiting factor. Comprehensive approach to increase utilization of CMHS is need of hour, to address the issue of drop out with special emphasis on PNC.

Correlation Between Pregravid Nutritional Status, Obstetric Nutritional Risk and Maternal Morbidity in High Risk Pregnancy: A Case Control Study

A high-risk pregnancy (HRP) is one with either an abnormal or pathologic condition, concomitant to gestation or delivery, that threaten the life or health of the mother or fetus [1]. Prevalence of HRP has been reported between 12% and 60%, depending on the country. Some of the risk factors leading to an HRP are woman´s age, nutritional status (diet), diabetes, autoimmune disorders, hypertension, infectious diseases, history of chronic disease and complications in previous pregnancy, multifetal pregnancies and less than 1-year gestational interval [1-3]. A compromised maternal nutrition can result in an adverse outcome of pregnancy and childbirth [4-7]. A clear relationship between maternal malnutrition and adverse pregnancy outcome has been accepted.