Obstetric Problems Research Articles

Addressing a broken drug pipeline for preterm birth: why early preterm birth is an orphan disease

Preterm birth remains one of the most urgent unresolved medical problems in obstetrics, yet only 2 therapeutics for preventing preterm birth have ever been approved by the United States Food and Drug Administration, and neither remains on the market. The recent withdrawal of 17-hydroxyprogesterone caproate (17-OHPC, Makena) marks a new but familiar era for obstetrics with no Food and Drug Administration-approved pharmaceuticals to address preterm birth. The lack of pharmaceuticals reflects a broad and ineffective pipeline hindered by extensive regulatory hurdles, soaring costs of performing drug research, and concerns regarding adverse effects among a particularly vulnerable population. The pharmaceutical industry has historically limited investments in research for diseases with similarly small markets, such as cystic fibrosis, given their rarity and diminished projected financial return. The Orphan Drug Act, however, incentivizes drug development for "orphan diseases", defined as affecting <200,000 people in the United States annually. Although the total number of preterm births in the United States exceeds this threshold annually, the early subset of preterm birth (<34 weeks' gestation) would qualify, which is predominantly caused by inflammation and infection. The scientific rationale for classifying preterm birth into early and late subsets is strong given that their etiologies differ, and therapeutics that may be efficacious for one subset may not work for the other. For example, antiinflammatory therapeutics would be expected to be highly effective for early but not late preterm birth. A robust therapeutic pipeline of antiinflammatory drugs already exists, which could be used to target spontaneous early preterm birth, in combination with antibiotics shown to sterilize the amniotic cavity. New applications for therapeutics targeting spontaneous early preterm birth could categorize as orphan disease drugs, which could revitalize the preterm birth therapeutic pipeline. Herein, we describe why drugs targeting early preterm birth should qualify for orphan status, which may increase pharmaceutical interest for this vitally important obstetrical condition.

Legal medicine aspects of female sterilization: our experience.

The most frequent sterilization procedures include postpartum tubal ligation, laparoscopic tubal disruption or salpingectomy, and hysteroscopic tubal occlusion. It may be performed via laparoscopy, mini-laparotomy, or hysteroscopy. Safety, efficacy, short-term complications, long-term complications, and non-contraceptive benefits of sterilization are different for each procedure. Female sterilization has become an important professional liability problem in obstetrics and gynecology. We analyzed 6 cases of surgical sterilization that have been the subject of civil proceedings. We review indications, contraindications, and complications associated with each sterilization procedure. In our small number of cases, women who have undergone sterilization performed negligently are entitled to recover damages for wrongful conception, negligence, and wrongful birth. We also consider the issue of female sterilization of minors. Tubal sterilization can be performed with different techniques, chosen in light of the various situations involved, with the goal of reducing as many as possible any failures. Thorough and complete communication of information is of primary importance. Sterilization is the most widely used birth control method around the world. The procedure is generally safe and highly effective. As reported in the literature, the decision concerning method depends on the setting, the surgeon's experience, the country's economic development, and the woman's preference, but we think that some techniques present a greater risk of failure and expose the surgeon to malpractice litigation.

Profil Maternal pada Kasus Kematian Neonatus di Rumah Sakit Umum Daerah (RSUD) Ciawi

In 2013, 4.6 million babies died worldwide before their first birthday, with 50% dying on the first day and nearly 75% within the first week. Most stillbirths and premature newborn deaths are attributable to birth complications that are preventable. The maternal profile in neonatal mortality cases plays an important role in understanding the factors that contribute to this high mortality rate. This cross-sectional study aims to determine the maternal profile of neonatal death cases at Ciawi Hospital, which were selected according to the criteria by total sampling based on medical record data from January 1, 2020, to December 31, 2020. The variables utilized in this study include maternal factors such as gestational age, type of delivery, twin pregnancy, presentation of pregnancy, medical condition of the mother, and obstetric problems. The data is presented in a descriptive format. Among the 58 respondents, the average age was 30.26 years, with a higher prevalence of preterm births (55.2%). The most frequently encountered medical condition in the maternal profile of neonatal deaths at Ciawi General Hospital is chronic hypertension. Conversely, the most common obstetric problems are premature rupture of membranes and oligohydramnios. Efforts to address medical issues in mothers can contribute to the reduction of neonatal mortality cases.&#x0D; &#x0D;

Behavioral, productive, and reproductive aspects of the water buffalo in Mexico

Water buffalo (Bubalus bubalis) production in Mexico has generated particular interest in understanding the bases of the development of this species. As a result, alliances have emerged between scientific, governmental, industrial, and productive sectors and other organisms involved with this species nationally and internationally. We must recognize that thanks to specific anatomical characteristics, water buffaloes present a low incidence of complications during calving, though they are not exempt from obstetric and perinatological problems that can end in morbidity and mortality for mother and/or offspring, with losses for both branches of dual-purpose production systems: calves-milk and meat, and draft animals. This article analyzes scientific advances related to water buffalo production in Mexico, including productivity, thermoregulation, behavior, and physiology, and key subthemes like obstetric and perinatological handling, imprinting, milking, and dual-purpose production systems. It highlights features inherent to milk production and the neurophysiological and metabolic processes involved in obtaining meat and milk. Finally, it presents a brief overview of current legislation and summarizes key areas of opportunity.

Perineal injuries in childbirth. Analysis of causes

One of the most significant problems of obstetrics are perineal injuries, in the structure of which dominate ruptures. According to Russian and world literature data, the frequency of perineal ruptures ranges from 7 to 25 % of all the childbirths. The article considers the most significant predictors of this condition, including violation of vaginal microbiocenosis, perineal injuries in the anamnesis and instrumental birth. In addition, perineal injuries lead to immediate and long-term complications that significantly reduces the quality of women's life. Among the consequences of ruptures, most often pain and discomfort in the perineum area, impaired urination and fecal incontinence, as well as the development of infectious complications are observed.

Ipsilateral Uterine Artery Access Through Unilateral Transfemoral Approach Using Simple-Curve Catheter.

Uterine artery embolization (UAE) is a technique for management of various obstetrical and gynecological problems. Transfemoral approach (TFA) is preferred which can be unilateral or bilateral; however, unilateral puncture is preferred due to lesser chances of puncture-related complications as compared to bilateral puncture. UAE through unilateral TFA is possible with use of reverse loop catheters (Roberts uterine catheter [RUC] or Gandras catheter) to access ipsilateral uterine artery. Other way of cannulating the ipsilateral uterine artery is by maneuvering catheters to form Waltman's loop/Simmon's reverse loop. With advent of RUC, unilateral TFA became standard of care. In the recent past, RUC was retracted from Indian market and its nonavailability had mandated use of either bilateral TFA or use of catheters and techniques used in the past for unilateral TFA. Herein, we describe a technique of doing UAE by unilateral TFA using simple gentle curve catheter (Picard) by making a reverse curve loop.

Maternal exposure to ambient air pollution mixture and premature rupture of membranes: Evidence from a large cohort in Southern California (2008–2018)

BackgroundThere is minimal evidence of relationships between maternal air pollution exposure and spontaneous premature rupture of membranes (SPROM), a critical obstetrical problem that can significantly increase maternal and fetal mortality and morbidity. No prior study has explored the PROM risk related to specific components of particulate matter with aerodynamic diameters of ≤ 2.5 µm (PM2.5). We examined associations between maternal exposure to nitrogen dioxide (NO2), ozone (O3), PM2.5, PM10, and PM2.5 constituents and SPROM. MethodsA large retrospective cohort study was conducted and included 427,870 singleton live births from Kaiser Permanente Southern California during 2008–2018. Monthly averages of NO2, O3 (8-h daily maximum), PM2.5, and PM10 were measured using empirical Bayesian kriging based on measurements from monitoring stations. Data on PM2.5 sulfate, nitrate, ammonium, organic matter, and black carbon were obtained from a fine-resolution model. A discrete time approach with pooled logistic regressions was used to estimate associations throughout the pregnancy and based on trimesters and gestational months. The quantile-based g-computation models were fitted to examine the effects of 1) the air pollution mixture of four pollutants of interest and 2) the mixture of PM2.5 components. ResultsThere were 37,857 SPROM cases (8.8%) in our study population. We observed relationships between SPROM and maternal exposure to NO2, O3, and PM2.5. PM2.5 sulfate, nitrate, ammonium, and organic matter were associated with higher SPROM risks in the single-pollutant model. Mixture analyses demonstrated that the overall effects of the air pollution mixture and PM2.5 mixture in this study were mainly driven by O3 and PM2.5 nitrate, respectively. Underweight mothers had a significantly higher risk of SPROM associated with NO2. ConclusionOur findings add to the literature on associations between air pollution exposure and SPROM. This is the first study reporting the impact of PM2.5 constituents on SPROM.

Prelabour Rupture of Membranes among Pregnant Women Visiting a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Prelabour rupture of membranes is a common obstetrics problem associated with maternal and perinatal morbidity and mortality. The exact cause is not known although various factors are found to be related to this condition. Hence, the objective of this study was to find out the prevalence of prelabour rupture of membranes among pregnant women in a tertiary care centre. This was a descriptive cross-sectional study conducted from 1 November 2021 to 30 November 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: 2078/79/49). A structured proforma was filled out after taking a detailed history from each pregnant woman. Convenience sampling method was used. Point estimate and 99% Confidence Interval were calculated. Among 700 pregnant women, the prevalence of prelabour rupture of membranes was 56 (8%) (5.36-10.64, 99% Confidence Interval). Among them, 40 (71.43%) occurred in the term, while preterm (before 37 weeks) occurred in 16 (28.57%) of all pregnancies. Previous miscarriage occurred in 15 (26.78%) followed by gestational diabetes mellitus 8 (14.28%). The prevalence of prelabour rupture of membranes was found to be lower than other studies done in similar settings. miscarriage; oligohydramnios; prevalence.

Longitudinal Study to Assess the Reliability and Predictive Validity of Ultrasound Measurements in Tracking Fetal Growth and Development Throughout Pregnancy

The utilization of ultrasound in obstetrics is extremely common due to its accurate fetal imaging capabilities. By early identifying anomalies such intrauterine growth restrictions and macrosomia, ultrasonography scanning during pregnancy primarily aims to reduce the risk of obstetric problems. Fetal weight is currently estimated using morphometric formulas. They employ fundamental biometric variables. Hadlock's formula, which is used for estimation of fetal weight, has 20 percent error rate, though. Due to this particular cause, the researchers from all around world had already searching for the additional sonographic characteristics having a stronger predictive value that correlate with fetal weight. According to recent scientific studies, assessing fetal weight can benefit from using novel parameters of sonograph such measurements of the thickness of soft tissue. The fetus's body can be measured in a number of locations, including upper arm, the thigh, abdomen, and the subscapular region. Diverse measurements have varying degrees of connection with some other anthropometric &amp; sonographic factors, including body mass &amp; gestational age. Numerous research using novel formulas for calculating fetal weight have been produced in response to the reports. For measuring fetal weight, measurements other than those including soft tissue, including such those lean and adipose tissue or utilising 3D ultrasonography are acquired. For the purpose of sonographic pregnancy assessment, ultrasound examination of the thicknesses of subcutaneous tissue in the several body regions might evidence to become reliable indicator of the fetal weight. Keywords: Pregnancy, postpartum hypoglycaemia, foetus, Intra-uterine, pregnancy ultrasound

Reproductive Concerns Among Women with Disability: A Host of Opportunities for Reproductive Health Care Professionals.

Maternal health in India is likely to move towards an obstetric transition, wherein there is sustained reduction of maternal mortality and focus shifts towards improving quality of care. In such a context, reproductive concerns of special populations gain prominence. One such population group is women with disability. This mini-review examines the incremental importance given to people with disabilities and the sparse data available on the topic of reproductive concerns among women with disability. The attitudes of the women with disability towards childbearing and the association between disability and obstetric problems are discussed. The limited available data on specific medical and obstetric problems among women with disability are reviewed. The article calls for all obstetricians to display increased sensitivity and heightened cognizance towards the reproductive concerns among women with disability.

Using Fetal Fibronectin Test to Reduce Hospital Admissions with Diagnosis of Preterm Labor: An Economic Evaluation Study.

Background: Preterm labor and delivery remain a major problem in obstetrics accounting for perinatal morbidity and mortality. The challenge is to identify those with true preterm labor to avoid unnecessary hospital admissions. The fetal fibronectin (FFN) test is a strong predictor of preterm birth and can help identify women with true preterm labor. However, its cost-effectiveness as a strategy for triaging women with threatened preterm labor is still debatable. Objective: To evaluate the effect of FFN test implementation on hospital resources by reducing the admission rate of threatened preterm labor in a tertiary hospital, Latifa Hospital, UAE. Methods: A retrospective cohort study of singleton pregnancies between 24 and 34 weeks of gestation who attended Latifa Hospital in the period of September 2015-December 2016, complaining of threatened preterm labor after the availability of an FFN test, and a historical cohort study for those who attended with threatened preterm labor before the availability of an FFN test. Data analysis was performed using a Kruskal-Wallis test, Kaplan-Meier, Fischer exact chi-square and cost analysis. The significance was set at p-value < 0.05. Results: In total, 840 women met the inclusion criteria and were enrolled. The relative risk of FFN for delivery at term was 4.35 times higher among the negative-tested compared to preterm delivery (p-value < 0.001). A total of 134 (15.9%) women were unnecessarily admitted (FFN tested negative, delivered at term) which yielded $107,000 in extra costs. After the introduction of an FFN test, a 7% reduction of threatened preterm labor admissions was recorded.

The effect of taurine on state of experimental gestosis in rats

BACKGROUND: Gestosis (preeclampsia) is an important problem of modern obstetrics. Despite the improvement of methods of prevention and treatment, there is an increase in the rate of this pregnancy complication. In this regard, the search for new approaches to the treatment of preeclampsia is an important problem of modern perinatology.&#x0D; AIM: The aim of this study is studying of the effect of taurine on experimental gestosis in rats.&#x0D; MATERIALS AND METHODS: Preeclampsia was induced on female rats by sodium nitrite and lipopolysaccharide. 2-aminoethanesulfonic acid was administered at a dose of 44.3 mg / kg (in terms of taurine) from the 16th to the 19th day of pregnancy. The number of implantation sites, resorption sites, live fetuses, weight of placentas and fetuses, lactate dehydrogenase activity, content of lactic and pyruvic acids, nitric oxide, malondialdehyde and creatine were evaluated.&#x0D; RESULTS: It has been shown that 2-aminoethanesulfonic acid leads to normalization of the metabolic processes (the level of malondialdehyde, nitric oxide, lactate and lactate dehydrogenase activity) in the body of pregnant female rats with induced preeclampsia in the last trimester of pregnancy. Taurine reduced the quantity of resorption, increased the weight of placentas and fetuses. Along with a correction of the lactate level, pyruvate and lactate dehydrogenase activity, it was observed a decrease of creatine level in placentas.&#x0D; CONCLUSIONS: Obtained results allows us to recommend taurine, which has antioxidant, antihypoxic, membrane stabilizing, detoxifying, osmoregulating and diuretic effects, for the treatment of placental disorders with preeclampsia.

Association of lupus anticoagulants with risk factors for obstetric complications and adverse gestational outcome.

Lupus anticoagulant (LA) may be a cause of poor obstetric outcome. To search the association of LA with risk factors for obstetric complications and adverse gestational outcome. This retrospective cohort was consisted of 2 groups of pregnancies with poor obstetric history; 1) LA (+) gestations (Study Group, n= 20) and 2) LA (-) gestations (Control Group, 78). All patients were admitted to a special antenatal care program and were examined in terms of risk factors for thrombotic events, placenta-related obstetric complications, and poor gestational outcomes. Patients were administered low-dose low-molecular-weight heparin (LMWH), low-dose salicylic acid and low-dose corticosteroid (if necessary) within the framework of a prophylaxis protocol in addition to their already existing medications. We have shown that adverse gestational outcome was 1.7-fold more frequent in LA (+) pregnancies with poor obstetric history (p= 0.039, 70% vs. 41%). Higher rates of autoimmune diseases and hereditary thrombophilia were observed among LA (+) patients compared to LA (-) gestations (35% vs. 10.3%, p< 0.012 and 55% vs. 19.2%, p< 0.003, respectively). To identify the effectiveness of low-dose LMWH prophylaxis protocol, we compared gestational outcomes and demonstrated that the miscarriage rate was significantly decreased to half in current pregnancies compared to the previous gestations (73.6% vs. 35%, p= 0.003). Autoimmune diseases and hereditary thrombophilia are more frequent in LA (+) pregnancies, and these women are prone to obstetric problems. Low-dose LMWH and salicylic acid prophylaxis are critical in the management of LA (+) pregnant women.

Sickle Cell Disease in Pregnancy: Obstetrician’s Nightmare in Resource-Poor Countries!

Sickle Cell Disease in Pregnancy: Obstetrician’s Nightmare in Resource-Poor Countries!

Telemedicine: A Natural Evolution of Obstetric and Gynaelogical health Care System of Bangladesh during COVID-19 Pandemic

Background: The word Telemedicine literally translates to ‘healing at a distance’. Here remote diagnosis and treatment of patients is done by means of telecommunication technology. First published record of telemedicine is in the first half of the 20th century when ECG was transmitted over the telephone line. In Bangladesh telemedicine was not so popular as patients prefer face to face visit to a medical practitioner. But in Covid-19 Pandemic to prevent transmission and Lock down situation telemedicine becomes popular and emerges as a natural evolution of Obstetrics and Gynaecologic health care system in Bangladesh.&#x0D; The Aim of the study: To see the outcome of patients taking telemedicine for their Obstetric and Gynaecologic problems. The reasons of seeking consultation through telemedicine are also studied.&#x0D; Materials and Methods: This is a Cross sectional prospective study done during Lock down period in Bangladesh. Study period was 27th March to 20th May. Total 201 women got telemedicine service free of cost via sms, messenger, imo, whatsapp, email using smart phone were included in this study. The data was collected, edited and tabulated by hand tabulation. Calculation was done on scientific calculator.&#x0D; Results: About 96.51% patients suffering from Obstetrics and Gynaecological diseases were cured by taking medicine, counselling and assurance through telemedicine. Majority of pregnant women(23.88%) sought telemedicine service for consultation about advice regarding diet, medicine, anxiety about ANC visits. 2.48% women were worried about Tetanus Toxoid vaccine.Women (.99%) suffering from Gynaecological diseases such as Fibroid uterus, Uterine Prolapse were seeking for operation.3.48% women suffereing from DUB and managed by medication . Only 3.48% patients were required to refer to Hospital for Emergency admission.&#x0D; Conclusion: Telemedicine can’t give solution to all problems, but it definitely helps in managing women suffering from Obstetric and Gynaecological diseases at a large extent especially during awakward situation like Covid 19 pandemic.&#x0D; Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 23-27

A spectrum of pathological changes induced by SARS-COV-2: An observational study in a cohort of pregnant women from Mizoram, India

BackgroundMaternal infection by SARS-CoV-2 may lead to adverse pregnancy outcomes and causes pathological changes in the placenta. However, consensus regarding characteristic pathological features is lacking. Researchof the placental histopathology in a cohort of women from Mizoram, India, was conducted to relate the SARS-CoV-2 infection's effectswith pregnancy and its outcome. Materials and methodsThe characteristics of 72 pregnant women diagnosed positive for SARS-CoV-2 who eventually delivered at Zoram Medical College Hospital, Mizoram, neonates’ well-being, and histopathological features of placentas were studied. ResultsOf 72 women in this study, 59 (81.9%) gave birth at full term. Among these births, 5 were normal vaginal deliveries, while the remaining 67 (93.1%) were delivered via cesarean section. The reasons for cesarean delivery were either related to SARS-CoV-2 infection (n ​= ​49), existing obstetric problems (n ​= ​15) or fetal-distress (n ​= ​5). All deliveries resulted in live births of COVID-negative babies, with 80.6% (n ​= ​58) of the newborns having a birth weight of over 2.5 ​kg. APGAR scores ranged from 4 to 6 in 61 (84.7%) of the babies, and 10 neonates required resuscitation, of which 8 were managed in the neonatal intensive care unit (NICU). The placental histopathology showed increased fibrin thrombi in 8 cases (11.1%), while 20 cases (28%) showed focal infarction, microcalcification levels were elevated in 16 cases (22.2%), and a small percentage of cases (1.4%) exhibited small fibrotic villi and inter-villus agglutination. Placental chorioangiosis was detected in 28 (38.9%) of the cases, while avascular villi were seen in 6 cases. Meconium-stained liquor was observed in a single case. Intervillous hemorrhage was found in 42 cases, whileintervillous inflammation and increased syncytial knots were present in 14 and 5 cases, respectively. The placenta pathology of 10 neonates who required resuscitation/NICU admission was not significantly different from that of the 62 neonates who did not require it. However, a higher proportion of placenta from the asymptomatic group showed no abnormality compared to the symptomatic group (p ​= ​0.046). ConclusionSARS-CoV-2 infection causes a range of morphological changes and lesions in the placenta, including chorangiosis, villositis, chorioamnionitis, fetal vascular malperfusion/thrombosis, fibrin-deposition, increased syncytial-knotting, increased microcalcification, increased villous agglutination, focal infarct, intervilloushemorrhage as well as inflammation. Placental histopathological findings from this study can provide additional information to the existing literature on the subject.

СРАВНИТЕЛЬНАЯ ОЦЕНКА ТЕЧЕНИЯ И ИСХОДОВ БЕРЕМЕННОСТИ У ПАЦИЕНТОК С НЕДИФФЕРЕНЦИРОВАННОЙ ДИCПЛАЗИЕЙ СОЕДИНИТЕЛЬНОЙ ТКАНИ ПРИ ИСПОЛЬЗОВАНИИ ОБЩЕПРИНЯТОЙ И ПЕРСОНАЛИЗИРОВАННОЙ ПРЕГРАВИДАРНОЙ ПОДГОТОВКИ

Background. Preparation for pregnancy in patients with extragenital pathology is an important problem of current obstetrics. Purpose. To perform comparative assessment of the course and outcomes of pregnancy in patients with undifferentiated connective tissue dysplasia (UCTD) after using conventional and personalized preconception preparation. Material and methods. A total of 262 patients were examined, including 159 with UCTD. Group I (the main group) included 125 patients with minor heart abnormalities and at least 4 signs of undifferentiated connective tissue dysplasia, who underwent the generally accepted preconception preparation: folic acid – 400 μg/day, potassium iodide – 200 μg/day orally for 3 months. Group II (the intervention group) consisted of 34 patients who received personalized preconception preparation: folic acid – 400 μg/day orally, potassium iodide – 200 μg/day orally for 3 months, Mg2+ preparations at a dose of 300 mg/day, glycine –400 mg/day, multivitamin complex containing vitamin B1 (10 mg/day), vitamin B2 (10 mg/day), vitamin B6 (10 mg/day), vitamin E (400 mg/day) for 3 months. Group III (the control group) included 103 patients without signs of UCTD who received a standard amount of preconception preparation. The evaluation of the effectiveness of personalized preconception preparation was carried out according to the criteria of evidence-based medicine. Relative risk (RR), relative risk reduction (RRR), absolute risk reduction (ARR), the number of patients who needed treatment to prevent 1 adverse outcome (NNT), the odds ratio (OR) for a particular outcome were calculated. Results of the study. In the intervention group, statistically significant results were obtained in terms of reducing the risk of developing a threatened miscarriage and preterm birth in patients with undifferentiated connective tissue dysplasia, as well as reducing the absolute risk of developing isthmic-cervical isufficiency. Conclusions. Identification of signs of UCTD at the preconception stage and the use of personalized preconception preparation in this group of patients contributes to the improvement of perinatal outcomes.

Ведення вагітності та розродження жінок з оперованою маткою і локалізацією плаценти на передній стінці матки (огляд літератури)

Purpose – to bring to the attention of obstetrician-gynecologists the relevance of influence of the placental location on the anterior uterine wall in women with an operated uterus after cesarean section (CS) on the course of pregnancy and childbirth with the prevention and minimization of possible complications. The placental location on the anterior wall of the uterus in pregnant women with a uterine scar after CS is the object of research in modern obstetrics. This factor of placental location can affect the course of pregnancy and childbirth, as well as creation increased risk of complications related to the health of the mother and fetus. An operated uterus with placental location on the anterior uterine wall can become a potential etiological factor of perinatal morbidity, which can be accompanied by intrauterine growth restriction, an increase in miscarriage and preterm birth, placenta previa and placenta accreta spectrum frequency, as well as an increased risk of uterine rupture in attempting vaginal birth after cesarean. As commonly stated, optimal conditions for fetal development are created by the placental location at uterus fundus, though labor dystocia is often observed during childbirth in this case. An increase in the percentage of CS and pregnancy in women with a uterine scar is often the cause of the decidual membrane defect and increases the frequency of placenta accretion (placenta accreta/increta/percreta) cases up to 30% in the cohort. One of the possible factors contributing to the attachment of the placenta to the anterior uterine wall is the presence of uterine scar after previous CS. Numerous studies indicate a significant increase in the frequency of placenta accreta cases over the past 20 years due to increase in CS cases and wide implementation of assisted reproductive technologies. Studies according to established criteria are still insufficient in modern obstetrics due to the limited number of pregnant women with localization of the placenta along the anterior wall after CS. More attention in studies is paid to the course of pregnancy and the method of delivery of pregnant women with a scar on the uterus. That states the focus of this article on the importance of clarification the pathogenesis, prevention of complications and delivery of pregnant women with uterine scar after CS and the placental anterior uterine wall localization. These findings confirm the need for further scientific research on this obstetric problem. Understanding the mechanisms behind this etiological connections can contribute to the development of better strategies for monitoring, diagnosis and various options for the delivery with the minimization of possible perinatal complications. No conflict of interests was declared by the authors.

Self-Help Group Therapy as Community Nursing Intervention to Reduce Stress Response and Increase Self-Efficacy in High-Risk Pregnant Women

Background: Unexpected and unanticipated obstetric problems that can have a direct or indirect impact on the well-being of mothers and babies are considered high-risk pregnancies. Uncertainty in health conditions is felt as a life-threatening event that can threaten the lives of mothers and babies. This condition will trigger various stress responses felt by the mother. Moderate to severe stress during pregnancy greatly increases the risk of developing postpartum depression. One of the important coping sources to deal with stress is self-efficacy. Personal abilities are all aspects of an individual that can be utilized to solve problems. One of the interventions that can be used to improve coping mechanisms is self-help groups. Self Help group is a group approach to help its members solve their problems. Purpose: This study aims to determine the impact of self-help groups as therapy in the community to reduce stress responses and increase self-efficacy in high-risk pregnant women. Methods: The research design used was a quasi-experimental one-group pre-test post-test design. 15 respondents were given intervention in 3 sessions for 90 minutes in each session. Stress response and self-efficacy were measured before and after the intervention. Data analysis was carried out using the paired sample T-test. Results: This study shows that the average assessment stress response and self-efficacy score of mothers before the self-help group therapy is 128 and 35. After the therapy, the average response stress and self-efficacy score of mothers was 86 and 53. The study shows the effect of self-help group therapy on stress response (?-value = 0,012) and self-efficacy (?-value = 0,021). Conclusion: It was concluded that self-help group therapy was effective in decreasing stress respons and improving self-efficacy for high-risk pregnant women.

The effectiveness of CRP and leukocyte examinations as a detection of risk factors for pre-eclampsia in pregnant women

Introduction: Preeclampsia is an important problem in obstetrics because it is a pregnancy complication often found and results in high morbidity and mortality in both mother and baby. Preeclampsia is one of the complications of pregnancy that needs to be detected or monitored for symptoms, because in addition to being risky for the mother, it will also have an impact on the occurrence of preterm birth and even further impact, namely fetal death in the womb. This study aimed to determine the effectiveness of CRP and leukocyte examination to detect preeclampsia. Method: This research was conducted at the Jagir Health Center Surabaya in March-July 2022. The research used case control with 30 pregnant women as samples divided into 15 as a control group of normal pregnant women and 15 pregnant women with preeclampsia. Result: The results showed that of the 15 respondents who had preeclampsia more than half (60%) had high leukocyte and CRP levels, the remaining less than half (40%) had normal CRP and leukocyte levels. While in the control group more than half (67%) had normal CRP and leukocyte levels and less than half (33%) had normal CRP and leukocyte levels. The results of data analysis showed p value 0.001 (&lt;0.005), which means there is a relationship between the CRP and leukocytes on the incidence of preeclampsia. Conclusion: Examination of CRP levels and leukocyte count proved effective for detecting the incidence of preeclampsia in pregnant women. It is expected that pregnant women carry out routine pregnancy checks and health workers are expected to routinely carry out early detection to prevent pregnancy complications such as preeclampsia