Premature Birth Rate Research Articles

Clinical and statistical analysis of the course of preterm birth based on the materials of communal enterprise «Regional Perinatal Center of the Rivne Regional Council» in 2013–2023 years

One of the priority tasks of modern medical science and practice is the preservation of reproductive health and the gene pool of the nation. It is especially difficult to perform this task during the russian war in Ukraine, which has been going on for more than ten years. According to sociologists, the outcomes of a low birth rate for the country will be catastrophic precisely because of the war.One of the reasons for the decline in the quality of health in the future is the increase in the specific weight of premature births, the frequency of which, according to the World Health Organization, has increased in Ukraine already after six months of full-scale war.The objective: to conduct an analysis of the course of premature births in the conditions of war based on the materials of the communal enterprise (CE) “Regional Perinatal Center of the Rivne Regional Council” for 2013–2023.Materials and methods. A retrospective clinical and statistical analysis of 2,742 histories of pregnancy and childbirth of women who were in labor between 22/0–36/6 weeks of gestation in obstetric departments of the communal enterprise “Regional Perinatal Center of the Rivne Regional Council” in 2013–2023 was carried out.Results. According to CE “Regional Perinatal Center of the Rivne Regional Council”, a progressive decrease in the total number of births by 41.9% was observed in the Rivne Region from 2013 to 2023. At the same time, in the general population of women giving birth, the specific rate of premature births did not have a tendency to increase.In the structure of preterm births, early and late preterm births prevailed. The specific gravity of very early preterm births, which are the most unfavorable for perinatal outcomes, did not have a sustained upward trend. At the same time, the frequency of too early premature births among residents of districts and territorial communities of the Rivne region has significantly increased (2013 – 19 (79.2%) cases, 2023 – 17 (100.0%) cases; p<0.05).Every second premature birth occurred within the first day of hospitalization of a pregnant woman, while the specific rate of such too early premature births increased by 3.4 times during the analyzed period, which significantly worsens the chances of survival of newborns and is the reason for their high perinatal morbidity.The number of premature births in pregnant women with multiple pregnancies remains stable. Every third preterm birth took place on the background of early premature rupture of the fetal membranes, while a significant increase in the frequency of this complication was found in women who gave birth at 22/0–27/6 weeks of pregnancy.Traditionally, the specific rate (55.7–57.5%) of surgical delivery by caesarean section of pregnant women and mothers with premature births remains high, which contributed to a reliable reduction of the perinatal mortality rate of premature babies by 13.7% due to the reduction of antenatal losses. Indicators of early neonatal death were formed at the expense of newborns from too early and early premature births in the same ratio.Conclusions. According to thedata of CE “Regional Perinatal Center of the Rivne Regional Council”, there was a progressive decrease in the birth rate in the Rivne Region with a simultaneous stabilization of the number of premature births. The widespread use of a holistic approach during the medical care of pregnant women and the introduction of modern methods of care for premature newborns ensured a significant decrease in the rate of perinatal death of premature infants due to the reduction of antenatal losses.

Prenatal diagnosis in fetal right aortic arch using chromosomal microarray analysis and whole exome sequencing: a Chinese single-center retrospective study

BackgroundRight aortic arch (RAA) is a common congenital aortic arch abnormality. Fetuses with RAA frequently have good outcomes after birth. However, chromosomal abnormalities and genetic syndromes suggest poor prognosis for these patients. So far the underlying genetic etiology is still not identified in most RAA patients based on traditional genetic techniques and a problem is still debated whether fetuses with isolated RAA should be referred for CMA. Our study aims to investigate the genetic etiology of fetuses with right aortic arch (RAA) by chromosomal microarray analysis (CMA) and whole exome sequencing (WES) and evaluate the efficacy of CMA in fetal isolated RAA.ResultsAmong these 153 fetuses, 99 (64.7%) with isolated RAA and 54 (35.3%) with non-isolated RAA; 25.5% (39/153) with additional intracardiac anomalies (ICA), and 19.0% (29/153) with extracardiac anomalies (ECA). Tetralogy of Fallot (n = 10) and persistent left superior vena cava (n = 11) are the most common ICA and ECA, respectively. CMA detected 15 clinically significant copy number variations (CNVs) in 14 cases (9.2%); microdeletion of 22q11.21 was the most common pathogenic CNVs (7.8%). The chromosomal abnormalities rate was higher in non-isolated RAA and RAA with ICA groups than in isolated RAA group (16.7% vs. 5.1%; 20% vs. 5.1%, both p < 0.05). From five cases further undergoing WES, a diagnostic variant in MTOR gene (c.7255G > A, de novo) was first reported in prenatal, extending the prenatal manifestation of Smith–Kingsmore syndrome (OMIM: 616638); a clinically relevant variant c.3407A > T in STAG2 was identified, being inherited from the healthy mother. Moreover, the premature birth and termination rates were higher in non-isolated RAA group than in isolated RAA group (11.1% vs. 1.0%; 37.0% vs. 2.0%, both p < 0.01).ConclusionsWe demonstrate that CMA and WES are useful diagnostic tools for fetal RAA, particularly non-isolated RAA, and all fetuses with RAA should be referred for CMA. The data probably aids in prenatal diagnosis and prenatal counseling of fetal RAA.

Placental Pathologic Features and Perinatal Outcomes in Pregnant Woman With Autoimmune Connective Tissue Disease.

We aimed to investigate the association between perinatal outcomes and placental pathological features in pregnant women with ACTD, including systemic lupus erythematosus (SLE), antiphospholipid antibody syndrome (APS), and undifferentiated connective tissue disease (UCTD). Placental tissue from SLE (n=44), APS (n=45), and UCTD (n=45) were included, and contemporaneous deliveries of placenta were served as a control group (n=46) between September 2015 and March 2021. The placental histopathology was evaluated using the Manual of Human Placental Pathology and classified according to the Amsterdam consensus framework. SLE pregnant women have a higher rate of cesarean section (61.40%), premature birth (24.56%), and SGA (26.32%) when compared to control group (p=0.008, p=0.005, and p=0.000, respectively). The rate of vascular malperfusion, inflammatory-immune lesions, and other placental lesions in the SLE group was 47.73%, 56.82%, and 63.64%, which were higher than the control group (p=0.000, p=0.000, and p=0.006, respectively). In the meantime, the incidence of inflammatory-immune lesions in the APS group (42.22%, p=0.004) and vascular malperfusion in the UCTD group (37.78%, p=0.007) were increased when compared to the control group. SLE appeared to confer increased risk for a wide range of adverse perinatal outcomes. We determined elevated placental histopathology risk for most women with ACTD, including vascular maldevelopment, vascular malperfusion, and inflammatory-immune lesions.

«Perinatal portrait», reproductive health parameters and risk factors for fat metabolism disorders in young overweight women

Overweight and obesity are one of the most serious social and medical problems today. It is appropriate to single out a special category of young women aged 18–35 years with excessive body weight, that is, the age which is capable of ensuring the reproductive potential of the future.The objective: to determine the probable factors of metabolic imbalance and the main parameters of reproductive health disorders in young overweight women.Materials and methods. Reproductive health parameters and the main predictors of its impairment were evaluated in two groups of patients – the main group (890 women with BMI &gt; 25.0 kg/m2) and a control group (40 patients with BMI of 18.5–24.9 kg/m2).The main group was divided into two subgroups taking into account the age of formation of overweight and obesity: I subgroup – 596 women with pubertal obesity (66.9%) and II subgroup – 294 women with overweight in the postpubertal period (33.1%).Results. A high rate of pregnancy complications (86.9%), gestational diabetes (25.8%), preeclampsia (34.1%), premature birth and low birth weight fetus (20.9%), as well as the birth of a girl with a large body weight (24.4%), can become modified factors in the formation of the reproductive system according to the characteristics of the “perinatal portrait” and form the basis of screening programs. The relationship between the early introduction of complementary foods and the absence of breastfeeding and the presence of obesity in the girl in the future was established (OR=7.25; 95% CI: 2.99–17.59; χ2=23.53, p&lt;0.0001).Attention should be paid to reproductive function disorders: amenorrhea was found 1.7 times more often in the case of postpubertal obesity, as well as abnormal uterine bleeding or metrorrhagia, infertility (24.4%), dyshormonal breast diseases (34.7%), polycystic ovary syndrome (59.8%), proliferative processes of the endometrium and myometrium (34.7%), as well as the formation of endometrial hyperplasia and polyposis with age (25.8%).A high percentage of stressogenic factors was determined in the examined cohort of patients, which could initiate the manifestation of metabolic and endocrine disorders in 569 cases – 63.9% (OR=4.14; 95% CI: 2.07–8.25; χ2=17.38, p&lt;0.0001).Conclusions. Probable predictors of impaired fat metabolism in young women were statistically identified: heredity from the mothers of such patients regarding metabolic and endocrine disorders, body weight at birth more than 4000 g and artificial feeding, early age of menarche, pubertal paratrophy, stress factors, infectious diseases during menarche, hypodynamia and a high level of intellectual differentiation.The reproductive health of women with overweight and obesity is characterized by a high frequency of menstrual cycle disorders, increased manifestations of changes in the vaginal microbiome and dysuric symptoms, as well as infertility, hormone-dependent diseases, and impaired reproductive function.

End-organ damage from neonatal invasive fungal infection: a 14-year retrospective study from a tertiary center in China

BackgroundInvasive fungal infection (IFI) has become an increasing problem in NICU neonates, and end-organ damage (EOD) from IFI is one of the leading causes of morbidity and mortality in neonates. This study was conducted to summarize clinical data on epidemiology, risk factors, causative pathogens, and clinical outcomes of IFI-associated EOD among neonates in a center in China for the sake of providing references for prevention and treatment of fungal infections in neonates in future.MethodsThe clinical data of IFI neonates who received treatment in a tertiary NICU of China from January 2009 to December 2022 were retrospectively analyzed, including causative pathogens and the incidence of EOD. The neonates were divided into EOD group and non-EOD (NEOD) group. The general characteristics, risk factors and clinical outcomes of the two groups were compared.ResultsIncluded in this study were 223 IFI neonates (137 male and 86 female) with a median gestational age (GA) of 30.71 (29,35) weeks and a median birth weight (BW) of 1470 (1120,2150) g. Of them, 79.4% were preterm infants and 50.2% were born at a GA of ≥ 28, <32 weeks, and 37.7% with BW of 1000–1499 g. Candida albicans (C. albicans) was the most common Candida spp. in these neonates, accounting for 41.3% of all cases, followed by C. parapsilosis (30.5%) and C. glabrata (7.2%). EOD occurred in 40 (17.9%) of the 223 cases. Fungal meningitis was the most common EOD, accounting for 13.5% of the 40 EOD cases. There was no significant difference in the premature birth rate, delivery mode, GA and BW between EOD and NEOD groups, but the proportion of male infants with EOD was higher than that without. There was no significant difference in antenatal corticosteroid use, endotracheal intubation, invasive procedures, use of antibiotics, total parenteral nutrition, blood transfusion, postnatal corticosteroid use, fungal prophylaxis and the incidence of necrotizing enterocolitis between the two groups, but the proportion of C. albicans infection cases in EOD group was higher than that in NEOD group (57.5% vs. 37.7%). Compared with NEOD group, the proportion of cured or improved infants in EOD group was significantly lower (P < 0.05), and the number of infants who died or withdrew from treatment was larger (P < 0.05).ConclusionsOur retrospective study showed that preterm infants were prone to fungal infection, especially very preterm infants. C. albicans was the most common Candida spp. for IFI, and was a high-risk factor for EOD. EOD can occur in both full-term and premature infants, so the possibility of EOD should be considered in all infants with IFI.

Effect of extended precision nursing on neurobehavioral function and pregnancy outcome in patients with threatened abortion.

This study aimed to assess the impact of continuous precision nursing on neurobehavioral function and pregnancy outcomes in patients experiencing threatened abortion. A total of 130 patients with early threatened abortion admitted to our hospital between October 2020 and January 2023 were selected and categorized into 2 groups based on intervention methods. The control group received routine nursing intervention, whereas the observation group received continuous precision nursing intervention. Changes in affective status scores, SF-36 scores, knowledge mastery scores, and satisfaction scores in the neurobehavioral function test before and after intervention were recorded in both groups. Additionally, pregnancy outcomes, obstetric adverse reaction rates, and neonatal conditions were documented. Following intervention, scores for tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment gradually decreased in both groups, with significantly lower scores observed in the observation group compared to the control group (P < .05). SF-36 scores in 8 dimensions, including physical functioning, role-physical, bodily pain, and overall health rating, showed a gradual increase in both groups, with the observation group scoring higher than the control group (P < .05). Knowledge mastery and satisfaction scores also increased significantly after intervention, with the observation group surpassing the control group (P < .05). The observation group exhibited lower rates of abortion and premature birth, along with a higher rate of full-term pregnancy compared to the control group, with statistically significant differences (P < .05). Furthermore, the observation group displayed lower rates of adverse reactions and low birth weight infants, with significant differences compared to the control group (P < .05). No significant differences were observed in neonatal mortality and neonatal intensive care unit transfer rates between the observation and control groups (P > .05). Continuous precision nursing contributes to improved pregnancy outcomes for patients with threatened miscarriage within the first 12 weeks of pregnancy. This comprehensive care approach is associated with enhanced knowledge retention, protection of neurological function, and an overall improvement in quality of life.

Internet-Based Interventions for Preventing Premature Birth Among Pregnant Women: Systematic Review.

Premature birth rates have slightly increased globally, making its prevention critical for both short-term and long-term health outcomes. Various interventions have been developed in response to the multifaceted risk factors for premature birth, including internet-based programs. These programs offer accessibility and enhanced engagement; however, their overall efficacy in preventing premature births requires thorough evaluation. This systematic review aims to identify the study designs and assess the effectiveness of internet-based interventions in preventing premature birth among pregnant women. A comprehensive search of the MEDLINE, Embase, CINAHL, and Cochrane Library databases was conducted to identify randomized trials and quasi-experimental studies evaluating internet-based interventions for premature birth prevention in pregnant women. The search was inclusive, with no restrictions based on language or geographical location, allowing for a comprehensive global perspective. The time frame for the inclusion of studies extended until February 2023. The risk of bias (RoB) in each study was independently assessed by 3 authors forming pairs, using the revised Cochrane RoB tool (RoB 2) for randomized trials, as per the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Owing to heterogeneity in populations, measurements, and interventions, a meta-analysis was not conducted. This review included 26 articles, comprising 12 intention-to-treat and 14 per-protocol studies. The overall RoB was high in most intention-to-treat studies and of some concern in most per-protocol studies. The target populations varied, including nonspecific pregnant women, those with gestational diabetes mellitus (GDM) or those at risk of GDM, individuals with anxiety or depression, and those experiencing preterm labor. Psychosocial, physiological, and wellness health outcomes were evaluated. Internet-based interventions effectively reduced stress/distress in nonspecific pregnant women but not in those experiencing preterm labor. Their effectiveness in reducing anxiety and depression varied, with inconsistent results among different groups. In women with GDM or those at risk of GDM, interventions successfully controlled fasting plasma glucose and 2-hour postprandial plasma glucose levels but did not consistently manage glycated hemoglobin levels. These interventions did not reduce the incidence of premature births across the various populations studied. The effectiveness of these internet-based interventions in addressing substance or alcohol abuse and insomnia also varied. Internet-based interventions show promise in improving psychosocial health and managing blood sugar to prevent premature birth, highlighting variability in effectiveness across different risk factors. Further research, including clinical trials, is vital for developing, evaluating, and disseminating effective, safe internet-based interventions. Establishing standardized measurement tools and rigorous evaluation processes is crucial for enhancing these interventions' effectiveness and reliability in clinical practice, significantly contributing to preventing premature births and improving maternal health outcomes. PROSPERO CRD42021278847; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021278847.

COMPARATIVE OUTCOME OF NEONATES BORN TO SARS-COV2 (RTPCR TEST) POSITIVE MOTHERS IN 1ST, 2ND, AND 3RD WAVE OF COVID PANDEMIC AT A TERTIARY CARE HOSPITAL IN NORTH INDIA

Aims and Objectives: To access the incidence of perinatal transmission of SARS‑CoV‑2 virus from pregnant mothers having RTPCR test positive for SARS‑CoV‑2 virus to their newborn babies, to evaluate the morbidity and mortality in these neonates, and to compare the outcomes of these neonates during the first, second, and third waves of the COVID pandemic (March 2020–July 2022) admitted at a tertiary care health facility in North India (Punjab). Methods: Data were retrospectively gathered from hospital records for all neonates born to pregnant women who had tested positive for the virus using the RTPCR method from March 2020 to July 2022, when the SARS‑CoV‑2 pandemic was in full swing. In order to assess the relationship between various maternal and perinatal risk factors, a thorough history of the neonate and the pregnant mother was recorded. Results: During the COVID-19 outbreak, 168 neonates in total were born to mothers who tested positive for the SARS‑CoV‑2 virus. The majority of these neonates were healthy, although the premature birth rate was higher. Our study’s results show a statistically significant relationship between pregnancy-related issues and newborn problems like premature births, low neonatal weight, newborns exhibiting one or more disease symptoms, and poorer neonatal outcomes. Conclusions: According to our research, there was very little perinatal transmission of the SARS‑CoV‑2 virus from the pregnant mothers to the newborns. Although there were more premature babies, most of them managed to survive.

Clinical features of recurrent preeclampsia: a retrospective study of 109 recurrent preeclampsia patients.

Our study aimed to investigate the clinical features of recurrent preeclampsia (rPE) and evaluate the preventive effect of low-dose aspirin (LDA) in rPE. We retrospectively analyzed the data of 109 patients who experienced preeclampsia in two consecutive pregnancies and delivered at Peking University First Hospital from January 2016 to December 2022. We analyzed the pregnancy outcomes of patients with rPE and assessed whether the use of LDA during pregnancy could improve these outcomes. Our results revealed that patients with rPE had a higher body mass index (BMI) and a higher incidence of diabetes during pregnancy compared to their first onset of preeclampsia (29.01 ± 4.70 kg/m2 vs. 27.13 ± 4.25 kg/m2, P < 0.05; 11.01% vs. 1.83%, P < 0.05). Furthermore, the incidence of severe preeclampsia was higher at recurrence in patients with rPE compared to their first onset (83.49% vs. 70.64%, P < 0.05), as well as the incidence of severe preeclampsia with chronic hypertension (34.86% vs. 8.26%, P < 0.05). Additionally, the incidence of gestational diabetes and postpartum hemorrhage was higher in patients with rPE compared to their first preeclampsia onset (25.69% vs. 5.50%, P < 0.05; 20.18% vs. 5.83%, P < 0.05). Compared to the first onset of preeclampsia, patients with rPE had an earlier gestational age at delivery (35.42 ± 3.06 weeks vs. 36.60 ± 2.74 weeks, P < 0.05), lower birth weight of neonates (2478.39 ± 828.44 g vs. 2883.71 ± 712.94 g, P < 0.05), and a higher risk of premature birth (67.00% vs. 47.19%, P < 0.05). However, in patients with rPE, the use of LDA delayed the gestational age at delivery, increased the birth weight of the neonate, reduced the premature birth rate, and increased the perinatal survival rate. In conclusion, patients with rPE are at an increased risk of adverse maternal and fetal outcomes. However, the use of LDA during pregnancy effectively improves these outcomes.

Clinical Characteristics, Outcomes, and Risk Factors for Mortality in Pregnant/Puerperal Women with COVID-19 Admitted to ICU in Turkey: A Multicenter, Retrospective Study from a Middle-Income Country.

Coronaviruses have been the cause of 3 major outbreaks during the last 2 decades. Information on coronavirus diseases in pregnant women is limited, and even less is known about seriously ill pregnant women. Data are also lacking regarding the real burden of coronavirus disease 2019 (COVID-19) infection in pregnant women from low/middle-income countries. The aim of this study was to determine the characteristics and clinical course of COVID-19 in pregnant/puerperal women admitted to ICUs in Turkey. This was a national, multicenter, retrospective study. The study population comprised all SARS-CoV-2-infected pregnant/puerperal women admitted to participating ICUs between 1 March 2020 and 1 January 2022. Data regarding demographics, comorbidities, illness severity, therapies, extrapulmonary organ injuries, non-COVID-19 infections, and maternal and fetal/neonatal outcomes were recorded. LASSO logistic regression and multiple logistic regression analyses were used to identify predictive variables in terms of ICU mortality. A total of 597 patients (341 pregnant women, 255 puerperal women) from 59 ICUs in 44 hospitals were included and of these patients, 87.1% were unvaccinated. The primary reason for ICU admission was acute hypoxemic respiratory failure in 522 (87.4%), acute hypoxemic respiratory failure plus shock in 14 (2.3%), ischemic cerebrovascular accident (CVA) in 5 (0.8%), preeclampsia/eclampsia/HELLP syndrome in 6 (1.0%), and post-caesarean follow-up in 36 (6.0%). Nonsurvivors were sicker than survivors upon ICU admission, with higher APACHE II (p < 0.001) and SOFA scores (p < 0.001). A total of 181 (30.3%) women died and 280 (46.6%) had received invasive mechanical ventilation (IMV). Myocardial injury, the highest SOFA score during ICU stay, LDH levels on admission, the highest levels of AST during ICU stay, average daily dose of corticosteroids, IMV, prophylactic dose anticoagulation (compared with therapeutic dose anticoagulation), PaO2/FiO2 ratio <100, pulmonary embolism, and shock were identified as predictors of mortality. Rates of premature birth (46.4%), cesarean section (53.7%), fetal distress (15.3%), stillbirth (6.5%), and low birth weight (19.4%) were high. Rates of neonatal death (8%) and respiratory distress syndrome (21%) were also high among live-born infants. Severe/critical COVID-19 infection during the pregnancy/puerperal period was associated with high maternal mortality and fetal/neonatal complication rates in Turkey.

Exploring Risk Factors and Perinatal Outcomes of Preterm Birth in a Tertiary Care Hospital: A Comprehensive Analysis.

Background Preterm birth before 37 weeks of gestation is a global public health challenge, particularly in India, where the prevalence varies regionally. Understanding risk factors, such as maternal age and complications like hypertensive disorders, is vital. India's diverse healthcare landscape and regional disparities further complicate this issue. Preterm infants face increased mortality and morbidity risks like respiratory distress and intraventricular hemorrhage. This study in a tertiary care hospital aimed to analyze risk factors, assess perinatal outcomes, and contribute to the understanding of preterm birth in this complex context, providing valuable insights for maternal and child health strategies. Methods This retrospective cohort study was conducted at the Venkateshwara Institute of Medical Science, Rajabpur, over one year, extracting data from electronic health records. The study aimed to analyze risk factors associated with preterm delivery and assess perinatal outcomes. The study included diverse pregnancies, both singleton and multiple gestations, and employed sample size calculations to ensure statistical validity. Trained medical personnel collected extensive data on maternal characteristics, obstetric history, antenatal care, perinatal outcomes, and mode of delivery. Statistical analysis, utilizing SPSS (IBM, Chicago, USA), involved descriptive statistics, comparative analysis, chi-square tests, t-tests, Mann-Whitney U tests, and multivariate logistic regression models. Findings with a p-value <0.05 were considered significant. Results The study included 2042 deliveries, with a preterm birth prevalence of 14.2%. Multiparous women had higher preterm birth rates than primigravida (72.92% vs. 27.08%). Maternal age, history of preterm delivery, hypertensive disorders, inadequate antenatal care compliance, previous cesarean section, multiple gestations, antepartum hemorrhage (APH), polyhydramnios, oligohydramnios, and premature rupture of membranes (PROM) were significantly associated with preterm birth. Apgar scores at one minute and five minutes, neonatal complications, and mortality rates were notably worse among preterm births. Vaginal delivery rates were significantly lower in the preterm group (36.3%) compared to full-term deliveries (48.8%), with a higher rate of emergency cesarean sections (19.7% vs. 10.8%). Conclusion This study provides valuable insights into the risk factors and perinatal outcomes of preterm delivery at a tertiary care hospital, with precise values illustrating the extent of associations. The findings such as history of preterm delivery, hypertensive disorders, and inadequate antenatal care compliance as the most commonly associated conditions with preterm birthand management of such associated conditions may help reduce the rate of premature birth.

Fertility policy changes, maternal and foetal characteristics and birth timing patterns at a tertiary referral centre in Beijing: a ten-year retrospective study

ObjectiveThis study aimed to explore the impacts of the changing national fertility policy on maternal and fetal characteristics, and birth timing patterns and provide a basis for the management of...

Uzrok prevremenog porođaja kao prognostički faktor neonatalnog ishoda i načina završavanja porođaja

Introduction: Premature birth, occurring before the 37th gestational week, is commonly attributed to uterine contractions, premature rupture of the amniotic sac, or placental abruption. In 20% - 30% cases involving maternal or fetal complications, premature birth may be induced, often due to conditions such as preeclampsia, fetal growth retardation, or severe maternal heart disease. Aim: The study aims to determine whether the cause and time of preterm birth affect the neonatal outcome. Material and methods: This retrospective study analyzes patients prematurely born at the Obstetrics and Gynecology Clinic Narodni Front in 2020, the cause of their premature birth, as well as the status of the fetus after birth. In the study, we compared the neonatal outcome in spontaneously induced preterm birth. Results: Among all the births (n = 4,211), in the period between July and December 2020, there were 498 preterm births, i.e., 11.83%. Based on the data on the status of the premature infants' vital signs, the percentage of stillborn preterm infants was 8.9% while the percentage of live births was 91.1%. The Apgar score was the highest in neonates born by vaginal birth after the 34th week of gestation, with intact fetal membranes and spontaneous contractions. According to the study, 54.1% of preterm births ended in cesarean section due to gestational age younger than 28 weeks and with a predominantly pelvic presentation of the fetus. Conclusion: The high rate of premature births highlights a serious problem and suggests a continued rising trend, despite preventive efforts. Improved outcomes are seen in pregnancies reaching later gestational weeks, particularly after the 34th week of gestation, with intact fetal membranes and no signs of infection. Spontaneously born premature infants tend to have higher Apgar scores and better neonatal outcomes, as compared to induced births.

Pathological Changes and Pregnancy Outcomes in Cervical Intraepithelial Neoplasia Patients After Cold Knife Conization.

Analyze women treated with underwent cold knife conization (CKC) to remove advanced squamous intraepithelial lesions (CIN) of the cervix. The histopathological upgrading of the lesions previously detected on vaginal biopsy and postoperative pregnancy outcomes of were investigated, to identify high-risk subgroups in women. A retrospective study was conducted at the First Central Hospital of Baoding City from June 2019 to December 2022 to analyze confirmed cases of Cervical Intraepithelial Neoplasia CIN-II and CIN-III. Investigation of pathological changes in postoperative pathological tissues, and to perform binary logistic analysis to identify risk factors for histopathological escalation in postoperative lesions. We analyze the effects of CKC surgery on pregnancy outcomes in patients by comparing against a control group of healthy pregnant women. Out of the 176 patients diagnosed with CIN-II who underwent cervical biopsy, 39 (22.16%) were found to have a final specimen diagnosis of CIN-III, while 7 (3.98%) were downgraded to CIN-I. Among the 108 patients diagnosed with CIN-III who underwent cervical biopsy, 7 cases (6.48%) were ultimately confirmed to have CIN-III. Ki67-positive, p16-positive (OR = 1.13, 95% CI 1.01-1.15), and colposcopy biopsy for CIN-II (OR = 1.59, 95% CI 1.33-3.6) were independent risk factors for pathological upgrade after CKC. Compared with healthy pregnant women, CIN patients had higher rates of premature birth (14.4%), premature rupture of the fetal membrane (13.6%), and cesarean section (37.5%) (P < 0.05). The mode of conception, abortion rate, ectopic pregnancy rate, and postpartum hemorrhage were not different between healthy pregnant women and CIN patients (P > 0.05). Following cervical multi-point biopsy or CKC, along with pathological examination, the accurate diagnosis of cervical lesions is crucial as it allows for more precise identification of such lesions. Additionally, CKC increases the risk of premature birth, premature rupture of membranes, and the need for cesarean section.

How Did the COVID-19 Pandemic Affect Maternal and Neonatal Health?

The aim of this study was to investigate the effects of the coronavirus disease 2019 (COVID-19) pandemic on the proportional growth of the fetus, maternal health, and neonatal outcomes. The study group (Group 1) included pregnant women with a history of COVID-19. Pregnant women who were hospitalized during the same period without COVID-19 were the control group (Group 2). Maternal and neonatal outcomes were compared between the groups. A total of 230 pregnant women and their infants were assessed. Group 1 (n = 74) had significantly higher rates of diabetes mellitus and hypertension than Group 2 (n = 156; p = 0.015 and 0.014, respectively). Premature birth and cesarean section rates were also significantly higher in Group 1 than in Group 2 (p = 0.001 and 0.040, respectively). While the rate of iatrogenic preterm birth was significantly higher in Group 1, the rate of spontaneous preterm birth was significantly higher in Group 2 (p = 0.049). Infants born to COVID-19-positive mothers had lower median gestational age, birth weight, and Apgar scores (p < 0.01). There was no significant difference between the groups in terms of the results of cord blood gas analysis (p > 0.05). The rate of admission to the neonatal intensive care unit (NICU) and need for mechanical ventilation was significantly higher in infants of COVID-19-positive mothers (p < 0.05 for both). The length of stay in the NICU was also significantly longer for the infants of COVID-19-positive mothers (p < 0.05). Birth weights decreased due to increased cases of iatrogenic preterm births (p < 0.05). However, ponderal indices (PIs) of newborns of pregnant COVID-19 mothers did not differ at birth (p > 0.05). COVID-19 is associated with low Apgar scores, increased risk of premature birth complications, and maternal comorbidities, with no effect on the PI and proportionate growth of the infant at birth. · No difference in ponderal indices.. · No difference in postnatal cardiovascular adaptation.. · COVID-19 is frequent in pregnant women with comorbidities like diabetes mellitus and hypertension..

Editorial

Editorial

Critical Need For Breastmilk Collection Centres For High-risk Premature Babies

Premature babies are very vulnerable and exposed to various life-threatening diseases. World Health Organization reported that many premature babies were saved from morbidity and mortality when they were fed with breastmilk starting from within the first hour after their birth. The rate of premature birth in Malaysia has increased exponentially since 2018—more than 20 percent premature births. Therefore, hospitals should have enough supplies of breastmilk to save the lives of the precious premature babies. However, only one hospital in Malaysia provides supplies of breastmilk on demand. This study employed philosophical method to argue for the establishment of breastmilk collection centre. It examined the concept of maqāṣid al-sharīʿah to justify the proposal of the establishment of breastmilk collection centres in hospitals throughout Malaysia to save the lives, intellects, and progenies of the at-risk premature babies. The primary issues resulting from breastmilk sharing according to Islamic perspective were examined and practical steps were proposed to rectify them. The steps involved obtaining signed consent from wet nurse and her husband; screening of wet nurse’s health and personality characteristics; screening of the breastmilk by the milk collection centre; obtaining signed consent from the premature baby’s parents; feeding breastmilk to the premature baby with the consent of witnesses; meeting between wet nurse and her family and the baby’s parents and family; and completing wet nursing document to be given to the newly formed milk kinship family.

Effectiveness of the Preterm Labor Prevention Program for High-Risk Pregnant Women: A Randomized Controlled Trial

Preterm labor significantly impacts premature birth, influencing infant development and health outcomes. This randomized controlled trial aimed to develop and test the effectiveness of the Preterm Labor Prevention Program on primary outcomes (knowledge, attitudes, self-care practices) and secondary outcomes (preterm labor, preterm birth rates). Sixty-six high-risk participants aged 15-49 attending antenatal care clinics in Northeastern Thailand were selected using multi-stage random sampling. They were randomly assigned to either the experimental group (n = 32) receiving the Preterm Labor Prevention Program in addition to routine care or the control group (n = 34) receiving routine care. Data collection employed questionnaires on knowledge, attitude, self-care practice, preterm labor, and preterm birth rates. Data were analyzed using one-way repeated measures ANOVA for knowledge, attitudes, and self-care practice scores across three-time points at baseline before the intervention, immediately and four weeks after program completion, and chi-square tests for comparing preterm labor and premature birth rates across groups. Results indicated that the mean score of knowledge, attitude, and self-care practice in the experiment group was significantly increased over time immediately and four weeks after program completion and significantly higher than that of the control group at both time points. Furthermore, the incidence of preterm labor and the preterm birth rate in the experiment group were 6.25% and 3.10%, respectively. However, the incidence of preterm labor and the preterm birth rate in the control group were equal at 20.60%. Nurses and midwives can apply this program to increase knowledge, more positive attitudes, and practice to reduce preterm labor and preterm birth in high-risk pregnancies, but first, testing of the program is required with an increased number of participants.

Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease

Background During pregnancy and delivery, hemodynamics are altered and complex congenital heart disease has been associated with adverse maternal and neonatal outcomes. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. Materials and methods We studied women with ACHD discussed at multidisciplinary conferences at Lund University Hospital March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n = 36, 24.1%), II (n = 43, 28.9%), II-III (n = 43, 28.9%), III (n = 24, 16.1%) and IV (n = 3, 2.0%). Results Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, (OR, 5.1; 95% CI, 2.0–12.5; p&lt;0.001). The odds of premature delivery were significantly higher among pregnant women with mWHO class ≥III (OR, 6.7; 95% CI, 2.6–17.4; p&lt;0.001). We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes, hemorrhage &gt;1000 ml or cardiac defect in the neonate depending on WHO-class. Women in mWHO classes III-IV had a higher rate of fetal growth restriction (FGR) compared to women in mWHO classes I, II, II-III (p&lt;0.007). Conclusions Our findings indicate that women with more complex heart disease (mWHO classes III or IV) tend to have a higher rate of cesarean section, premature birth and FGR.

Increased cesarean section rate and premature birth according to modified WHO maternal cardiovascular risk in pregnant women with congenital heart disease

Abstract Background During pregnancy and delivery, hemodynamics are altered, and women with adult congenital heart disease (ACHD) might have a higher risk of obstetric and neonatal complications. We sought to investigate pregnancy outcome and complications in relation to complexity of heart condition. Materials and methods We studied women with ACHD discussed at multidisciplinary conferences March 2009-May 2021. We studied 149 pregnancies in 101 women. We scored each woman retrospectively according to the modified World Health Organization (mWHO) risk classification and included patients in risk class I (n=36, 24.1%), II (n=43, 28.9%), II-III (n=43, 28.9%), III (n=24, 16.1% and IV (n=3, 2.0%). Relative risks were assessed with logistic regression adjusting for parity and age. Results Women with mWHO class ≥III underwent cesarean section more often than women in less complex mWHO classes, p&amp;lt;0.001. Women in mWHO classes I, II and II-III were 83.8% (CI 54.4%-94.2% p&amp;lt;0.001) less likely to give birth prematurely compared to women in mWHO classes III and IV. We found no difference in incidence of preeclampsia, gestational hypertension, gestational diabetes or hemorrhage &amp;gt;1000 ml depending on WHO-class (table 1). Women in mWHO classes III-IV had a higher rate of fetal growth restriction compared to women in mWHO classes I, II, II-III (p&amp;lt;0.007). Conclusions Women with complex congenital heart disease (mWHO ≥III) tend to have a higher rate of cesarean section, premature birth and fetal growth restriction.Table 1