Reduce Pregnancy Complications Research Articles

Artificial Intelligence: Introducing to the Field of Infertility on Patient Having Ovarian Cancer

Artificial intelligence (AI) is a human-invented technology that is supposed to perform specific tasks more quickly and with fewer resources. Machine data base or machine calculation is much accurate, which shows a positive point towards patient safety.AI is a discipline of computer science that focuses on developing intelligent machines that can accomplish tasks that would normally need human intelligence. Ovarian cancer is such a widespread disease that it is observed all over the world. It may cause infertility since it has a direct effect on the reproductive organs.AI will play a critical role in future IVF facilities, boosting outcomes and reducing pregnancy complications. This review article looks at how artificial intelligence (AI) can help infertile ovarian cancer patients. In the field of infertility, Artificial intelligence (AI) is a well-developed platform. Patients with ovarian cancer may experience infertility.If a patient is able to conceive following ovarian cancer, there is a higher risk of disease transmission from parent to offspring through gene.Through gene mapping, AI can read the gene coding and alert to the impact of diseases, reducing the danger of disease transmission. It may also reduce the pregnancy complication.

Impact of Bifidobacterium longum1714® on maternal cytokine response in peripheral blood mononuclear cells

PurposeThe maternal immune system is implicated in adverse pregnancy outcomes. Manipulation of maternal immune response by probiotics holds potential to reduce pregnancy complications. The MicrobeMom2 study investigates the impact of probiotic supplementation on maternal immune responses to pathogen associated molecular patterns (PAMPs) in peripheral blood mononuclear cells (PBMCs) during pregnancy. MethodsThis double-blinded randomised-controlled trial involved oral supplementation of Bifidobacterium longum subsp. longum 1714® (B. longum 1714; daily ingestion of a minimum of 1x109 colony forming units) or placebo from 16 to 20-weeks’ gestation until delivery in healthy pregnant women. The primary outcome was a change in IL-10 production, after stimulation with Lipopolysaccharide (LPS) or anti-CD3/28/2, in PBMCs isolated from blood samples taken at baseline (11–15 weeks’ gestation) and late pregnancy (28–32 weeks’ gestation) after 48 h incubation. 68 subjects were needed (34ineachgroup) for 80 % power at an alpha significance of 0.05 to detect differences in IL10. Results72 women (mean ± SD age 33.17 ± 4.53 years and median (25th, 75th centile) body mass index 24.93 (21.93, 27.57 kg/m2)) were recruited with primary outcome data. Using LPS, late pregnancy fold change in IL-10 in PBMCs after 48 h incubation was median (25th, 75th centile) 88.45 (4.88, 488.78) in the intervention, 24.18 (6.36, 141.17) in the control group, p = 0.183. Using anti-CD3/28/2, values were 189.69 (425.96, 866.57),148.74 (31.67, 887.03) in intervention and control groups, respectively, p = 0.506. No significant differences were observed between the two groups. ConclusionMaternal antenatal supplementation with B. longum 1714 did not alter cytokine production by maternal PBMCs in response to PAMPs or anti-CD3/28/2.Trial registration number: ISRCTN registry ISRCTN43013285.

P-612 Comparison the effectiveness and safety of letrozole-stimulated and hormone replacement treatment in endometrial preparation for frozen embryo transfer in patients with polycystic ovary syndrome

Abstract Study question Whether letrozole-stimulated protocol has advantages over hormone replacement therapy (HRT) in frozen embryo transfer in patients with polycystic ovary syndrome (PCOS)? Summary answer Letrozole-stimulated protocol is more suitable for endometrial preparation than HRT in patients with PCOS, which can increase the live birth rate and reduce pregnancy complications. What is known already The current routine endometrial preparation protocol for women with PCOS is HRT. However, HRT is expensive, and recent studies have found HRT may increase the risk of adverse maternal and neonatal complications such as hypertensive disorders of pregnancy. Letrozole induces mono-ovulatory and has no antiestrogenic effect, and has been found to increase live birth rate compared with clomiphene in fresh embryo cycles. However, Letrozole is rarely used in frozen embryo cycles. Whether letrozole-stimulated protocol is suitable for frozen embryo transfer in patients with PCOS and for whom is suitable is still lack of evidence. Study design, size, duration This is a retrospective cohort study involving all frozen embryo transfer cycles with letrozole-stimulated and HRT for PCOS during the period from August 2018 to December 2020 at a tertiary care center. Participants/materials, setting, methods A total of 2011 letrozole-stimulated cycles and 2211 HRT cycles were included in the analysis. Multivariate Logistic regression was used to analyze the differences in clinical pregnancy rate, live birth rate, miscarriage rate, the incidence of other pregnancy and obstetric outcomes between letrozole-stimulated protocol and HRT after adjusting for possible confounding factors. Subgroup analysis was used to explore the population for which letrozole-stimulated protocol was suitable. Main results and the role of chance After adjusting for confounding, letrozole-stimulated protocol increased the clinical pregnancy rate (OR,1.44; 95%CI,1.21-1.70), live birth rate (OR,1.49; 95%CI,1.27-1.74) and reduced the incidence of miscarriage (OR, 0.71; 95%CI,0.55-0.92), hypertensive disorders of pregnancy (OR, 0.66; 95%CI,0.45,0.98), gestational diabetes mellitus (OR,0.75; 95%CI,0.57,0.98) and cesarean section (OR,0.78; 95%CI,0.61,0.99) than HRT. There were no significant differences in other outcomes such as preterm birth, small for gestational age, and large for gestational age between the two endometrial preparation protocols. Subgroup analysis according to maternal age, BMI, insulin resistance and PCOS classification showed that the live birth rate of letrozole-stimulated protocol was significantly higher than that of HRT in all subgroups. Limitations, reasons for caution This study is a retrospective study, the population characteristics of the two endometrial preparation protocols existed differences. Although multivariate logistic regression was used to adjust some factors, the interference of known and unknown factors on the outcomes cannot be completely avoided. Wider implications of the findings This retrospective study found letrozole-stimulated protocol has more advantages than HRT, which can improve the live birth rate and reduce the incidence of hypertensive disorders of pregnancy, gestational diabetes mellitus in patients with PCOS. High-quality well-powered randomised clinical trials and possible mechanistic studies are needed to further validate this conclusion. Trial registration number NA

Pregnancy Outcome After Selective Fetal Reduction in Dichorionic Twin Pregnancies.

This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021. This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded. A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus. The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA. Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

Noninvasive preeclampsia prediction using plasma cell–free RNA signatures

Preeclampsia, especially preterm preeclampsia and early-onset preeclampsia, is a life-threating pregnancy disorder, and the heterogeneity and complexity of preeclampsia make it difficult to predict risk and to develop treatments. Plasma cell-free RNA carries unique information from human tissue and may be useful for noninvasive monitoring of maternal, placental, and fetal dynamics during pregnancy. This study aimed to investigate various RNA biotypes associated with preeclampsia in plasma and to develop classifiers to predict preterm preeclampsia and early-onset preeclampsia before diagnosis. We performed a novel, cell-free RNA sequencing method termed polyadenylation ligation-mediated sequencing to investigate the cell-free RNA characteristics of 715 healthy pregnancies and 202 pregnancies affected by preeclampsia before symptom onset. We explored differences in the abundance of different RNA biotypes in plasma between healthy and preeclampsia samples and built preterm preeclampsia and early-onset preeclampsia prediction classifiers using machine learning methods. Furthermore, we validated the performance of the classifiers using the external and internal validation cohorts and assessed the area under the curve and positive predictive value. We detected 77 genes, including messenger RNA (44%) and microRNA (26%), that were differentially expressed in healthy mothers and mothers with preterm preeclampsia before symptom onset, which could separate participants with preterm preeclampsia from healthy samples and that played critical functional roles in preeclampsia physiology. We developed 2 classifiers for predicting preterm preeclampsia and early-onset preeclampsia before diagnosis based on 13 cell-free RNA signatures and 2 clinical features (invitro fertilization and mean arterial pressure), respectively. Notably, both classifiers showed enhanced performance when compared with the existing methods. The preterm preeclampsia prediction model achieved 81% area under the curve and 68% positive predictive value in an independent validation cohort (preterm, n=46; control, n=151); the early-onset preeclampsia prediction model had an area under the curve of 88% and a positive predictive value of 73% in an external validation cohort (early-onset preeclampsia, n=28; control, n=234). Furthermore, we demonstrated that downregulation of microRNAs may play vital roles in preeclampsia through the upregulation of preeclampsia-relevant target genes. In this cohort study, a comprehensive transcriptomic landscape of different RNA biotypes in preeclampsia was presented and 2 advanced classifiers with substantial clinical importance for preterm preeclampsia and early-onset preeclampsia prediction before symptom onset were developed. We demonstrated that messenger RNA, microRNA, and long noncoding RNA can simultaneously serve as potential biomarkers of preeclampsia, holding the promise of prevention of preeclampsia in the future. Abnormal cell-free messenger RNA, microRNA, and long noncoding RNA molecular changes may help to elucidate the pathogenic determinants of preeclampsia and open new therapeutic windows to effectively reduce pregnancy complications and fetal morbidity.

Nutrition Based on the Traditional Chinese Medicine and Complications of Subclinical Gestational Hypothyroidism

We have explored the effect of nutrition management based on the principles of traditional Chinese medicine nutrition on the complications of subclinical gestational hypothyroidism. A total of 228 pregnant women from the Affiliated Hospital of Jiangnan University and the Wuxi Xishan People’s Hospital who were diagnosed with subclinical hypothyroidism between June 2020 and April 2022 were recruited. The patients were divided into the control group (n = 120) and intervention group (n = 108) using the historical control method. The intervention group adopted the traditional Chinese medicine nutrition management model, while the control group was given conventional gestational nutrition management. Iodine nutritional status, maternal and neonatal outcomes, pregnancy complications, pregnancy stress, and social support were compared between the two groups before intervention, at 20 weeks of pregnancy, and before labor. The intervention group had significantly lower iodine nutritional status, better postpartum nutritional status, better pregnancy outcome, lower incidences of pregnancy complications, and better pregnancy stress and social support than in the control group (P < 0.05). In conclusion, traditional Chinese medicine-based nutrition management can effectively control iodine nutritional status, improve maternal and neonatal outcomes, reduce pregnancy complications, and decrease pregnancy stress in postpartum women.

Towards an explainable clinical decision support system for large-for-gestational-age births.

A myriad of maternal and neonatal complications can result from delivery of a large-for-gestational-age (LGA) infant. LGA birth rates have increased in many countries since the late 20th century, partially due to a rise in maternal body mass index, which is associated with LGA risk. The objective of the current study was to develop LGA prediction models for women with overweight and obesity for the purpose of clinical decision support in a clinical setting. Maternal characteristics, serum biomarkers and fetal anatomy scan measurements for 465 pregnant women with overweight and obesity before and at approximately 21 weeks gestation were obtained from the PEARS (Pregnancy Exercise and Nutrition with smart phone application support) study data. Random forest, support vector machine, adaptive boosting and extreme gradient boosting algorithms were applied with synthetic minority over-sampling technique to develop probabilistic prediction models. Two models were developed for use in different settings: a clinical setting for white women (AUC-ROC of 0.75); and a clinical setting for women of all ethnicity and regions (AUC-ROC of 0.57). Maternal age, mid upper arm circumference, white cell count at the first antenatal visit, fetal biometry and gestational age at fetal anatomy scan were found to be important predictors of LGA. Pobal HP deprivation index and fetal biometry centiles, which are population-specific, are also important. Moreover, we explained our models with Local Interpretable Model-agnostic Explanations (LIME) to improve explainability, which was proven effective by case studies. Our explainable models can effectively predict the probability of an LGA birth for women with overweight and obesity, and are anticipated to be useful to support clinical decision-making and for the development of early pregnancy intervention strategies to reduce pregnancy complications related to LGA.

AWARENESS AMONG GYNECOLOGISTS IN JAMNAGAR DISTRICT ABOUT PERIODONTAL HEALTH AND ITS CORRELATION TO ADVERSE PREGNANCY OUTCOMES - A CROSS –SECTIONAL QUESTIONNAIRE SURVEY.

Introduction: Periodontitis is an inammatory disease of the soft and hard support tissues of tooth in response to the supra and subgingival microorganisms. In women with periodontitis, the infected periodontal tissues may act as reservoirs of bacteria and their products that can disseminate to the foetus-placental unit causing adverse pregnancy outcomes like preterm birth. This is a cross sectional survey carried out to Aim: access the level of knowledge, attitude, practice and awareness of Gynecologists in Jamnagar district regarding periodontal health and its correlation with adverse pregnancy outcomes. An online structured questionnaire had bee Materials and method: n made and was distributed through social media, responses were collected for a period of 3 months and the collected data were then subjected to statistical analysis. Result: Out of 64 participants, 44.88% of the gynecologists answered that regular screening of pregnant patients for periodontal disease is needed and 43.75% agree that dental treatment during pregnancy can reduce pregnancy complications. Only 65.63% were aware of the association between APO (adverse pregnancy outcomes) and periodontal disease. Collaborative treatment Conclusion: by gynaecologists and dentists help to improve the maternal oral health, reduce the postnatal complications and increases awareness among pregnant women regarding oral hygiene and regular dental check-up during pregnancy.

Folate and vitamin D during pregnancy: association for reducing pregnancy complications

Folate and vitamin D during pregnancy: association for reducing pregnancy complications

Iron deficiency in women: ways to reduce prevalence

Iron deficiency states (IDSs) are common disorders at the nexus of various fields. The etiology and pathogenesis of IDSs have been well studied in recent decades, but their prevalence is still high. The highest incidence of IDSs is reported in women of reproductive age. The timely correction of iron deficiency improves women's quality of life and reduces pregnancy complications and infant morbidity. To achieve and maintain the improvement, caution in risk groups, early diagnosis, physiology-based therapy, and follow-up are necessary. Iron sulfate agents are well known as an effective way to treat iron deficiency anemia. However, the high rate of previously reported side effects posed significant challenges to the complete course of therapy. The development of a new molecule with prolonged iron release minimizes the complications of therapy, providing new prospects for iron deficiency treatment. The combination of folic acid to iron sulfate in one tablet simplifies prevention regimens and therapy for pregnant women and those planning to become pregnant and reduces the time to improve.

Influence of pre-gravid preparation on the course and outcomes of the pregnancy in genital herpes

Introduction. According to researchers from different countries, the incidence of neonatal herpes varies noticeably. Objective. Optimization of pre-gravid preparation of women with chronic recurrent genital herpes to reduce pregnancy complications and improve perinatal outcomes. Мaterials and methods. The study included 58 women with confirmed chronic recurrent genital herpes. Two groups were formed, the main group included 30 women receiving pre-gravid preparation, complex treatment with antiviral and immunomodulatory drugs, the comparison group was represented by 28 women receiving pre-gravid preparation and only antiviral drug. Evaluation of the effectiveness of the treatment of chronic genital herpes and the benefits of pre-gravid preparation were carried out by assessing clinical manifestations, determining the immune status, analyzing the characteristics of the course of pregnancy, childbirth, and perinatal outcomes. Results. As a result of the study, the available data confirm the feasibility of using complex therapy in the treatment of chronic recurrent genital herpes in combination with pre-gravid preparation. Conclusion. Pre-gravid preparation and specific treatment of women with chronic recurrent genital herpes improve the clinical status of patients, increase the interrecurrent period, reduce the severity of prodromal symptoms, the duration and intensity of relapses of the disease, and contribute more favorable course of pregnancy and improvement perinatal outcomes.

A Big Role for microRNAs in Gestational Diabetes Mellitus.

Maternal diabetes is associated with pregnancy complications and poses a serious health risk to both mother and child. Growing evidence suggests that pregnancy complications are more frequent and severe in pregnant women with pregestational type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) compared to women with gestational diabetes mellitus (GDM). Elucidating the pathophysiological mechanisms that underlie the different types of maternal diabetes may lead to targeted strategies to prevent or reduce pregnancy complications. In recent years, microRNAs (miRNAs), one of the most common epigenetic mechanisms, have emerged as key players in the pathophysiology of pregnancy-related disorders including diabetes. This review aims to provide an update on the status of miRNA profiling in pregnancies complicated by maternal diabetes. Four databases, Pubmed, Web of Science, EBSCOhost, and Scopus were searched to identify studies that profiled miRNAs during maternal diabetes. A total of 1800 articles were identified, of which 53 are included in this review. All studies profiled miRNAs during GDM, with no studies on miRNA profiling during pregestational T1DM and T2DM identified. Studies on GDM were mainly focused on the potential of miRNAs to serve as predictive or diagnostic biomarkers. This review highlights the lack of miRNA profiling in pregnancies complicated by T1DM and T2DM and identifies the need for miRNA profiling in all types of maternal diabetes. Such studies could contribute to our understanding of the mechanisms that link maternal diabetes type with pregnancy complications.

P-770 Is there an association between blood hCG elevation rate in very early IVF pregnancy and adverse pregnancy outcomes?

Abstract Study question Is a slow elevation rate between the first and second hCG values following a successful fresh IVF cycle associated with long-term pregnancy outcomes? Summary answer A slow rate of hCG elevation in early IVF pregnancies is associated with an increased risk for low birth weight neonates. What is known already IVF pregnancies are associated with higher prevalence of late obstetrical complications such as preterm birth, preeclampsia and small for gestational age. Different baseline characteristics and treatment parameters are associated with obstetrical complications. Abnormal, mostly slow, hCG elevation patterns have been strongly associated with short-term adverse pregnancy outcomes such as non-viability, miscarriage, early fetal demise and ectopic pregnancies. However, the long-term impact of slow hCG elevation rate on pregnancies that do continue to term is unknown. Study design, size, duration Single center cohort study between 2008-2019 including 703 fresh cycles resulting in live singleton birth. Full obstetrical data for these pregnancies was available. Participants/materials, setting, methods The first blood hCG measurement was performed 14±1.4 days after ovum pick-up (OPU), and the second one 48-72h later. The slope between the two measurements was calculated and adjusted per day. Slow hCG elevation was defined as a slope value below the 10th percentile. Maternal and short-term neonatal outcomes were compared between cycles with a slow elevation (n = 71) and a “normal” elevation (n = 632) in hCG values. Multivariate analysis was used to control for potential confounders. Main results and the role of chance There were no differences between the slow and normal hCG elevation groups in maternal age, numbers of retrieved oocytes, ICSI rates, number of transferred and usable embryos, and gestational age at delivery. Neonates from cycles with a slow hCG elevation weighed significantly less (2876±619 gr vs. 3083±553 gr, p < 0.005) and were at a higher risk (21% vs. 12%, OR = 1.96, 95% CI 1.06-3.64) of having low birth weight (LBW) (below 2500 grams). Women with slow hCG elevation rate had more hypertension-preeclampsia related complications (11% vs. 6%, p < 0.05), although barely reaching statistical significance in the multivariate analysis (OR = 1.76, 95% CI 1.0-3.6). Limitations, reasons for caution Retrospective design, single center, applicability to fresh cycles only. Wider implications of the findings Very early (5th week) initial blood hCG elevation slope, measured only in IVF gestations, might be a novel marker for identifying patients at risk for hypertensive complications during pregnancy and low birth-weight neonates. Tighter prenatal care for these patients could potentially reduce pregnancy complications and improve long-term outcome. Trial registration number not applicable

560-P: Medical Nutrition Therapy Treatment for Gestational Diabetes

Objective: Gestational Diabetes Mellitus (GDM) is a controversial disorder that can be defined as glucose intolerance or obesity in offspring or unfortunate perinatal complications and outcomes. Inadequate treatment of GDM might lead to foetal complications. This study will aim at assessing the effects of Medical Nutritional Therapy (MNT) as a treatment therapy for pregnant women with gestational diabetes. Methods: This study was conducted in two center between March to July 2021. A total of 76 patients had been evaluated among whom 20 women had been diagnosed with GDM while the other 56 women had normal tolerance for glucose. Women diagnosed with GDM had received medical nutrition therapy with recommended nuts and olive oil intake. Results: The HbA1C level of the GDW women (5.1% ± 0.3% (32 ± 0.9 mmol/mol) was higher as opposed to those with Normal tolerance for glucose (NGT) (4.9% ± 0.3% (30 ± 0.9 mmol/mol) , p = 0.001) . In a similar manner, the insulin resistance among the GDM women (24-28 GWs, p = 0.001) was higher. The total weight gain during the pregnancy period was lesser in comparison with the NGT women. Along with these, occurrences of adverse events during pregnancy were lesser among GDW women. Conclusion: With the help of Medical Nutrition therapy during gestational diabetes management, the outcomes of pregnancies among GDW women can be made similar to those with NGT. MNT is an effective treatment since it reduces pregnancy complications and enhances outcomes. Disclosure A.Shankar: None.

FPR2 Expression in Placental Extravillous Trophoblasts, and Its Relationship with Race, Delivery Mode, and Chorioamnionitis

ObjectivesPolyunsaturated fatty acids (PUFAs) are critical for appropriate development of the fetal brain and are known to reduce pregnancy complications like preeclampsia and preterm birth. Their benefits are thought to be mediated through bioactive metabolites; upon ingestion, PUFAs are converted to specialized pro-resolving mediators (SPMs). These SPMs resolve inflammatory processes by binding receptors, including the formyl-peptide receptor-2 (FPR2) in placental extra-villous trophoblasts tissue. The purpose of this study was to quantify FPR2 expression in placental tissue samples and correlate these levels with maternal-fetal outcomes and characteristics.MethodsPlacental tissue samples were collected from postpartum mothers (n = 27) and stained for FPR2. QuPath was used to quantify FPR2 expression and determine the percentages of low, medium, and high expression in each sample. A Kruskal-Wallis test was performed to compare FPR2 expression across race. Mann-Whitney U-tests compared FPR2 expression from vaginal vs cesarean deliveries, and with vs without chorioamnionitis. A p-value < 0.05 was considered statistically significant.ResultsThere was a significant difference in distribution of % high FPR2 expression based on race and ethnicity. In post-hoc pairwise comparisons, Hispanic mothers had significantly higher % high FPR2 expression than White mothers (2.95%, 0.11%, p = 0.031) and African American mothers (2.95%, 0.10%, p = 0.049). Mothers who gave birth vaginally had a greater % high FPR2 expression, but this difference only approached significance (0.126%, 0.027%, p = 0.07). Mothers with chorioamnionitis also appeared to have a lower % medium FPR2 expression, but this difference did not reach statistical significance (7.16%, 13.62%, p = 0.076).ConclusionsThis study demonstrates the potential role FPR2 plays in perinatal outcomes. Greater % high FPR2 expression in Hispanic mothers suggests a genetic upregulation of FPR2 expression. The data also suggests FPR2 expression may be related to clinical outcomes such as delivery mode and chorioamnionitis; however, further investigation with a higher sample size is warranted.Funding SourcesUNMC Pediatrics Department; Child Health Research Institute.

The clinical outcomes of selective and spontaneous fetal reduction of twins to a singleton pregnancy in the first trimester: a retrospective study of 10\xa0years

BackgroundSingleton pregnancy is encouraged to reduce pregnancy complications. In addition to single embryo transfer (SET), selective and spontaneous fetal reduction (SEFR and SPFR) can also achieve singleton pregnancies. After SEFR or SPFR, an inanimate fetus remains in the uterus. It is unclear whether the inanimate fetus would adversely affect another fetus or the mother. Previous studies have focused on the differences between pre- and post-reduction. However, studies focusing on the influence of SEFR and SPFR on the remaining fetal development and maintenance of pregnancy are rare.MethodsMaterials from 5922 patients whose embryo transfer dates ranged from March 2011 to January 2021 were collected. Both the SEFR group (n = 390) and SPFR group (n = 865) had double embryos transferred (DET) and got twin pregnancies, but subsequent selective or spontaneous fetal reduction occurred. The SET group (n = 4667) had only one embryo transferred. All were singleton pregnancies on the 65th day after embryo transfer. Clinical outcomes, including pregnancy outcomes, pregnancy complications, and newborn outcomes, were compared among the three groups.ResultsAfter adjusting for age, infertility duration, types of infertility, states of embryos, body mass index, and factors affecting SET or DET decisions, multivariate regression analysis revealed that SEFR increased the risk of miscarriage (OR 2.368, 95% CI 1.423–3.939) and preterm birth (OR 1.515, 95% CI 1.114–2.060), and reduced the gestational age (βeta -0.342, 95% CI -0.544– -0.140). SPFR increased the risk of gestational diabetes mellitus (GDM) (OR 1.657, 95% CI 1.215–2.261), preterm premature rupture of membranes (PPROM) (OR 1.649, 95% CI 1.057–2.574), and abnormal amniotic fluid volume (OR 1.687, 95% CI 1.075–2.648). Both SEFR and SPFR were associated with reduced live birth rate (OR 0.522, 95% CI 0.330–0.825; OR 0.671, 95% CI 0.459–0.981), newborn birth weight (βeta -177.412, 95% CI -235.115–-119.709; βeta -42.165, 95% CI -83.104–-1.226) as well as an increased risk of low-birth-weight newborns (OR 2.222, 95% CI 1.490–3.313; OR 1.510, 95% CI 1.092–2.087).ConclusionsDET with subsequent fetal reduction was related to poor clinical outcomes. We recommend that DET with subsequent fetal reduction should only be considered as a rescue method for multiple pregnancy patients with potential complications, and SET is more advisable.

Determinants of optimal antenatal care visit among pregnant women in Ethiopia: a multilevel analysis of Ethiopian mini demographic health survey 2019 data

BackgroundOptimal antenatal care (ANC4+) needs to be used throughout pregnancy to reduce pregnancy complications and maternal mortality. The World Health Organization (WHO) recommends eight ANC contacts, while Ethiopia has the lowest coverage of at least four ANC visits. Therefore, this study aimed to identify factors associated with optimal ANC visits among pregnant women in Ethiopia.MethodsThis study is a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). A multilevel logistic regression model is set up to identify factors associated with optimal ANC visits. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to estimate the strength of the association between the outcome and the predictor variables.ResultsOverall, 43% of women had optimal ANC visits during their last pregnancy. Higher educated women are 3.99 times more likely (AOR = 3.99; 95% CI: 2.62–6.02) to have optimal ANC visits than women with no formal education. The wealthiest women are 2.09 times more likely (AOR = 2.09; 95% CI: 1.56–2.82) to have optimal ANC visits than women in the poorest quintile. The odds of optimal ANC visit is 42 percent lower in rural women (AOR = 0.58, 95% CI: 0.41–0.83) compared to women living in urban areas.ConclusionWomen's educational status, wealth status, mass media exposure, place of residence and region are factors that are significantly associated with optimal ANC visit. These findings help health care programmers and policymakers to introduce appropriate policies and programs to ensure optimal ANC coverage. Priority should be given to addressing economic and educational interventions.

Analisis Dukungan Keluarga Terhadap Perilaku Ibu Dalam Perawatan Kehamilan Di Bpm Restu Ibu Sragen

ABSTRACTBackground: Maternal death in the reproductive process is a worrying tragedy, because the presence of a mother is the main milestone for achieving a prosperous family and the death of a mother is a disaster for her family2. For this reason, the mother's attitude in preventing pregnancy complications or to reduce pregnancy complications early is to carry out routine checks according to the recommendations of health workers (Doctors, Midwives). So that mothers, husbands and families can find out as soon as possible how to prevent pregnancy complications and if there are problems that arise in pregnancy3. Mortality and morbidity in pregnant women is a major problem in developing countries. In poor countries around 25-50%. The death of fertile women is caused by things related to pregnancy. Death during childbirth is usually a major factor in the mortality of young women at their peak of productivity. In 1996 WHO (Word Health Organization) estimated that more than 585,000 mothers per year died during pregnancy or childbirth, actually more than 50% of deaths in 2 developing countries. The deaths of pregnant women in Indonesia are bleeding, infection and eclampsia, besides that, deaths due to abortion and prolonged labor are also included. About 50% of maternal deaths are caused by diseases that worsen due to pregnancy, such as heart disease and chronic infections. The results of a preliminary study of 10 pregnant women regarding family support for prenatal care, it turns out that there are still 80% (8 people) pregnant women get very good support from their husbands and families, while 20% (2 people) pregnant women get a lot of support from their husbands. as well as family. Objective : To find out family support for the behavior of pregnant women in pregnancy care at BPM Restu Ibu Sragen. Methods : This research was conducted at BPM Restu Ibu Sragen in August 2021. The research design used univariate correlation with this research design using cross sectional.Results : By using the Chi-Square formula and the contingency coefficient, it was found that 53.3% of pregnant women received support from their families and 60% of pregnant women did not regularly perform prenatal care. The results of the cross tabulation between family support and maternal behavior in pregnancy care showed that 40% of pregnant women who did not receive family support behaved irregularly in pregnancy care, with the results of x2 count = 7.22 and x2 table = 3.84 where x2 count &gt; x2 table with a significant level of 0.05. Conclusion: There is a relationship between family support and maternal behavior in pregnancy care at BPM Restu Ibu Sragen. Keywords: Family Support, Behavior of Pregnant Women

SİSTEMİK LUPUS ERİTEMATOZUSLU GEBE KADINLARIN MATERNAL VE FETAL SONUÇLARININ DEĞERLENDİRİLMESİ

Aim: To evaluate obstetrical and perinatal outcomes of pregnancies with systemic lupus erythematosus (SLE).&#x0D; Materials and Method: This was a retrospective study evaluating obstetric outcomes of 35 patients with SLE who were followed up between 2010 and 2020. Lupus activity was based on SLE Disease Activity Index (SLEDAI) criteria and pregnancy outcomes were evaluated by grouping as active and inactive SLE.&#x0D; Results: The mean maternal age was 29 (21-39). The rate of antiphospholipid syndrome and active disease was 5% and 40% respectively. There were 30 live births. Two elective abortions were reported, one with major cardiac anomaly and the other with renal agenesis. One spontaneous abortion and 2 stillbirths were observed in the active SLE group. Overall rates of intrauterine growth retardation, preeclampsia, and preterm delivery were 8%, 20%, and 26%, respectively. Fetal loss and preterm delivery were significantly higher in the active SLE group (p=0,018, p=0,023). A higher rate of neonatal intensive care unit (NICU) admission was observed in the active SLE group (p=0,034) but Apgar scores less than 0,05).&#x0D; Conclusion: Despite advances in the medical sciences, an active disease with SLE has an elevated risk of inducing adverse pregnancy outcomes. Close follow-up could helps reduce pregnancy complications, especially preterm deliveries.

TAMARINDUS INDICA IMPROVED GROWTH RETARDATION ASSOCIATED WITH PRENATAL ETHANOL EXPOSURE IN WISTAR RAT NEONATES

Background: Complications associated with alcoholism such as enduring growth retardation, especially during pregnancy, are serious health issues calling for lots of attention. Objectives: The study evaluated the effect of Tamarindus indica during prenatal ethanol (ET) exposure on pregnancy outcome and morphometric features of Wistar rat pups. Methodology: Twenty-four (24) pregnant timed Wistar rats were randomly assigned into 6 groups (n=4); Group A received 2 ml (distilled water), Groups B and C were administered 200 mg/kg ethanol extract of Tamarindus indica pulp (EETI), and 300 mg/kg of Vitamin E respectively, Group D received 30%v/v (2 mg/kg) of ET, Group E received 30%v/v (2 mg/kg) of ET + 200 mg/kg EETI, while Group F was administered 30%v/v (2 mg/kg) of ET + 300 mg/kg of Vitamin E. All administrations were via the oral route and lasted for 7 days from prenatal day 7 to 14. On postnatal day (PoND) zero, physical observations were made and the total number of littered pups was counted. Morphometric studies involved the measurements of the crown-rump length (CRL), fore-limb length (FL), hind-limb length (HL), tail length (TL), and body weight (BW) of pups were made using digital vernier caliper and analytical balance. Result: Prenatal ET exposure interfered with the pregnancy outcome, CRL, FL, HL, TL, and BW measurement; while treatment with EETI and vitamin E was associated with marked improvement. Conclusion: The administration of EETI during prenatal ethanol exposure was associated with significant improvements CRL, FL, HL, TL, and BW pups. Therefore, more attention should be given to the important medicinal plant that could possibly reduce pregnancy complications associated with prenatal ethanol exposure.